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Sample records for underwent concurrent sling

  1. Urinary incontinence - vaginal sling procedures

    Science.gov (United States)

    ... your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried ... vaginal sling; Transobturator sling; Midurethral sling Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  2. Is there an association between polypropylene midurethral slings and malignancy?

    Science.gov (United States)

    King, Ashley B; Zampini, Anna; Vasavada, Sandip; Moore, Courtenay; Rackley, Raymond R; Goldman, Howard B

    2014-10-01

    To examine any association between polypropylene mesh used in midurethral slings and malignancy in humans. Macroporous, monofilament polypropylene midurethral slings have been established as a safe and effective treatment for stress urinary incontinence. However, despite long-term studies supporting the efficacy and safety of midurethral slings, there have been concerns regarding the general risks of using mesh in transvaginal surgery. In addition, concerns have recently been raised about synthetic midurethral slings and a possible link with malignancy. Therefore, the goal of this work was to further assess any association between polypropylene mesh slings and malignancy. All sling procedures performed at our institution from 2004 to 2013 were retrospectively reviewed. From within this group, the International Classification of Disease codes for urethral cancer, vaginal cancer, and bladder cancer were reviewed. From 2004-2013, 2545 procedures were performed. Of these, 2361 (96.3%) underwent polypropylene midurethral sling placement. Average follow-up after sling placement was 42.0 ± 38.6 months, with follow-up extending up to 122.3 months. The rate of bladder cancer after the sling procedure was 1 of 2361 (0.0%), with the same rate of vaginal cancer. No sarcomas were noted. Overall, the rate of malignancy after polypropylene mesh midurethral sling placement in our series was 0.0% (2 of 2361). With a mean follow-up of almost 4 years and follow-up extending up to a maximum of 122.3 months, our series does not support any association between the polypropylene mesh used for midurethral slings and the development of malignancy in humans. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.

    Science.gov (United States)

    Elliott, Jason E; Maslow, Ken D

    2012-02-01

    Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.

  4. Predictive value of urodynamics on outcome after midurethral sling surgery for female stress urinary incontinence

    NARCIS (Netherlands)

    Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Kil, Paul J. M.; Vervest, Harry A. M.

    OBJECTIVE: The aim of this study was to evaluate the value of urodynamic investigation in the preoperative workup of midurethral sling surgery and to identify risk factors for failure after 3 different midurethral sling procedures. STUDY DESIGN: Retrospective cohort study. 437 women who underwent a

  5. The Outcome of Repeated Mid Urethral Sling in SUI Treatment after Vaginal Excisions of Primary Failed Sling: Preliminary Study

    Directory of Open Access Journals (Sweden)

    Jacek Kociszewski

    2016-01-01

    Full Text Available Mid urethral sling is the standard in SUI treatment. Nevertheless, the risk of reoperation reaches 9%. There is no consensus as to the best treatment option for complications. A question is raised: what is the optimal way to achieve the best result in patients after primary failure? The aim of the study was to evaluate the outcomes of repeat MUS surgery in patients after excision of the sling with recurrent SUI. We compared its effectiveness with uncomplicated cases treated with TVT. 27 patients who underwent the repeated MUS and 50 consecutive patients after primary TVT were enrolled in the study. After 6 months, we have found that 24 (88.46% patients from repeat sling group and 48 (96% patients after primary sling were dry (1-hour pad test, 2 g or less. The difference between groups was not significant. We showed statistically significant improvement of quality of life in both groups. In conclusion, we showed that repeated sling after MUS excision is almost as effective as primary MUS. We postulate that sling excision and repeated MUS may be the best option for persistent SUI and/or complications after MUS procedures. Further multicenter observations are ongoing as to provide results on bigger group of cases.

  6. Postoperative magnetic resonance imaging characterization of slings for female stress urinary incontinence.

    LENUS (Irish Health Repository)

    Giri, Subhasis K

    2012-01-31

    PURPOSE: The aim was to characterize different types of slings such as autologous rectus fascia (ARF), porcine dermis (PD) and tension-free vaginal tape (TVT) in the early postoperative period with regard to its visibility and location by using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Between October 2003 and June 2007, total of 60 patients underwent MRI after a sling procedure. Thirty-six patients had ARF slings. Twelve patients had a PD sling and 12 had a TVT. All patients had pelvic MRI 6-8 hr postoperatively. Six patients in the ARF sling group had both preoperative and postoperative images at 6 hr and 3 months. MRI images were analyzed with regard to visibility and location. All data were collected prospectively. RESULTS: ARF slings were clearly visible in both T1W and T2W images. ARF appeared as low signal intensity area with surrounding high signal intensity due to fat attached to the rectus fascia in the MRI images obtained 6 hr after the procedure. Although the fatty component of the sling was diminished but was still visible on MRI scan 3 months postoperatively. On the other hand PD and TVT sling materials were not visible by MRI. Most of the ARF slings were located just below the bladder neck. CONCLUSIONS: The ARF sling is easily identifiable on MRI in the early postoperative period primarily because of the fat attached to the autologous rectus fascia. However, depiction of the PD and TVT slings in the early postoperative period is very poor.

  7. Pubovaginal sling, the godfather of midurethral slings that remained so

    Directory of Open Access Journals (Sweden)

    Diaa-Eldin Taha

    2015-06-01

    Full Text Available Forty years ago, autologous fascial slings became the gold standard in the treatment of genuine stress incontinence. In 1996, a synthetic material sling was introduced to the urogynecological literature known as tension-free vaginal tape. Some years later, another synthetic tape was introduced through a novel trajectory: transobturator. Due the conception of most polypropylene synthetic tapes, scores of devices, applicators and tape designs evolved. Now, with reports surfacing in the urologic literature on the adverse events of synthetic tapes and their potentially fatal complications, it is prudent to endeavor once more the place of autologous pubovaginal sling. This review addresses the evolution of pubovaginal slings and milestones of its journey to its current position in surgery of incontinence.

  8. Comparison of the clinical outcomes of transobturator and single-incision slings for stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Ling-Ying Wu

    2016-07-01

    Full Text Available The aim of this study was to compare the clinical outcomes of anti-incontinence surgeries employing the transobturator sling and single-incision sling (SIS. Our hypothesis is that the outcome of the SIS is not inferior to the obturator sling. This retrospective study reviewed the medical records of patients who underwent anti-incontinence surgery with the transobturator sling or SIS from July 2005 to November 2014. Patients who underwent concomitant pelvic organ reconstruction with an artificial mesh were excluded. Assessments included preoperative and postoperative urodynamic examinations, perioperative complications, and postoperative urogenital symptoms. A total of 122 women were recruited according to the inclusion and exclusion criteria. Among them, 68 patients underwent transobturator sling procedures while 54 patients underwent SIS procedures. The subjective failure rate of the transobturator sling and SIS were 10.2% and 18.5%, respectively (p = 0.292. The objective failure rate, defined as a pad test showing more than 2 g of urine, was 10.2% for the transobturator sling and 12.9% for the SIS (p = 0.777. SIS resulted in less blood loss, operative time, length of hospital stay, and transient voiding dysfunction after the operation. No major complication occurred after either surgical intervention. In conclusion, SIS and transobturator slings might have similar efficacy, safety, and effects on new-onset urogenital symptoms.

  9. Synthetic Sling Failure - Evaluations and Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, C. S. [Washington River Protection Solutions, Richland, WA (United States); Mackey, Thomas C. [Washington River Protection Solutions, Richland, WA (United States)

    2009-10-26

    The information and evaluations provided in this report were compiled to address the recurring problem of synthetic sling failure. As safety is the number one priority in all work aspects, a solution must be devised to prevent accidents from occurring. A total of thirteen cases regarding synthetic sling failure were evaluated in order to determine their causes, effects, and preventative measures. From the collected data, it was found that all cases in which the synthetic sling contacted the edge of its load resulted in sling failure. It is required that adequate synthetic sling protection devices be used to protect slings in any lift where the sling comes in direct contact with the edge or corner of its load. However, there are no consensus codes or standards stating the type, material, or purpose of the type of protective device used to protect the sling from being cut. Numerous industry standards and codes provide vague descriptions on how to protect synthetic slings. Without a clear, concise statement of how to protect synthetic slings, it is common for inadequate materials and sling protection devices to be used in an attempt to meet the intent of these requirements. The use of an inadequate sling protection device is the main cause of synthetic sling failure in all researched cases. Commercial sling protection devices come in many shapes and sizes, and have a variety of names, as well as advertised uses. 'Abrasion pads' and 'wear protectors' are two different names for products with the same intended purpose. There is no distinguishable way to determine the extent of sling protection which these devices will provide, or what specific scenarios they are made for. This creates room for error in a field where error is unacceptable. This report provides a recommended action for hoisting and rigging activities which require synthetic slings to contact a load, as well as recommended changes to industry standards which will benefit overall

  10. Transobturator Midurethral Slings versus Single-Incision Slings for Stress Incontinence in Overweight Patients

    Directory of Open Access Journals (Sweden)

    Omer Bayrak

    2015-08-01

    Full Text Available ABSTRACTPurpose:To compare transobturator midurethral sling (TOS and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2 female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL.Materials and Methods:In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL.Results:There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05. ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively. In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190.Conclusions:The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.

  11. 21 CFR 890.3640 - Arm sling.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Arm sling. 890.3640 Section 890.3640 Food and... PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3640 Arm sling. (a) Identification. An arm sling is a device intended for medical purposes to immobilize the arm, by means of a fabric band...

  12. 29 CFR 1910.184 - Slings.

    Science.gov (United States)

    2010-07-01

    ...=Diameter of cable body. Table N-184-13—Rated Capacities for Strand Laid Endless Slings—Mechanical Joint... lifting hook. Cable laid endless sling-mechanical joint is a wire rope sling made endless by joining the... six wire ropes wrapped around a fiber or wire rope core. Cable laid rope sling-mechanical joint is a...

  13. Slings in iatrogenic male incontinence: Current status

    Directory of Open Access Journals (Sweden)

    Fabrizio Gallo

    2010-01-01

    Conclusions: Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure.

  14. Clitoral Pain Following Retropubic Midurethral Sling Placement

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    Melanie Christofferson, DO

    2015-12-01

    Conclusion: Clitoral pain symptoms following placement of a retropubic midurethral sling should be evaluated and promptly addressed, given the potential negative impact on the patient's sexual function. Christofferson M, Barnard J, and Montoya TI. Clitoral pain following retropubic midurethral sling placement. Sex Med 2015;3:346–348.

  15. Primary fixation of mini slings: a comparative biomechanical study in vivo

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    Paulo Palma

    2012-04-01

    Full Text Available INTRODUCTION AND OBJECTIVES: The mini sling concept for stress urinary incontinence is an anatomical approach that involves placing a midurethral low-tension tape anchored to the obturator internus muscles bilaterally. They overcome the blind passage of long needles and all the related complications. There are many different devices available and because these are outpatient procedures, primary fixation plays an important role in the outcome. The objective is to evaluate the primary fixation of the various devices of attachment of the commercially available mini-slings through biomechanical tests. MATERIALS AND METHODS: A total of 45 Wistar rats were divided in 3 groups of 15 rats each. They underwent 5 subcutaneous implantation of different mini slings and one polipropilene mesh (control, as follows: TVT-Secur® (Gynecare, USA, Type 1 polypropylene mesh (control; Ophira Mini Sling System® (Promedon, Argentina, Tissue Fixation System® (TFS PTY, Australia, Zipper Sling® and "T device" (Prosurg, USA. The abdominal wall was removed on bloc at different times after implant for biomechanical evaluation, which consisted in application of unidirectional force to the extremity of the fixation system or mesh, until it was completely removed from the tissue using a tension meter (Nexygen 3.0 Universal Testing Machine - LLOYD Instruments. The force was measured in Newtons (N. RESULTS: There was significant difference in the resistance to extraction among the different fixation systems. At 7 days the Ophira Mini Sling System® presented the best fixation and "T dispositive" the worst. CONCLUSION: Ophira mini sling System® presented the best primary fixation at 7º, 14º and 30º days. The impact of this feature in the clinical setting needs to be verified.

  16. TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

    Science.gov (United States)

    Aniuliene, Rosita; Aniulis, Povilas; Skaudickas, Darijus

    2015-01-01

    The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

  17. Adjustable mini-sling compared to conventional mid-urethral slings in women with urinary incontinence

    DEFF Research Database (Denmark)

    Rudnicki, Martin; von Bothmer-Ostling, Katarina; Holstad, Anja

    2017-01-01

    INTRODUCTION: The primary aim was to compare the objective and subjective outcomes and short-term complication rates of an adjustable single-incision mini-sling (SIMS) versus standard mid-urethral slings (SMUS). The secondary aim was reporting pain perception and complications at one-year follow...

  18. Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia.

    Science.gov (United States)

    Shah, Ketul; Nikolavsky, Dmitriy; Gilsdorf, Daniel; Flynn, Brian J

    2013-12-01

    We present our management of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling using a novel combination of surgical techniques including total or near total mesh excision, urinary tract reconstruction, and concomitant pubovaginal sling with autologous rectus fascia in a single operation. We retrospectively reviewed the medical records of 189 patients undergoing transvaginal removal of polypropylene mesh from the lower urinary tract or vagina. The focus of this study is 21 patients with LUT mesh perforation after mid-urethral polypropylene mesh sling. We excluded patients with LUT mesh perforation from prolapse kits (n = 4) or sutures (n = 11), or mesh that was removed because of isolated vaginal wall exposure without concomitant LUT perforation (n = 164). Twenty-one patients underwent surgical removal of mesh through a transvaginal approach or combined transvaginal/abdominal approaches. The location of the perforation was the urethra in 14 and the bladder in 7. The mean follow-up was 22 months. There were no major intraoperative complications. All patients had complete resolution of the mesh complication and the primary symptom. Of the patients with urethral perforation, continence was achieved in 10 out of 14 (71.5 %). Of the patients with bladder perforation, continence was achieved in all 7. Total or near total removal of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling can completely resolve LUT mesh perforation in a single operation. A concomitant pubovaginal sling can be safely performed in efforts to treat existing SUI or avoid future surgery for SUI.

  19. Frontalis sling surgery: do we really need the Wright needle?

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    Eduardo Damous Fontenele Feijó

    2016-04-01

    Full Text Available ABSTRACT Purpose: The aim of this study is to describe a variation in technique of the frontalis sling surgery with silicone rods and its results, using an alternative needle with similar effectiveness to the Wright needle at a reduced cost. Methods: This was a prospective, interventional, noncomparative study of patients with severe ptosis who underwent surgical correction using a simple and modified frontalis sling surgery technique. Patients were included in this study from January 2012 to January 2014. 23 surgeries were performed on 15 patients. The minimum "follow-up" was 12 months. Results: Most patients had congenital ptosis (86% and the average preoperative margin reflex distance 1 (MRD1 was -1.1 mm (range -3 to 0 mm. 1 week post-operation, this was 2.7 mm ( 1.8 to 3.8 mm, 1.8 mm after 1 month and 1.7 mm (1 to 2.5 mm after one year. The satisfaction rate was 80% (12 patients. Among the dissatisfied patients, one had extrusion and infection with subsequent explantation of the wire, one had asymmetry greater than 2 mm and one had persistent lagophthalmos and punctate keratitis, with subsequent explantation of silicone. Conclusion: The use of silicone rods with tarsal fixation using an alternative needle was effective in the treatment of severe ptosis with few complication rates, a low rate of dissatisfaction and good stability of the results in the follow-up period.

  20. Clip reconstruction and sling wrapping of a fusiform aneurysm: technical note.

    Science.gov (United States)

    Kim, Louis J; Klopfenstein, Jeffrey D; Spetzler, Robert F

    2007-09-01

    To describe an alternative method of clip reconstruction and wrapping of fusiform aneurysms that provides structural support for the reconstructed parent artery or residual aneurysm. A 57-year-old woman with an unruptured distal middle cerebral artery fusiform aneurysm underwent surgical treatment via a pterional craniotomy. A right-angled titanium clip was used to obliterate the aneurysm and to clip reconstruct the parent vessel, which was composed of a single inflow and outflow vessel. After the aneurysm was decompressed with a fine-gauge needle, the remnant/parent artery was wrapped with a thin layer of muslin gauze followed by circumferential application of the Gore-tex (W.L. Gore and Associates, Inc., Flagstaff, AZ) sling. Finally, a second right-angled aneurysm clip was applied to the free ends of the sling immediately adjacent to the parent vessel while the sling was cinched against the parent vessel. This maneuver allowed the Gore-tex material to buttress the reconstructed vessel circumferentially. Clip reconstruction with a Gore-tex sling preserves the parent vessel and simultaneously buttresses the reconstructed vessel wall with radial forces provided by the Gore-tex material. This method is a novel alternative to conventional methods for the treatment of fusiform aneurysms.

  1. Review on midurethral sling procedures for stress urinary incontinence

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    Nazura Bt Karim

    2015-05-01

    Full Text Available Minimally invasive suburethral slings, namely the retropubic suburethral sling or the tension-free vaginal tape (TVT, has become the mainstay for surgical management of moderate to severe stress urinary incontinence (SUI taking over the place of Burch's colposuspension after its introduction in the 1990s. Following the introduction of retropubic sling procedures are the transobturator (TVT-O procedures and the mini-sling procedures. This review attempts to summarize the current trend of midurethral sling (MUS procedures in the management of SUI.

  2. Update on complications of synthetic suburethral slings

    Science.gov (United States)

    Gomes, Cristiano Mendes; Carvalho, Fabrício Leite; Bellucci, Carlos Henrique Suzuki; Hemerly, Thiago Souto; Baracat, Fábio; de Bessa, Jose; Srougi, Miguel; Bruschini, Homero

    2017-01-01

    ABSTRACT Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings. PMID:28266818

  3. Repeat surgery after failed midurethral slings

    DEFF Research Database (Denmark)

    Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: The objective was to describe the choice of subsequent surgery after failure of synthetic midurethral slings (MUS) based on a nationwide background population. METHODS: We used the Danish National Patient Registry to identify women who had undergone first-time synthet...

  4. 29 CFR 1918.81 - Slinging.

    Science.gov (United States)

    2010-07-01

    ... gear while hoisting successive drafts, shall be attached by shackles, or other positive means shall be..., dunnage and other pieces, the top layer of which is not bound by the sling, shall be slung in a way that... or descending lifting gear. (l) The employer shall not permit employees to ride the hook or the load...

  5. Risk factors for postoperative urinary tract infection following midurethral sling procedures.

    Science.gov (United States)

    Doganay, Melike; Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Aksakal, Orhan Seyfi; Erkaya, Salim

    2017-04-01

    To identify the potential risk factors for urinary tract infections following midurethral sling procedures. 556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4-8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn't were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. Of 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (purinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1-0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1-22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1-19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings CONCLUSION: Urinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies. Copyright © 2017. Published by Elsevier B.V.

  6. Single-incision sling operations for urinary incontinence in women.

    Science.gov (United States)

    Nambiar, Arjun; Cody, June D; Jeffery, Stephen T

    2014-06-01

    Urinary incontinence has been shown to affect up to 50% of women. Studies in the United States have shown that up to 80% of these women have an element of stress urinary incontinence. Colposuspension and now mid-urethral slings have been shown to be effective in treating patients with stress incontinence. However, associated adverse events include bladder and bowel injury, groin pain and haematoma formation. This has led to the development of third-generation single-incision slings, also referred to as mini-slings.It should be noted that TVT-Secur (Gynecare, Bridgewater, NJ, USA) is one type of single-incision sling; it has been withdrawn from the market because of poor results. However, it is one of the most widely studied single-incision slings and was used in several of the trials included in this review. Despite its withdrawal from clinical use, it was decided that data pertaining to this sling should be included in the first iteration of this review, so that level 1a data are available in the literature to confirm its lack of efficacy. To assess the effectiveness of mini-sling procedures in women with urodynamic clinical stress or mixed urinary incontinence in terms of improved continence status, quality of life or adverse events. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process; we handsearched journals and conference proceedings (searched 6 February 2013) and searched ClinicalTrials.gov (searched 20 September 2012), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 20 September 2012) and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials in women with urodynamic stress incontinence, symptoms of stress incontinence or stress-predominant mixed urinary incontinence, in which at least one trial arm involves one of the

  7. [Female stress urinary incontinence. Surgical repair with pubovaginal sling techniques].

    Science.gov (United States)

    Escribano Patiño, Gregorio; Hernández Fernández, Carlos; Subirá Ríos, David; Castaño González, Irene; Moralejo Gárate, Mercedes; Martinez Salamanca, Juan Ignacio

    2002-11-01

    To review the treatment of female stress urinary incontinence by new systems of tension-free urethral sling TVT type (Tension free vaginal tape) or IVS (intravaginal slingplasty), and the bone anchoring trasvaginal sling procedure Infast. We describe the surgical techniques of the various procedures and perform a bibliographic review on the topic. The pubovaginal sling has become the gold standard in the treatment of female stress urinary incontinence, mainly if there is sphincter intrinsic dysfunction. The concept of tension free medium urethra support has been the most important contribution, that questions the classification of incontinence in types I, II and III, because the pubocervical tension free sling can correct all three. Tension free urethral sling techniques have demonstrated to be effective, minimally invasive with a low complication rate, easily reproducible, and with good continence results in the mid-term.

  8. Evaluation of safety and efficacy of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis.

    Science.gov (United States)

    Rizvi, Syed Ali Raza; Gupta, Yogesh; Yousuf, Snober

    2014-01-01

    To evaluate the efficacy and safety of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis. A prospective, case series study was performed in 46 patients (56 eyelids) who underwent tarsofrontalis sling surgery using silicone rod for severe congenital ptosis. The efficacy of the silicone rod in tarsofrontalis sling surgery was evaluated by marginal reflex distance1 (MRD1), postoperative eyelid symmetry, and recurrence of ptosis. Safety of silicone rod was assessed by noting postoperative complications. The postoperative results were considered as good if MRD1 was 4.0 ± 0.5 mm (3.5-4.5 mm) and symmetry ≤1 mm; fair if MRD1 was 2.5 ± 0.5 mm (2-3 mm) and symmetry 1.5 to 2.0 mm; and poor if MRD1 was <2.0 mm and symmetry <2.0 mm. In cases of unilateral congenital ptosis, good results were seen in 83.3% cases, fair results in 11.1% cases, and poor results in 5.5% cases. In cases of bilateral congenital ptosis, good results were seen in 80.0% cases, fair in 15.0% cases, and poor result in 5.0% cases. Satisfactory postoperative eyelid elevation of ≥2 mm was seen in 93% cases. Complications in the form of granuloma formation, subsequent silicone rod extrusion, and recurrence occurred in 4% cases. The use of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis repair is a safe and effective surgery, with few complications and easy removal and adjustment.

  9. Immediate Gore-Tex sling suspension for management of facial paralysis in head and neck extirpative surgery.

    Science.gov (United States)

    Skourtis, Mia E; Weber, Stephen M; Kriet, J David; Girod, Douglas A; Tsue, Terance T; Wax, Mark K

    2007-08-01

    We sought to evaluate the functional and aesthetic outcomes of immediate facial reconstruction with a Gore-Tex (expanded polytetrofluoroethylene) sling in irradiated patients undergoing large head and neck tumor extirpation with facial nerve resection. We conducted a retrospective study of 17 patients at two academic institutions who underwent extirpative surgery with immediate Gore-Tex sling reconstruction and completed radiotherapy. Functional and aesthetic results were evaluated at three intervals. All patients had excellent immediate results and good or excellent intermediate-term results. At long-term follow-up, results were good to excellent in 47% and unacceptable in 35% of patients. In irradiated patients undergoing total parotidectomy with immediate facial reconstruction using Gore-Tex slings, early results are excellent, but there is a high incidence of major wound complications and unacceptable results in long-term follow-up. There is a high rate of late complications associated with immediate facial reconstruction with Gore-Tex slings in irradiated patients.

  10. Transvaginal retropubic sling systems: efficacy and patient acceptability

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    Moldovan CP

    2015-02-01

    Full Text Available Christina P Moldovan,1 Michelle E Marinone,2 Andrea Staack3 1Department of Psychology, Loma Linda University, Loma Linda, California, United States of America; 2School of Medicine, Loma Linda University, Loma Linda, California, United States of America; 3Department of Urology, Loma Linda University Medical Center, Loma Linda, California, United States of America Abstract: Stress urinary incontinence is a common, disabling, and costly medical problem that affects approximately 50% of women with urinary incontinence. Suburethral retropubic slings have been developed as a minimally invasive and effective surgical option, and they have been used as a first-line treatment for stress urinary incontinence since 1995. However, complications including vaginal extrusion, erosion, pain, bleeding, infections, lower urinary tract symptoms, urinary retention, and incontinence have been reported with use of the slings. Several companies manufacture sling kits, and the sling kits vary with regard to the composition of the mesh and introducer needle. The aim of this review was to determine which sling kit was most effective for patients, had minimal reported side effects, and was best accepted by patients and surgeons. In a review of the literature, it was found that a total of 38 studies were published between 1995 and 2014 that reported on eight tension-free retropubic sling kits: SPARC, RetroArc, Align, Advantage, Lynx, Desara, Supris, and Gynecare TVT. The Gynecare TVT was the most cited sling kit; the second most cited was the SPARC. This review provides a summary of the studies that have examined positive and negative outcomes of the retropubic tension-free suburethral sling procedure using various sling kits. Overall, the results of the literature review indicated that data from comparisons of the available sling kits are insufficient to make an evidenced-based recommendation. Therefore, the decision regarding which sling kit is appropriate to use in

  11. A criterion based sling weaning progression (sweap) and outcomes following shoulder arthroscopic surgery in an active duty military population.

    Science.gov (United States)

    Hire, Justin M; Pniewski, Joshua E; Dickston, Michelle L; Jacobs, Jeremy M; Mueller, Terry L; Abell, Brian E; Bojescul, John A

    2014-04-01

    Little objective evidence is available to guide rehabilitation protocols in regard to the sling weaning process following arthroscopy surgery of the shoulder. The purpose of this study was to establish an objective, criterion based protocol for accelerated sling weaning following shoulder arthroscopy. 82 active duty service members (ADSM) underwent elective shoulder arthroscopic surgery by three orthopaedic staff surgeons. One physical therapist progressed patients through the criterion based sling weaning progression (SWEAP) protocol for each surgery and documented pain levels, sleep habits, and decrease in sling use. Preoperative and six month postoperative Quick Disability of the Arm, Shoulder, and Hand (qDASH) and Shoulder Pain and Disability Index (SPADI) scores were obtained. The ability to perform an Army Physical Fitness Test (APFT) was recorded at six months postoperative. Patients completed sling weaning at an overall mean of 16.6 ± 5.0 days with continued use in unprotected military settings only beyond this timeframe. As patients steadily progressed out of the sling for 1 hour, 2-3 hours, and half-day periods, average pain scores decreased during these time periods at 5.0±1.2, 3.7±1.2, and 2.1±1.3 (0-10 pain scale), respectively. Patients obtained 6-7 hours of sleep or normal sleep habits at an average of 10.9±4.4 days postoperative. Overall, preoperative qDASH and SPADI scores improved from 39.8±13.0 to 2.4±2.0 and 46.4±16.1 to 3.3±3.2, respectively, at 6 months follow up. All 82 patients were able to return to deployable status. 30 (36.6%) patients required formal restrictions for the push-up portion of the APFT at six months postoperative. 7 of these 30 patients required running restrictions. Early improvement in quality of life indicators can be obtained in the initial postoperative period with a progressive, criterion based SWEAP protocol. Patients demonstrated favorable outcomes with return to occupational and physical fitness activities

  12. Midurethral bulbocavernous muscle sling for genuine stress incontinence - an alternative to synthetic slings?

    Directory of Open Access Journals (Sweden)

    N Rajamaheswari

    2003-01-01

    Full Text Available Objectives: To assess the efficacy of midurethral bulbo-cavernous muscle sling (BCMS in the treatment of genu-ine stress incontinence in women. Methods: A prospective study comprising 25 women was carried out at the Govt. Kasturba Gandhi Hospital, Chennai. The women whose age was in the range of 30-65 years had GSI as proved by urodynamic evaluation. The bulbocavernous muscle sling implies the approximation of both the bulbocavernous muscles around the midurethra with prolene sutures. The procedure is done under regional anaesthesia. Results: These patients were followed up for 2 years. Eighteen (72% women reported complete cure, 4 (16% were significantly improved and in 3 the surgery failed. Conclusions: The bulbocavernous muscle sling is a promising new procedure for genuine stress incontinence. There is no need for intraoperative cystoscopy and the chances of bladder injury are nonexistent. Larger sample with long term follow up and randomized controlled trials comparing it with the other surgical techniques may prove its true efficacy.

  13. Mersilene Mesh Vs Autogenous Fascia Lata for Upper Lid Sling Procedure

    Directory of Open Access Journals (Sweden)

    Hossein Salour

    2008-12-01

    Full Text Available

    PURPOSE: To compare mersilene mesh and autogenous fascia lata for upper lid sling procedure in the management of ptosis with poor levator function. METHODS: This randomized clinical trial included 9 patients with unilateral and 11 patients with bilateral congenital ptosis and poor levator function. All subjects underwent upper lid sling procedure with a random choice of two different materials: mersilene mesh in 16 eyelids and autogenous fascia lata in 15 eyelids. RESULTS: Overall, 31 eyelids underwent the upper lid sling procedure. There was no difference between the two groups in terms of final functional (lid fissure height stability and cosmetic (lid margin contour results. Dermatochalasis was more common in the fascia lata group (10 eyes compared to the mersilene mesh group (2 eyes. Mersilene mesh extrusion occurred in two eyelids. CONCLUSION: Mersilene mesh has favorable long-term functional results and a low rate of complications. This material may be considered as an alternative to autogenous fascia lata for frontalis suspension surgery.

  14. [Suburethral sling removal due to chronic pain].

    Science.gov (United States)

    Homola, P; Hensel, G; Škorničková, Z; Košťál, M

    2017-01-01

    To point out one possible complication after suburethral tape insertion. To present methods of treatment, especially partial or total removal of the tape. Few successful cases of treatment are shown in case reports. Case report. Department of obstetrics and gynecology, Pardubice hospital. Chronic pain after insertion of suburethral tape is a rare complication. There are several possible causes, such as tape erosion with chronic inflamation, post-colposuspension syndrome, myo-fascial syndrome, nerve damage during tape implantation or due to overproduction of fibrous tissue. Partial or total tape removal is needed when the conservative treatment fails. Patients may remain continent or a new tape is placed. Pain relief is usually complete but there are times when additional treatment is needed. Sling removal is a successful method of treating chronic pain after suburethral tape insertion. Patients describe plain relief and improvement of quality of life.

  15. Effect of pregnancy and delivery on urinary incontinence after the midurethral sling procedure.

    Science.gov (United States)

    Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Erkilinc, Selcuk; Aksakal, Orhan Seyfi; Doganay, Melike

    2015-05-01

    To evaluate the continence status and to reveal the optimal delivery mode of women who had an infant after application of a midurethral sling to treat stress urinary incontinence. Between January 2007 and January 2013, 12 women who delivered an infant after application of a midurethral sling were detected and demographic data, type of MUS, interval between MUS and delivery, mode of delivery, birth weight of the newborn, complications during pregnancy, and continence status after delivery were collected. Between 2000 and 2014, in 14 articles listed in Pubmed, the data of 54 patients who had delivered after successful midurethral sling application were included. Postpartum recurrence of urinary incontinence was evaluated according to delivery type in 54 patients. Mean age of 12 patients at the time of MUS was 33.1 ± 4.3 years old and the interval between MUS procedure and pregnancy was 30.2 ± 14.2 months. Four patients had a transvaginal tape (TVT; 33.3%) and 8 had transobturator tape (TOT) procedure (66.7%) and mean follow-up after MUS surgery was 52 ± 12.3 months. Seven women had cesarean section (CS; 58.3%) and 5 women delivered vaginally (41.7%). Nine women were continent during pregnancy (75%) and 10 were continent after delivery (83.3%). Among 54 women who were included in the review, 28 underwent CS (51.9%), 26 women delivered vaginally (48.1%), and 11 women had postpartum incontinence (20.3%). In the case of postpartum urinary incontinence, there was no statistically significant difference between the CS and vaginal delivery groups (14.3 vs 26.9% respectively, p = 0.32). In logistic regression, incontinence during pregnancy was a risk factor for postpartum incontinence (OR:5.5; 95% CI: 1.1-27.6, p = 0.036). Risk of postpartum SUI recurrence in women who underwent application of midurethral slings seems to be similar independent of delivery mode and incontinence during pregnancy may be a risk factor for postpartum incontinence.

  16. Traditional suburethral sling operations for urinary incontinence in women.

    Science.gov (United States)

    Rehman, Haroon; Bezerra, Carlos A; Bruschini, Homero; Cody, June D; Aluko, Patricia

    2017-07-26

    Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional suburethral slings are one of the surgical operations used to treat women with symptoms of stress urinary incontinence. To determine the effects of traditional suburethral slings on stress or mixed incontinence in comparison with other management options. We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles. Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence. At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, we calculated a summary statistic: a relative risk for dichotomous data and a weighted mean difference for continuous data. We included 26 trials involving 2284 women. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6 to 24 months.One medium-sized trial compared traditional suburethral sling operations with oxybutynin in the treatment of women with mixed urinary incontinence. Surgery appeared to be more effective than drugs in treating participant-reported incontinence (n = 75, risk ratio (RR) 0.18, 95% confidence interval (CI) 0.08 to 0.43).One trial found that traditional slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21, 95% CI 0.09 to 0.21)Seven trials compared slings with open abdominal retropubic colposuspension. Participant-reported incontinence was lower with the slings after one year (RR 0.75, 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter

  17. Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos

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    Ramesh C Gupta

    2014-01-01

    Full Text Available Aim : To evaluate the efficacy of modified temporalis muscle transfer (TMT by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods : Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed-up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre- and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis : Paired t-test was applied to measure the statistical outcome. Results : Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD lid gap on eye closure was 7.7 (0.86 mm preoperatively, 0.5 (0.47 mm at 1 st postoperative day, and 0.7 (0.75 mm at 3 rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001 which is highly significant. The mean (SD vertical interpalpebral distance during primary gaze was 12.05 (1.12 mm preoperatively, 10 (0.94 mm at 1 st postoperative day, and 10.35 (1.08 mm at 3 rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001 which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion : Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.

  18. Mid-urethral slings in female incontinence: Current status

    Directory of Open Access Journals (Sweden)

    Ryan M Krlin

    2011-01-01

    Full Text Available The advent of the mid-urethral sling (MUS 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI. Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients. Single incision sling (SIS is the newest addition to the MUS group and was developed in an attempt to minimize morbidity and create an anti-incontinence procedure that could be performed in the office. The efficacy of SIS remains unknown as the current literature regarding SIS lacks long-term results and comparative trials. The suprapubic arc sling appears to have equally effective outcomes in at least the short-term when compared with TVT. Although evolution of the SIS has led to a less invasive procedure with decreased post-op pain and reduced recovery time, durability of efficacy could be the endpoint we are sacrificing. Until longer-term data and more quality comparison trials are available, tailoring one′s choice of MUS to the individual patient and her unique clinical parameters remains the best option.

  19. Self-reported urinary continence outcomes for repeat midurethral synthetic sling placement

    Directory of Open Access Journals (Sweden)

    Jonathan A. Eandi

    2008-06-01

    Full Text Available OBJECTIVE: To evaluate our experience with tension-free transvaginal tape (TVT placement for the management of stress urinary incontinence (SUI in women who had previously undergone a failed midurethral synthetic sling (MUS procedure. MATERIALS AND METHODS: Ten women underwent retropubic TVT insertion for continued or recurrent SUI following a prior MUS procedure. No attempt was made to remove the previously placed sling at the time of surgery. A retrospective chart review was performed to obtain perioperative and follow-up patient information. Post-operatively, each patient completed a mailed incontinence questionnaire to assess self-reported urinary continence outcomes. RESULTS: All 10 women were available for follow-up at a mean period of 16 months (range 6 to 33. Four of the 10 patients achieved complete continence, and another three patients reported significantly improved continence and quality of life. Three women stated that their continence did not improve. CONCLUSIONS: TVT placement may be a viable option for the management of women with persistent or recurrent SUI following an initial MUS procedure.

  20. Dextranomer/hyaluronic acid bladder neck injection for persistent outlet incompetency after sling procedures in children with neurogenic urinary incontinence.

    Science.gov (United States)

    DaJusta, Daniel; Gargollo, Patricio; Snodgrass, Warren

    2013-06-01

    We report outcomes after dextranomer/hyaluronic acid (Dx/HA) bladder neck injection for persistent outlet incompetency despite prior sling or Leadbetter/Mitchell bladder neck revision plus sling (LMS) in children with neurogenic urinary incontinence. Consecutive patients with outlet incompetency after sling (n = 17) or LMS (n = 9) underwent a maximum of 2 Dx/HA injections. Antegrade and/or retrograde endoscopy was used to access the bladder outlet, and injection done in quadrants to achieve visual mucosal coaptation. Outcomes were described as either "dry", not requiring pads, or "wet". There were 24 children with follow-up after injection, of which 9 (38%) were initially dry and 15 (62%) remained wet. Of the 9 dry patients, 4 had recurrent incontinence at a mean of 16 months while 5 remained dry at a mean of 27 months. Second injections were done in a total of 14 children, with 1 dry at 39 months. Of all 24 children, up to 2 injections resulted in 6 (25%) dry patients, while the remainder was wet at last follow-up. Gender, initial outlet surgery, pre-injection pad use, injection technique, and volume injected did not predict outcomes. Dx/HA bladder neck injection resulted in dryness in 25% of patients in this series after failed sling or LMS. Second injections after either initial failure or success achieved dryness in only 7%, and are no longer recommended. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  1. [Attachment theory and baby slings/carriers: technological network formation].

    Science.gov (United States)

    Lu, Zxy-Yann Jane; Lin, Wan-Shiuan

    2011-12-01

    Healthcare providers recognize the important role played by attachment theory in explaining the close relationship between mental health and social behavior in mothers and their children. This paper uses attachment theory in a socio-cultural context to ascertain the mechanism by which baby slings/carriers, a new technology, produced and reproduced the scientific motherhood. It further applies a social history of technology perspective to understand how baby carriers and attachment theory are socially constructed and historically contingent on three major transformations. These transformations include the use of attachment theory-based baby carriers to further scientific motherhood; the use of baby slings/carriers to further the medicalization of breastfeeding and enhance mother-infant attachment; and the use of baby slings/carriers to transform woman's identities by integrating scientific motherhood, independence and fashion. Implications for nursing clinical policy are suggested.

  2. Sling de aponeurose e com faixa sintética sem tensão para o tratamento cirúrgico da incontinência urinária de esforço feminina Pubovaginal sling and tension-free vaginal tape for surgical treatment of stress urinary incontinence in women

    Directory of Open Access Journals (Sweden)

    João Paulo Sartori

    2008-03-01

    ções detectadas, a retenção urinária no pós-operatório foi superior no Grupo Sling.PURPOSE: to compare sling operations of aponeurosis and tension-free vaginal tape (TVT for the correction of stress urinary incontinence (SUI regarding: the rates of subjective and objective healing, the mobility of the bladder neck with ultrasonography, the variation of the absorbent test, the urodynamic alterations and the incidence of complications. METHODS: eighty patients with SUI were selected. Among them, 61 underwent a TVT surgery and 19, an abdominal rectum sling operation of aponeurosis. Average age, index of body mass and parity were 50.1 years old, 29.7 kg/m² and 4.1 deliveries (median=3 for the patients with aponeurosis sling, and 51.7 years old, 28.1 kg/m² and 4.1 deliveries (median=3 for the ones with TVT. All of them have undergone anamnesis, physical examination, bladder neck ultrasonography, absorbent test and urodynamic evaluation before and at least six months after the surgery. After 15 or 19 months and after about four or five years, they were again interviewed concerning the surgery results. RESULTS: after six months, 96.7% of the women with TVT and 89.5% of the ones with sling thought they were healed in the subjective evaluation. Nevertheless, after 15 to 19 months, the TVT Group kept the same subjective healing rate, while among the Sling Group the rate decreased to 77.8%. There was a significant decrease in the mobility of the neck bladder that was similar in both groups and an improvement in the absorbent test. At the end of the urodynamic study, 93.4% of the women from the TVT Group and 78.9% of the ones from the Sling Group were classified as having an objective healing. The average time of bladder probing was higher in the Sling Group. Urinary retention was observed in 42.1% of the sling cases and in 9.8% of the TVT's. The rates of late healing were 90% for TVT and 55.6% for sling. CONCLUSIONS: TVT surgery provided better subjective healing after 15 or 19

  3. The Effects of Shoulder Slings on Balance in Patients With Hemiplegic Stroke

    Science.gov (United States)

    Sohn, Min Kyun; Jee, Sung Ju; Hwang, Pyoungsik; Jeon, Yumi

    2015-01-01

    Objective To investigate the effects of a shoulder sling on balance in patients with hemiplegia. Methods Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. Results The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (pBobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. Conclusion The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position. PMID:26798614

  4. Prospective and randomized clinical trial comparing transobturator versus retropubic sling in terms of efficacy and safety.

    Science.gov (United States)

    Palos, Claudia Cristina; Maturana, Ana P; Ghersel, Frederico R; Fernandes, Cesar E; Oliveira, Emerson

    2018-01-01

    The midurethral sling is the most commonly performed surgical procedure for stress urinary incontinence (SUI). We compared the efficacy of transobturator tape (TOT) and retropubic (RP) slings by evaluating objective and subjective cure rates at 12 months postsurgery and evaluate the impact on quality of life (QoL) and record intra- and postoperative complications. This was a randomized, controlled, prospective, clinical trial with analysis of noninferiority. The hypothesis was that the TOT sling is not inferior to the RP sling. A total of 92 women with SUI were selected and randomized into two groups: TOT and RP slings. Eighty-one patients maintained follow-up 12 months postoperatively. In the per-protocol analysis, the objective cure rates were 100% for the RP sling and 93% for the TOT sling (p = 0.029). The subjective cure rates were 92% for the RP sling and 90% for the TOT sling (p = 0.02). Because none of the upper limits of the confidence interval (CI) were above the noninferiority margin, noninferiority of the TOT sling could be concluded. In contrast, the intention-to-treat analysis could not show that the TOT sling was not inferior to the RP sling, because the upper limit of the CI surpassed the noninferiority margin. Postoperative complications were similar for both groups, except for higher urinary retention rates in the RP group. Regarding QoL, there was a significant improvement. The cure rates of the per-protocol analysis showed the noninferiority of the TOT relative to the RP sling. The RP sling group exhibited higher urinary retention. Quality of life improved significantly in both groups.

  5. Rectus Fascia Sling for the Treatment of Total Urethral Incontinence ...

    African Journals Online (AJOL)

    Objectives: Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Patients and Methods: Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this ...

  6. Suburethral sling procedures after previous surgery for urinary ...

    African Journals Online (AJOL)

    Objective. To compare the outcome of suburethral sling procedures (tension-free vaginal tape (TVT), obturator tape (Ob-tape)) for stress urinary incontinence (SUI) in women with previous surgery for SUI or pelvic organ prolapse (POP). Methods. A comparative, descriptive, retrospective study was done using information ...

  7. 29 CFR 1915.112 - Ropes, chains and slings.

    Science.gov (United States)

    2010-07-01

    ... (CONTINUED) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT Gear and Equipment for Rigging and Materials Handling § 1915.112 Ropes, chains and slings. The provisions of this section shall apply... links having proper dimensions and made of material similar to that of the chain. Before repaired chains...

  8. Sling surgery for stress urinary incontinence; the perfect solution?

    NARCIS (Netherlands)

    Hogewoning, C.R.C.

    2017-01-01

    Stress urinary incontinence (SUI) is the most observed type of urinary incontinence and is defined as the loss of urine following a rise in abdominal pressure. The TVT (Tension-free Vaginal Tape), a mid-urethral sling (MUS), was introduced in 1996 and soon became the gold standard in the surgical

  9. The TVT Worldwide Observational Registry for Long-Term Data: safety and efficacy of suburethral sling insertion approaches for stress urinary incontinence in women.

    Science.gov (United States)

    Tincello, Douglas G; Botha, Theunis; Grier, Douglas; Jones, Peter; Subramanian, Dhinagar; Urquhart, Colin; Kirkemo, Aaron; Khandwala, Salil

    2011-12-01

    We examined the clinical effectiveness of a single incision sling in women with stress urinary incontinence and obtained comparative perioperative and postoperative data on retropubic and transobturator slings. Women who underwent a cough stress test were treated with surgery using a single incision, retropubic or obturator sling (Gynecare® TVT SECUR™, TVT™ or TVT Obturator System, respectively) with the choice of sling based on surgeon preference. Objective cure was assessed by the standing cough stress test at 1 year. Subjective outcomes were assessed by the Incontinence Quality of Life Questionnaire and EQ-5D™. Perioperative data and return to normal activity were recorded. Of the 1,398 women who underwent surgery there were postoperative data on 1,334, including 32.8%, 17.8% and 49.4% who received a tension free vaginal tape, obturator tension free vaginal tape and SECUR, respectively. After obturator tension free vaginal tape surgery fewer women had a positive cough stress test than after TVT and SECUR surgery (4 of 110 or 3.6% vs 24 of 187 or 12.8% and 59 of 374 or 15.8%, respectively). Incontinence Quality of Life Questionnaire effect size was 1.87, 1.42 and 1.56, respectively, indicating a large treatment effect. Using our Incontinence Quality of Life Questionnaire response definition 85.4%, 79.0% and 85.2% of the TVT, TVT outside-in obturator system and SECUR cohorts, respectively, were treatment responders (p = 0.11).The SECUR cohort had the shortest operative time, the lowest proportion of women who required an overnight stay and the most women who underwent surgery under local anesthesia. Median time to return to employment, housework, sex life and hobbies was most rapid for SECUR. This registry demonstrates the high effectiveness of all 3 approaches. The single incision sling appeared to have objective and subjective efficacy similar to that of the retropubic sling and it can be performed under local anesthesia in an office environment

  10. An evaluation of the sling surgical method of the bulbar urethra in the treatment of men's stress urinary incontinence at Shohadaye Ashayer Teaching Hospital in 2008.

    Science.gov (United States)

    Heidari, Mohammad; Khorramabadi, Manoochehr Shams

    2012-11-01

    To evaluate the utility and efficacy of bulbar urethera sling in the management of sphincter insufficiency that usually occurs after prostate surgery or posterior urethral injuries and may lead to moderate to severe stress incontinence. A total of 30 patients underwent sling surgery with rectus fascia in a four-year period at the Shohadaye Ashayer Teaching Hospital in Iran. Urinary incontinence occurred in 8 patients after open prostatectomy, in 12 patients after prostatectomy through urethra, in 8 patients after radical prostatectomy. For the purpose of the study, 2 patients in whom incontinence occurred after pelvic fracture were excluded. The 28 patients were followed up for a one-year period after the operation. All patients had incontinence from one to six years. After hospitalisation, an 18 gauge Foley's catheter was introduced in the urethra in every patient. The perineum was incised longitudinally, and the bulbar urethra was freed and a 2x7 cm span of rectus fascia was separated and placed under the bulbar urethra. Treatment was defined as use of one or no pad per day and recovery, as a reduction of at least 50% in the number of the used pads after sling operation. After operation, all patients suffering from moderate to severe stress incontinence were treated with 0-1 pad per day. Four patients were unable to urinate; in 2 patients the sling was modified and loosened, and in two others dilatation resolved their problems. Bulbar urethra sling can be carried out in moderate to severe urinary incontinence treatment in any hospital at a modest cost with satisfactory results.

  11. Outcomes of vaginal hysterectomy and constricting colporrhaphy with concurrent levator myorrhaphy and high perineorrhaphy in women older than 75 years of age

    Directory of Open Access Journals (Sweden)

    Töz E

    2015-06-01

    Full Text Available Emrah Töz, Aykut Özcan, Nesin Apaydin, İbrahim Uyar, Betül Kocakaya, Gülin Okay Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey Objectives: We performed constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy, and investigated the intraoperative complications, and short-term outcomes of these constricting procedures in patients aged 75 years or older.Methods: We searched our hospital database for cases, between January 2011 and January 2014, of women aged over 75 years who underwent surgery for pelvic organ prolapse of stage 2 or higher, via vaginal hysterectomy, constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy, with or without treatment of urinary incontinence. All volunteers were evaluated via pelvic examination using the pelvic organ prolapse quantification system, the modified Decision Regret Scale–Pelvic Floor Disorders form, the Satisfaction Decision Scale–Pelvic Floor Disorders form, and the Pelvic Floor Distress Inventory form.Results: Fifty-four patients were included in the study. The mean follow-up time was 24.4 months after constricting surgery (range: 8–44 months. There were four cases (7% of de novo urge incontinence (the symptoms resolved upon prescription of anticholinergic medication. Two patients developed de novo stress urinary incontinence after the procedure and were treated via transobturator sling surgery using Safyre T® polypropylene monofilament slings. No anatomical or subjective recurrence of prolapse was noted during the follow-up period. No patient required additional surgery for recurrence of prolapse.Conclusion: Constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy is a feasible, safe, and effective surgical option in elderly patients at low anesthesiological risk. The decision

  12. A randomized, controlled trial comparing an innovative single incision sling with an established transobturator sling to treat female stress urinary incontinence

    NARCIS (Netherlands)

    Hinoul, Piet; Vervest, Harry A. M.; den Boon, Jan; Venema, Pieter L.; Lakeman, Marielle M.; Milani, Alfredo L.; Roovers, Jan-Paul W. R.

    2011-01-01

    Mid urethral sling procedures have become the surgical treatment of choice for female stress urinary incontinence. Innovative modifications of mid urethral sling procedures were recently introduced with the claim of offering similar efficacy and decreased morbidity. We compared the efficacy and

  13. "Sling" retropúbico e transobturatório no tratamento da incontinênca urinária de esforço Retropubic and transobturator sling in treatment of stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Andrea Lopes Salzedas Tanuri

    2010-01-01

    Full Text Available OBJETIVO: Comparar resultados das técnicas de "sling" retropúbico e transobturador para o tratamento de mulheres com incontinência urinária de esforço (IUE. MÉTODOS: Foram randomizadas 30 pacientes, sendo que 20 se submeteram ao sling retropúbico e 10 ao transobturador. As pacientes foram avaliadas antes e após o tratamento com um, seis e 12 meses, por meio de história clínica, exame físico, questionário de qualidade de vida ("King's Health Questionnaire", teste do absorvente e avaliação urodinâmica. Os grupos foram homogêneos no pré-operatório. RESULTADOS: Houve melhora significante na avaliação da qualidade de vida em ambos os grupos após a terapêutica, sem diferença entre os grupos. Houve diminuição no peso do absorvente para os dois grupos. As taxas de cura pela avaliação urodinâmica em 12 meses foram de 84,2% para o grupo transobturador e 88,8% para o retropúbico. Da mesma forma, a cura subjetiva foi de 85% e 88,8%, respectivamente. Não observamos diferenças entre os grupos consoante as complicações. CONCLUSÃO: As cirurgias deste sling, pelas vias retropúbica e transobturadora, foram eficazes para o tratamento de mulheres com IUE, no seguimento de 12 meses. Observamos elevada taxa de cura e melhora da qualidade de vida com baixos índices de complicações.OBJECTIVE: The aim of this study was to compare results of retropubic and transobturator sling for surgical treatment of female stress urinary incontinence (SUI. METHODS: Thirty randomized patients with SUI were divided in two groups, twenty who underwent the transobturator sling and ten the retropubic sling procedure. .Patients were assessed before and after one, six and twelve months of treatment by clinical history, physical examination, quality of life questionnaire (King's Health Questionnaire, pad test and urodynamic parameters. At preoperative both groups were homogenous. RESULTS: One year after surgery, incontinence and quality of life

  14. Population based trends in procedures following sling surgery for urinary incontinence.

    Science.gov (United States)

    Suskind, Anne M; Kaufman, Samuel R; Dunn, Rodney L; Stoffel, John T; Clemens, J Quentin; Hollenbeck, Brent K

    2013-05-01

    To investigate practice patterns and variation associated with sling removal/revision and urethrolysis on a population level. We used CPT 4 codes and the State Ambulatory Surgery Database (SASD) to identify all ambulatory procedures for sling removal/revision and urethrolysis from 2004 to 2009 in Florida. Next, we calculated adjusted rates for these procedures and measured regional variation in rates at the level of the Hospital Service Area (HSA). During this time period, rates of secondary procedures following slings more than doubled from 3.2 per 100,000 to 6.5 per 100,000 population (pfollowing sling placement. The large amount of variability in rates of secondary procedures following slings signifies considerable uncertainty about the indications for these procedures. Further research is warranted to better explain potential sources for this variation in order to improve the quality of care surrounding midurethral sling placement and the recognition and treatment of its complications.

  15. Mid-term follow-up of the TVT-Secur midurethral sling for primary stress incontinence.

    Science.gov (United States)

    Angleitner-Flotzinger, Johannes; Aigmueller, Thomas

    2014-09-01

    The TVT-Secur was introduced in 2006 as a less invasive alternative to retropubic and transobturator suburethral slings. This retrospective cohort study evaluated objective and subjective results in a series of 158 consecutive patients as well as complications and the reoperation rate after TVT-Secur procedure. Between November 2006 and June 2010 a total of 158 patients underwent a TVT-Secur procedure at a single institution. All patients underwent preoperative urodynamic testing. All patients were invited for follow-up including physical examination, urodynamic studies and subjective evaluation. A total of 96 patients (61%) were available for follow-up with a mean follow-up of 29.8 months (range 5-50, median 30). At follow-up, eight (8%) of 96 patients had reoperations for stress incontinence. There were no reoperations for bleeding/hematoma, tape erosions or obstructed micturition and there were no tape erosions or exposures. 29 patients (30%) had a negative cough stress test and 44 patients (46%) subjectively considered themselves "cured". Nine of 43 patients (21%) without urgency symptoms preoperatively developed de novo urgency; 24 of 35 patients (69%) with preoperative urgency complaints were free of urgency symptoms. At 2.4 years, the TVT-Secur appears to have a low adverse events profile but inferior results compared with traditional midurethral slings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Arc-to-Arc mini-sling 1999: a critical analysis of concept and technology.

    Science.gov (United States)

    Palma, Paulo

    2011-01-01

    The aim of this study was to critically review the Arc-to-Arc mini-sling (Palma's technique) a less invasive mid-urethral sling using bovine pericardium as the sling material. The Arc-to-Arc mini-sling, using bovine pericardium, was the first published report of a mini-sling, in 1999. The technique was identical to the "tension-free tape" operation, midline incision and dissection of the urethra. The ATFP (white line) was identified by blunt dissection, and the mini-sling was sutured to the tendinous arc on both sides with 2 polypropylene 00 sutures. The initial results were encouraging, with 9/10 patients cured at the 6 weeks post-operative visit. However, infection and extrusion of the mini-sling resulted in sling extrusion and removal, with 5 patients remaining cured at 12 months. The Arc-to-Arc mini-sling was a good concept, but failed because of the poor technology available at that time. Further research using new materials and better technology has led to new and safer alternatives for the management of stress urinary incontinence.

  17. Arc-to-arc mini-sling 1999: a critical analysis of concept and technology

    Directory of Open Access Journals (Sweden)

    Paulo Palma

    2011-04-01

    Full Text Available PURPOSE: The aim of this study was to critically review the Arc-to-Arc mini-sling (Palma's technique a less invasive mid-urethral sling using bovine pericardium as the sling material. MATERIALS AND METHODS: The Arc-to-Arc mini-sling, using bovine pericardium, was the first published report of a mini-sling, in 1999. The technique was identical to the "tension-free tape" operation, midline incision and dissection of the urethra. The ATFP (white line was identified by blunt dissection, and the mini-sling was sutured to the tendinous arc on both sides with 2 polypropylene 00 sutures. RESULTS: The initial results were encouraging, with 9/10 patients cured at the 6 weeks post-operative visit. However, infection and extrusion of the mini-sling resulted in sling extrusion and removal, with 5 patients remaining cured at 12 months. CONCLUSION: The Arc-to-Arc mini-sling was a good concept, but failed because of the poor technology available at that time. Further research using new materials and better technology has led to new and safer alternatives for the management of stress urinary incontinence.

  18. “U-Method” TVT-Secur Slings: Are they obstructive?

    Science.gov (United States)

    Richard, Patrick; Gagnon, Louis-Olivier; Tu, Le Mai

    2012-01-01

    Introduction: The TVT-Secur, a single incision sling, was introduced in 2006. It is implanted using either the “hammock” or the “U-method” technique. With the latter, the sling is tightened to create a “pillowing effect” on the urethra until a negative stress test is obtained. Short-term results seem promising. However, no study has ever reported on the voiding pattern 12 months after its implantation. Our objective was to assess whether the “U-method” technique creates an obstructive voiding pattern on pressure-flow study (PFS) 12 months after the surgery. Methods: In this retrospective study, we reviewed the charts of 33 women who underwent the “U-method” TVT-Secur. Patients were evaluated before and 12 months postoperatively with regard to different urodynamic studies (UDS). The incontinence status was also assessed 12 months after surgery. Results: At 12 months after the operation, 12.5% (4/32) of the patients reported an improvement of their stress urinary incontinence, while 78.1% (25/32) reported being cured from it. The objective cure rate was 63% (19/30). One patient had a suspected bladder outlet obstruction (BOO) based on PFS. Maximal flow rate (Qmax) was significantly lower 12 months after surgery (26.0 mL/s [range: 19.0–36.5] vs. 21.5 mL/s [range: 16.0–32.3]). However, median voided volume was lower on the postoperative uroflowmetry (446 mL [range: 348–605] vs. 320 mL [range: 243–502]). Furthermore, none of the patients complained of voiding symptoms after surgery. Conclusions: Although one patient had findings compatible with BOO, none complained of voiding symptoms. TVT-Secur may result in a lower Qmax. However, this finding may be due to a lower voiding volume on the postoperative UDS. PMID:22511425

  19. Concurrent Collections

    OpenAIRE

    Budimlić, Zoran; Burke, Michael; Cavé, Vincent; Knobe, Kathleen; Lowney, Geoff; Newton, Ryan; Palsberg, Jens; Peixotto, David; Sarkar, Vivek; Schlimbach, Frank; Taşırlar, Sağnak

    2010-01-01

    We introduce the Concurrent Collections (CnC) programming model. CnC supports flexible combinations of task and data parallelism while retaining determinism. CnC is implicitly parallel, with the user providing high-level operations along with semantic ordering constraints that together form a CnC graph. We formally describe the execution semantics of CnC and prove that the model guarantees deterministic computation. We evaluate the performance of CnC implementations on several applications an...

  20. Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up

    Directory of Open Access Journals (Sweden)

    Dubuisson Jean-Bernard

    2009-09-01

    Full Text Available Abstract Backround The transobturator tape procedure (TOT is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions. Methods It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris®, Obtape®, TVT-O®. Follow-up information was available for 225 (96.6% women. Results There were few per operative complications. Forty-eight women (21.3% reported late complications including de novo or worsening of preexisting urgencies (10.2%, perineal pain (2.2%, de novo dyspareunia (9%, and vaginal erosion (7.6%. The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris®, Obtape® and TVT-O® respectively (P = 0.001. The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4% compared to women who did not (78.4% (RR 0.14, 95% CI 0.05-0.38, P Conclusion Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.

  1. Documentation of specific mesh implant at the time of midurethral sling surgery in women with stress incontinence.

    Science.gov (United States)

    Kassis, Nadine C; Thompson, Jennifer C; Scheidler, Anne M; Daggy, Joanne K; Hale, Douglass S

    2015-01-01

    We aimed to assess documentation completeness of the operative record for mesh implanted at the time of midurethral sling surgery and to identify modifiable predictors of documentation completeness. A retrospective cross-sectional study of women with stress incontinence who underwent midurethral sling placement between January 2009 and December 2011 was conducted. Data from the dictated operative note and nursing operative record were extracted to determine if the specific mesh implanted during surgery was documented. The primary outcome was the rate of documentation of mesh implanted in the physician's dictated operative note and in the nursing record. Logistic regression was used to determine if any characteristics were associated with the rate of documentation while accounting for correlation of patients from the same dictating surgeon. There were 816 surgeries involving the implantation of a midurethral sling during the study period. All surgeries were performed at 6 Indiana University hospitals. Fifty-two surgeons of varying specialties and levels of training dictated the operative notes. A urogynecologist dictated 71% of the operative notes. The rate of documentation completeness for mesh implanted in the physician's note was 10%. The rate of documentation completeness for mesh implanted in the nursing operative record was 92%. Documentation of mesh implanted in the physician's note was not significantly associated with the level of training, specialty, or year of surgery. Documentation completeness for specific mesh implant in the physician's note is low, independent of specialty and level of training. Nursing documentation practices are more rigorous. Postmarket surveillance, currently mandated by the Food and Drug Administration, may not be feasible if only the physician's note is available or if nursing practices are inconsistent. Development of documentation guidelines for physicians would improve the feasibility of surveillance.

  2. A cost-effectiveness analysis of retropubic midurethral sling versus transobturator midurethral sling for female stress urinary incontinence.

    Science.gov (United States)

    Seklehner, Stephan; Laudano, Melissa A; Te, Alexis E; Kaplan, Steven A; Chughtai, Bilal; Lee, Richard K

    2014-11-01

    To compare the cost-effectiveness (CE) of retropubic midurethral sling (RMS) versus transobturator midurethral sling (TMS) for the treatment of female stress urinary incontinence (SUI). A Markov chain decision model was created to simulate treatment of SUI with RMS versus TMS. Costing data were obtained from the Medicare RBRVS. Data regarding the efficacy and complications associated with RMS versus TMS was compiled from a literature review of 21 randomized RCTs with a minimum of 12 months follow-up, as were corresponding utilities for different continence states. Deterministic and probabilistic estimates of cost-effectiveness (CE) for each procedure were calculated and compared, and sensitivity analyses were performed. In the base-case deterministic analysis, the efficacy of RMS was 6.275 versus 6.272 QALYs for TMS. QALYs represent a measure of disease burden accounting for both quantity and quality of life lived and are used to assess the monetary value of a medical intervention. The average cost for treatment with RMS however was higher at $9,579 versus $9,017 with TMS. TMS was therefore overall more cost-effective than RMS (CE = $1,438/QALY vs. $1,527/QALY). Sensitivity analysis demonstrated that physician and sling characteristics such as device cost, surgeon fee, efficacy of treatment, operative time, and duration of hospitalization could all affect the relative CE of the therapies. Our study demonstrated that TMS was more cost-effective than RMS as a treatment for female SUI. The efficacy of the two treatments could be affected by physician and sling characteristic factors. © 2013 Wiley Periodicals, Inc.

  3. Posterior axilla sling traction for shoulder dystocia: case review and a new method of shoulder rotation with the sling.

    Science.gov (United States)

    Cluver, Catherine Anne; Hofmeyr, G Justus

    2015-06-01

    The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling. A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented. We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was shoulder was difficult because of very severe impaction, the sling could be used to rotate the shoulders easily through 180 degrees assisted by counter pressure on the back of the anterior shoulder. This new method was used in 5 cases and may reduce fetal trauma further during difficult shoulder delivery. This review confirms that PAST can be a lifesaving technique when all another techniques for shoulder dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Assessment of voiding after sling: a randomized trial of 2 methods of postoperative catheter management after midurethral sling surgery for stress urinary incontinence in women.

    Science.gov (United States)

    Tunitsky-Bitton, Elena; Murphy, Alana; Barber, Matthew D; Goldman, Howard B; Vasavada, Sandip; Jelovsek, J Eric

    2015-05-01

    The objective of this study was to compare the backfill standard voiding trial (SVT) that relies on the assessment of voided volume to subjective patients' evaluation of their voiding based on the assessment of the force of stream (FOS) after an outpatient midurethral sling surgery. This double-blinded randomized trial included patients undergoing an outpatient midurethral sling surgery without any other concomitant surgery. Participants were randomized to either the SVT group or to the FOS group. The primary outcome was the rate of catheterization any time up to 6 weeks after surgery. Both groups underwent the same backfill voiding trial protocol postoperatively. Measurements of the voided amount, postvoid residual, and the response to the FOS visual analog scale were collected. The criteria for passing the voiding trial in the SVT group was voiding at least two-thirds of the instilled amount; while the criteria for passing the trial in the FOS group was assessment of FOS at least 50% of the baseline, regardless of the voided volume. Participants were interviewed preoperatively and 2-4 days, 7-9 days, and 6 weeks postoperatively. All postoperative interviews included assessments of pain, tolerance of physical activity, urinary FOS, as well as satisfaction with the surgery. Validated questionnaires (Incontinence Severity Index and Urinary Distress Inventory, short form) before the surgery and 6 weeks after were used to evaluate urinary symptoms. A total of 108 patients were enrolled and randomized, and 6-week follow-up data were available for 102 participants (FOS 50, SVT 52). The 2 groups were similar with respect to demographic characteristics and urinary symptoms. The incidence of catheterization was also similar between the groups (FOS 13 [26%], SVT 13 [25.5%]; P=.95). Amount voided had a moderate correlation with FOS assessment (Spearman rho 0.5; PInventory, short form scores between the 2 groups. Of the patients who were discharged home without a catheter in

  5. Concurrent Collections

    Directory of Open Access Journals (Sweden)

    Zoran Budimlić

    2010-01-01

    Full Text Available We introduce the Concurrent Collections (CnC programming model. CnC supports flexible combinations of task and data parallelism while retaining determinism. CnC is implicitly parallel, with the user providing high-level operations along with semantic ordering constraints that together form a CnC graph. We formally describe the execution semantics of CnC and prove that the model guarantees deterministic computation. We evaluate the performance of CnC implementations on several applications and show that CnC offers performance and scalability equivalent to or better than that offered by lower-level parallel programming models.

  6. Transvaginal sling suspension of bladder neck in female patients with neurogenic sphincter incontinence

    NARCIS (Netherlands)

    Dik, Pieter; Klijn, Aart J.; van Gool, Jan D.; de Jong, Tom P. V. M.

    2003-01-01

    Many surgical options exist to enhance bladder neck closing pressure in women. Most procedures are relatively large with a success rate of between 70% and 90%. Sling procedures with the sling placed between the anterior vaginal wall and bladder neck cause a risk of traumatic lesions of the bladder

  7. Clinical trial comparing autogenous fascia lata sling and Gore-Tex suspension in bilateral congenital ptosis.

    Science.gov (United States)

    Elsamkary, Mahmoud Ahmed; Roshdy, Maged Maher Salib

    2016-01-01

    To study the effect of autogenous fascia lata sling (AFLS) versus Gore-Tex suspension (GTS) regarding the functional and aesthetic outcomes in patients with bilateral congenital ptosis. A prospective comparative randomized single-center study enrolled 110 patients with bilateral congenital ptosis. One group (n=55) underwent AFLS and the second group (n=55) underwent GTS. Exclusion criteria were good levator function, absent Bell's phenomenon, and abnormal ocular motility. Follow-up period was 2 years. Functional outcome was measured from digital photos by analysis of upper eyelid margin position relative to the superior limbus and classified as very good (5 mm), and recurrent. Aesthetic outcome was assessed in terms of lid contour, symmetry of eyelid height, and lid crease presence. Complications were also reported. Failure rate (recurrence and complications) was less in AFLS (P=0.035). Symmetrical lid height and good contour were more frequently attained by AFLS (P=0.007 and 0.047, respectively). However, the frequency of very good, good, poor, recurrence, lagopthalmos, ectropion, infection, and formed lid crease individually showed no statistically significant difference (P=0.252, 0.482, 1, 0.489, 0.438, 1, 0.618, and 0.506, respectively). AFLS is a better choice in surgery for patients with bilateral congenital ptosis because it has fewer complications and a lesser recurrence rate than GTS.

  8. Arterial tortuosity syndrome: An extremely rare disease presenting as a mimic of pulmonary sling

    Directory of Open Access Journals (Sweden)

    Amy Farkas, MD

    2018-02-01

    Full Text Available Pulmonary sling is the anatomic variant defined by the aberrant origin of the left pulmonary artery from the right pulmonary artery. This patient presented with a mimic of pulmonary sling as a result of an extremely rare condition, arterial tortuosity syndrome (ATS. The patient was first diagnosed with pulmonary sling on prenatal echocardiogram performed by cardiology. Computed tomography angiography of the chest obtained at birth to evaluate respiratory depression demonstrated ATS. The early detection of ATS has been demonstrated to improve patient outcome. This case provides an overview of the typical imaging features of ATS to aid radiologists in making this uncommon diagnosis.

  9. Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.

    Science.gov (United States)

    Joyce, M; Thirion, P; Kiernan, F; Byrnes, C; Kelly, P; Keane, F; Neary, P

    2009-04-01

    Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.

  10. Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.

    LENUS (Irish Health Repository)

    Joyce, M

    2012-02-01

    BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.

  11. Decreasing transobturator sling groin pain without decreasing efficacy using TVT-Abbrevo.

    Science.gov (United States)

    Shaw, Jonathan S; Jeppson, Peter C; Rardin, Charles R

    2015-09-01

    Groin pain following a transobturator (TO) midurethral sling is not uncommon and can be difficult to manage. We sought to determine if decreasing the mesh burden in the groin would decrease pain. The primary objective was to compare the incidence of post-operative groin pain following placement of full-length TVT-Obturator versus the shorter TVT-Abbrevo. Secondarily, we aimed to compare the efficacy between both devices 6 months after surgery. This is a retrospective cohort study of all women who underwent a TO midurethral sling by the division of urogynecology at one institution between 1 January 2007 and 31 October 2013. Charts were reviewed and the incidence of post-operative groin pain in the two groups dichotomized as present or absent and compared using a Chi-squared test. Validated questionnaire scores of the groups were compared using t tests. There were 125 patients who received a TVT-Obturator and 100 patients who received a TVT-Abbrevo. No differences in demographic data were present between the groups. Twelve patients (9.6 %) in the TVT-Obturator group and 1 patient (1 %) in the TVT-Abbrevo group experienced bothersome groin pain (P value = 0.007). The complete pre- and 6-month post-operative ISI, UDI-6 and PFIQ-7 scores were available for 76 (61 %), 47 (38 %), and 45 (36 %) patients following TVT-Obturator and 57 (57 %), 30 (30 %), and 28 (28 %) following TVT-Abbrevo treatment. At 6 months the mean improvement in questionnaire scores for the TVT-Obturator and TVT-Abbrevo groups were as follows: 5.0 and 5.1 for ISI (P value = 0.9), 8.3 and 7.9 for UDI-6 (P value = 0.8), and 4.8 and 6.1 for PFIQ-7 (P value = 0.4). Use of TVT-Abbrevo reduces post-operative groin pain compared with the full-length TVT-Obturator, without any reduction in efficacy.

  12. Dorsal clitoral nerve injury following transobturator midurethral sling

    Directory of Open Access Journals (Sweden)

    Moss CF

    2016-09-01

    Full Text Available Chailee F Moss,1 Lynn A Damitz,2 Richard H Gracely,3 Alice C Mintz,3 Denniz A Zolnoun,2–4 A Lee Dellon5 1Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus, OH, USA; 2Department of Surgery, University of North Carolina at Chapel Hill, NC, USA; 3Department of Endodontics, University of North Carolina at Chapel Hill, NC, USA; 4Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; 5Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: Transobturator slings can be successfully used to treat stress urinary incontinence and improve quality of life through a minimally invasive vaginal approach. Persistent postoperative pain can occur and pose diagnostic and therapeutic dilemmas. Following a sling procedure, a patient complained of pinching clitoral and perineal pain. Her symptoms of localized clitoral pinching and pain became generalized over the ensuing years, eventually encompassing the entire left vulvovaginal region.Aim: The aim of this study was to highlight the clinical utility of conventional pain management techniques used for the evaluation and management of patients with postoperative pain following pelvic surgery. Methods: We described a prototypical patient with persistent pain in and around the clitoral region complicating the clinical course of an otherwise successful sling procedure. We specifically discussed the utility of bedside sensory assessment techniques and selective nerve blocks in the evaluation and management of this prototypical patient. Results: Neurosensory assessments and a selective nerve block enabled us to trace the source of the patient’s pain to nerve entrapment along the dorsal nerve of the clitoris. We then utilized a nerve stimulator-guided hydrodissection technique to release the scar contracture Conclusion: This case

  13. Use of the adjustable trans-obturator male sling system for the ...

    African Journals Online (AJOL)

    M.S. El Badry

    2016-03-25

    Obturator Male Sling System. (ATOMS)” as a new surgical technique for the treatment of different types of male urinary incontinence. Subjects and methods: Between March 2012 and December 2013, 9 patients with a mean ...

  14. Mesh-related chronic infections in silicone-coated polyester suburethral slings.

    Science.gov (United States)

    Lee, Joseph K-S; Agnew, Gerard; Dwyer, Peter L

    2011-01-01

    despite claims of equivalence to the tension-free vaginal tape, a variety of suburethral slings have been introduced, with various modifications. Complications in certain synthetic slings and meshes have led to a recent FDA public health notification. we report the case histories and management of five women with complications following implant of an InFast sling. four of the five patients presented with symptom of chronic vaginal discharge, one presenting with irritative voiding symptoms and bladder pain. Resolution of presenting symptoms requires total removal of this silicone-coated polyester mesh, which often requires a combined vaginal-abdominal approach. the silicone-coated mesh of the AMS InFAST sling, can become a focus for chronic infection forming a sinus tract into the vagina or other viscus, causing symptoms years after its placement.

  15. Clinical trial comparing autogenous fascia lata sling and Gore-Tex suspension in bilateral congenital ptosis

    Directory of Open Access Journals (Sweden)

    Elsamkary MA

    2016-03-01

    Full Text Available Mahmoud Ahmed Elsamkary,1 Maged Maher Salib Roshdy1,2 1Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 2Pediatric Ophthalmology Department, Al Watany Eye Hospital, Cairo, Egypt Purpose: To study the effect of autogenous fascia lata sling (AFLS versus Gore-Tex suspension (GTS regarding the functional and aesthetic outcomes in patients with bilateral congenital ptosis. Patients and methods: A prospective comparative randomized single-center study enrolled 110 patients with bilateral congenital ptosis. One group (n=55 underwent AFLS and the second group (n=55 underwent GTS. Exclusion criteria were good levator function, absent Bell’s phenomenon, and abnormal ocular motility. Follow-up period was 2 years. Functional outcome was measured from digital photos by analysis of upper eyelid margin position relative to the superior limbus and classified as very good (<3 mm, good (3–5 mm, poor (>5 mm, and recurrent. Aesthetic outcome was assessed in terms of lid contour, symmetry of eyelid height, and lid crease presence. Complications were also reported. Results: Failure rate (recurrence and complications was less in AFLS (P=0.035. Symmetrical lid height and good contour were more frequently attained by AFLS (P=0.007 and 0.047, respectively. However, the frequency of very good, good, poor, recurrence, lagopthalmos, ectropion, infection, and formed lid crease individually showed no statistically significant difference (P=0.252, 0.482, 1, 0.489, 0.438, 1, 0.618, and 0.506, respectively. Conclusion: AFLS is a better choice in surgery for patients with bilateral congenital ptosis because it has fewer complications and a lesser recurrence rate than GTS. Keywords: ptosis surgery, surgical outcomes, ptosis recurrence, lagophthalmos

  16. Transobturator tension-free “inside-to-out” suburethral sling procedure for the treatment of stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Laketić Darko

    2012-01-01

    Full Text Available Introduction. Stress urinary incontinence is an involuntary leakage of urine on a sudden increase of intra-abdominal pressure by physical activity, exercise, coughing, sneezing or laughing. Objective. To assess symptoms, functional and anatomical status of voiding function, complications and short term success of a novel procedure, tension-free vaginal tape obturator technique (TVT-O in the treatment of stress urinary incontinence. Methods. A prospective study was performed on 40 female patients who underwent the TVT-O suburethral sling at the Urology Department of the Health Centre in Prokuplje and Urology Hospital in Niš between May 2009 and February 2010. The mean patients’ age was 58 years (range 34-84 years. Preoperative evaluation included a detailed history and gynaecologic examination including urodynamic testing and voiding studies.UDI-6 and UIQ-7 score testing was performed before, and six months after surgery. All patients who demonstrated stress urinary incontinence with a Q-tip test-angle during maximal straining were included into the study. Postoperatively, outcomes evaluation included voiding function, anatomical parameters, complications, as well as subjective success rates. Results. In 30 patients surgery was performed under spinal and in ten under general anaesthesia. The average intraoperative blood loss during the TVT-O was minimal (<50 ml. There were no vascular, bladder, bowel, and neurological injuries. Thirty-eight patients (95% were discharged voiding satisfactorily. There was a statistically significant difference in symptoms between UDI-6 and UIQ-7 before and after surgery. Conclusion. Initial experience with TVT-O suburethral sling is promising. The TVT-O differs from retropubic procedures by resulting in lower postoperative morbidity, intraoperative and postoperative complications.

  17. CT demonstration of chicken trachea resulting from complete cartilaginous rings of the trachea in ring-sling complex

    Energy Technology Data Exchange (ETDEWEB)

    Calcagni, Giulio; Bonnet, Damien; Sidi, Daniel [University Paris Descartes, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, AP-HP, Paris (France); Brunelle, Francis [University Paris Descartes, Department of Paediatric Radiology, Hopital Necker-Enfants Malades, AP-HP, Paris Cedex 15 (France); Vouhe, Pascal [University Paris Descartes, Department of Paediatric Cardiovascular Surgery, Hopital Necker-Enfants Malades, AP-HP, Paris (France); Ou, Phalla [University Paris Descartes, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, AP-HP, Paris (France); University Paris Descartes, Department of Paediatric Radiology, Hopital Necker-Enfants Malades, AP-HP, Paris Cedex 15 (France)

    2008-07-15

    We report a 10-month-old infant who presented with tetralogy of Fallot and respiratory disease in whom the suspicion of a ring-sling complex was confirmed by high-resolution CT. CT demonstrated the typical association of left pulmonary artery sling and the ''chicken trachea'' resulting from complete cartilaginous rings of the trachea. (orig.)

  18. CT demonstration of chicken trachea resulting from complete cartilaginous rings of the trachea in ring-sling complex

    International Nuclear Information System (INIS)

    Calcagni, Giulio; Bonnet, Damien; Sidi, Daniel; Brunelle, Francis; Vouhe, Pascal; Ou, Phalla

    2008-01-01

    We report a 10-month-old infant who presented with tetralogy of Fallot and respiratory disease in whom the suspicion of a ring-sling complex was confirmed by high-resolution CT. CT demonstrated the typical association of left pulmonary artery sling and the ''chicken trachea'' resulting from complete cartilaginous rings of the trachea. (orig.)

  19. Basic Concurrency Theory

    DEFF Research Database (Denmark)

    Løvengreen, Hans Henrik

    2002-01-01

    In this set of notes, we present some of the basic theory underlying the discipline of programming with concurrent processes/threads. The notes are intended to supplement a standard textbook on concurrent programming.......In this set of notes, we present some of the basic theory underlying the discipline of programming with concurrent processes/threads. The notes are intended to supplement a standard textbook on concurrent programming....

  20. Assessment of stress in laboratory beagle dogs constrained by a Pavlov sling.

    Science.gov (United States)

    Stracke, Jenny; Bert, Bettina; Fink, Heidrun; Böhner, Jörg

    2011-01-01

    The 3Rs - Replacement, Reduction and Refinement - have become increasingly important in designing animal experiments. The Pavlov sling is thought to be a non-invasive method to restrain dogs for examinations. The aim of our study was to investigate whether laboratory Beagle dogs that had been trained to tolerate restraint by a Pavlov sling are stressed by this procedure and, furthermore, to analyze their behavior during this period. Five male and five female Beagle dogs were used, each three years of age. Animals were restrained in the Pavlov sling for 30 min on six days with an interval of at least two days. The following behaviors were recorded every minute for each session: postures of body, head, and ears, as well as state of eyes, tail, legs, and mouth. Additionally, the animals were observed for the occurrence of particular stress signs, including body shaking, sweating of the paws, increased saliva production, piloerection, blinking of eyes, snout licking, yawning, and panting. As an indicator for stress, salivary cortisol levels were measured before, during, and after each session. Our results show that for most behavioral parameters, e.g., body, leg, head, tail, and ear posture, the frequency of changes between different behavior patterns, as well as cortisol concentration, were not influenced by restraint in the Pavlov sling. Therefore, the Pavlov sling does not seem to be perceived as a stressful situation by the Beagle dogs. Our study demonstrates that under certain conditions the use of the Pavlov sling in trained dogs can substitute for more ordinary methods of immobilization, e.g., the use of narcotics.

  1. Measuring and modelling concurrency

    Science.gov (United States)

    Sawers, Larry

    2013-01-01

    This article explores three critical topics discussed in the recent debate over concurrency (overlapping sexual partnerships): measurement of the prevalence of concurrency, mathematical modelling of concurrency and HIV epidemic dynamics, and measuring the correlation between HIV and concurrency. The focus of the article is the concurrency hypothesis – the proposition that presumed high prevalence of concurrency explains sub-Saharan Africa's exceptionally high HIV prevalence. Recent surveys using improved questionnaire design show reported concurrency ranging from 0.8% to 7.6% in the region. Even after adjusting for plausible levels of reporting errors, appropriately parameterized sexual network models of HIV epidemics do not generate sustainable epidemic trajectories (avoid epidemic extinction) at levels of concurrency found in recent surveys in sub-Saharan Africa. Efforts to support the concurrency hypothesis with a statistical correlation between HIV incidence and concurrency prevalence are not yet successful. Two decades of efforts to find evidence in support of the concurrency hypothesis have failed to build a convincing case. PMID:23406964

  2. Constraints meet concurrency

    CERN Document Server

    Mauro, Jacopo

    2014-01-01

    This book describes the benefits that emerge when the fields of constraint programming and concurrency meet. On the one hand, constraints can be used in concurrency theory to increase the conciseness and the expressive power of concurrent languages from a pragmatic point of view. On the other hand, problems modeled by using constraints can be solved faster and more efficiently using a concurrent system. Both directions are explored providing two separate lines of development. Firstly the expressive power of a concurrent language is studied, namely Constraint Handling Rules, that supports constraints as a primitive construct. The features of this language which make it Turing powerful are shown. Then a framework is proposed to solve constraint problems that is intended to be deployed on a concurrent system. For the development of this framework the concurrent language Jolie following the Service Oriented paradigm is used. Based on this experience, an extension to Service Oriented Languages is also proposed in ...

  3. Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques.

    Science.gov (United States)

    Castroviejo-Royo, F; Martinez-Sagarra-Oceja, J M; Marina-García-Tuñón, C; Conde-Redondo, C; Rodríguez-Toves, L A; González-Tejero, C

    2013-10-01

    The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc(®) (single-incision suburethral mini-sling). Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc(®) mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P≤.005. The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc(®), technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc(®), a difference that was statistically significant. We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

  4. Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques.

    Science.gov (United States)

    Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre

    2018-01-01

    Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.

  5. Temporal Concurrent Constraint Programming

    DEFF Research Database (Denmark)

    Nielsen, Mogens; Palamidessi, Catuscia; Valencia, Frank Dan

    2002-01-01

    The ntcc calculus is a model of non-deterministic temporal concurrent constraint programming. In this paper we study behavioral notions for this calculus. In the underlying computational model, concurrent constraint processes are executed in discrete time intervals. The behavioral notions studied...... reflect the reactive interactions between concurrent constraint processes and their environment, as well as internal interactions between individual processes. Relationships between the suggested notions are studied, and they are all proved to be decidable for a substantial fragment of the calculus...

  6. Domain Theory for Concurrency

    DEFF Research Database (Denmark)

    Nygaard, Mikkel

    Concurrent computation can be given an abstract mathematical treatment very similar to that provided for sequential computation by domain theory and denotational semantics of Scott and Strachey. A simple domain theory for concurrency is presented. Based on a categorical model of linear logic and ...... towards more expressive languages than HOPLA and Affine HOPLA—in particular concerning extensions to cover independence models. The thesis concludes with a discussion of related work towards a fully fledged domain theory for concurrency....

  7. Clinical and quality-of-life outcomes after autologous fascial sling and tension-free vaginal tape: a prospective randomized trial

    Directory of Open Access Journals (Sweden)

    Joao L. Amaro

    2009-02-01

    Full Text Available Purpose: Evaluate the impact autologous fascial sling (AFS and tension-free vaginal tape (TVT procedures on quality-of-life in incontinent women. Materials and Methods: Forty-one women were randomly distributed into two groups. Group G1 (n = 21, underwent AFS and group G2 (n = 20 TVT implant. The clinical follow up was performed at 1, 6, 12 and 36 months. Results: TVT operative time was significantly shorter than AFS. Cure rates were 71% at 1 month, 57% at 6 and 12 months in G1. In G2, cure rates were 75% at 1 month, 70% at 6 months and 65% at 12 months; there was no significant difference between groups. As regards the satisfaction rate, there was no statistical difference between groups. Analysis of quality of life at 36 months revealed that there was no significant difference between groups. Conclusion: Similar results between AFS and TVT, except for operative time were shorter in TVT.

  8. 76 FR 27367 - Slings; Extension of the Office of Management and Budget's (OMB) Approval of Information...

    Science.gov (United States)

    2011-05-11

    ... failure during material handling. Paragraph (e) of the Standard covers alloy steel chain slings. Paragraph..., and retaining proof testing certificates. DATES: Comments must be submitted (postmarked, sent, or... titled SUPPLEMENTARY INFORMATION. Docket: To read or download comments or other material in the docket...

  9. Ultrasound diagnosis of pulmonary sling with proximal stenosis of left pulmonary artery and patent arterial duct

    Directory of Open Access Journals (Sweden)

    Wojciech Mądry

    2013-03-01

    Full Text Available Authors discuss methods of echocardiographic diagnosis of the pulmonary sling with stenosis and hypoplasia of the left pulmonary artery and patent arterial duct with massive left‑to‑right shunt, based on a case of the newborn with resistant to treatment heart failure, with initial diagnosis of patent ductus arteriosus, referred to surgical treatment. The optimal echocardiographic views permitting establish diagnosis of the pulmonary sling were suggested. The special attention was paid to high parasternal and suprasternal views visualizing vessels of the upper mediastinum as well as characteristic differences between the normal and pathologic picture. The typical features of the echocardiogram suggesting pulmonary sling, like the lack of the left pulmonary artery in its expected position, and the abnormal branching pattern of the right pulmonary artery were indicated. The greatest diagnostic difficulties in visualization of the abnormal route of the left pulmonary artery were related to the presence of air‑containing tissues, like lungs and central airways between the ultrasound probe and area of interest. The other was the masking influence of the large patent arterial duct, that may mimic the left pulmonary artery arising from the pulmonary trunk. The other entities requiring differentiation with sling, like aplasia of the left lung, the direct or indirect aortic origin of the left pulmonary artery, were discussed. The role of other visualization technics, like computed 3D tomography, and magnetic nuclear resonance, as well as direct visualization of central airways with bronchoscopy in establishing precise diagnosis were stressed.

  10. A Danish national survey of women operated with mid-urethral slings in 2001

    DEFF Research Database (Denmark)

    Ammendrup, Astrid Cecilie; Jørgensen, Anette; Sander, Pia

    2009-01-01

    OBJECTIVE: To perform a national survey on self-reported cure, satisfaction and complications four years after mid-urethral sling (MUS) for urinary stress incontinence in Danish women operated in 2001. DESIGN: A postal questionnaire survey. POPULATION: All Danish women who received an MUS operation...

  11. Comparison of TVT, TVT-O/TOT and mini slings for the treatment of female stress urinary incontinence: 30 months follow up in 531 patients.

    Science.gov (United States)

    Stavros, Charalambous; Ioannis, Vouros; Vasileios, Sakalis I; Gkotsi, Anastasia Ch; Georgios, Salpiggidis; Papathanasiou, Athanasios; Rombis, Vasileios

    2012-09-01

    Although mid-urethral slings (MUS), have been extensively used for the treatment of female stress urinary incontinence (SUI), no published data exists for the efficiency and the complications of these methods in large patient series. This is a retrospective analysis on patients who underwent MUS surgery since 1999. 531 patients were studied and the results of preoperative assessment, perioperative, early postoperatively and each follow up were registered. Patients were classified in three groups according to the MUS used. Efficacy of each method was evaluated in terms of early postoperative course, late complications and patient's symptoms improvement based questioners, pad test, uroflowmetry, filling cystometry and ultrasonography. Evaluation took place at 7th and 30th postoperative day, 3rd and 12th month and then annually. Each patient was characterized as cured, improved or failed. Trans Obturator (TO) group prevailed in efficiency with no significant differences between trans obturator route with inside-out (TVT-O) and outside-in (TOT). Success rate at 30th month evaluation, was higher in the TO group than in Tension-free Vaginal Tape (TVT) or Single-Incision Mini Slings (SIMS) group (93.4% vs 89.5%, 93.4% vs. 91.7%). None TVT patient required reoperation for remaining/reoccurring SUI, while 1.04% of TO group and 5.48% of SIMS group did. Patients of TVT group underwent reoperation for tape related complications in 2.25%, while 2.07% of TO group and none of SIMS group did. The potential limitation of the study is its retrospective character. Even though TO tapes and SIMS seem more efficient than TVT, they carry a risk of SUI re-occurrence that must be weighted towards the risk of potential complications after TVT.

  12. Morphology and dynamics of the male pelvic floor before and after retrourethral transobturator sling placement: first insight using MRI.

    Science.gov (United States)

    Soljanik, Irina; Bauer, Ricarda M; Becker, Armin J; Stief, Christian G; Gozzi, Christian; Soljanik, Olga; Kirchhoff, Sonja M

    2013-06-01

    We prospectively evaluated changes in morphology and dynamics of the male pelvic floor on magnetic resonance imaging (MRI) associated with retrourethral transobturator sling (RTS) placement. Twenty-six men with post-prostatectomy incontinence consecutively underwent functional cine-MRI before and 12 months after RTS. The membranous urethra length (MUL) and severity of periurethral/urethral fibrosis were assessed on static MRI. A lowering of the posterior bladder wall (BPW), the bladder neck (BN), the external urinary sphincter (EUS) and symphysial rotation of these structures were analysed on dynamic MR images. The success rate was defined as cure (0-1 dry 'security' pad) or improvement (pad reduction ≥ 50 %). The success rate was 77 % (20/26 patients). The mean follow-up was 20.4 months. The MUL significantly increased post-operatively (p elevation of the BPW (p elevation of the BN, BPW and EUS. De novo development of periurethral or urethral fibrosis seems not to be confirmed. The RTS failure was related to the severity of pre- and post-operative periurethral fibrosis. The impact of MRI on pre-operative diagnostics of RTS failure needs further evaluation.

  13. Eyelid reanimation with gold weight implant and tendon sling suspension: evaluation of excursion and velocity using the FACIAL CLIMA system.

    Science.gov (United States)

    Hontanilla, Bernardo; Marre, Diego

    2013-04-01

    This study aims to analyse the efficacy of static techniques, namely gold weight implant and tendon sling, in the reanimation of the paralytic eyelid. Upper eyelid rehabilitation in terms of excursion and blinking velocity is performed using the automatic motion capture system, FACIAL CLIMA. Seventy-four patients underwent a total of 101 procedures including 58 upper eyelid gold weight implants and 43 lower eyelid tendon suspension with 27 patients undergoing both procedures. The presence of lagophtalmos, eye dryness, corneal ulcer, epiphora and lower lid ptosis/ectropion was assessed preoperatively. The Wilcoxon signed-rank test was used to compare preoperative versus postoperative measurements of upper eyelid excursion and blinking velocity determined with FACIAL CLIMA. Significance was set at p CLIMA revealed significant improvement of eyelid excursion and velocity of blinking (p CLIMA system is a reliable method to quantify upper eyelid excursion and blinking velocity and to detect the exact position of the lower eyelid. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Temporal Concurrent Constraint Programming

    DEFF Research Database (Denmark)

    Nielsen, Mogens; Valencia Posso, Frank Dan

    2002-01-01

    The ntcc calculus is a model of non-deterministic temporal concurrent constraint programming. In this paper we study behavioral notions for this calculus. In the underlying computational model, concurrent constraint processes are executed in discrete time intervals. The behavioral notions studied...

  15. Temporal Concurrent Constraint Programming

    DEFF Research Database (Denmark)

    Valencia, Frank Dan

    Concurrent constraint programming (ccp) is a formalism for concurrency in which agents interact with one another by telling (adding) and asking (reading) information in a shared medium. Temporal ccp extends ccp by allowing agents to be constrained by time conditions. This dissertation studies...

  16. Building Safe Concurrency Abstractions

    DEFF Research Database (Denmark)

    Madsen, Ole Lehrmann

    2014-01-01

    Concurrent object-oriented programming in Beta is based on semaphores and coroutines and the ability to define high-level concurrency abstractions like monitors, and rendezvous-based communication, and their associated schedulers. The coroutine mechanism of SIMULA has been generalized into the no...

  17. Impredicative concurrent abstract predicates

    DEFF Research Database (Denmark)

    Svendsen, Kasper; Birkedal, Lars

    2014-01-01

    We present impredicative concurrent abstract predicates { iCAP { a program logic for modular reasoning about concurrent, higher- order, reentrant, imperative code. Building on earlier work, iCAP uses protocols to reason about shared mutable state. A key novel feature of iCAP is the ability to dene...

  18. Concurrent weighted logic

    DEFF Research Database (Denmark)

    Xue, Bingtian; Larsen, Kim Guldstrand; Mardare, Radu Iulian

    2015-01-01

    We introduce Concurrent Weighted Logic (CWL), a multimodal logic for concurrent labeled weighted transition systems (LWSs). The synchronization of LWSs is described using dedicated functions that, in various concurrency paradigms, allow us to encode the compositionality of LWSs. To reflect these......, CWL contains modal operators indexed with rational numbers to predicate over the numerical labels of LWSs as well as a binary modal operator that encodes properties concerning the (de-) composition of LWSs. We develop a Hilbert-style axiomatic system for CWL and we prove weak- and strong......-completeness results for this logic. To complete these proofs we involve advanced topological techniques from Model Theory....

  19. Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence.

    Science.gov (United States)

    Leanza, V; Intagliata, E; Leanza, A; Ferla, F; Leanza, G; Vecchio, R

    2014-01-01

    To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard midurethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques.

  20. Sexual function and quality of life following retropubic TVT and single-incision sling in women with stress urinary incontinence: results of a prospective study.

    Science.gov (United States)

    Naumann, Gert; Steetskamp, Joscha; Meyer, Mira; Laterza, Rosa; Skala, Christine; Albrich, Stefan; Koelbl, Heinz

    2013-05-01

    The objective of this prospective cohort study was to compare effectiveness, morbidity, quality of life (QoL) and sexual function in women treated with tension-free vaginal tape (TVT) versus single-incision sling (SIS) in the treatment of female stress urinary incontinence (SUI). Retropubic TVT sling or SIS was implanted in local anesthesia and patients were followed post-operatively for 6 months. Evaluation was performed to assess post-operative rate of continence, complications, changes in sexual function and patient reported quality of life. Female sexual function was evaluated before and after sling procedure using Female Sexual Function Index (FSFI) in sexually active patients. From January 2009 to December 2011, 150 patients were enrolled and underwent a procedure to implant the retropubic TVT (n = 75) or the MiniArc(®) and Ajust(®) SIS (n = 75). Overall, 93.3 % of the patients who successfully received SIS demonstrated total restoration (84 %) or improvement of continence (9.3 %) at the 6 month post-operative study visit. In TVT group we found 88 % total continence and 6.7 % improvement, respectively. Improvements were seen in the QoL scores related to global bladder feeling (89.3 %) in SIS group and 96 % for TVT. Post-operative FSFI score improves significantly and were comparable in both groups (SIS pre-operative 24.30 ± 4.56 to 27.22 ± 4.66 (P TVT 24.63 ± 6.62 to 28.47 ± 4.41, respectively). The SIS procedure appears to be as effective in improving incontinence-related quality of life and sexual function as the TVT through 6 months of post-operative follow-up. No differences in complications and sexual function were demonstrated between the groups.

  1. Compositional relaxed concurrency.

    Science.gov (United States)

    Batty, Mark

    2017-10-13

    There is a broad design space for concurrent computer processors: they can be optimized for low power, low latency or high throughput. This freedom to tune each processor design to its niche has led to an increasing diversity of machines, from powerful pocketable devices to those responsible for complex and critical tasks, such as car guidance systems. Given this context, academic concurrency research sounds notes of both caution and optimism. Caution because recent work has uncovered flaws in the way we explain the subtle memory behaviour of concurrent systems: specifications have been shown to be incorrect, leading to bugs throughout the many layers of the system. And optimism because our tools and methods for verifying the correctness of concurrent code-although built above an idealized model of concurrency-are becoming more mature. This paper looks at the way we specify the memory behaviour of concurrent systems and suggests a new direction. Currently, there is a siloed approach, with each processor and programming language specified separately in an incomparable way. But this does not match the structure of our programs, which may use multiple processors and languages together. Instead we propose a compositional approach, where program components carry with them a description of the sort of concurrency they rely on, and there is a mechanism for composing these. This will support not only components written for the multiple varied processors found in a modern system but also those that use idealized models of concurrency, providing a sound footing for mature verification techniques.This article is part of the themed issue 'Verified trustworthy software systems'. © 2017 The Author(s).

  2. Simultaneous penile prosthesis and male sling/artificial urinary sphincter

    Science.gov (United States)

    Lee, Dominic; Romero, Claudio; Alba, Frances; Westney, O Lenaine; Wang, Run

    2013-01-01

    Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach. PMID:23202702

  3. Vaginocutaneous fistula and inguinal abcess presented 6 years after tension-free vaginal tape sling

    Directory of Open Access Journals (Sweden)

    Ali Feyzullah Sahin

    2013-06-01

    Full Text Available Surgical treatment of female stress urinary incontinence (SUI has become very pop- ular after respectable success with minimal invasive surgeries. This is the first report of long term vaginocutaneous fistula (VCF plus inguinal abcess after tension-free vaginal tape (TVT. A 67 year-old woman with vaginal discharge lasting more than 3 years complained with a painful swelling in the left inguinal area for the last three months. She had a medical history of TVT sling procedure for SUI six years ago. She had no history of pelvic surgery, cancer treatment or pelvic irradiation before or after TVT sling. No urethrovaginal or vesicovaginal fistula was found in physical examination and cystocopy. MRI showed a vaginocutenaous fistula and inguinal abcess. This case highlights the need for a high index of suspicion for VCF after TVT.

  4. Adult Presentation of Right Lung Agenesis and Left Pulmonary Artery Sling

    International Nuclear Information System (INIS)

    Espinosa, L.; Agarwal, P.

    2008-01-01

    The combination of right lung agenesis and left pulmonary artery (LPA) sling is a rare entity that has been described only in the pediatric population. Cross-sectional imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) have an advantage over echocardiography and pulmonary angiography in demonstrating the anomalous left pulmonary artery, particularly in the presence of coexisting lung agenesis, as exemplified in this case. We report the first case of this rare entity in an adult. It is important to be aware that this abnormality, though rare, can present even in adulthood, and therefore close attention should be paid to the course of the pulmonary artery to ensure detection of a sling in association with lung agenesis

  5. Adult Presentation of Right Lung Agenesis and Left Pulmonary Artery Sling

    Energy Technology Data Exchange (ETDEWEB)

    Espinosa, L.; Agarwal, P. (Div. of Cardiothoracic Radiology, Dept. of Radiology, Univ. of Michigan, Ann Arbor, MI (US))

    2008-02-15

    The combination of right lung agenesis and left pulmonary artery (LPA) sling is a rare entity that has been described only in the pediatric population. Cross-sectional imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) have an advantage over echocardiography and pulmonary angiography in demonstrating the anomalous left pulmonary artery, particularly in the presence of coexisting lung agenesis, as exemplified in this case. We report the first case of this rare entity in an adult. It is important to be aware that this abnormality, though rare, can present even in adulthood, and therefore close attention should be paid to the course of the pulmonary artery to ensure detection of a sling in association with lung agenesis

  6. Operative shortening of the sling as a second-line treatment after TVT failure

    Science.gov (United States)

    Matuszewski, Marcin; Michajłowski, Jerzy; Krajka, Kazimierz

    2011-01-01

    Introduction Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure. Materials and methods Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients. Results All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure. Conclusions The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure. PMID:24578885

  7. Using ultrasound to assess the thickness of the transversus abdominis in a sling exercise.

    Science.gov (United States)

    Lükens, Jörn; Boström, Kim J; Puta, Christian; Schulte, Tobias L; Wagner, Heiko

    2015-08-19

    Activation of the deep stabilizing trunk muscle transversus abdominis (TrA) is important for trunk stabilization and spine stability. Sling exercises are used for the activation of trunk muscles, therefore we determined the thickness of the TrA in a standardized sling exercise in comparison to rest and abdominal press. Furthermore we propose a standardized measurement method, which can be used to compare relative muscle thickness levels in different exercises. The main objective of the study was to assess and to compare the thickness of the TrA during different conditions; resting condition, sling exercise condition (non-voluntary contraction), and abdominal press condition (voluntary contraction) using a non-invasive ultrasound-based measurement method. Ultrasound measurement (USM; 8.9 MHz, B-mode) was employed to measure the thickness of the TrA in twenty healthy volunteers (13 m, 7 f), each one measured three times with breaks of 48 h. On each measurement day, the subjects were measured on three different conditions: resting condition (RC), sling condition (SC), and abdominal press condition (APC). The USM images were analyzed using a custom-made MatLab script, to determine the thickness of the TrA. A two-way repeated-measurements ANOVA was performed with a significant effect of the factor condition [F(2,38) = 47.82, p exercise can be used to significantly increase the TrA thickness, and that the TrA thickness was significantly different on the three conditions (RC, SC, APC) using the ultrasound-based method.

  8. Acellular dermal matrix slings in tissue expander breast reconstruction: are there substantial benefits?

    Science.gov (United States)

    Collis, George N; TerKonda, Sarvam P; Waldorf, James C; Perdikis, Galen

    2012-05-01

    Acellular dermal matrix (ADM) slings in breast reconstruction are increasingly used but are not yet validated. This study compares immediate, expander-based breast reconstruction with and without the use of inferolateral ADM slings. There were 63 patients (106 breasts) in the ADM group and 42 patients (68 breasts) in the control group. Initial intraoperative fill volumes were significantly greater in the ADM group, median 69% full (250 mL) versus 50% full (180 mL; P < 0.001). However, the number of days to complete expansion between the 2 groups was similar. One less office visit was required to complete the fills in the ADM group (P < 0.01). Drains were removed 3 days later in the ADM group (P < 0.01). Overall complication rate was greater in the ADM group (18.9% vs. 7.4%, P < 0.05), with a slightly higher percentage of expanders requiring removal due to infection in the ADM group (5.7% vs. 4.4%, P = NS). This study suggests inferolateral ADM slings in expander-based breast reconstruction allow for significantly increased initial fill volumes and may offer an aesthetic advantage; however, its use is costly and increases complications.

  9. A case that underwent bilateral video-assisted thoracoscopic ...

    African Journals Online (AJOL)

    No Abstract Available A case that underwent bilateral video-assisted thoracoscopic surgical (VATS) biopsy combined with pneumonectomy is presented. The patient developed hypoxia during the contralateral VATS biopsy. His hypoxia was treated with positive expiratory pressure (PEEP) to the dependent lung and apneic ...

  10. Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings: analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings

    Directory of Open Access Journals (Sweden)

    Elisabetta Costantini

    2008-02-01

    Full Text Available OBJECTIVE: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI. MATERIALS AND METHODS: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT or transobturator tape (TOT. They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6 and the impact of incontinence on quality of life (IIQ-7 questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS. Preoperative VLPP was correlated with primary and secondary outcome variables. RESULTS: Mean follow-ups were 32 + 12 months (range 12-55 for TVT and 31 + 15 months (range 12-61 for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5% patients showed a VLPP > 60 cm H2O and 50 (34.5% patients had a VLPP 60 cm H2O and 72% for those with VLPP 60 cm H2O (82 % vs. 68.9% p of 60 cm H2O, preoperative VLPP was not linked to outcome after TVT or TOT procedures.

  11. Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke: a randomized trial.

    Science.gov (United States)

    Ada, Louise; Foongchomcheay, Anchalee; Langhammer, Birgitta; Preston, Elisabeth; Stanton, Rosalyn; Robinson, John; Paul, Serene; Canning, Colleen

    2017-02-01

    Shoulder subluxation is a common secondary impairment of the upper limb following stroke. A range of supportive devices are used in rehabilitation to prevent shoulder subluxation, including hemi-slings and firm supports, such as arm troughs, however, there is little evidence regarding their efficacy. To determine whether a modified lap-tray during sitting and a triangular sling during standing is more effective than a hemi-sling in preventing shoulder subluxation, pain, contracture and upper limb activity limitation after stroke. A prospective, randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis. Three inpatient rehabilitation units in Australia and Norway. Forty-six acute stroke survivors within 3 weeks of stroke who were at risk of subluxation. The experimental group used a modified lap-tray while sitting and a triangular sling while standing to support the affected arm for four weeks. The control group used a hemi-sling while sitting and standing. The primary outcome was amount of shoulder subluxation on X-ray. Secondary outcomes were upper limb activity, pain and contracture. There was no significant difference between groups in terms of shoulder subluxation (MD -3 mm, 95% CI -8 to 3). There was a trend for the experimental group to develop less pain at rest (MD -0.7 out of 10, 95% CI -2.2 to 0.8) and during shoulder external rotation (MD -1.7 out of 10, 95% CI -3.7 to 0.3) and a trend towards having less contracture of shoulder external rotation (MD -10 deg, 95% CI -22 to 2). There was no significant difference between groups in terms of other contractures and activity of the upper limb. A lap-tray during sitting combined with a triangular sling during standing is no more effective than a hemi-sling in preventing subluxation, pain, contracture and activity limitation in acute stroke survivors at risk of shoulder subluxation. The use of a lap-tray during sitting and triangular sling during standing is not indicated as

  12. A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients.

    Science.gov (United States)

    van Bladel, Anke; Lambrecht, Gert; Oostra, Kristine M; Vanderstraeten, Guy; Cambier, Dirk

    2017-06-01

    Arm slings are often used in clinical practice to support the hemiplegic arm aiming to prevent or treat glenohumeral subluxation. Evidence supporting the corrective effect of slings on subluxation is scarce and long-term studies are lacking. The aim of this study was to determine both the immediate and long-term effect on acromiohumeral distance using the Actimove® sling and Shoulderlift and to determine the effect of slings on pain and passive range of motion of the shoulder in stroke patients with glenohumeral subluxation. Randomized control trial. Hospital inpatients. Stroke patients. Twenty-eight stroke patients, with severe upper limb impairments, were randomly allocated to 3 groups (Actimove, Shoulderlift, No sling). Patients wore their supportive device for 6 weeks and no sling in the control group. Immediate and postinterventional effect on acromiohumeral distance was measured using sonography. Pain (VAS), ROM (goniometry), spasticity (Modified Ashworth Scale), Fugl-Meyer Assessment and trunk stability (TIS) were also assessed before and after the intervention. The level of immediate correction of both slings was different at baseline and after 6 weeks (0 weeks: Shoulderlift 63%, Actimove 36%; 6 weeks: Shoulderlift 28%, Actimove 24%). Comparing the level of subluxation over time shows a distinct decrease in subluxation but only for the control group (-37.59% or 3.30 mm). Subluxation remained the same in the Actimove group (-2.77% or 0.27 mm) but increased in the Shoulderlift group (+12.44% or 1.03 mm). After 6 weeks, the Actimove group reported more pain at rest (P=0.036). ROM for abduction and external rotation decreased in 2 groups and remained un-altered in the Shoulderlift group. Results of immediate correction varied. Subluxation seemed to reduce in patients that did not wear a sling. The (assumed) presence of subluxation may not benefit from wearing an arm sling which may itself inhibit active correction. If a sling is indicated the Shoulderlift may

  13. Algebraic topology and concurrency

    DEFF Research Database (Denmark)

    Fajstrup, Lisbeth; Raussen, Martin; Goubault, Eric

    2006-01-01

    We show in this article that some concepts from homotopy theory, in algebraic topology,are relevant for studying concurrent programs. We exhibit a natural semantics of semaphore programs, based on partially ordered topological spaces, which are studied up to “elastic deformation” or homotopy...... differences between ordinary and directed homotopy through examples. We also relate the topological view to a combinatorial view of concurrent programs closer to transition systems, through the notion of a cubical set. Finally we apply some of these concepts to the proof of the safeness of a two...

  14. Did surgical failure and complications affect incontinence-related quality of life in women after transobturator sling procedure?

    Directory of Open Access Journals (Sweden)

    Wen-Chu Huang

    2018-04-01

    Full Text Available Objective: To report the objective outcome, subjective measurement of incontinence-related quality of life (QoL for female urodynamic stress incontinence (USI after transobturator sling surgery (TVT-O and to evaluate the effects of surgical failure and complications on QoL. Materials and methods: We analyzed the data from women who underwent TVT-O for USI and completed two validated QoL questionnaires, the Urogenital Distress Inventory (UDI-6 and Incontinence Impact Questionnaire (IIQ-7 preoperatively and at least 12 months postoperatively. We evaluated the subjective results of QoL questionnaires, objective results and compare the effect of QoL on those with surgical failure and complications after TVT-O surgery. Results: A total of 78 women were followed for a median of 13.5 months (range 12–15 months after surgery. Within this group, 75 (96% were considered subjectively cured or improved after TVT-O. There were significant improvements in the IIQ-7 and total UDI-6 scores postoperatively, as well as in the UDI-6 subscales for urge, stress and voiding dysfunction symptoms. Even the 18 women with objective urodynamic failure had significant improvement in QoL scores. For those with surgical related complications, the QoL scores were also significantly improved. Conclusions: TVT-O for USI resulted in improvement of incontinence-related QoL including urgency, stress, and voiding dysfunction symptoms. Surgical failure and complications didn't impair postoperative QoL. Keywords: Complication, Quality of life, Stress urinary incontinence, Transobturator tape, Urodynamic stress incontinence

  15. Prevalence and risk factors for urinary tract infection up to one year following midurethral sling incontinence surgery.

    Science.gov (United States)

    Weintraub, Adi Y; Reuven, Yonatan; Paz-Levy, Dorit; Yohay, Zehava; Idan, Inbal; Elharar, Debi; Glinter, Hannah; Tzur, Tamar; Yohay, David

    2018-03-01

    To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel. A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed. During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively). Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Incontinence surgery in obese women: comparative analysis of short- and long-term outcomes with a transobturator sling.

    Science.gov (United States)

    Pereira, Inês; Valentim-Lourenço, Alexandre; Castro, Catarina; Martins, Inês; Henriques, Alexandra; Ribeirinho, Ana Luísa

    2016-02-01

    Midurethral slings (MUS) are still discussed in complex incontinence situations, such as obesity, lacking sustained efficacy validation in this particular sub-population. We hypothesized that the outcomes of a transobturator MUS, such as TVT-O, do not differ according to body mass index (BMI) over a 4-year period. We conducted a retrospective analysis of 281 women who underwent TVT-O at our institution, between 2004 and 2012. Patients were stratified into obese (BMI ≥ 30 kg/m(2)) or non-obese (BMI < 30 kg/m(2)). We compared preoperative and postoperative parameters, including objective cure (negative stress test), complications, and quality of life scores. Data were collected at 0, 6, 12, 24, and 48 months. We used Fisher's exact test for categorical variables and Student's t test or the Mann-Whitney U test for continuous variables. Baseline characteristics of the obese (n = 122) and non-obese groups (n = 159) were similar. We found no significant differences between groups in terms of objective cure rates at all follow-up evaluations, with 95.8 % and 95 % at 48 months in the non-obese and obese groups respectively. There were no significant differences in the cumulative complication rates of both groups. Quality of life assessment also showed no significant differences between groups at all follow-up visits. At 48 months our follow-up rate was 59 % (n = 96) and 60.4 % (n = 72) in the non-obese and obese group respectively (p = 0.9). The TVT-O procedure is effective and safe in the long term for stress incontinence treatment, regardless of BMI.

  17. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  18. Does the design of mini slings anchoring systems really matter? A biomechanical comparison between Mini Arc™ and Ophira™.

    Science.gov (United States)

    Santos-Souza, R; Rodrigues-Palma, P C; Goulart-Fernandes-Dias, F; Teixeira-Siniscalchi, R; Zanettini-Riccetto, C L

    2016-11-01

    Currently, a sling implant is the standard treatment for stress urinary incontinence in women. To be effective, they require an adequate anchoring system. The aim of this study is compare biomechanical features of fixation systems of two mini slings models available on the market (Ophira™ and Mini Arc™) through a tensile test. Anchoring devices of each sling were surgically implanted in abdominal wall of 15 rats divided into three groups of five animals which were arranged according to the date of post implant euthanasia on 7, 14 and 30 days. Abdominal walls of rats were extracted on bloc containing the anchoring system and were submitted to a tensile strength test to measure the maximum load and elongation until device avulsion from the tissue. The results were compared using Student test t and a 5% cut off was considered significant. The Ophira™ mini sling fixation system demanded a greater maximum load and developed a longer stretch for avulsion from the implanted site at all moments evaluated (p value less than 0.05). There were significant differences in fixation patterns of the anchoring systems, which were exclusively related to their designs. The Ophira™ mini sling fixation device provided better fixation to the abdominal wall of rats compared to the Mini Arc™ device, even in the late post implant period. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Retrospective evaluation of male slings for patients with urinary incontinence after radical prostatectomy--one surgeon's experience.

    Science.gov (United States)

    Miodrag, Aćimović; Uroš, Babić; Aleksandar, Argirović; Mirko, Jovanović; Miodrag, Stanić; Boris, Kajmaković; Zoran, Džamić

    2014-01-01

    Stress urinary incontinence is one of the main complications after radical prostatectomy (RP) with a significant percentage of patients reporting bothersome incontinence > 1 year after surgery. Assessment of one surgeon's results in surgical treatment of urinary stress incontinence of patients with radical prostatectomy applying transobturator and suprapubic slings. From February 2010-February 2014, 20 patients, age 57-76, with moderate and severe stress urinary incontinence (SUI) were treated surgically. All patients previously had radical prostatectomy due to prostate cancer. All 20 patients with stress urinary incontinence (PRPUI) had Argus slings placement after radical prostatectomy. Patients were followed for a longer period of time, 6 months minimum, 48 months maximum.18 patients (90%) had negative, dry PAD test after surgery, one patient (5%) had positive PAD test, and one patient (5%) who previously had Advance transobturator sling placement with no positive results, had sling removed due to an infection. 6 patients (30%) needed additional sling adjustment, performed between 9-21st day after the surgery. We concluded that Argus sligs, suprapubic or transobturatory are an effective and safe treatment for PRPUI. This procedure is minimal invasive and our results clearly demonstrate that both heavy and moderate incontinence responds well.

  20. Double forced sling by combining in situ vaginal wall and Infast pubic bone suburethral stabilization techniques: a new method.

    Science.gov (United States)

    Kayigil, Onder; Biri, Aydan

    2002-06-01

    We evaluated the results and effectiveness of the double forced sling by combining in situ vaginal wall and Infast (Influence, Inc., San Francisco, California) pubic bone suburethral stabilization techniques as a new method. The new technique was used in 40 patients, of whom 32 completed 2 years of followup. Previous surgery included hysterectomy in 8 cases, anterior and posterior vaginal wall repair in 6, and 1 or 2 incontinence procedures in 24. Types 2, 3 and mixed incontinence were diagnosed in 12, 12 and 8 patients, respectively. With this technique a gelatin coated synthetic sling was fixed to the previously prepared vaginal sling surface with watertight stitches to create a doubled forced sling, which was fixed to the pubic bone with 2 screws using an Infast inserter. Patient outcomes were evaluated by questionnaire analysis and the pad test. The cure, improvement and failure rates were 81.25%, 6.25% and 12.5% in the 32 patients who completed 2 years of followup. Surprisingly successful results were achieved in all 24 secondary cases. Moderate cystocele in 4 patients and rectocele in 8 were corrected simultaneously. Temporary urinary retention in 4 patients resolved in 2 weeks. Of the 32 patients 28 reported that they would repeat the procedure and recommend it to others. The double forced sling has 2 advantages that make it superior to other techniques, namely a minimal complication rate and enhanced support accomplished by an easy and noninvasive technique.

  1. Correctness of concurrent processes

    NARCIS (Netherlands)

    E.R. Olderog (Ernst-Rüdiger)

    1989-01-01

    textabstractA new notion of correctness for concurrent processes is introduced and investigated. It is a relationship P sat S between process terms P built up from operators of CCS [Mi 80], CSP [Ho 85] and COSY [LTS 79] and logical formulas S specifying sets of finite communication sequences as in

  2. Composing Concurrent Objects

    NARCIS (Netherlands)

    Bergmans, Lodewijk

    1994-01-01

    Adopting the object-oriented paradigm for the development of large and complex software systems offers several advantages, of which increased extensibility and reusability are the most prominent ones. The object-oriented model is also quite suitable for modelling concurrent systems. However, it

  3. Autologous inferior dermal sling (autoderm) with concomitant skin-envelope reduction mastectomy: an excellent surgical choice for women with macromastia and clinically significant ptosis.

    Science.gov (United States)

    Dietz, Jill; Lundgren, P; Veeramani, A; O'Rourke, C; Bernard, S; Djohan, R; Larson, J; Isakov, R; Yetman, R

    2012-10-01

    Skin-sparing mastectomy and prosthetic reconstruction can be complicated by poor surgical outcomes in large-breasted, obese women. This article describes a single surgeon's experience comparing conventional skin-sparing mastectomy (SSM) and skin-reduction mastectomy using an autologous vascularized inferior dermal/cutaneous sling (autoderm). From July 2007 to May 2012, patients undergoing skin-sparing mastectomy were evaluated for surgical outcomes. After July 2009, the surgeon performed skin-reduction mastectomies with autoderm (SRM-AD) on all patients with macromastia or grade 3-4 ptosis. Remaining patients in this time period (SSM-cont) underwent conventional skin-sparing mastectomies while all previous patients (historical) also underwent skin-sparing mastectomies (SSM-hist). A predictive model was used to compare the large historical patients (who would have had reduction mastectomy if available) with the smaller historical patients to evaluate the effect of the procedure. Body mass index (BMI) and specimen weight were higher in both the SRM group and large historical group. The hazard ratio for having skin-reduction mastectomy was 0.53 (P = 0.51) compared with the historical group. There was a total of 16 complications for the whole study. Smoking was the only significant risk factor. This study shows that mastectomy with prosthetic reconstruction using a skin-reduction technique with autoderm can be done safely with a low complication rate and improved cosmetic outcomes in the traditionally "at-risk" group of women with high BMI and large ptotic breasts.

  4. Molecular adaptations to concurrent training.

    Science.gov (United States)

    de Souza, E O; Tricoli, V; Roschel, H; Brum, P C; Bacurau, A V N; Ferreira, J C B; Aoki, M S; Neves, M; Aihara, A Y; da Rocha Correa Fernandes, A; Ugrinowitsch, C

    2013-03-01

    This study investigated the chronic effects of concurrent training (CT) on morphological and molecular adaptations. 37 men (age=23.7±5.5 year) were divided into 4 groups: interval (IT), strength (ST) and concurrent (CT) training and a control group (C) and underwent 8 weeks of training. Maximum strength (1RM) and muscle cross-sectional area (CSA) were evaluated before and after training. Muscle samples were obtained before the training program and 48 h after the last training session. VO2max improved in 5±0.95% and 15±1.3% (pre- to post-test) in groups CT and IT, respectively, when compared to C. Time to exhaustion (TE) improved from pre- to post-test when compared to C (CT=6.1±0.58%; IT=8.3±0.88%; ST=3.2±0.66%). 1RM increased from pre-to post-test only in ST and CT groups (ST=18.5±3.16%; CT=17.6±3.01%). Similarly, ST and CT groups increased quadriceps CSA from pre-to post-test (6.2±1.4%; 7.8±1.66%). The p70S6K1 total protein content increased after CT. The ST group showed increased Akt phosphorylation at Ser473 (45.0±3.3%) whereas AMPK phosphorylation at Thr172 increased only in IT group, (100±17.6%). In summary, our data suggest that despite the differences in molecular adaptations between training regimens, CT did not blunt muscle strength and hypertrophy increments when compared with ST. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Efficacy and perioperative safety of synthetic mid-urethral slings in obese women with stress urinary incontinence

    DEFF Research Database (Denmark)

    Weltz, V; Guldberg, R; Lose, G

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more) and perio......INTRODUCTION AND HYPOTHESIS: Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more......) and perioperative safety of synthetic mid-urethral sling procedures for SUI in obese women. METHODS: A systematic search of PubMed, Embase and the Cochrane databases was performed using the MeSH terms "Stress urinary incontinence", "Overweight", "Obesity" and "Surgery". We included 13 full-text papers published...

  6. Concurrent credit portfolio losses.

    Science.gov (United States)

    Sicking, Joachim; Guhr, Thomas; Schäfer, Rudi

    2018-01-01

    We consider the problem of concurrent portfolio losses in two non-overlapping credit portfolios. In order to explore the full statistical dependence structure of such portfolio losses, we estimate their empirical pairwise copulas. Instead of a Gaussian dependence, we typically find a strong asymmetry in the copulas. Concurrent large portfolio losses are much more likely than small ones. Studying the dependences of these losses as a function of portfolio size, we moreover reveal that not only large portfolios of thousands of contracts, but also medium-sized and small ones with only a few dozens of contracts exhibit notable portfolio loss correlations. Anticipated idiosyncratic effects turn out to be negligible. These are troublesome insights not only for investors in structured fixed-income products, but particularly for the stability of the financial sector. JEL codes: C32, F34, G21, G32, H81.

  7. Sequential treatment with ProACT™ device implantation after male sling failure for male urinary incontinence.

    Science.gov (United States)

    Baron, M G; Delcourt, C; Nouhaud, F-X; Gillibert, A; Pfister, C; Grise, P; Cornu, J-N

    2017-12-01

    There is no strong evidence for second line therapy after male sling failure for post-prostatectomy urinary incontinence (PPUI). We report the outcomes after periurethral balloons implantation for persistence or recurrence of mild PPI symptoms after male sling implantation. All patients implanted of a ProACT™ device (Uromedica, Inc., MN, USA) following I-STOP transobturator male sling (TOMS) failure, in a tertiary reference center between 2009 and 2016, were included. Patients were evaluated by 24-hour pad-test before and after implantation, and after each balloon repressurizing procedure. PGI-I and Likert scale patient satisfaction were estimated during a telephone interview conducted in 2016. Objective and subjective cure of urinary incontinence were defined by a 24-hour pad-test<8g and the use of zero or one pad per day, respectively. Fourteen patients were included. Median follow-up was 34months [4-89]. Objective and subjective cure were 29% (n=4) and 57% (n=8), respectively. Median pad-test decreased from 95g [IQR: 130] to 34g [IQR: 83] (P=0.022). ProACT™ significantly decreased median pad-test by a factor 2.73 [1.19-6.29]. Eighty-eight percent patients were feeling a little better, much better or very much better and 77% were satisfied or very satisfied at the end of follow-up. Reoperation rate was 28% (n=4): 3 balloons were changed for caudally migration (n=2) or deflation (n=1) and 1 had a urinary sphincter implanted for severe UI. ProACT™ is a safe and efficient treatment that can be used in second line therapy after TOMS failure for PPUI. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. [Postoperative male stress urinary incontinence: outcomes of treatment by I-STOP TOMS® transobturator sling].

    Science.gov (United States)

    Ej-Jennane, A; Mouracade, P; Lang, H; Jacqmin, D; Saussine, C

    2014-02-01

    To evaluate the outcome of postoperative male stress urinary incontinence surgery using the I-STOP TOMS(®) sub-urethral sling. Between April 2007 and August 2012, 29 patients had been treated by sub-urethral sling. Stress urinary incontinence was classified as mild, moderate or severe according to the number of pads per day. Patients were also assessed thanks to IQOL, MHU and Ditrovie self-administered questionnaires. Before surgery, 16 patients (55.2%) had mild incontinence, 12 (41.4%) had moderate incontinence and one (3.4%) had severe incontinence. Preoperative median MHU was 9 (5-12); median IQOL was 73 (58-88); and median Ditrovie was 2.7 (2.1-3.3). Three months after surgery, median MHU was 7 (4-9); median IQOL was 85 (75-99); and median Ditrovie was 2.1 (1.6-2.4). Pre- and postoperative questionnaires scores show a significant improvement for IQOL (P=0.014) and Ditrovie (P<0.001). After 3 months, six patients were dry (20.7%), 19 patients had mild incontinence (65.5%) and four had moderate incontinence (13.8%); in résumé 17 patients (58.6%) showed a significant improvement in the number of pads (20.7% dry, 37.9% improved). After a mean follow-up of 24 ± 19.9 months, five patients were dry (17.2%), 20 patients (69%) had mild incontinence and four had moderate incontinence (13.8%). I-STOP TOMS(®) sub-urethral sling improved the level of postoperative stress urinary incontinence. However, the continence rate was weak. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. Management of female congenital short patulous urethra with urethral tapering and pubovaginal sling: A report of two cases.

    Science.gov (United States)

    Gahlawat, Sumit; Goel, Hemant; Khattar, Nikhil

    2018-01-01

    Congenital short patulous urethra is a rare entity and may be associated with developmental anomalies of mullerian ducts or urogenital sinus. We report the management of two cases of congenital short patulous urethra with stress urinary incontinence (SUI). Both the patients presented with SUI; one was diagnosed with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and the other had uterus didelphys with longitudinally septated vagina. Both patients were successfully managed by excisional tapering of the urethra and pubovaginal sling placement. SUI with congenital short patulous urethra can be managed with excisional tapering of urethra and pubovaginal sling placement.

  10. Synthetic pubovaginal sling (TVT: failure in conservative treatment following vaginal exteriorization

    Directory of Open Access Journals (Sweden)

    Edgar Thorell

    2004-04-01

    Full Text Available Female, 57 year-old patient, reported having undergone surgery for correction of urinary incontinence due to sphincteric insufficiency with the implantation of a synthetic pubovaginal sling 14 months earlier. Though she did not present urine loss any longer, approximately 60 days following the surgical procedure she started to report dysuria, pollakiuria and dyspareunia. Attempts of a conservative solution were ineffective. The appearance of a vaginal infra-urethral granuloma and the exteriorization of the synthetic material led to its removal.

  11. Effect of Resident Performance on Midurethral Sling Cure and Complication Rates

    Directory of Open Access Journals (Sweden)

    Sabri Cavkaytar

    2016-01-01

    Full Text Available Aim: To evaluate the cure rates and complications of midurethral slings performed by residents under an experienced surgeon supervision. Material and Method: Between January 2013 and January 2014, one hundred forty-one midurethral slings performed in the urogynecology clinic of Ankara Zekai Tahir Burak Women%u2019s Health Research and Education Hospital were reviewed.Age, parity,body mass index,menopausal status, grade 2 preoperative pelvic organ prolapsus,concomitant vaginal surgery and intraoperative (bladder and bowel perforations,bleeding,vaginal laceration and early postoperative (urinary retention etc.complications were recorded.All women were re-examined at postoperative 6 th month and symptoms were questioned. The patients were classified as %u2018%u2019cured%u2019%u2019 if the stress test was negative , %u2018%u2019partially cured%u2019%u2019 if continence frequency decreased but still continued and %u2018%u2019unsatisfied%u2019%u2019 if there was no change in symptoms. Both TVT and TOT groups were compared in case of complications and cure rates. Results: Among 141 patients who had undergone midurethral sling due to urinary stress incontinence,50(35.5% were TOT , 91(64.5% were TVT. In the TVT group, 3 (3.3% patients had bleeding which requires transfusion and 5(5.5% patients had bladder perforations. But in the TOT group,there was no bladder perforation and bleeding that requires transfusion. In the early postoperative period, urinary retention was encountered in 7(14.0% patients in TOT group and in 17(18.7% patients in TVT group. There was no statistically significant difference between the groups in case of complications. At postoperative 6th month, in the TOT group 76% of patients were cured,18% were partially cured and 6% were unsatisfied. In the TVT group, 83.5% of patients were cured, 12.1% were partially cured and 4.4% were unsatisfied and there was no significant difference in cure rates between the groups. Discussion: The

  12. Sling-on-a-Ring: Structure for an elevator to LEO

    OpenAIRE

    Meulenberg, Andrew; Poston, Timothy

    2015-01-01

    Various proposed space elevators may bypass the financial and environmental limits on rocket technology, but all have their own problems. A Low-Earth-Orbit, LEO, rotovator-based space-elevator version called 'sling-on-a-ring' may overcome them. This mass-lifting system uses the spatial stability of an orbital ring, accessorized for transfer and storage of momentum and electrical power. A high-tensile-strength equatorial circum-terra loop of colossal-carbon tube, CCT, fiber has solar-power and...

  13. Incontinência urinária tratamento pela técnica do sling pubovaginal

    Directory of Open Access Journals (Sweden)

    William Luis de Oliveira

    2007-05-01

    Full Text Available Os autores deste trabalho procuram mostrar os benefícios para a mulher com incontinência urinária, através da correção da mesma pela técnica do Sling pubovaginal. Estudaram-se clínica e cirurgicamente, 60 pacientes, relatando a técnica, os métodos e os resultados obtidos. Concluiu-se que houve melhora acentuada da incontinência urinária (I.U.E. com o uso desta técnica, em relação às técnicas convencionais.

  14. [Sub-urethral sling Advance(®) midterm results: patient selection and predictors of success].

    Science.gov (United States)

    Siegler, N; Droupy, S; Costa, P

    2013-10-01

    Sub-urethral trans-obturator male slings have been propose to treat men urinary incontinence. Medium term results are lacking: only one study has been published. To evaluate the efficacy of the sub-urethral sling Advance(®) (American Medical System, Minnetonka, MN, USA) and determinate factor of success. Single center retrospective study of patients implanted with an Advance(®) for urinary incontinence after radical prostatectomy. The degree of incontinence was evaluated by number of pads used per days: mild (use of 1 to 2 pads/day), moderate (3 to 4p/day) and severe (≥5p/day). The "Cure" was defined as no pad or just one for "security reason" and "improved" as decreased more than 50% of pads use. Between October 2007 and November 2009, 69 slings were implanted. Mean follow-up was 32.4months (±8.4months). Before treatment, 37.68% of the patients suffered from mild, 42.03% moderate and 20.29% severe urinary incontinence. At midterm, 21.8% of the patients were cured and 50.7% cured or improved. For patients who suffered from mild or moderate urinary incontinence, 23.6% were cured and 58.2% were cured or improved. The cure rate decreased with the severity of incontinence. It was respectively 30.8%, 17.2% and 14.2% for mild, moderate and severe incontinence. Failure rate was more important with severe incontinence: 78%. For patients with urethral fence pressure less than 57cmH2O, the risk of failure was multiply by 6.6. No severe complication was noted during follow-up. Only one male sling was removed. At midterm, one patient on five was cure and half was cured or improved. The technique presented an acceptable morbidity and a good tolerance. Two predictors of success were identified: severity of incontinence and residual sphincter function. Good candidates used less than three pads per day. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  16. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  17. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  18. Frequency of Helicobacter pylori in patients underwent endoscopy

    Directory of Open Access Journals (Sweden)

    Ahmet Tay

    2012-06-01

    Full Text Available Objectives: The aim of this study was to investigate thefrequency of Helicobacter pylori in patients underwent endoscopyeastern Anatolia.Materials and methods: The patients whose endoscopicantral biopsies were taken for any reason in our endoscopyunit in February-June 2010 period were includedand retrospectively investigated. The frequency of Helicobacterpylori was determined as separating the patientsaccording to general, sex and the age groups. Antral biopsieswere stained with hematoxylin-eosin and modified giemsamethod and examined under light microscope andreported as (+ mild, (++ moderate, (+++ severe positiveaccording to their intensities.Results: Biopsy specimens of 1298 patients were includedinto the study. The mean age was 47.5 ± 17.5 years(range 14-88 and 607 of these patients (47% were male.Histopathological evaluation revealed that, 918 of the patientswere (71% positive and 379 (29% were negativefor Helicobacter pylori. Approximately 60% of our patientshad mild, 29% had moderate and 11% had severe positivityfor Helicobacter pylori. No significant difference wasfound in the frequency of Helicobacter pylori betweenwomen and men. The frequencies of Helicobacter pyloriwere 73.2%, 71.5%, 68.6% and 70.4%, respectively, inthe age groups of 14-30 years, 31-45 years, 46-60 yearsand 61-88 years.Conclusion: The frequency of Helicobacter pylori was71% in Eastern Anatolia Region. No statistically significantdifference was found between genders and agegroups in term of the frequency of Helicobacter pylori.

  19. Muscle Activation of Vastus Medialis Oblique and Vastus Lateralis in Sling-Based Exercises in Patients with Patellofemoral Pain Syndrome: A Cross-Over Study

    Directory of Open Access Journals (Sweden)

    Wen-Dien Chang

    2015-01-01

    Full Text Available Objectives. To examine what changes are caused in the activity of the vastus medialis oblique (VMO and vastus lateralis (VL at the time of sling-based exercises in patients with patellofemoral pain syndrome (PFPS and compare the muscular activations in patients with PFPS among the sling-based exercises. Methods. This was a cross-over study. Sling-based open and closed kinetic knee extension and hip adduction exercises were designed for PFPS, and electromyography was applied to record maximal voluntary contraction during the exercises. The VMO and VL activations and VMO : VL ratios for the three exercises were analyzed and compared. Results. Thirty male (age = 21.19 ± 0.68 y and 30 female (age = 21.12 ± 0.74 y patients with PFPS were recruited. VMO activations during the sling-based open and closed kinetic knee extension exercises were significantly higher (P=0.04 and P=0.001 than those during hip adduction exercises and VMO : VL ratio for the sling-based closed kinetic knee extension and hip adduction exercises approximated to 1. Conclusions. The sling-based closed kinetic knee extension exercise produced the highest VMO activation. It also had an appropriate VMO : VL ratio similar to sling-based hip adduction exercise and had beneficial effects on PFPS.

  20. Morse Theory and Concurrency

    DEFF Research Database (Denmark)

    Wisniewski, Rafal

    2003-01-01

    The work is intended to provide some insight about concurrency theory using ideas from geometry and algebraic topology. We define a topological space containing all traces of execution of the computer program and the information about how time flows. This is the main difference with standard...... topological reasoning in which there is no information about relation "in time" among points. The main task is to define equivalence of paths reflecting execution of a program. We use the notion of homotopy history equivalence relation. The model space considered in this work is a differentiable manifold...

  1. A Concurrent Logical Relation

    DEFF Research Database (Denmark)

    Birkedal, Lars; Sieczkowski, Filip; Thamsborg, Jacob Junker

    2012-01-01

    We present a logical relation for showing the correctness of program transformations based on a new type-and-effect system for a concurrent extension of an ML-like language with higher-order functions, higher-order store and dynamic memory allocation. We show how to use our model to verify a number...... of interesting program transformations that rely on effect annotations. In particular, we prove a Parallelization Theorem, which expresses when it is sound to run two expressions in parallel instead of sequentially. The conditions are expressed solely in terms of the types and effects of the expressions...

  2. Mastering concurrency in Go

    CERN Document Server

    Kozyra, Nathan

    2014-01-01

    A practical approach covering everything you need to know to get up and running with Go, starting with the basics and imparting increasingly more detail as the examples and topics become more complicated. The book utilizes a casual, conversational style, rife with actual code and historical anecdotes for perspective, as well as usable and extensible example applications. This book is intended for systems developers and programmers with some experience in either Go and/or concurrent programming who wish to become fluent in building high-performance applications that scale by leveraging single-c

  3. Gunshot-like wound caused by sling shot injury – a case report

    Directory of Open Access Journals (Sweden)

    Vinuthinee N

    2015-02-01

    Full Text Available Naidu Vinuthinee,1,2 Anuar Azreen-Redzal,1 Jaafar Juanarita,1 Embong Zunaina2 1Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia; 2Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia Abstract: We report a rare case of sling shot injury that presented with a gunshot-like wound with preseptal cellulitis, in a toddler. An 11-month-old Malay child presented with a gunshot-like wound over the forehead following sling shot injury. On examination, he had a deep circular laceration wound over the forehead, measuring 2.0 cm in diameter, with minimal bleeding. There was no obvious foreign body seen inside the wound and no palpable foreign body surrounding the wound. The gunshot-like wound was associated with left preseptal cellulitis. A skull X-ray showed a white opaque foreign body in the left frontal bone. Computed tomography (CT scan of orbit and brain revealed a left comminuted fracture of the left orbital roof, and left frontal brain contusion with prelesional edema. Wound exploration was performed and revealed a 0.5 cm unshattered marble embedded in the left frontal bone. The marble and bone fragments were removed. The left preseptal cellulitis responded well to intravenous antibiotic and topical antibiotic. Keywords: preseptal cellulitis, orbital roof fracture, pediatric trauma

  4. Removal of obstructing synthetic sling from a urethra: English and Spanish version.

    Science.gov (United States)

    Pizarro-Berdichevsky, Javier; Goldman, Michelle P; Goldman, Howard B

    2016-12-01

    Urethral perforations after synthetic midurethral sling (MUS) placement are uncommon. Transvaginal removal is an option. The objective of this English and Spanish video is to demonstrate removal of an MUS that had perforated the urethra and the concomitant urethral reconstruction. A 66-year-old woman with a history of an anterior and posterior colporrhaphy and a retropubic MUS 12 years earlier presented with difficulty voiding, recurrent urinary tract infections, and mild stress incontinence (SUI). Physical examination revealed tenderness on the anterior vaginal wall (AVW) without mesh extrusion. Cystourethroscopy showed urethral perforation, distal to the bladder neck and urodynamics demonstrated an obstructive pattern. The patient wished to undergo transvaginal sling removal and reconstruction. The mesh was deep in the AVW perforating the urethra and the vaginal portion was completely removed. The video demonstrates several tips on how to remove a perforating MUS and subsequent urethral reconstruction. Ten months postoperatively the force of stream returned to normal, with no further UTIs, no evidence of fistula, and rare SUI. Urethral perforation with an MUS can be successfully treated with removal of any mesh in proximity to the urethra and urethral reconstruction via a completely transvaginal approach.

  5. Carcinogenic potential of polypropylene mid-urethral slings: what do we know so far?

    Science.gov (United States)

    Adel, Eugene; Shapiro, Robert; Zaslau, Stanley

    2017-05-01

    Polypropylene (PP) mesh has come under increased scrutiny owing to previous FDA safety communications regarding the risks of mesh in trans-vaginal surgery and ensuing class action litigation for post-operative complications. Additional concerns have been raised regarding a possible link between implanted PP mesh and the long-term development of malignancy. Until recently, no research was specifically committed to the exploration of such a link. Our objective was to provide an overview of the recent literature focusing on any association between the use of PP mesh for midurethral sling procedures and the development of malignancy. Multiple online research databases were searched for information related to any possible carcinogenic potential of PP mesh. There was no increased incidence in the development of malignancy after midurethral sling procedures using PP mesh in any of the studies. Given the scarcity of evidence suggesting otherwise, the likelihood of PP mesh causing malignancy is exceptionally low. However, with few studies and an unknown latency period between exposure and diagnosis, more observational data would prove useful to exclude causality.

  6. Predictive Value of Urodynamics on Outcome After Midurethral Sling Surgery for Female Stress Urinary Incontinence EDITORIAL COMMENT

    NARCIS (Netherlands)

    Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Kil, Paul J. M.; Vervest, Harry A. M.

    2009-01-01

    Urodynamic investigation (UDI) is routinely performed before midurethral sling surgery (MUS) for female stress urinary incontinence to detect factors that may adversely affect the surgical outcome or confirm the diagnosis. A recent review, however, concluded that there was insufficient evidence to

  7. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

    Directory of Open Access Journals (Sweden)

    Nicole Szell, DO

    2017-06-01

    Szell N, Komisaruk B, Goldstein SW, et al. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence. Sex Med 2017;5:e84–e93.

  8. A Randomized Study of Intraoperative Autologous Retropubic Urethral Sling on Urinary Control after Robotic Assisted Radical Prostatectomy.

    Science.gov (United States)

    Nguyen, Hao G; Punnen, Sanoj; Cowan, Janet E; Leapman, Michael; Cary, Clint; Welty, Christopher; Weinberg, Vivian; Cooperberg, Matthew R; Meng, Maxwell V; Greene, Kirsten L; Garcia, Maurice; Carroll, Peter R

    2017-02-01

    We evaluated whether placement of a retropubic urethral sling fashioned from autologous vas deferens during robotic assisted radical prostatectomy would improve recovery of continence. In a phase 2, single blind trial age stratified patients were randomized to undergo robotic assisted radical prostatectomy by multiple surgeons with or without sling placement. The outcomes were complete continence (0 urinary pads of any type) and near continence (0, an occasional or 1 pad per day) at 6 months, which was assessed by the Fisher exact test and logistic regression. The Kaplan-Meier method and the log rank test were used to evaluate time to continence. EPIC-UIN (Expanded Prostate Cancer Index Composite-Urinary Inventory) and I-PSS (International Prostate Symptom Score) 1, 3 and 6 months after catheter removal were evaluated by mixed models for repeated measures. Of 203 patients who were recruited 95 and 100 were randomized to undergo sling and no sling placement, respectively, and completed postoperative interviews. Six months after surgery the proportions reporting complete and near continence (66% and 87%, respectively) and times to complete and near continence were similar in the groups. Younger age was associated with a higher likelihood of complete continence (OR 1.74 per decreasing 5-year interval, 95% CI 1.23-2.48, p <0.01) and near continence (OR 2.18 per decreasing 5-year interval, 95% CI 1.21-3.92, p <0.01) adjusting for clinical, urinary and surgical factors. Adjusted EPIC-UIN and I-PSS scores changed with time but did not differ between the groups. No serious adverse events were observed. This trial failed to demonstrate a benefit of autologous urethral sling placement at robotic assisted radical prostatectomy on early return of continence at 6 months. Continence was related to patient age in adjusted models. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes.

    Science.gov (United States)

    Brennand, Erin A; Tang, Selphee; Birch, Colin; Murphy, Magnus; Ross, Sue; Robert, Magali

    2017-04-01

    The objective was to evaluate the impact of preoperative body mass index ≥30 on objective and subjective cure rates 5 years after midurethral sling surgery. Secondary analysis of the 5-year results of a randomized clinical trial evaluating tension-free vaginal tape vs transobturator tape surgery. Women (n = 176) were classified as obese or non-obese based on preoperative height and weight. Women self-reported symptoms and quality of life, and underwent standardized physical examinations and pad-testing. Categorical data were analyzed using Chi-squared or Fisher's exact tests, continuous data by Mann-Whitney U test. Primary outcome was objective cure defined as <1 g urine lost on pad-test at 5 years post-surgery. Secondary outcomes were subjective cure of incontinence, urinary urge incontinence symptoms, and quality of life scores. Non-obese women had a higher rate of objective cure, 87.4 % (n = 83 out of 95) compared with 65.9 % (n = 29 out of 44) in the obese group (P = 0.003, risk difference [RD] 21.5 %, 95 % CI 5.9-37.0 %). Subjectively, non-obese women also reported higher rates of cure, 76.7 % (n = 89 out of 116) compared with 53.6 % (n = 30 out of 56) of obese women (P = 0.002, RD 23.2 %, 95 % CI 8.0-38.3 %). Overall rates of urge incontinence symptoms were similar in the two groups, but rates of bothersome symptoms were higher for obese women (58.9 % vs 42.1 %, P = 0.039, RD 16.8 % 95 % CI 1.1-32.6). Five years after surgery, obese women continued to experience lower rates of cure compared with non-obese women.

  10. Concurrent Models for Object Execution

    OpenAIRE

    Diertens, Bob

    2012-01-01

    In previous work we developed a framework of computational models for the concurrent execution of functions on different levels of abstraction. It shows that the traditional sequential execution of function is just a possible implementation of an abstract computational model that allows for the concurrent execution of functions. We use this framework as base for the development of abstract computational models that allow for the concurrent execution of objects.

  11. Martius flap and anterior vaginal wall sling for correction of urethrovaginal fistula (UVF associated with stress urinary incontinence (SUI after vaginal delivery

    Directory of Open Access Journals (Sweden)

    A.M. Abdelbary

    2012-12-01

    Conclusions: Patients with a post-birth trauma in the form of UVF should be examined intra-operatively for the presence of associated SUI following correction of UVF. The use of the Martius flap and anterior vaginal wall sling in treating such patients is safe, efficient and reproducible. An anterior vaginal wall sling should be avoided in distal UVF to avoid recurrence of SUI.

  12. EFFECT OF MID URETHRAL SLING (TVT SURGERY ON FEMALE SEXUAL FUNCTION

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-09-01

    Full Text Available INTRODUCTION: Mid Urethral Slings is the main stay of therapy in the management of stress urinary incontinence in the female, w e evaluated the effect of TVT on sexual function in women who are from the rural backward districts of Rayalaseema districts of Andhra Pradesh. MATERIALS & METHODS: 30 Women with a mean age of 44 yrs with SUI were evaluated before TVT procedure and then every 3months for 1yr for sexual health using NSF - 9 questionnaire . RESULTS: The sexual function in all the domains including desire, frequency ar ousal , orgasm remained the same as before surgery in more than 80% pts. The satisfaction rate was better in pts who were leaking during sex before surgery in six out of ten patients. CONCLUSIONS: TVT surgery does not have any significant impact on sexual function Sexual function is not an important issue for the female beyond the age of 40 yrs in the perimenopau s e/ post menopause period

  13. Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial.

    Science.gov (United States)

    Mazloomdoost, Donna; Pauls, Rachel N; Hennen, Erin N; Yeung, Jennifer Y; Smith, Benjamin C; Kleeman, Steven D; Crisp, Catrina C

    2017-11-01

    Midurethral slings are commonly used to treat stress urinary incontinence. Pain control, however, may be a concern. Liposomal bupivacaine is a local anesthetic with slow release over 72 hours, demonstrated to lower pain scores and decrease narcotic use postoperatively. The purpose of this study was to examine the impact of liposomal bupivacaine on pain scores and narcotic consumption following retropubic midurethral sling placement. This randomized, placebo-controlled trial enrolled women undergoing retropubic midurethral sling procedures with or without concomitant anterior or urethrocele repair. Subjects were allocated to receive liposomal bupivacaine (intervention) or normal saline placebo injected into the trocar paths and vaginal incision at the conclusion of the procedure. At the time of drug administration, surgeons became unblinded, but did not collect outcome data. Participants remained blinded to treatment. Surgical procedures and perioperative care were standardized. The primary outcome was the visual analog scale pain score 4 hours after discharge home. Secondary outcomes included narcotic consumption, time to first bowel movement, and pain scores collected in the mornings and evenings until postoperative day 6. The morning pain item assessed "current level of pain"; the evening items queried "current level of pain," "most intense pain today," "average pain today with activity," and "average pain today with rest." Likert scales were used to measure satisfaction with pain control at 1- and 2-week postoperative intervals. Sample size calculation deemed 52 subjects per arm necessary to detect a mean difference of 10 mm on a 100-mm visual analog scale. To account for 10% drop out, 114 participants were needed. One hundred fourteen women were enrolled. After 5 exclusions, 109 cases were analyzed: 54 women received intervention, and 55 women received placebo. Mean participant age was 52 years, and mean body mass index was 30.4 kg/m 2 . Surgical and

  14. A New Sling Technique in Cervical Radiculopathy Caused by Vertebral Artery Loop Compression.

    Science.gov (United States)

    Ju, Chang Il; Kim, Jeong Mok; Kim, Jong Gyu; Kim, Seok Won; Lee, Seung Myung

    2017-08-01

    A 52-year-old woman had a 20-month history of progressive radiating pain in the left arm and numbness on C7 dermatome. On physical examination, left head rotation aggravated the radiculopathic pain. For an anatomic diagnosis of the vertebral artery and nerve root, magnetic resonance angiography was performed (computed tomography angiography was not possible because of her dye allergy history). Magnetic resonance angiography showed a left vertebral artery loop entering at the C6-7 intervertebral foramen. Surgical microvascular decompression was performed by an anterior cervical approach and the loop of the artery was fixed using a sling technique. Postoperative computed tomography angiography showed that the left vertebral artery was retracted anteriorly and the C7 nerve root was decompressed in the intervertebral foramen at the left C6-7 level. The patient's radiculopathic symptoms were improved and especially the aggravated pain by left head rotation subsided dramatically. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A preequatorial Gore-Tex sling to restore rectus muscle pathways in myopic strabismus fixus.

    Science.gov (United States)

    Shih, Min-Hsiu; Li, Mei-Lun; Huang, Fu-Chin

    2012-02-01

    A 74-year-old woman with high myopia presented with a rapid-onset, large-angle esotropia consistent with myopic strabismus fixus, or fallen eye syndrome. We treated the patient with combined bilateral disinsertion of the medial rectus muscles and resection of the right lateral rectus muscle with bilateral repositioning of the displaced superior and lateral rectus muscles toward their normal anatomic positions using a polytetrafluoroethylene (Gore-Tex) sling. The eyes were held in the orthotropic position for 7 days after surgery using nylon traction sutures. After 7 months of follow-up, the patient remained orthotropic at distance with a residual esotropia of 12(Δ) at near and a persistent limitation of elevation. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  16. Outside-in transobturator midurethral sling and the dorsal nerve of the clitoris.

    Science.gov (United States)

    Tate, Susan B; Culligan, Patrick J; Acland, Robert D

    2009-11-01

    An anatomical study on fresh cadavers was done to determine the vulnerability of the dorsal nerve of the clitoris to injury during "outside-in" transobturator sling procedures. The dorsal nerve of the clitoris was identified bilaterally in ten fresh cadavers. Transfixing needles marked the inferomedial border of the obturator foramen. The distance between the foramen border and the nerve was measured. The nerve ran medially in close approximation to the ischiopubic ramus and inferior to the obturator foramen in all specimens. In no instance did the nerve follow an aberrant course traversing the obturator foramen. The mean distance between the inferomedial border of the obturator foramen and the nerve was 9.3 mm, range 3-14 mm. When the "outside-in" technique is used, the introducer cannot come into contact with the dorsal nerve of the clitoris because the introducer would have to pass through the ischio-pubic ramus. This is not anatomically possible.

  17. A Danish national survey of women operated with mid-urethral slings in 2001.

    Science.gov (United States)

    Ammendrup, Astrid Cecilie; Jørgensen, Anette; Sander, Pia; Ottesen, Bent; Lose, Gunnar

    2009-01-01

    To perform a national survey on self-reported cure, satisfaction and complications four years after mid-urethral sling (MUS) for urinary stress incontinence in Danish women operated in 2001. A postal questionnaire survey. All Danish women who received an MUS operation in 2001 extracted from the Danish National Patient Register. The women received a validated postal questionnaire in 2005. The questionnaire included questions about subjective cure, satisfaction, complications and a Danish version of International Consultation on Incontinence Questionnaire-Short Form. The study was carried out in cooperation with the Danish National Board of Health. A total of 335 (92%) women responded to the questionnaire, among whom 105 (32%) felt completely cured, 119 (36%) were much improved, 55 (17%) were improved and 48 (15%) unchanged or worse. Cure rate varied between departments from 0% to 67%. Low-volume departments (decentralized organization with many low-volume departments seems inappropriate.

  18. Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation.

    Science.gov (United States)

    Giles, Joshua W; Boons, Harm W; Elkinson, Ilia; Faber, Kenneth J; Ferreira, Louis M; Johnson, James A; Athwal, George S

    2013-06-01

    Glenohumeral instability with glenoid bone loss is commonly treated with the Latarjet procedure. The procedure involves transfer of the coracoid and conjoint tendon, which is thought to provide a stabilizing sling effect; however, its significance is unknown. This study evaluated the effects of the Latarjet procedure, with and without conjoint tendon loading, on shoulder stability and range of motion (ROM). A custom simulator was used to evaluate anterior shoulder stability and ROM in 8 cadaveric shoulders. Testing conditions included intact, 30% glenoid defect, and Latarjet with and without conjoint loading. Unloaded and 10-N loaded states were tested in adduction and 90° abduction. Outcome variables included dislocation, stiffness (neutral and 60° external rotation), and internal-external rotational ROM. All 30% defects dislocated in abduction external rotation. The loaded Latarjet prevented dislocation in all specimens, whereas the unloaded Latarjet stabilized 6 of 8 specimens. In abduction external rotation, there were no significant differences in stiffness between loaded and unloaded transfers (P = .176). In adduction, there were no significant differences between the intact and the loaded Latarjet (P ≥ .228); however, in neutral rotation, the unloaded Latarjet (P = .015) and the 30% defects (P = .011) were significantly less stiff. Rotational ROM in abduction was significantly reduced with the loaded Latarjet (P = .014) compared with unloaded Latarjet, and no differences were found in adduction. These findings indicate that glenohumeral stability is improved, but not fully restored to intact, with conjoint tendon loading. The results support the existence of the sling effect and its importance in augmenting stability provided by the transferred coracoid. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  19. Mid-urethral slings on YouTube: quality information on the internet?

    Science.gov (United States)

    Larouche, Maryse; Geoffrion, Roxana; Lazare, Darren; Clancy, Aisling; Lee, Terry; Koenig, Nicole A; Cundiff, Geoffrey W; Stothers, Lynn

    2016-06-01

    Scant literature exists about the quality of urogynecological content on social media. Our objective was to measure the accuracy and comprehensiveness of YouTube videos related to mid-urethral sling (MUS) procedures. YouTube was searched using the terms "mid-urethral sling," "vaginal tape," "TVT," "TOT," "TVT surgery," and "TOT surgery." Duplicates and videos with less than 1,000 views were excluded. We developed a standardized questionnaire for this project, assessing each video's target audience, main purpose, relevance, informed consent elements, surgical steps, and bias. The primary outcome was the presence of all elements of informed consent. Inter-rater reliability (IRR) was calculated using the Fleiss' kappa statistic. Descriptive statistics were also obtained. Five reviewers each rated 56 videos. Mean IRR was moderate (Fleiss' kappa 0.58 ± 0.24). Video content was classified as physician educational material (67.9 %), patient information (16.1 %), advertisement (10.7 %), lawsuit recruitment (1.8 %), and unclear (3.6 %). MUS was the primary topic for 82.1 % of the videos. The remainder discussed other types of anti-incontinence procedures or prolapse surgery. None of the videos mentioned all four elements of informed consent. Of 32 videos demonstrating surgical technique, none showed the complete list of pre-determined surgical steps. The mean number of listed steps was 7.6/16. Only four videos mentioned at least one post-operative patient instruction. A marketing element was shown in 26.8 % of videos. Patient information about MUS on YouTube is lacking and often biased. Physicians and students viewing YouTube videos for educational purposes should be cognizant of the variability in the surgical steps demonstrated.

  20. [Multicenter study of Advance ® suburethral sling for treatment of postoperative urinary incontinence of male].

    Science.gov (United States)

    Mascle, L; Descazeaud, A; Robert, G; Bernhard, J-C; Bensadoun, H; Ferrière, J-M; Ballanger, P; Pasticier, G

    2015-04-01

    To estimate in the medium term, the efficiency and morbidity of Advance(®) for the treatment of postoperative urinary incontinence for male, and determine predictive preoperative factors of success or failure. Retrospective multicentric clinical study of patients presenting a postoperative urinary incontinence and treated by Advance(®) suburethral sling. The importance of the preoperative incontinence was classified in three groups: light (pad-test100 g/day or >3 pads/day). The functional results were classified in 4 categories: continence and improvement, defining the criterion of success and unchanged situation and deteriorated situation defining the criterion of failure. Sixty-six patients were included from 2008 till 2013. The radical prostatectomy was responsible in 85.5% of the cases. The incontinence was light, moderated and severe for respectively 43.4%, 35.6% and 21% of the patients. After treatment, 39.4% of the patients were continent and 78.9% in situation of success. The rate of success decreased with the severity of the incontinence (respectively 94%, 74% and 56%). For 9 patients, implantation of artificial urinary sphincter was performed without operative difficulties. Complications were urine retention (n=4), hematoma (n=3) and scrotal pains persistent more than one postoperative month (n=11). Advance(®) suburethral sling is a technique in which the efficiency decreases with the severity of the incontinence, but which does not seem to prevent from implanting artificial urinary sphincter. Its main problem is the apparition of scrotal pain. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Reconstruction of a Total Soft Palatal Defect Using a Folded Radial Forearm Free Flap and Palmaris Longus Tendon Sling

    Directory of Open Access Journals (Sweden)

    Myung Chul Lee

    2012-01-01

    Full Text Available BackgroundThe soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate.MethodsSix patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation.ResultsMean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%. The mean score of the speech acuity test was 5.84 (range, 5 to 6. These mean ratings represent a satisfactory level of speech function.ConclusionsThe large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.

  2. [Assessments of long-term results of different types of sling procedures for stress urinary incontinence in women].

    Science.gov (United States)

    Loran, O B; Seregin, A V; Dovlatov, Z A

    2016-02-01

    To evaluate long-term results of surgery for stress urinary incontinence in women using different types of sling procedures. The study included 698 patients aged 42 to 68 years (median 54 years) with stress urinary incontinence. TVT was used in 167 (23.9%) cases, TVT-O Gynecare system in 359 (51.4%), TVT-O Monarch system in 105 (15.0%), and TVT Secur mini-sling system - in 67 (9.6%). Follow-up ranged from 12 to 108 months (median 55 months). Patients' status was assessed using UDI-6 and IIQ-7 questionnaires, an improvised treatment satisfaction questionnaire, voiding diary, cough test and 1-hour Pad-test. The effectiveness of the treatment, according to objective criteria was 92.2%, 93.3%, 91.4% and 92.5% after surgery with TVT, TVT-O Gynecare, TVT-O Monarch and TVT Secur, respectively, and according to subjective criteria - 90.4%, 91.1%, 89.5% and 91.0%. No differences in the effectiveness of techniques were found. The data obtained in long-term observations of a large sample of patients treated with a variety of techniques in a single center showed the effectiveness and safety of modern sling procedures for correcting urinary incontinence in women.

  3. Reference Capabilities for Concurrency Control

    OpenAIRE

    Castegren, Elias; Wrigstad, Tobias

    2016-01-01

    The proliferation of shared mutable state in object-oriented programming complicates software development as two seemingly unrelated operations may interact via an alias and produce unexpected results. In concurrent programming this manifests itself as data-races. Concurrent object-oriented programming further suffers from the fact that code that warrants synchronisation cannot easily be distinguished from code that does not. The burden is placed solely on the programmer to reason ab...

  4. Concurrent engineering: effective deployment strategies

    Directory of Open Access Journals (Sweden)

    Unny Menon

    1996-12-01

    Full Text Available This paper provides a comprehensive insight into current trends and developments in Concurrent Engineering for integrated development of products and processes with the goal of completing the entire cycle in a shorter time, at lower overall cost and with fewer engineering design changes after product release. The evolution and definition of Concurrent Engineering are addressed first, followed by a concise review of the following elements of the concurrent engineering approach to product development: Concept Development: The Front-End Process, identifying Customer Needs and Quality Function Deployment, Establishing Product Specifications, Concept Selection, Product Architecture, Design for Manufacturing, Effective Rapid Prototyping, and The Economics of Product Development. An outline of a computer-based tutorial developed by the authors and other graduate students funded by NASA ( accessible via the world-wide-web . is provided in this paper. A brief discussion of teamwork for successful concurrent engineering is included, t'ase histories of concurrent engineering implementation at North American and European companies are outlined with references to textbooks authored by Professor Menon and other writers. A comprehensive bibliography on concurrent engineering is included in the paper.

  5. Comparison of Two Methods for Upper Lid Fascia Lata Sling in Congenital Blepharoptosis: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Abbas Bagheri

    2008-12-01

    Full Text Available

    PURPOSE: To compare the results of two different methods of upper lid sling with autogenous fascia lata in the treatment of congenital ptosis. METHODS: In a randomized clinical trial, patients with congenital upper lid ptosis and poor levator function (< 4mm were randomly assigned to two different methods of upper lid sling: group A, bitriangular fascia sling (modified Crawford method and group B, monotriangular fascia sling (modified Fox method. RESULTS:  This study included 30 upper eyelids (15 eyelids in each surgical group of 19 patients (8 unilateral and 11 bilateral cases with congenital ptosis. Mean increase in eyelid fissure height was 2.7±2.3 mm in group A and 3.4±2.2 mm in group B, respectively. Change in eyelid fissure in both groups was significant (P < 0.001, paired t-test but intergroup difference was not (P=0.4, independent sample t-test. Early complications such as corneal epithelial defects and entropion, and late complications such as undercorrection were comparable in the two groups. No patient experienced recurrent ptosis requiring reoperation in either group. CONCLUSION:  The monotriangular method of upper lid fascia sling can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation and a shorter period of anesthesia.

  6. Effect of a New Risk Calculator on Patient Satisfaction With the Decision for Concomitant Midurethral Sling During Prolapse Surgery: A Randomized Controlled Trial.

    Science.gov (United States)

    Miranne, Jeannine Marie; Gutman, Robert Eric; Sokol, Andrew Ian; Park, Amy Josephine; Iglesia, Cheryl Bernadette

    To determine whether use of a new personalized risk calculator increases patient satisfaction with the decision whether or not to have a prophylactic midurethral sling (MUS) during pelvic organ prolapse (POP) surgery. We performed a randomized controlled trial involving English-speaking women without symptoms of stress urinary incontinence (SUI) with ≥ stage 2 POP who planned to undergo POP surgery with 1 of 4 fellowship-trained urogynecologists at a single academic center. Women with a history of prior POP or incontinence surgery, or who were pregnant, or unable to complete study forms were excluded. Participants were randomly assigned to standard preoperative counseling or preoperative counseling with the use of a validated, online risk calculator for de novo SUI after POP surgery. The primary outcome was patient satisfaction with the decision for prophylactic MUS placement during POP surgery at 3 months postoperative assessed using the Satisfaction with Decision Scale for Pelvic Floor Disorders. Sixty-three women were approached for participation. Forty-two agreed to participate, 41 underwent randomization, and 33 had POP surgery and completed 3-month follow-up. Of these 33, 17 were randomized to the risk calculator and 16 to standard counseling. The mean age was 61.2 ± 9.1 years, and 41% (14/33) had a prophylactic MUS. At 3 months postoperative, there was no difference in Satisfaction with Decision Scale for Pelvic Floor Disorders scores between groups (4.67 ± 0.46 [intervention] vs 4.78 ± 0.34 [control]; P = 0.61). Use of the de novo SUI risk calculator did not increase patient satisfaction with the decision regarding MUS placement during POP surgery.

  7. Does body mass index influence the outcome of midurethral sling procedures for stress urinary incontinence?

    Science.gov (United States)

    Xia, Ziyuan; Qian, Jialei; Chen, Yuntian; Liao, Banghua; Luo, Deyi

    2017-06-01

    Whether midurethral sling (MUS) procedures are as effective in obese women as they are in women of normal weight is still a matter of controversy. The objective of this study was to determine if body mass index (BMI) influences the outcome of MUS procedures for stress urinary incontinence (SUI). We searched electronic databases including EMBASE, MEDLINE, Web of Science and Ovid evidence-based medicine reviews to identify studies that explored the association between BMI and outcomes of MUS procedures. The studies were rated using the Newcastle-Ottawa scale; the meta-analysis was performed using Review Manager 5.3 software. This review included 11 studies, 6 prospective cohort studies and 5 retrospective studies, with a total of 2,846 patients. The objective success rates of MUS in patients with BMI >25 kg/m 2 (overweight and obese) were lower than in patients with BMI 18.5 - 25 kg/m 2 as a risk factor when discussing the suitability of the MUS procedure in a patient with SUI.

  8. Pregnancy and delivery following midurethral sling surgery for stress urinary incontinence.

    Science.gov (United States)

    Huser, Martin; Belkov, Ivan A; Janku, Petr; Sedlakova, Katerina

    2012-11-01

    To analyze the available clinical evidence on the continued effectiveness of midurethral sling (MUS) surgery for stress urinary incontinence (SUI) in women who become pregnant and undergo delivery, and then to determine the optimal mode of delivery for such women. An online search was carried out to retrieve the available evidence regarding the risk of SUI recurrence during pregnancy and after delivery following a successful MUS treatment. Appropriate keywords were used to identify all relevant reports published from 1996 through 2011. Basic patient characteristics, mode of delivery, and presence of SUI during pregnancy and the postpartum were analyzed. No more than 36 relevant cases were found. The overall urinary continence rates were 91.7% during pregnancy and 80.6% during the postpartum. Most (58.3%) of the women were delivered vaginally. The evidence indicates that the risk of SUI recurrence is not significantly different after a vaginal or a cesarean delivery. In women successfully treated with a MUS, pregnancy care and delivery mode therefore need to be considered case by case, according to factors other than the risk of recurrence. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. MODERN METHODS FOR TREATING URINARY INCONTINENCE: LOOP OPERATIONS AND MINI-SLINGS (PART ONE

    Directory of Open Access Journals (Sweden)

    Y. A. Kupriyanov

    2014-01-01

    Full Text Available During the last century various loop operations are used in the treatment of stress urinary incontinence. Methods for treating urinary incontinence are inextricably linked with the development of urology as a science. Dominance concept of sphincter deficiency as the main cause of urinary incontinence led to the use of various muscle loops, which was considered by many authors, could carry the functional load. The last decade was marked by significant developments and achievements in the treatment of urinary incontinence in women. Data received today entitle say that, in general, the use of synthetic loops installed without tension in the middle of the urethra, to get rid of urinary incontinence significant number of patients with this medical and social problem worldwide. We can say that with the advent of SIMS and their use in the treatment of urinary incontinence, a new stage. The concept of using SIMS for implantation which the surgeon requires one incision under the middle third of the urethra, is not innovative. So Smith presented his minisling made of pig skin in 1987. First available for use SIMS became minisling TVT Secur company Gynaecare (Ethicon in 2005. To date, there are many SIMS: TVT Secur®, MiniArc®, Ophira®, Adjust®, Solyx®, Zipper Sling®, Prosurg®, Tissue Fixation System®, Needleless®, Altis®, Just-swing®, Desara®. Many manufacturers do not stop and continue to develop new minislingi with new locking mechanisms.

  10. Comparing Trans Obturator Tension Free Vaginal Tape Surgery with Needleless Suburethral Sling

    Directory of Open Access Journals (Sweden)

    Kadir Bakay

    2014-03-01

    Full Text Available Aim: Urinary incontinence is described by the International Continence Society as an involuntary urinal discharge that can be objectively proved to cause hygenic and social problems. We aim to share our surgical experience in 51 patients in which trans obturator tension free vaginal tape procedure [TOT] is compared with needleless suburethral sling placement, also known as minisling. Material and Method: 51 patients complaining of genuine stress incontinence between December 2011 and December 2012 were retrospectively involved in the study group. All patients were examined and urodynamically tested for diagnosis. After getting positive results as genuine stress incontinence, surgery was planned. Patients were operated using outside-inside TOT technique and minisling technique, results were compared in terms of blood loss, operation time, and the surgical effectiveness of the technique. Results: Operation time was 27 ± 6 minutes for TOT and 11 ± 4 minutes for minisling respectively. Comparison of operation time and blood loss was in favor of the minisling group. Disscussion: TOT and minisling are both described as minimally invasive procedures that can be performed under regional anesthesia to an outpatient with minisling bearing all the advantages of TOT without needle complications.

  11. Effect of Sling Exercise Training on Balance in Patients with Stroke: A Meta-Analysis.

    Science.gov (United States)

    Chen, Lianghua; Chen, Junqi; Peng, Qiyuan; Chen, Jingjie; Zou, Yucong; Liu, Gang

    2016-01-01

    This study aims to evaluate the effect of sling exercise training (SET) on balance in patients with stroke. PubMed, Cochrane Library, Ovid LWW, CBM, CNKI, WanFang, and VIP databases were searched for randomized controlled trials of the effect of SET on balance in patients with stroke. The study design and participants were subjected to metrological analysis. Berg balance Scale (BBS), Barthel index score (BI), and Fugl-Meyer Assessment (FMA) were used as independent parameters for evaluating balance function, activities of daily living(ADL) and motor function after stroke respectively, and were subjected to meta-analysis by RevMan5.3 software. Nine studies with 460 participants were analyzed. Results of meta-analysis showed that the SET treatment combined with conventional rehabilitation was superior to conventional rehabilitation treatments, with increased degrees of BBS (WMD = 3.81, 95% CI [0.15, 7.48], P = 0.04), BI (WMD = 12.98, 95% CI [8.39, 17.56], P risk of bias. Therefore, more multi-center and large-sampled randomized controlled trials are needed to confirm its clinical applications.

  12. A multicentre prospective randomised study of single-incision mini-sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the management of female stress urinary incontinence: pain profile and short-term outcomes.

    Science.gov (United States)

    Mostafa, Alyaa; Agur, Wael; Abdel-All, Mohamed; Guerrero, Karen; Lim, Chi; Allam, Mohamed; Yousef, Mohamed; N'Dow, James; Abdel-fattah, Mohamed

    2012-11-01

    To compare the postoperative pain profile, peri-operative details, and short-term patient-reported and objective success rates of single-incision mini-slings (SIMS) versus standard mid-urethral slings (SMUS). In a multicentre prospective randomised trial in six UK centres in the period between October 2009 and October 2010, 137 women were randomised to either adjustable SIMS (Ajust®, C. R. Bard Inc., NJ, USA), performed under local anaesthesia as an opt-out policy (n=69), or SMUS (TVT-O™, Ethicon Inc., Somerville, USA) performed under general anaesthesia (n=68). Randomisation was done through number-allocation software and using telephone randomisation. Postoperative pain profile (primary outcome) was assessed on a ten-point visual analogue scale at fixed time-points. Pre- and post operatively (4-6 months) women completed symptom severity, urgency perception scale (UPS), quality of life and sexual function questionnaires. In addition, women completed a Patient Global Impression of Improvement Questionnaire and underwent a cough stress test at 4-6 months follow up. Sample size calculation was performed and data were analysed using SPSS 18. Descriptive analyses are given and between-group comparisons were performed using chi-square, Fischer exact test and Mann-Whitney test as appropriate. Significance level was set at 5%. Women in the SIMS Ajust® group had a significantly lower postoperative pain profile up to 4 weeks (p=TVT-O™ groups respectively. There was a trend towards higher rates of de novo urgency or worsening of pre-existing urgency in the SIMS Ajust® group (21.7% versus 8.8%) but this did not reach statistical significance (p=0.063). Women in the SIMS Ajust® group had shorter hospital stay (median (IQR) 3.65 (2.49, 4.96)) compared to (4.42 (3.16, 5.56)) the TVT-O™ group 95% CI (-0.026, 1.326), with significantly earlier return to normal activities (p=0.025) and to work (p=0.006). The adjustable single-incision mini-sling (Ajust®) is associated

  13. Concurrency & Asynchrony in Declarative Workflows

    DEFF Research Database (Denmark)

    Debois, Søren; Hildebrandt, Thomas; Slaats, Tijs

    2015-01-01

    Declarative or constraint-based business process and workflow notations have received increasing interest in the last decade as possible means of addressing the challenge of supporting at the same time flexibility in execution, adaptability and compliance. However, the definition of concurrent...... of concurrency in DCR Graphs admits asynchronous execution of declarative workflows both conceptually and by reporting on a prototype implementation of a distributed declarative workflow engine. Both the theoretical development and the implementation is supported by an extended example; moreover, the theoretical...

  14. Concurrent Delay in Construction Disputes

    DEFF Research Database (Denmark)

    Cavaleri, Sylvie Cécile

    period of delay can potentially be attributed to several events falling within both parties' spheres of responsibility, commonly termed concurrent delay, is rarely regulated in construction contracts in spite of its common occurrence. This book analyses both the theoretical foundations and the practical......Delay is one of the issues most frequently encountered in today’s construction industry; it causes significant economic damage to all parties involved. Construction contracts, standard and bespoke, almost invariably consider delay from a perspective of single liability. If the event causing...... solutions to the issue of concurrent delay in a comparative perspective between common and civil law systems, with an emphasis on Danish and English law....

  15. Fuzzy simulation in concurrent engineering

    Science.gov (United States)

    Kraslawski, A.; Nystrom, L.

    1992-01-01

    Concurrent engineering is becoming a very important practice in manufacturing. A problem in concurrent engineering is the uncertainty associated with the values of the input variables and operating conditions. The problem discussed in this paper concerns the simulation of processes where the raw materials and the operational parameters possess fuzzy characteristics. The processing of fuzzy input information is performed by the vertex method and the commercial simulation packages POLYMATH and GEMS. The examples are presented to illustrate the usefulness of the method in the simulation of chemical engineering processes.

  16. Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery

    DEFF Research Database (Denmark)

    Weltz, Vibeke; Guldberg, Rikke; Larsen, Michael D.

    2018-01-01

    Introduction and hypothesis: The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. Methods: Data were retrieved from the national Danish Urogynaecological Database, including women...... with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation...... was defined as any new surgical procedure for stress urinary incontinence performed within the study period. Results: During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence...

  17. TVT-Secur mini-sling for stress urinary incontinence: a review of outcomes at 12 months.

    Science.gov (United States)

    Walsh, Colin A

    2011-09-01

    • Synthetic mid-urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single-incision mini-slings. The present paper is a systematic review of studies reporting 12-month outcomes after the TVT-Secur (TVT-S) procedure. • Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled-trials.com online trial registries were searched for English-language articles containing the terms 'TVT-Secur', 'TVT Secur' or 'mini-sling'. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri-operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates. • Among 1178 women undergoing the TVT-S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the 'U-type' approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT-S procedure 5% of women required repeat continence surgery. • Longer-term studies and randomized comparisons with more established MUSs are required before TVT-S should be routinely used in the surgical treatment of stress urinary incontinence. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  18. Sling-based Exercise for External Rotator Muscles: Effects on Shoulder Profile in Young Recreational Tennis Players

    Science.gov (United States)

    Goulet, Charles; Rogowski, Isabelle

    2016-12-19

    Context: Tennis playing generates specific adaptations, particularly at the dominant shoulder. It remains to be established whether shoulder strength balance can be restored by sling-based training for adolescent recreational tennis players. Objective: We added a sling-based exercise for shoulder external rotators to investigate its effects on external rotator muscle strength, on internal rotator muscle strength, on glenohumeral range of motion and on tennis serve performance. Design: Test-retest design. Setting: Tennis training sports facilities. Participants: Twelve adolescent male players volunteered to participate in this study (age: 13.3 ± 0.5 years; height: 1.64 ± 0.07 cm, mass: 51.7 ± 5.8 kg, International Tennis Number: 8). Intervention: The procedure spanned 10 weeks. For the first five weeks, players performed their regular training (RT) twice a week. For the last five weeks, a sling-based exercise (SE) for strengthening the shoulder external rotator muscles was added to their regular training. Main Outcome Measures: Maximal isometric strength of shoulder external and internal rotator muscles and glenohumeral range of motion in external and internal rotation were assessed in both shoulders. Serve performance was also evaluated by accuracy and post-impact ball velocity, using a radar gun. Results: No change was found in any measurement after the RT period. Significant increases in external (~+5%; pexternal/internal strength ratio (~+4%; pexternal rotator muscles appears effective in restoring strength balance at the dominant shoulder, and may prevent adolescent tennis players from sustaining degenerative shoulder problems which could later impair their performance of daily and work-related tasks.

  19. TranQuill sling snoreplasty for snoring: A single-arm pilot study for safety and effectiveness.

    Science.gov (United States)

    Murphey, Alexander W; Nguyen, Shaun A; Fuller, Colin; Weber, Aimee C; Camilon, Marc P; Gillespie, M Boyd

    2016-01-01

    Determine safety and efficacy of the TranQuill Sling Snoreplasty (TSS) (Surgical Specialties Corp., Vancouver, BC, Canada) for the treatment of snoring in adults with benign snoring or mild obstructive sleep apnea. Prospective, unblinded, single-center pilot study. From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS. Subjects with apnea hypopnea index 85%, and body mass index (BMI) snoring, pain visual analog scales, WatchPAT (Itamar Medical Ltd, Caesarea Ind. Park, Israel) home sleep studies, and flexible endoscopy at baseline and 90-day follow-up. Thirteen males and seven females were enrolled. Average age was 49.1 (range 31-67) and BMI of 25.8 ± 2.66. TranQuill Sling Snoreplasty significantly reduced snoring symptom scores from 8.70 ± 4.27 to 6.42 ± 4.14, P = 0.012. Snoring visual analog scores demonstrated reduction of 17.8 mm (59.4 mm ± 22.1 to 41.6 mm ± 29.2), P = 0.0184. Thirty-five percent (7/20) of subjects reported complications related to the trial, with no serious adverse events. TranQuill Sling Snoreplasty is a safe therapy that improves snoring symptoms in most adult subjects with benign snoring or mild sleep apnea. Further study is required to better identify patients likely to respond to the therapy. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Modal abstractions of concurrent behavior

    DEFF Research Database (Denmark)

    Nielson, Flemming; Nanz, Sebastian; Nielson, Hanne Riis

    2011-01-01

    We present an effective algorithm for the automatic construction of finite modal transition systems as abstractions of potentially infinite concurrent processes. Modal transition systems are recognized as valuable abstractions for model checking because they allow for the validation as well as re...

  1. Relationships between models of concurrency

    DEFF Research Database (Denmark)

    Nielsen, Mogens; Sassone, Vladimiro; Winskel, Glynn

    1994-01-01

    Models for concurrency can be classified with respect to the three relevant parameters: behaviour/system, interleaving/noninterleaving, linear/branching time. When modelling a process, a choice concerning such parameters corresponds to choosing the level of abstraction of the resulting semantics....

  2. Permanency Action through Concurrent Planning.

    Science.gov (United States)

    Katz, Linda

    1996-01-01

    Highlights a failure on the part of social services to respond to the current needs of the child welfare system. Strongly advocates a commitment to concurrent planning, defined here as the process of working toward family reunification while at the same time establishing an alternative plan, usually in the form of permanency with a relative or…

  3. Concurrent flow lanes - phase III.

    Science.gov (United States)

    2011-01-01

    This report describes efforts taken to develop and calibrate VISSIM models of existing : concurrent flow lane designs of north- and southbound lanes of I-270 from the interchange at : I-70 to interchanges on I-495 at Connecticut Avenue in Maryland an...

  4. 3-Dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female

    OpenAIRE

    Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi

    2017-01-01

    We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). ...

  5. Bladder injury and success rates following retropubic mid-urethral sling: TVT EXACT™ vs. TVT™.

    Science.gov (United States)

    Thubert, Thibault; Canel, Virginie; Vinchant, Marie; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier

    2016-03-01

    Although placement of a retropubic mid-urethral slings (MUS) is one of the gold standard surgical treatments for stress urinary incontinence, new devices are poorly evaluated before marketing. We compared TVT-EXACT™ (TVT-E), a new device expected to reduce bladder injuries, with the historically described bottom-to-top TVT™ (TVT). This retrospective study compared TVT-E (n=49) and TVT (n=49). The main outcomes were the prevalence of complications (bladder injuries, immediate postoperative pain, perioperative complications, etc.) and the short-term success rate (no reported urinary leakage and negative cough test) of both MUSs. Minimum follow-up was 12 months. The characteristics of the two groups were comparable. The prevalence of bladder injury for TVT-E and TVT was 8% and 6%, respectively (p=1). The intensity of immediate postoperative pain (VAS/100) was lower following TVT-E than after TVT (8.0 vs. 15.9, p=0.01). The first post-void residual was increased in the TVT-E group (153.9 vs. 78.9mL, p=0.045), and there were more postoperative bladder outlet obstruction (BOO) symptoms in the TVT-E group (24% vs. 6%, p=0.02). However, there was no difference when considering only de novo BOO (14% vs. 4%, p=0.16). The prevalence of peri- and post-operative complications was equal in the two groups. The success rate was similar at 12 months of follow-up (80 vs. 82%, p=1). The prevalence of bladder injury was unchanged with TVT-EXACT™ compared with TVT™, but post-operative pain was decreased. The success rate of both retropubic MUSs was similar at 12 months of follow-up. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. The dorsal nerve of the clitoris in relation to urinary incontinence sling procedures.

    Science.gov (United States)

    van der Walt, Sonè; van Wijk, Frans J; Abdool, Zeelha; Oettlé, Anna C

    2017-01-01

    To avoid injury to the perineal branches of the pudendal nerve during urinary incontinence sling procedures, a thorough knowledge of the course of these nerve branches is essential. The dorsal nerve of the clitoris (DNC) may be at risk when performing the retropubic (tension-free vaginal tape) procedure as well as the inside-out and outside-in transobturator tape procedures. The purpose of this study was to identify the anatomical relationships of the DNC to the tapes placed during the procedures mentioned and to determine the influence of body variations. In this cadaveric study, the body mass index (cBMI) of unembalmed cadavers was determined. Suburethral tape procedures were performed by a registered urologist and gynecologist on a sample of 15 female cadavers; six retropubic, seven inside-out and nine outside-in transobturator tapes were inserted. After embalmment, dissections were performed and the distances between the DNC and the tapes measured. In general the trajectory of the outside-in tape was closer to the DNC than that of the other tapes. cBMI was weakly and nonsignificantly correlated with the distance between the trajectory of the tape and the DNC for the inside-out tape and the tension-free vaginal tape, but not for the outside-in tape. The findings suggest that the DNC is less likely to be injured during the inside-out tape procedure than during the outside-in procedure, regardless of BMI. Future studies on larger samples are desirable to confirm these findings.

  7. Mid-urethral sling operations for stress urinary incontinence in women.

    Science.gov (United States)

    Ford, Abigail A; Rogerson, Lynne; Cody, June D; Ogah, Joseph

    2015-07-01

    Urinary incontinence is a very common and debilitating problem affecting about 50% of women at some point in their lives. Stress urinary incontinence (SUI) is a contributory or predominant cause in 30% to 80% of these women. Mid-urethral sling (MUS) operations are a recognised minimally invasive surgical treatment for SUI. MUS involves the passage of a small strip of tape through either the retropubic or obturator space, with entry or exit points at the lower abdomen or groin, respectively. This review does not include single incision slings. To assess the clinical effects of mid-urethral sling (MUS) operations for the treatment of stress urinary incontinence (SUI), urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE in process, ClinicalTrials.gov and handsearching of journals and conference proceedings (searched 26 June 2014), Embase and Embase Classic (January 1947 to Week 25 2014), WHO ICTRP (searched on 30 June 2014) and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials amongst women with SUI, USI or MUI, in which both trial arms involve a MUS operation. Two review authors independently assessed the methodological quality of potentially eligible studies and extracted data from the included trials. We included 81 trials that evaluated 12,113 women. We assessed the quality of evidence for outcomes using the GRADE assessment tool; the quality of most outcomes was moderate, mainly due to risk of bias or imprecision.Fifty-five trials with data contributed by 8652 women compared the use of the transobturator route (TOR) and retropubic route (RPR). There is moderate quality evidence that in the short term (up to one year) the rate of subjective cure of TOR and RPR are similar (RR 0.98, 95% CI 0.96 to 1.00; 36 trials, 5514 women; moderate quality evidence) ranging from

  8. Data refinement for true concurrency

    Directory of Open Access Journals (Sweden)

    Brijesh Dongol

    2013-05-01

    Full Text Available The majority of modern systems exhibit sophisticated concurrent behaviour, where several system components modify and observe the system state with fine-grained atomicity. Many systems (e.g., multi-core processors, real-time controllers also exhibit truly concurrent behaviour, where multiple events can occur simultaneously. This paper presents data refinement defined in terms of an interval-based framework, which includes high-level operators that capture non-deterministic expression evaluation. By modifying the type of an interval, our theory may be specialised to cover data refinement of both discrete and continuous systems. We present an interval-based encoding of forward simulation, then prove that our forward simulation rule is sound with respect to our data refinement definition. A number of rules for decomposing forward simulation proofs over both sequential and parallel composition are developed.

  9. PyCSP - controlled concurrency

    DEFF Research Database (Denmark)

    Friborg, Rune Møllegaard; Vinter, Brian; Bjørndalen, John Markus

    Producing readable and correct programs while at the same time taking advantage of multi-core architectures is a challenge. PyCSP is an implementation of Communicating Sequential Processes algebra (CSP) for the Python programming language, taking advantage of CSP’s formal and verifiable approach...... to controlling concurrency and the readability of Python source code. We describe PyCSP, demonstrate it through examples and demonstrate how PyCSP compares to Pthreads using a benchmark....

  10. PyCSP - controlled concurrency

    DEFF Research Database (Denmark)

    Vinter, Brian; Friborg, Rune Møllegaard; Bjørndalen, John Markus

    2010-01-01

    Producing readable and correct programs while at the same time taking advantage of multi-core architectures is a challenge. PyCSP is an implementation of Communicating Sequential Processes algebra (CSP) for the Python programming language, that take advantage of CSP's formal and verifiable approach...... to controlling concurrency and the readability of Python source code. We describe PyCSP, demonstrate it through examples and demonstrate how PyCSP compares to Pthreads in a master-worker benchmark....

  11. The Effect of Specific Sling Exercises on the Functional Movement Screen Score in Adolescent Volleyball Players: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Linek Paweł

    2016-12-01

    Full Text Available The existing data indicate that the result of the Functional Movement Screen (FMS test influences the likelihood of subsequent injury in professional athletes. Therefore, exercises increasing test scores of the FMS may be useful at various stages of sports activity. This study evaluated the effects of the NEURAC sling exercises method on the FMS test score in teenage volleyball players. The study was conducted on 15 volleyball players aged 14 years. The FMS test was performed three times interspersed with a two-month interval. Between the first and the second assessment, neither additional treatment nor training was applied, while between the second and the third assessment, the participants performed stabilisation exercises based on the NEURAC method. Training was carried out twice a week, for eight weeks. The analysis showed that between the first and the second measurement, no significant differences occurred. The use of specific sling exercises caused a significant improvement in FMS results (p ≤ 0.01 between the first and the third, as well as the second and the third measurement. The applied stabilisation exercises based on the NEURAC method positively influenced the FMS test result in male subjects practicing volleyball. Performance of such exercises also resulted in more than 90% of the subjects having a total FMS test score ≥ 17, which may be important in the prevention of injuries. The preliminary results indicate that this type of exercise should be included in a teenage volleyball training routine.

  12. Effects of various gait speeds on the latissimus dorsi and gluteus maximus muscles associated with the posterior oblique sling system.

    Science.gov (United States)

    Shin, Seung-Je; Kim, Tae-Young; Yoo, Won-Gyu

    2013-11-01

    [Purpose] This study investigated the effect of different gait speeds on the muscle activities of the latissimus dorsi and gluteus maximus muscles in relation to the posterior oblique sling system. [Subjects] We recruited 14 young adult males. [Methods] We measured the left latissimus dorsi muscle activity and right gluteus maximus muscle activity of all subjects while they walked on a treadmill at speeds of 1.5 km/h, 3.5 km/h and 5.5 km/h. [Results] There was a significant increase in latissimus dorsi muscle activity with a treadmill speed of 5.5 km/h compared with 1.5 km/h and 3.5 km/h. The gluteus maximus muscle activity significantly increased in the order of 1.5 km/h < 3.5 km/h < 5.5 km/h. [Conclusion] The present results indicate that arm swing connected to increasing gait speed influences the muscle activity of the lower limbs through the posterior oblique sling system.

  13. Concurrent interstitial ectopic pregnancy and appendicitis: a case report.

    Science.gov (United States)

    Biggs, R Lee; Magann, Everett F; O'Boyle, John D

    2008-05-01

    Concurrent ectopic pregnancy and acute appendicitis is rarely encountered. Since 1960, only 22 cases have been reported. No case of concurrent interstitial ectopic pregnancy and appendicitis has ever been reported. A 24-year-old, African American woman, gravida 4, para 3, had a right interstitial ectopic pregnancy. She was managed as an inpatient with parenteral methotrexate and her beta-human chorionic gonadotropin level decreased appropriately. She was discharged 3 days after treatment but subsequently returned with right lower quadrant pain, nausea, vomiting and fever. The patient underwent laparoscopy with removal of a suppurative appendix. A stable interstitial ectopic pregnancy was visualized and left in situ. The discipline to consider concomitant abdominal pathology is paramount. The perceived rarity of an ectopic pregnancy and appendicitis should not obscure a thorough clinical evaluation.

  14. Generalized coherence concurrence and path distinguishability

    International Nuclear Information System (INIS)

    Chin, Seungbeom

    2017-01-01

    We propose a new family of coherence monotones, named the generalized coherence concurrence (or coherence k -concurrence), which is an analogous concept to the generalized entanglement concurrence. The coherence k -concurrence of a state is nonzero if and only if the coherence number (a recently introduced discrete coherence monotone) of the state is not smaller than k , and a state can be converted to a state with nonzero entanglement k -concurrence via incoherent operations if and only if the state has nonzero coherence k -concurrence. We apply the coherence concurrence family to the problem of wave-particle duality in multi-path interference phenomena. We obtain a sharper equation for path distinguishability (which witnesses the duality) than the known one and show that the amount of each concurrence for the quanton state determines the number of slits which are identified unambiguously. (paper)

  15. Generalized coherence concurrence and path distinguishability

    Science.gov (United States)

    Chin, Seungbeom

    2017-11-01

    We propose a new family of coherence monotones, named the generalized coherence concurrence (or coherence k-concurrence), which is an analogous concept to the generalized entanglement concurrence. The coherence k-concurrence of a state is nonzero if and only if the coherence number (a recently introduced discrete coherence monotone) of the state is not smaller than k, and a state can be converted to a state with nonzero entanglement k-concurrence via incoherent operations if and only if the state has nonzero coherence k-concurrence. We apply the coherence concurrence family to the problem of wave-particle duality in multi-path interference phenomena. We obtain a sharper equation for path distinguishability (which witnesses the duality) than the known one and show that the amount of each concurrence for the quanton state determines the number of slits which are identified unambiguously.

  16. The effects of stabilization exercises using a sling and stretching on the range of motion and cervical alignment of straight neck patients.

    Science.gov (United States)

    Oh, Seung-Hyean; Yoo, Kyung-Tae

    2016-01-01

    [Purpose] The purpose of this study was to assess how stretching exercise training and sling exercise training for stabilization influences the cervical spine angles and cervical range of motion of straight neck patients. [Subjects and Methods] Twenty straight neck patients were selected as subjects and they were randomly divided into two groups, the stretching and sling stabilization exercise groups which 60 minutes of exercise three times a week for 6weeks. All the subjects in each of the two respective study groups received an X-ray and had their cervical range of motion measured, both before and after the exercise. [Results] When differences in the cervical spine angle between the pre- and the post-test were checked, it was found that only the stretching exercise group showed statistically significant decreases in the craniovertebral angle and the cranial rotation angle. When differences in the range of motion between pre- and post-test were checked, the sling stabilization exercise group showed a significant change in flexion, right rotation, left lateral bending, right lateral bending, and the stretching exercise group showed a significant change in left rotation, left lateral bending, and right lateral bending. [Conclusion] These results indicate that both types of exercises are effective at improving the cervical range of motion of straight neck patients, and that the stretching exercise was more effective than the sling stabilization exercise at improving cervical spine angles.

  17. Effect of core muscle thickness and static or dynamic balance on prone bridge exercise with sling by shoulder joint angle in healthy adults.

    Science.gov (United States)

    Park, Mi Hwa; Yu, Jae Ho; Hong, Ji Heon; Kim, Jin Seop; Jung, Sang Woo; Lee, Dong Yeop

    2016-03-01

    [Purpose] To date, core muscle activity detected using ultrasonography during prone bridge exercises has not been reported. Here we investigated the effects of core muscle thickness and balance on sling exercise efficacy by shoulder joint angle in healthy individuals. [Subjects and Methods] Forty-three healthy university students were enrolled in this study. Ultrasonography thickness of external oblique, internal oblique, and transversus abdominis during sling workouts was investigated. Muscle thickness was measured on ultrasonography imaging before and after the experiment. Dynamic balance was tested using a functional reaching test. Static balance was tested using a Tetrax Interactive Balance System. [Results] Different muscle thicknesses were observed during the prone bridge exercise with the shoulder flexed at 60°, 90° or 120°. Shoulder flexion at 60° and 90° in the prone bridge exercise with a sling generated the greatest thickness of most transversus abdominis muscles. Shoulder flexion at 120° in the prone bridge exercise with a sling generated the greatest thickness of most external oblique muscles. [Conclusion] The results suggest that the prone bridge exercise with shoulder joint angle is an effective method of increasing global and local muscle strength.

  18. [A comparative study between two procedures of TVT retropubic mid-urethral sling placement for treatment of female stress urinary incontinence].

    Science.gov (United States)

    Sergent, F; Gay-Crosier, G; Resch, B; Pons, J-C; Marpeau, L

    2014-03-01

    To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (P<0.05), those of reoperations for pulling the sling downward 11.1% and 1.5% (P<0.05). A 1 year and more, healing and satisfaction rates were respectively 83.3% and 79.2% for the standard TVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (P<0.05). By modifying the placement of the classic TVT, it is possible to reduce its complications while maintaining its efficacy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Concurrent chemoradiation for vaginal cancer.

    Directory of Open Access Journals (Sweden)

    David T Miyamoto

    Full Text Available BACKGROUND: It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT or concurrent chemoradiation therapy (CRT. METHODS: Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS and disease-free survival (DFS rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. RESULTS: The median age at diagnosis was 61 years (range, 18-92 years and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011. Twenty-three patients (45% in the RT group had a relapse at any site compared to 3 (15% in the CRT group (p = 0.027. With regard to the sites of first relapse, 10 patients (14% had local only, 4 (6% had local and regional, 9 (13% had regional only, 1 (1% had regional and distant, and 2 (3% had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10-0.97; p = 0.04. CONCLUSIONS: Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.

  20. Concurrence classes for general pure multipartite states

    International Nuclear Information System (INIS)

    Heydari, Hoshang

    2005-01-01

    We propose concurrence classes for general pure multipartite states based on an orthogonal complement of a positive operator-valued measure on quantum phase. In particular, we construct W m class, GHZ m , and GHZ m-1 class concurrences for general pure m-partite states. We give explicit expressions for W 3 and GHZ 3 class concurrences for general pure three-partite states and for W 4 , GHZ 4 and GHZ 3 class concurrences for general pure four-partite states

  1. 78 FR 41078 - Acceptance of Concurrent Jurisdiction

    Science.gov (United States)

    2013-07-09

    ... National Park Service Acceptance of Concurrent Jurisdiction AGENCY: National Park Service, Interior. ACTION: Notice of Concurrent Jurisdiction. SUMMARY: On behalf of the United States, the National Park Service has accepted concurrent legislative jurisdiction from the State of Michigan over lands and waters administered...

  2. 78 FR 8189 - Acceptance of Concurrent Jurisdiction

    Science.gov (United States)

    2013-02-05

    ... National Park Service Acceptance of Concurrent Jurisdiction AGENCY: National Park Service, Interior. ACTION: Notice of Concurrent Jurisdiction. SUMMARY: On behalf of the United States, the National Park Service has accepted concurrent legislative jurisdiction from the State of Washington over lands and waters...

  3. Simple concurrent garbage collection almost without synchronization

    NARCIS (Netherlands)

    Hesselink, Wim H.; Lali, M.I.

    We present two simple mark and sweep algorithms, A and B, for concurrent garbage collection by a single collector running concurrently with a number of mutators that concurrently modify shared data. Both algorithms are based on the ideas of Ben-Ari's classical algorithm for on-the-fly garbage

  4. TVT-Secur (Hammock) versus TVT-Obturator: a randomized trial of suburethral sling operative procedures.

    Science.gov (United States)

    Hota, Lekha S; Hanaway, Katherine; Hacker, Michele R; Disciullo, Anthony; Elkadry, Eman; Dramitinos, Patricia; Shapiro, Alexander; Ferzandi, Tanaz; Rosenblatt, Peter L

    2012-01-01

    This study aimed to compare TVT-Secur (TVT-S) and TVT-Obturator (TVT-O) suburethral slings for treatment of stress urinary incontinence (SUI). This was a single-center, nonblinded, randomized trial of women with SUI who were randomized to TVT-S or TVT-O from May 2007 to April 2009. The primary outcome, SUI on cough stress test (CST), and quality-of-life and symptom questionnaires (Pelvic Floor Distress Inventory [PFDI-20] and Pelvic Floor Impact Questionnaire [PFIQ-7]) were assessed at 12 weeks and 1 year. Forty-three women were randomized to TVT-S and 44 to TVT-O. There were no differences in median baseline PFDI-20 and PFIQ-7. Twenty-two (52.4%) of 42 participants randomized to TVT-S had a positive CST result at evaluation after 12 weeks or 1 year, whereas 4 (9.1%) of the 44 in the TVT-O group had a positive CST result. The intent-to-treat analysis showed that the risk of a positive CST result was 6 times higher after TVT-S than TVT-O (risk ratio, 6.0; 95% confidence interval [CI], 2.3-16.0). Among women not lost to follow-up, the risk ratio for a positive CST result after TVT-S compared with TVT-O was 17.9 (95% CI, 2.5-128.0) at 12 weeks and 3.5 (95% CI, 1.1-11.0) at 1 year. Both TVT-S and TVT-O resulted in improved quality of life and symptoms at 12 weeks. There was no difference between the groups for PFDI-20 (P = 0.40) or PFIQ-7 (P = 0.43). A similar pattern was seen at 1 year (P = 0.85 and P = 0.36). The TVT-S seems to have a higher risk of positive postoperative CST result; however, the procedures result in similar improvements in quality of life and symptoms.

  5. The SIMS trial: adjustable anchored single-incision mini-slings versus standard tension-free midurethral slings in the surgical management of female stress urinary incontinence. A study protocol for a pragmatic, multicentre, non-inferiority randomised controlled trial

    Science.gov (United States)

    Abdel-Fattah, Mohamed; MacLennan, Graeme; Kilonzo, Mary; Assassa, R Phil; McCormick, Kirsty; Davidson, Tracey; McDonald, Alison; N’Dow, James; Wardle, Judith; Norrie, John

    2017-01-01

    Introduction Single-incision mini-slings (SIMS) represent the third generation of midurethral slings. They have been developed with the aim of offering a true ambulatory procedure for treatment of female stress urinary incontinence (SUI) with reduced morbidity and earlier recovery while maintaining similar efficacy to standard midurethral slings (SMUS). The aim of this study is to determine the clinical and cost-effectiveness of adjustable anchored SIMS compared with tension-free SMUS in the surgical management of female SUI, with 3-year follow-up. Methods and analysis A pragmatic, multicentre, non-inferiority randomised controlled trial. Primary outcome measure The primary outcome measure is the patient-reported success rate measured by the Patient Global Impression of Improvement at 12 months. The primary economic outcome will be incremental cost per quality-adjusted life year gained at 12 months. Secondary outcome measures The secondary outcomes measures include adverse events, objective success rates, impact on other lower urinary tract symptoms, health-related quality of life profile and sexual function, and reoperation rates for SUI. Secondary economic outcomes include National Health Service and patient primary and secondary care resource use and costs, incremental cost-effectiveness and incremental net benefit. Statistical analysis The statistical analysis of the primary outcome will be by intention-to-treat and also a per-protocol analysis. Results will be displayed as estimates and 95% CIs. CIs around observed differences will then be compared with the prespecified non-inferiority margin. Secondary outcomes will be analysed similarly. Ethics and dissemination The North of Scotland Research Ethics Committee has approved this study (13/NS/0143). The dissemination plans include HTA monograph, presentation at international scientific meetings and publications in high-impact, open-access journals. The results will be included in the updates of the National

  6. Late health effects of radiation for eustachian tube dysfunction : a non-concurrent prospective study

    NARCIS (Netherlands)

    P.G. Verduijn

    1988-01-01

    textabstractThe present study is a non-concurrent prospective cohort study on the risks of the Crowe therapy in 2,542 subjects who underwent this treatment compared to 2,380 - similar - non-irradiated control subjects. The study population consisted of patients from five Dutch ENT clinics. The

  7. Concurrent ultrasonic weld evaluation system

    Science.gov (United States)

    Hood, Donald W.; Johnson, John A.; Smartt, Herschel B.

    1987-01-01

    A system for concurrent, non-destructive evaluation of partially completed welds for use in conjunction with an automated welder. The system utilizes real time, automated ultrasonic inspection of a welding operation as the welds are being made by providing a transducer which follows a short distance behind the welding head. Reflected ultrasonic signals are analyzed utilizing computer based digital pattern recognition techniques to discriminate between good and flawed welds on a pass by pass basis. The system also distinguishes between types of weld flaws.

  8. A Model for Concurrent Objects

    DEFF Research Database (Denmark)

    Sørensen, Morten U.

    1996-01-01

    We present a model for concurrent objects where obejcts interact by taking part in common events that are closely matched to form call-response pairs, resulting in resulting in rendez-vous like communications. Objects are built from primitive objects by parallel composition, encapsulation and hid...... and hiding. The behavour of a composite object is straightforwardly derived from the behavour of the constituent objects. Defining refinement as a strengthened form of trace inclusion, object composition and refinement togehter form a basis for step-wise development....

  9. Swallowing rehabilitation before and during concurrent chemoradiotherapy for oropharyngeal cancer

    International Nuclear Information System (INIS)

    Tsuneyuki, Miki; Yonezawa, Kouichiro; Morimoto, Koichi; Tanimoto, Hitoshi; Saito, Miki; Otsuki, Naoki; Nibu, Ken-ichi

    2011-01-01

    Recently, oropharyngeal cancer is more frequently being managed with concurrent chemoradiotherapy (CCRT). As more patients receive CCRT, there is increasing attention on dysphagia. Since 2009, speech therapists in our hospital have performed swallowing rehabilitation for dysphagia associated with CCRT. We evaluated dysphagia after CCRT and examined the relationship between swallowing rehabilitation and swallowing disability. A total of 26 patients (22 males and 4 females) with a mean age of 63 years (range, 41 to 79), underwent CCRT between March 2008 and March 2010. Dysphagia after treatment was graded at the end of CCRT and discharge according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 and Fujishima dysphagia grade. Ten of the 26 patients underwent swallowing rehabilitation, exercise and education on muscle strengthening programs before and during CCRT. They tended not to have severe dysphagia, but there were no significant differences. (author)

  10. A randomised controlled trial comparing TVT, Pelvicol and autologous fascial slings for the treatment of stress urinary incontinence in women.

    Science.gov (United States)

    Guerrero, K L; Emery, S J; Wareham, K; Ismail, S; Watkins, A; Lucas, M G

    2010-11-01

    To compare TVT(TM) , Pelvicol(TM) and autologous fascial slings (AFSs). A multicentre randomised control trial. Four units in the UK. Women requiring primary surgery for stress urinary incontinence (SUI). A total of 201 women with urodynamically proven stress incontinence were randomised into three groups and assessed at baseline, 6 weeks, 6 months and 1 year. The primary outcome was patient-reported improvement rates. Secondary outcomes included operative complications/time, intermittent self-catheterisation (ISC) and re-operation rates. The quality-of-life tools used were the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL. Fifty women had a Pelvicol(TM) sling, 79 had AFSs and 72 had TVT(TM). At 6 months the Pelvicol(TM) arm had poorer improvement rates (73%) than TVT(TM) (92%)/AFS (95%); P=0.003. At 1 year only 61% of the Pelvicol(TM) slings remained as improved, versus 93% of TVTs and 90% of AFSs (PTVT(TM) (55%)/AFS (48%) (P=0.001) at 1 year; hence, the Pelvicol(TM) arm was suspended following interim analysis. There is no difference in the success rates between TVT(TM) and AFS. One in five women in the Pelvicol(TM) arm had further surgery for SUI by 1 year, but none required further surgery in the other arms. AFS took longer to do (54 minutes versus 35 minutes for TVT(TM) /36 minutes for Pelvicol(TM) ) and had higher ISC rates (9.9 versus 0% Pelvicol(TM) /TVT(TM) 1.5%). Hospital stay was shortest for TVT(TM) (2 days). Most BFLUTS domains showed improvement in all three arms. The improvement for women in the Pelvicol(TM) arm, however, was less than for women in the other arms in several key domains. Pelvicol(TM) cannot be recommended for the management of SUI. TVT(TM) does not have greater efficacy than AFS, but does utilise fewer resources. © 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

  11. The somatic and autonomic innervation of the clitoris; preliminary evidence of sexual dysfunction after minimally invasive slings.

    Science.gov (United States)

    Bekker, Milou D; Hogewoning, Cornelis R C; Wallner, Chris; Elzevier, Henk W; DeRuiter, Marco C

    2012-06-01

    Vaginal sling procedures may have a negative effect on sexual function due to damage to vascular and/or neural genital structures. Even though autonomic innervation of the clitoris plays an important role in female sexual function, most studies on the neuroanatomy of the clitoris focus on the sensory function of the dorsal nerve of the clitoris (DNC). The autonomic and somatic pathways in relationship to sling surgery have up to the present not been described in detail. The aim of this study is to reinvestigate and describe the neuroanatomy of the clitoris, both somatic and autonomic, in relation to vaginal sling procedures for stress urinary incontinence. Serially sectioned and histochemically stained pelves from 11 female fetuses (10-27 weeks of gestation) were studied, and three-dimensional reconstructions of the neuroanatomy of the clitoris were prepared. Fourteen adult female hemipelves were dissected, after a tension-free vaginal tape (TVT) (7) or tension-free vaginal tape-obturator (TVT-O) (7) procedure had been performed. Three-dimensional (3-D) reconstruction and measured distance between the clitoral nerve systems and TVT/TVT-O. The DNC originates from the pudendal nerve in the Alcock's canal and ascends to the clitoral bodies. In the dissected adult pelves, the distance of the TVT-O to the DNC had a mean of 9 mm. The cavernous nerves originate from the vaginal nervous plexus and travel the 5 and 7 o'clock positions along the urethra. There, the autonomic nerves were found to be pierced by the TVT needle. At the hilum of the clitoral bodies, the branches of the cavernous nerves medially pass/cross the DNC and travel further alongside it. Just before hooking over the glans of the clitoris, they merge with DNC. The DNC is located inferior of the pubic ramus and was not disturbed during the placement of the TVT-O. However, the autonomic innervation of the vaginal wall was disrupted by the TVT procedure, which could lead to altered lubrication

  12. Patients survey after concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Shimane, Toshikazku; Egawa, Syunya; Mori, Tomoaki; Ono, Tomohiro; Monden, Tetsuya; Kobayashi, Sei; Sanbe, Takeyuki; Suzaki, Harumi

    2010-01-01

    Concurrent chemoradiotherapy for cancer of head and neck is becoming more popular as the treatment of choice. It is considered to maintain the quality of life (QOL) of patients better than operative treatments in terms of preserving the functions, organs, and figure, but recently we cannot necessarily say that it maintains the QOL of patients better than operative treatments because its complications after therapy disturb daily life. We report the results of a questionnaire survey about complications after therapy, problems during therapy, improvements, and satisfaction level directed at patients with cancer of the head and neck who received Concurrent chemoradiotherapy for the purpose of ascertaining if patients can actually maintain their QOL after therapy. As a result, the most controversial problem was mouth dryness, but the symptom improved as the follow-up duration got longer. As for the satisfaction level, 'very-satisfied' and 'almost-satisfied' were more than 90%, so we concluded that the QOL of patients is maintained after therapy, while there are still improvements to be made. We also concluded that we should continue to make improvement and try to improve the QOL of patients during and after therapy. (author)

  13. Concurrency at work with Go

    CERN Document Server

    CERN. Geneva

    2017-01-01

    High Energy and Nuclear Physics (HENP) libraries are now required to be increasingly multi-thread-safe, if not multi-thread-friendly and multi-threaded. This is usually done using the new constructs and library components offered by the C++11 and C++14 standards. These components are however quite low-level (threads, mutexes, locks, ...) and hard to use and compose, or easy to misuse. However, Go -- a somewhat new language -- provides a set of better building blocks for tackling concurrency: goroutines and channels. This language is now used by the cloud industry at large; docker/moby, rkt, Kubernetes, OpenShift, etc... are obvious flagships for Go. It is also used in other interesting places like SpaceX's telemetry monitoring system and in the New York Times', YouTube's or Disney's content delivery infrastructures. In this talk, we will describe the building blocks of Go and see how they are combined to easily create concurrent programs that grow with grace, are fast to compile and deploy, but also easy to...

  14. Predictive factors that influence treatment outcomes of innovative single incision sling: comparing TVT-Secur to an established transobturator sling for female stress urinary incontinence.

    Science.gov (United States)

    Hwang, Eugene; Shin, Ju Hyun; Lim, Jae Sung; Song, Ki Hak; Sul, Chong Koo; Na, Yong Gil

    2012-07-01

    This study aims to identify independent risk factors for treatment failure of tension-free vaginal tape TVT-Secur (TVT-S) compared to that of the well-established transobturator tape. Of a total of 175 consecutive patients with urodynamically confirmed stress urinary incontinence (SUI) identified between July 2007 and March 2010, 89 patients underwent TVT-S, and 86 underwent TOT. Cure was defined using the Urogenital Distress Inventory as no urinary leakage during physical activity, coughing, or sneezing as reported by patients during a telephone survey. To identify predictors of treatment failure, multivariable logistic regression models were used, and odds ratios (ORs) were calculated using variables identified during univariate analysis. There were more patients with cystocele ≥ grade 2 in the TVT-S group (p = 0.031); otherwise the groups were well matched. After a median follow-up of 32 months (range, 12-44 months), the overall cure rate was 80.6%; it was 70.8% for those treated with TVT-S and 90.7% for those treated with TOT (p = 0.001). In a multivariate model, previous incontinence surgery (OR 27.1, p = 0.005) and a cystocele ≥ grade 2 (OR 3.0, p = 0.020) were independent risk factors influencing the outcome of TVT-S procedures. For the TOT procedures, detrusor overactivity was an independent risk factor in a multivariate model (OR 8.6, p = 0.033). TVT-S could be performed for selected patients, but conventional TOT procedures are still superior to the novel TVT-S device.

  15. Concurrent chemotherapy with intensity-modulated radiation therapy for locally advanced squamous cell carcinoma of the larynx and oropharynx: A retrospective single-institution analysis

    NARCIS (Netherlands)

    N.F. Saba (Nabil); D.J. Edelman (David); M. Tighiouart (Mourad); J.G. Gaultney (Jennifer G.); L.W. Davis (Lawrence); F.R. Khuri (Fadlo); A. Chen (Amy); S. Grist (Scott); D.M. Shin (Dong)

    2009-01-01

    textabstractBackground. We present outcome data from concurrent chemotherapy and intensity-modulated radiation therapy (IMRT) for squamous cell carcinoma (SCC) of the larynx and oropharyx. Methods. Eighty patients with laryngeal (n = 15) or oropharyngeal (n = 65) SCC underwent concurrent IMRT and

  16. Horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of upper lobe bronchi

    International Nuclear Information System (INIS)

    Oguz, Berna; Haliloglu, Mithat; Alan, Serdar; Ozcelik, Ugur

    2009-01-01

    Horseshoe lung, a rare congenital anomaly, is almost always associated with unilateral (usually right-sided) lung hypoplasia, and, in most cases, in conjunction with the scimitar syndrome. We present an 8-month-old boy with horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of the upper lobe bronchi, diagnosed by multidetector CT (MDCT) imaging. The study also revealed an anomalous origin of the left vertebral artery as the last branch of the aortic arch, distal to the left subclavian artery, and an anomalous origin of the left common carotid artery from the brachiocephalic trunk. A hemivertebral anomaly of the seventh cervical vertebra was incidentally detected. MDCT with high-quality multiplanar and three-dimensional reconstructions is a noninvasive and rapid technique for detecting the complex combination of vascular, tracheobronchial and parenchymal anomalies, and any potential bone anomalies, in one imaging study. (orig.)

  17. Horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of upper lobe bronchi

    Energy Technology Data Exchange (ETDEWEB)

    Oguz, Berna; Haliloglu, Mithat [Hacettepe University Faculty of Medicine, Department of Radiology, Ankara (Turkey); Alan, Serdar; Ozcelik, Ugur [Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara (Turkey)

    2009-09-15

    Horseshoe lung, a rare congenital anomaly, is almost always associated with unilateral (usually right-sided) lung hypoplasia, and, in most cases, in conjunction with the scimitar syndrome. We present an 8-month-old boy with horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of the upper lobe bronchi, diagnosed by multidetector CT (MDCT) imaging. The study also revealed an anomalous origin of the left vertebral artery as the last branch of the aortic arch, distal to the left subclavian artery, and an anomalous origin of the left common carotid artery from the brachiocephalic trunk. A hemivertebral anomaly of the seventh cervical vertebra was incidentally detected. MDCT with high-quality multiplanar and three-dimensional reconstructions is a noninvasive and rapid technique for detecting the complex combination of vascular, tracheobronchial and parenchymal anomalies, and any potential bone anomalies, in one imaging study. (orig.)

  18. Evaluating single-incision slings in female stress urinary incontinence: the usefulness of the CONSORT statement criteria.

    Science.gov (United States)

    Diallo, Stéphanie; Cour, Florence; Josephson, Anne; Vidart, Adrien; Botto, Henri; Lebret, Thierry; Bonan, Brigitte

    2012-09-01

    To evaluate the usefulness and applicability of the Consolidated Standards of Reporting Trials (CONSORT) for journal articles reporting randomized, controlled trials evaluating single-incision slings in the treatment of female stress urinary incontinence. Original articles reporting randomized, controlled trials assessing single-incision slings in the treatment of female stress urinary incontinence were searched for in the PubMed and Embase databases in 2011. Reporting quality was studied by 2 hospital pharmacists and 2 urologic surgeons. Primary outcome was the score out of 20 in the abstract CONSORT checklist. Secondary outcomes were the scores in the standard CONSORT checklist and the extension CONSORT additional items for trials assessing nonpharmacologic treatments. Among 135 articles retrieved, 8 met the inclusion criteria and were assessed. Abstract scores ranged from 4.7-14.1. Standard scores were >10.0 out of 20 for most articles; the extension scores did not exceed 5.0 out of 10. Four reported trials were not identified as randomized in the title. The interventions were incompletely reported. Four articles reported whether blinding was achieved but lack of blinding was never discussed as a potential source of bias. Few articles reported the operators and centers characteristics and their impact on statistical analysis. The combination of the 3 checklists was considered a useful guideline to enhance and assess the reporting quality of a surgical trial. Our results support the further use of CONSORT criteria as a basic standardized tool in all stages of clinical evaluation for any prosthetic device in female pelvic surgery. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Intraoperative maximal urethral closing pressure measurement: a new technique of tape tension adjustment in transobturator sling surgery?

    Directory of Open Access Journals (Sweden)

    Myung Beum Kang

    2011-12-01

    Full Text Available PURPOSE: Tape tension adjustment is an essential procedure in mid-urethral sling surgery. The goal of this study was to determine if intraoperative maximal urethral closing pressure (MUCP elevation could be used as a reference value for adequate tape tension adjustment and predict transobturator (TOT sling surgery outcome. MATERIALS AND METHODS: A prospective study was performed using MUCP measurements just before tape insertion and just after tension adjustment during surgery. Clinical data including preoperative urodynamic results were collected. The cure rate was determined by questionnaire. Patients were divided into two groups. The MUCP elevation group included patients with a MUCP elevation of more than 10 cmH2O before tape insertion; the others were regarded as the non-elevation group. The cure rate and pre- and postoperative clinical variables were compared between the two groups. RESULTS: A total of 48 patients had TOT surgery. The MUCP elevation group (n=19 and the non-elevation group (n=29 were similar with regard to patient characteristics and the preoperative parameters including age, mixed incontinence prevalence, Q-tip angle, peak flow rate, MUCP and the valsalva leak point pressure (VLPP. The mean follow-up period was nine months. The cure rate was significantly higher in the group with MUCP elevation than in the non-elevation group (84% vs. 52%, p=0.02. There was no significant difference in the mean postoperative peak flow rate between the two groups and there was no retention episode. CONCLUSIONS: MUCP elevation of more than 10 cmH2O just after tape insertion was a prognostic factor.

  20. Long-term outcomes of I-Stop TOMS™ male sling implantation for post-prostatectomy incontinence management.

    Science.gov (United States)

    Malval, B; Rebibo, J-D; Baron, M; Nouhaud, F-X; Pfister, C; Cornu, J-N; Grise, P

    2017-12-01

    To report long-term outcomes after I-Stop TOMS™ implantation for PPI. A retrospective evaluation was conducted in three tertiary reference centers. All consecutive patients implanted with an I-Stop TOMS™ sling between 2007 and 2012 for mild to moderate PPI (24-hour Pad test<400g) without history of pelvic radiation therapy were included. Evaluation had been conducted preoperatively, at one and six months postoperative and yearly thereafter. The main outcome criterion was the number of pads per day. Secondary criteria were International Consultation on Incontinence Questionnaire (ICIQ), SF-36 questionnaire, and complications. A hundred patients were evaluated with a median follow-up of 58months [19-78]. Pad use was significantly reduced and quality of life improved at last follow-up (P<0.0001). The percentage of patients dry and socially continent (0 or 1 pad) were 40% and 77% at 1 year, then dropped to 15% and 22%, respectively after 5years. Twelve patients were treated by artificial urinary sphincter implantation, five by ProACT™ balloons and one by a re-do I-Stop TOMS™. No severe complications were recorded at last follow-up. I-Stop TOMS™ implantation is a safe and effective option in the short-term for mild to moderate PPI management. However, a significant trend to recurrence of leakage has been established after long-term follow-up. If confirmed by further studies, these results may substantially impact patient information before male sling implantation. 4. Copyright © 2017. Published by Elsevier Masson SAS.

  1. [Adjustable retropubic suburethral sling Remeex®in the treatment of male stress urinary incontinence: One-year results].

    Science.gov (United States)

    Leizour, B; Chevrot, A; Wagner, L; Droupy, S; Costa, P

    2017-03-01

    To evaluate the efficacy and safety of the adjustable suburethral sling Remeex ® in the treatment of male stress urinary incontinence (SUI). Single-center prospective study of patients treated for SUI after radical prostatectomy or transurethral resection of prostate. The severity of incontinence was evaluated by the number of pads used per day. Success rate, complications and number of adjustments were studied. From February 2011 to May 2015, Remeex ® was implanted in 25 patients. The average preoperative number of pads used per day was 3,8 (±1,8). Sling tension has been adjusted the day after surgery in all patients. Mean follow-up was 31 months (±15). During follow-up, 6 patients did not need any readjustment (24%) and 15 patients (60%) had to be readjusted. One Remeex system had to be completely removed because of a sub-occlusive syndrome. Three patients had early infection requiring partial system removal (Varitensor). At the end of follow-up, 9 patients were cured (36%), 9 patients (36%) were significantly improved and 7 patients (28%) were not improved. Five patients are waiting for a new readjustment. In this short series of patients who had prostatic surgery, at mid-term follow-up, the placement of a BSUA-R was associated with an improvement or cure of urinary incontinence symptoms in two-thirds of cases. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. Nutritional strategies to support concurrent training.

    Science.gov (United States)

    Perez-Schindler, Joaquin; Hamilton, D Lee; Moore, Daniel R; Baar, Keith; Philp, Andrew

    2015-01-01

    Concurrent training (the combination of endurance exercise to resistance training) is a common practice for athletes looking to maximise strength and endurance. Over 20 years ago, it was first observed that performing endurance exercise after resistance exercise could have detrimental effects on strength gains. At the cellular level, specific protein candidates have been suggested to mediate this training interference; however, at present, the physiological reason(s) behind the concurrent training effect remain largely unknown. Even less is known regarding the optimal nutritional strategies to support concurrent training and whether unique nutritional approaches are needed to support endurance and resistance exercise during concurrent training approaches. In this review, we will discuss the importance of protein supplementation for both endurance and resistance training adaptation and highlight additional nutritional strategies that may support concurrent training. Finally, we will attempt to synergise current understanding of the interaction between physiological responses and nutritional approaches into practical recommendations for concurrent training.

  3. Rain VM: Portable Concurrency through Managing Code

    OpenAIRE

    Brown, Neil C.C.

    2006-01-01

    A long-running recent trend in computer programming is the growth in popularity of virtual machines. However, few have included good support for concurrency - a natural mechanism in the Rain programming language. This paper details the design and implementation of a secure virtual machine with support for concurrency, which enables portability of concurrent programs. Possible implementation ideas of many-to-many threading models for the virtual machine kernel are discussed, and initial benchm...

  4. Flow Java: Declarative Concurrency for Java

    OpenAIRE

    Drejhammar, Frej

    2005-01-01

    This thesis presents the design, implementation, and evaluation of Flow Java, a programming language for the implementation of concurrent programs. Flow Java adds powerful programming abstractions for automatic synchronization of concurrent programs to Java. The abstractions added are single assignment variables (logic variables) and futures (read-only views of logic variables). The added abstractions conservatively extend Java with respect to types, parameter passing, and concurrency. Future...

  5. When to perform urodynamics before mid-urethral sling surgery for female stress urinary incontinence?

    NARCIS (Netherlands)

    Houwert, R.M.; Roovers, J.P.W.R.; Venema, P.L.; Bruinse, H.W.; Dijkgraaf, M.G.W.; Vervest, H.A.M.

    2010-01-01

    INTRODUCTION AND HYPOTHESIS: Development of a model that can predict in which group of women pre-operative urodynamics can be safely omitted. METHODS: Three hundred and eighty-one uncomplicated women who underwent pre-operative urodynamics were evaluated. A multivariate logistic regression model was

  6. Concurrence of three Jaynes-Cummings systems

    Science.gov (United States)

    Qiang, Wen-Chao; Sun, Guo-Hua; Dong, Qian; Camacho-Nieto, Oscar; Dong, Shi-Hai

    2018-04-01

    We apply genuine multipartite concurrence to investigate entanglement properties of three Jaynes-Cummings systems. Three atoms are initially put in GHZ-like state and locally interact with three independent cavities, respectively. We present analytical concurrence expressions for various subsystems including three-atom, three-cavity and some atom-cavity mixed systems. We also examine the global system and illustrate the evolution of its concurrence. Except for the sudden death of entanglement, we find for some initial entanglement parameter θ , the concurrence of the global system may maintain unchanged in some time intervals.

  7. Concurrent rendezvous control of underactuated spacecraft

    Science.gov (United States)

    Muralidharan, Vijay; Reza Emami, M.

    2017-09-01

    The concurrent control of spacecraft equipped with one-axis unilateral thruster and three-axis attitude actuator is considered in this paper. The proposed control law utilizes attitude control channels along with the single thrust force concurrently, for three-dimensional trajectory tracking and rendezvous with a target object. The concurrent controller also achieves orbital transfer to low Earth orbits with long range separation. To demonstrate the orbit transfer capabilities of the concurrent controller, a smooth elliptical orbit transfer trajectory for co-planar circular orbits is designed. The velocity change and energy consumption of the designed orbit transfer trajectory is observed to be equivalent to that of Hohmann transfer.

  8. Concurrent sexual partnerships among female sex workers and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico.

    Science.gov (United States)

    Robertson, Angela Marie; Syvertsen, Jennifer L; Rangel, M Gudelia; Staines, Hugo S; Morris, Martina; Patterson, Thomas L; Ulibarri, Monica D; Strathdee, Steffanie A

    2013-06-01

    To investigate the prevalence and correlates of concurrent (overlapping) sexual partnerships among female sex workers (FSWs) and their non-commercial male partners in two Mexico-US border cities. A cross-sectional survey of FSWs and their non-commercial male partners was conducted in Tijuana and Ciudad Juárez, Mexico (2010-2011). Eligible FSWs and verified non-commercial partners were aged ≥18 years; FSWs had ever used hard drugs (lifetime) and recently exchanged sex for money, drugs or other goods (past month). Participants underwent baseline questionnaires obtaining dates of sex and condom use with ≤5 other recurring partners, including FSWs' regular clients. These dates were compared with dates of sex with enrolled study partners to determine overlap (ie, 'recurring' concurrency). Bivariate probit regression identified recurring concurrency correlates. Among 428 individuals (214 couples), past-year recurring concurrency prevalence was 16% and was higher among women than their non-commercial male partners (26% vs 6%). In 10 couples (5%), both partners reported recurring concurrency. The majority of couples (64%) always had unprotected sex, and most of the individuals (70%) with recurring concurrency 'sometimes' or 'never' used condoms with their concurrent partners. Recurring concurrency was positively associated with FSWs' income, men's caballerismo (a form of traditional masculinity) and men's belief that their FSW partners had sexually transmitted infections (STIs). Recurring concurrency, representing sustained periods of overlapping partnerships in which unprotected sex was common, should be addressed by couple-based STI prevention interventions.

  9. Effects of 6-week sling-based training of the external-rotator muscles on the shoulder profile in elite female high school handball players.

    Science.gov (United States)

    Genevois, Cyril; Berthier, Philippe; Guidou, Vincent; Muller, Franck; Thiebault, Boris; Rogowski, Isabelle

    2014-11-01

    In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength. This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players. Crossover study. National elite handball training center. 25 elite female high school handball players. The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone. Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides. After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017). This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.

  10. The effects of performing a one-legged bridge with hip abduction and use of a sling on trunk and lower extremity muscle activation in healthy adults.

    Science.gov (United States)

    Choi, Kyuju; Bak, Jongwoo; Cho, Minkwon; Chung, Yijung

    2016-09-01

    [Purpose] This study investigated the changes in the muscle activities of the trunk and lower limbs of healthy adults during a one-legged bridge exercise using a sling, and with the addition of hip abduction. [Subjects and Methods] Twenty-seven healthy individuals participated in this study (14 males and 13 females). The participants were instructed to perform the bridge exercises under five different conditions. Trunk and lower limb muscle activation of the erector spinae (ES), external oblique (EO), gluteus maximus (GM), and biceps femoris (BF) was measured using surface electromyography. Data analysis was performed using the mean scores of three trials performed under each condition. [Results] There was a significant increase in bilateral EO and contralateral GM with the one-legged bridge compared with the one-legged bridge with sling exercise. Muscle activation of the ipsilateral GM and BF was significantly less during the one-legged bridge exercise compared to the one-legged bridge with sling exercise, and was significantly greater during the one-legged bridge with hip abduction compared to the one-legged bridge exercise. The muscle activation of the contralateral GM and BF was significantly greater with the one-legged bridge with hip abduction compared to the general bridge exercise. [Conclusion] With the one-legged bridge with hip abduction, the ipsilateral EO, GM and BF muscle activities were significantly greater than those of the one-legged bridge exercise. The muscle activation of all trunk and contralateral lower extremity muscles increased with the bridge with sling exercises compared with general bridge exercises.

  11. The effects of performing a one-legged bridge with hip abduction and use of a sling on trunk and lower extremity muscle activation in healthy adults

    OpenAIRE

    Choi, Kyuju; Bak, Jongwoo; Cho, Minkwon; Chung, Yijung

    2016-01-01

    [Purpose] This study investigated the changes in the muscle activities of the trunk and lower limbs of healthy adults during a one-legged bridge exercise using a sling, and with the addition of hip abduction. [Subjects and Methods] Twenty-seven healthy individuals participated in this study (14 males and 13 females). The participants were instructed to perform the bridge exercises under five different conditions. Trunk and lower limb muscle activation of the erector spinae (ES), external obli...

  12. New concurrent iterative methods with monotonic convergence

    Energy Technology Data Exchange (ETDEWEB)

    Yao, Qingchuan [Michigan State Univ., East Lansing, MI (United States)

    1996-12-31

    This paper proposes the new concurrent iterative methods without using any derivatives for finding all zeros of polynomials simultaneously. The new methods are of monotonic convergence for both simple and multiple real-zeros of polynomials and are quadratically convergent. The corresponding accelerated concurrent iterative methods are obtained too. The new methods are good candidates for the application in solving symmetric eigenproblems.

  13. Notes on Timed Concurrent Constraint Programming

    DEFF Research Database (Denmark)

    Nielsen, Mogens; Valencia, Frank D.

    2004-01-01

    A constraint is a piece of (partial) information on the values of the variables of a system. Concurrent constraint programming (ccp) is a model of concurrency in which agents (also called processes) interact by telling and asking information (constraints) to and from a shared store (a constraint...

  14. Effect of Concurrent Trypanosoma brucei Infection on ...

    African Journals Online (AJOL)

    The effect of concurrent Trypanosoma bruceiinfection on caprine haemonchosis was investigated in Red Sokoto (Maradi) goats infected with either Haemonchus contortus alone or concurrently with Trypanosoma brucei. The goats infected with H. contortus alone manifested clinical disease that was mild and without ...

  15. A Temporal Concurrent Constraint Programming Calculus

    DEFF Research Database (Denmark)

    Palamidessi, Catuscia; Valencia Posso, Frank Darwin

    2001-01-01

    The tcc model is a formalism for reactive concurrent constraint programming. In this paper we propose a model of temporal concurrent constraint programming which adds to tcc the capability of modeling asynchronous and non-deterministic timed behavior. We call this tcc extension the ntcc calculus...

  16. Ecological association between HIV and concurrency point ...

    African Journals Online (AJOL)

    Ecological association between HIV and concurrency point-prevalence in South Africa's ethnic groups. Chris Kenyon. Abstract. HIV prevalence between different ethnic groups within South Africa exhibits considerable variation. Numerous authors believe that elevated sexual partner concurrency rates are important in the ...

  17. Short- and Long-Term Effects of Concurrent Strength and HIIT Training in Octogenarians with COPD.

    Science.gov (United States)

    Guadalupe-Grau, Amelia; Aznar-Laín, Susana; Mañas, Asier; Castellanos, Juan; Alcázar, Julián; Ara, Ignacio; Mata, Esmeralda; Daimiel, Rosa; García-García, Francisco José

    2017-01-01

    To investigate the short- and long-term effects of concurrent strength and high-intensity interval training (HIIT) on octogenarian COPD patients, nine males (age = 84.2 ± 2.8 years, BMI = 29.3 ± 2.3) with low to severe COPD levels (2.1 ± 1.5 BODE index) underwent a supervised 9-week strength and HIIT exercise program. Training had a significant (p training-induced gains returned to their preintervention values except for the chest press 1RM (p concurrent strength and HIIT training increases physical fitness in the oldest-old COPD patients, and has potential long-term benefits.

  18. Effects of cross-education on the muscle after a period of unilateral limb immobilization using a shoulder sling and swathe.

    Science.gov (United States)

    Magnus, Charlene R A; Barss, Trevor S; Lanovaz, Joel L; Farthing, Jonathan P

    2010-12-01

    The purpose of this study was to apply cross-education during 4 wk of unilateral limb immobilization using a shoulder sling and swathe to investigate the effects on muscle strength, muscle size, and muscle activation. Twenty-five right-handed participants were assigned to one of three groups as follows: the Immob + Train group wore a sling and swathe and strength trained (n = 8), the Immob group wore a sling and swathe and did not strength train (n = 8), and the Control group received no treatment (n = 9). Immobilization was applied to the nondominant (left) arm. Strength training consisted of maximal isometric elbow flexion and extension of the dominant (right) arm 3 days/wk. Torque (dynamometer), muscle thickness (ultrasound), maximal voluntary activation (interpolated twitch), and electromyography (EMG) were measured. The change in right biceps and triceps brachii muscle thickness [7.0 ± 1.9 and 7.1 ± 2.2% (SE), respectively] was greater for Immob + Train than Immob (0.4 ± 1.2 and -1.9 ± 1.7%) and Control (0.8 ± 0.5 and 0.0 ± 1.1%, P effect on maximal voluntary activation or EMG. The cross-education effect on the immobilized limb was greater after elbow extension training. This study suggests that strength training the nonimmobilized limb benefits the immobilized limb for muscle size and strength.

  19. Pedicled rectus abdominis muscle and fascia flap sling the bulbar urethra for treatment for male-acquired urinary incontinence: report of ten cases.

    Science.gov (United States)

    Xu, Yue-Min; Zhang, Xin-Ru; Xie, Hong; Song, Lu-Jie; Feng, Chao; Fei, Xiao-Fang

    2014-03-01

    Male urinary incontinence is relatively common complication of radical prostatectomy and of posterior urethroplasty following traumatic pelvic fracture. Here, we investigate the use of pedicled rectus abdominis muscle and fascia flap sling of the bulbar urethra for treatment for male-acquired urinary incontinence. Ten patients with acquired urinary incontinence were included in the study. Urinary incontinence was secondary to TURP in three patients and was secondary to posterior urethroplasty performed following traumatic pelvic fracture in seven patients. Pedicled rectus abdominalis muscle and fascial flaps, approximately 2.5 cm wide and 15 cm long, were isolated. The flaps were inserted into a perineal incision through a subcutaneous tunnel. The free end of the flap was sectioned to form two muscle strips, each 3 cm in length, and inserted into the space between bulbar urethra and corpus cavernosa. After adequate sling tension had been achieved, the two strips of muscle were anastomosed around the bulbar urethra using a 2-zero polyglactin suture. The patients were followed up for between 12 and 82 months (mean 42.8 months). Complete continence was achieved with good voiding in seven of the 10 patients. In other three patients achieved good voiding following catheter removal, but incontinence was only moderately improved. A pedicled rectus muscle fascial sling of the bulbar urethra is an effective and safe treatment for male patients with mild to moderate acquired urinary incontinence, but it may not be suitable for severe incontinence or for patients with weak rectus abdominalis muscles.

  20. Multiparty Compatibility for Concurrent Objects

    Directory of Open Access Journals (Sweden)

    Roly Perera

    2016-06-01

    Full Text Available Objects and actors are communicating state machines, offering and consuming different services at different points in their lifecycle. Two complementary challenges arise when programming such systems. When objects interact, their state machines must be "compatible", so that services are requested only when they are available. Dually, when objects refine other objects, their state machines must be "compliant", so that services are honoured whenever they are promised. In this paper we show how the idea of multiparty compatibility from the session types literature can be applied to both of these problems. We present an untyped language in which concurrent objects are checked automatically for compatibility and compliance. For simple objects, checking can be exhaustive and has the feel of a type system. More complex objects can be partially validated via test cases, leading to a methodology closer to continuous testing. Our proof-of-concept implementation is limited in some important respects, but demonstrates the potential value of the approach and the relationship to existing software development practices.

  1. Between quantum logic and concurrency

    Directory of Open Access Journals (Sweden)

    Luca Bernardinello

    2014-07-01

    Full Text Available We start from two closure operators defined on the elements of a special kind of partially ordered sets, called causal nets. Causal nets are used to model histories of concurrent processes, recording occurrences of local states and of events. If every maximal chain (line of such a partially ordered set meets every maximal antichain (cut, then the two closure operators coincide, and generate a complete orthomodular lattice. In this paper we recall that, for any closed set in this lattice, every line meets either it or its orthocomplement in the lattice, and show that to any line, a two-valued state on the lattice can be associated. Starting from this result, we delineate a logical language whose formulas are interpreted over closed sets of a causal net, where every line induces an assignment of truth values to formulas. The resulting logic is non-classical; we show that maximal antichains in a causal net are associated to Boolean (hence "classical" substructures of the overall quantum logic.

  2. Correção da Incontinência Urinária de Esforço com Sling: Resultados Iniciais Stress Urinary Incontinence Correction with Sling: First Results

    Directory of Open Access Journals (Sweden)

    José Antônio M. Martins

    2000-06-01

    Full Text Available Objetivo: analisar os resultados cirúrgicos após slings com mucosa vaginal, realizados pelo setor de Uroginecologia e Cirurgia Vaginal da UNIFESP/EPM, no tratamento de mulheres incontinentes com hipermobilidade do colo vesical, que apresentam alto risco de falha cirúrgica para outras técnicas ou naquelas com defeito esfincteriano intrínseco e, ainda, recidivas cirúrgicas. Métodos: foram avaliadas 21 pacientes submetidas à cirurgia para correção de incontinência urinária pela técnica de sling vaginal, no período de dezembro de 1997 a fevereiro de 1999, com seguimento pós-operatório que variou de 1 a 14 meses (média de 8,2. A média de idade das pacientes foi de 56 anos (39 a 77 anos, sendo que 15 (71,4% encontravam-se na menopausa e 6 (28,6% no menacme. Todas as pacientes foram avaliadas antes da cirurgia por meio de anamnese, exame clínico, estudo ultra-sonográfico e urodinâmico, sendo o grau de perda urinária acentuado em 66,7% e moderado em 33,3% das pacientes. Todas as pacientes apresentavam hipermobilidade da junção uretrovesical (superior a 10 mm e 12 pacientes apresentavam cirurgia prévia para correção de incontinência urinária. Ao estudo urodinâmico, as pacientes apresentavam perda urinária com pressão máxima de fechamento uretral (PMFU variando de 20 a 124 cmH2O (média de 55,2 e "Valsalva leak point pressure" (VLPP variando de 18 a 128 cmH2O (média de 60,3. As indicações das cirurgias foram: defeito esfincteriano (11 pacientes - 52,4%, obesidade (5 pacientes - 23,8%, defeito esfincteriano e obesidade (2 pacientes - 9,5%, recidiva cirúrgica (2 pacientes - 9,5% e defeito esfincteriano e prolapso uterino de 1º grau (1 paciente - 4,8%. Resultados: como complicações, 6 pacientes (28,6% apresentaram retenção urinária temporária no pós-operatório, 1 (4,8% infecção do trato urinário, 1 (4,8% presença de fio de polipropileno na vagina, 1 (4,8% infecção da ferida cirúrgica, 4 pacientes (19

  3. Leptin, cortisol and distinct concurrent training sequences.

    Science.gov (United States)

    Rosa, G; Dantas, E; Biehl, C; de Castro e Silva, H; Montano, M A E; de Mello, D B

    2012-03-01

    In order to investigate the effects of distinct concurrent training sequences on serum leptin and cortisol levels, 10 subjects (27.1±4.8 years, body mass index 25.38±0.09) were submitted to a control session, concurrent training 1 and concurrent training 2. Samples of leptin and cortisol were collected. Concurrent training 1 consisted of indoor cycling followed by strength training and concurrent training 2 of strength training followed by indoor cycling. No exercises were performed at the control session. Blood was collected once again to verify the same variables. Shapiro-Wilk, 2-way ANOVA and Tukey post-hoc tests were used. There was a reduction in leptin levels after concurrent training 1 (Δ%= - 16.04; p=0.05) and concurrent training 2 (Δ%= - 8.54; p=0.02). Cortisol decreased after concurrent training 1 (Δ%= - 26.32; p=0.02) and concurrent training 2 (Δ%= - 33.57; p=0.05). There was a high and significant correlation between blood variables only in CS (lep PRE X cort PRE and cort POST: r= - 0.80 and r= - 0.81; lep POST X cort PRE and cort POST: r= - 0.62 and r= - 0.62). Concurrent training promoted a reduction in leptin and cortisol levels irrespective of sequence. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

    Directory of Open Access Journals (Sweden)

    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  5. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

    Directory of Open Access Journals (Sweden)

    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  6. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  7. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  8. How does concurrent sourcing affect performance?

    DEFF Research Database (Denmark)

    Mols, Niels Peter

    2010-01-01

    /methodology/approach – Based on transaction cost, agency, neoclassical economic, knowledge-based, and resource-based theory, it is proposed to show how concurrent sourcing affects performance. Findings – The paper argues that concurrent sourcing improves performance when firms face a combination of volume uncertainty......, performance uncertainty, non-decomposability, and asset specificity. Concurrent sourcing can also be a way to exploit both strong internal capabilities and external suppliers’ strong capabilities. Originality/value – The main contribution is a number of propositions, explanations, and discussions regarding...

  9. Salvage surgery for lymph node metastasis after concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Kataoka, Hideyuki; Takeuchi, Eiji; Kawamoto, Katsuyuki; Fujiwara, Kazunori; Fukuhara, Takahiro; Miyake, Naritomo; Kitano, Hiroya

    2009-01-01

    Concurrent chemoradiation (CCRT) for advanced head and neck cancer is becoming more widely used. CCRT represents an effective treatment for patients with advanced head and neck cancer, and possibly improves survival. In the present study, all of 25 patients underwent planned neck dissection 6-8 weeks after the completion of radiation. Selective neck dissection was performed whenever possible. Radical neck dissection was carried out for patients with residual adenopathy that had invaded the surrounding structures and/or enclosed the carotid arteries. A complete response at the primary sites was achieved in all patients. Of the 25 cases, 7 (28%) showed viable cancer cells within their neck dissection specimens. Local and regional disease control was excellent after CCRT with neck dissection. Unfortunately, CCRT followed by neck dissection sometimes induces stomal infection and swallowing dysfunction. We have been performing additional surgery to improve the swallowing function and bilateral neck dissection simultaneously. (author)

  10. Postoperative groin pain and success rates following transobturator midurethral sling placement: TVT ABBREVO® system versus TVT™ obturator system.

    Science.gov (United States)

    Canel, Virginie; Thubert, Thibault; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier

    2015-10-01

    Placement of a transobturator midurethral sling (MUS) is the standard surgical treatment for stress urinary incontinence. Most recent MUS procedures have been poorly evaluated. We compared the results using a "new" device expected to reduce postoperative pain, the TVT ABBREVO® system (TVT-Abb), with those using the TVT™ obturator system (TVT-O). This was a retrospective study comparing the use of the TVT-Abb (in 50 patients) and the TVT-O (in 50 patients). The main outcomes were the amount of postoperative pain, the success rate (no reported urinary leakage and negative cough test) with both MUS procedures, and the prevalence of complications. The mean follow-up time was 12 months. The preoperative characteristics of the two groups were comparable. There was less postoperative pain (VAS, 0 to 100) in the TVT-Abb group than in the TVT-O group (12.2 vs. 24.4, p TVT-Abb group and the TVT-O group (8 % vs. 12 %, p = 0.74). The prevalences of perioperative and postoperative complications (bladder/urethral injury, haemorrhage) in the two groups were equal. The success rates were similar at 12 months after surgery (88 % vs. 78 %, p = 0.29). The success rates with TVT-Abb and TVT-O were equal at 12 months after surgery, but there was less immediate postoperative pain with TVT-Abb.

  11. Evaluating Product Machinability for Concurrent Engineering

    National Research Council Canada - National Science Library

    Nau, Dana S; Zhang, Guangming; Gupta, Satyandra K; Karinthi, Raghu R

    1992-01-01

    .... Thus, in order to address the goals of concurrent engineering, it is important to evaluate the machinability of the proposed design, so that the designer can change the design to improve its machinability...

  12. Inheritance and Synchronization in Concurrent OOP

    Science.gov (United States)

    Briot, Jean-Pierre; Yonezawa, Akinori

    This paper discusses knowledge sharing (inheritance) mechanisms for Object-Oriented Programming (OOP) in the context of concurrent (distributed) languages. We review three different schemes: inheritance, delegation and copy. A fourth model, called recipe-query, is presented and all are compared and criticized. Techniques relying on the shared memory assumption are rejected. We point out the conflict between distributing knowledge among objects and the synchronization of concurrent objects.

  13. Drug discrimination under a concurrent schedule.

    OpenAIRE

    Snodgrass, S H; McMillan, D E

    1996-01-01

    Three pigeons were trained to discriminate a 5.0 mg/kg dose of pentobarbital from saline under a two-key concurrent schedule with responding on the key associated with the presession injection, under both stimulus conditions, producing four times as many reinforcers as responding on the other key. This concurrent schedule resulted in approximately 70% responding to the higher reinforcement key under the pentobarbital stimulus and approximately 30% responding to that key under the saline stimu...

  14. Spondylodiscitis concurrent with infectious aortic aneurysm caused by Candida tropicalis: a case report.

    Science.gov (United States)

    Oichi, Takeshi; Sasaki, Satoru; Tajiri, Yasuhito

    2015-08-01

    We report a case of spondylodiscitis concurrent with infectious aortic aneurysm caused by Candida tropicalis in a 79-year-old immunocompromised man. The patient underwent percutaneous drainage of the abscess and endoluminal exclusion of the aneurysm using a bifurcated stent graft. Micafungin was administered intravenously for 8 weeks, followed by a prolonged course of oral fluconazole. At the one-year follow-up, no recurrence was noted, and the patient could walk with a cane without low back pain.

  15. Can concurrent teaching promote equal biomechanical adaptations at front crawl and backstroke swimming?

    OpenAIRE

    Costa, Mário; Barbosa, Tiago; Morais, Jorge; Miranda, Sérgio; Marinho, Daniel

    2017-01-01

    The biomechanical adaptations in front crawl and backstroke swimming, as influenced by the implementation of a concurrent teaching programme were analysed. Methods: Sixteen participants (19.75 ± 1.13 years) underwent a 30 weeks intervention characterized by an increasing complexity to accomplish motor skills in the following order: (i) lower limbs propulsion; (ii) lower limbs propulsion synchronized with breathing cycle; (iii) lower limbs propulsion synchronized with one upper limb action; (i...

  16. Female sexual function following a novel transobturator sling procedure without paraurethral dissection (modified-TOT

    Directory of Open Access Journals (Sweden)

    Burak Arslan

    Full Text Available ABSTRACT Purpose To determine whether there is a difference in sexual function after modified and classical TOT procedures. Materials and Methods Of the 80 sexually active women with SUI, 36 underwent an original outside-in TOT as described by Delorme, and 44 underwent modified TOT procedure, between 2011 and 2015. The severity of incontinence and sexual function were evaluated using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF and Female Sexual Function Index (FSFI questionnaires preoperatively and 3 months after surgery. Results The postoperative ICIQ-SF score was significantly lower than the preoperative ICIQ-SF score in both groups (p=0.004 for modified TOT and p=0.002 for classical TOT. There was no significant difference in the ICIQ-SF score reduction between the two groups (14.1±2.1 vs. 14.4±1.9; p=0.892. Complication rates according to the Clavien-Dindo classification were also similar in both groups. In both groups, difference between preoperative and postoperative FSFI scores revealed a statistically significant improvement in all domains. Comparison of postoperative 3-month FSFI scores of modified and classical TOT groups showed statistically significant differences in arousal, lubrication and orgasm domains. Desire, satisfaction, pain and total FSFI scores did not differ significantly between two groups. Conclusion The modified TOT technique is a simple, reliable and minimal invasive procedure. The cure rate of incontinence and complication rates are the same as those of the classical TOT technique. However, due to the positive effects of minimal tissue damage on sexual arousal and orgasmic function, modified TOT has an advantage over the classical TOT.

  17. Voiding patterns of adult patients who underwent hypospadias repair in childhood.

    Science.gov (United States)

    Jaber, Jawdat; Kocherov, Stanislav; Chertin, Leonid; Farkas, Amicur; Chertin, Boris

    2017-02-01

    This study aimed at evaluating the voiding patterns of adult patients who underwent hypospadias repair in childhood. Following IRB approval 103 (22.7%) of 449 adult patients who underwent hypospadias repair between 1978 and 1993 responded to the following questionnaires: International Prostate Symptom Score (I-PSS) and Short Form 12 questionnaire (SF-12). Uroflowmetry (UF) was performed for all patients. The patients were divided into three groups according to the primary meatus localization. Group I had 63 patients (61.5%) treated for glanular hypospadias, group II had 19 patients (18.4%) treated for distal hypospadias, and group III comprised the remaining 21 patients (20.4%) treated for proximal hypospadias. The mean ± SD I-PSS score for all patients who responded to the questionnaire was 2.3 ± 2.4, and UF was 21.1 ± 4.3 mL/s. The patients from groups I and III had fewer urinary symptoms compared with those of the group II: 1.3 ± 1.5, 5.5 ± 2.4, and 1.6 ± 1.4, respectively (p hypospadias repair in childhood had normal or mild voiding disturbance, with no effects on their physical or mental status. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  18. [Prognostic Analysis of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy Using QOL-ACD].

    Science.gov (United States)

    Fukui, Yasuhiro; Kashiwagi, Shinichiro; Takada, Koji; Goto, Wataru; Asano, Yuka; Morisaki, Tamami; Noda, Satoru; Takashima, Tsutomu; Onoda, Naoyoshi; Hirakawa, Kosei; Ohira, Masaichi

    2017-11-01

    We investigated into association of quality of life(QOL)and prognosis of breast cancer patients who underwent neoadjuvant chemotherapy(NAC). We retrospectively studied 228 patients with breast cancer who were performed NAC during a period between 2007 and 2015. TheQ OL score was measured with"The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs(QOL-ACD)". We evaluate association between QOL score with antitumor effect and prognosis. Changes in the QOL score between before and after NAC were compared as well. We divided 2 groups by QOL-ACD scoreinto high and low groups. Therapeautic effect of NAC on 75 patients were pathological complete response(pCR). QOL-ACD score was not significantly associated with pCR rate in both high and low groups(p=0.199). High group was significantly associated with higher survival rate in both of disease free survival(p=0.009, logrank)and overall survival(p=0.040, logrank). QOLACD score decreased after NAC in both of pCR and non-pCR patients. In conclusion, QOL evaluation using QOL-ACD could be an indicator of breast cancer patients' prognosis who underwent NAC.

  19. HLA-G regulatory haplotypes and implantation outcome in couples who underwent assisted reproduction treatment.

    Science.gov (United States)

    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Wowk, Pryscilla Fanini; Mattar, Sibelle Botogosque; Vargas, Rafael Gustavo; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; Bicalho, Maria da Graça

    2012-09-01

    The role of HLA-G in several clinical conditions related to reproduction has been investigated. Important polymorphisms have been found within the 5'URR and 3'UTR regions of the HLA-G promoter. The aim of the present study was to investigate 16 SNPs in the 5'URR and 14-bp insertion/deletion (ins/del) polymorphism located in the 3'UTR region of the HLA-G gene and its possible association with the implantation outcome in couples who underwent assisted reproduction treatments (ART). The case group was composed of 25 ART couples. Ninety-four couples with two or more term pregnancies composed the control group. Polymorphism haplotype frequencies of the HLA-G were determined for both groups. The Haplotype 5, Haplotype 8 and Haplotype 11 were absolute absence in ART couples. The HLA-G*01:01:02a, HLA-G*01:01:02b alleles and the 14-bp ins polymorphism, Haplotype 2, showed an increased frequency in case women and similar distribution between case and control men. However, this susceptibility haplotype is significantly presented in case women and in couple with failure implantation after treatment, which led us to suggest a maternal effect, associated with this haplotype, once their presence in women is related to a higher number of couples who underwent ART. Copyright © 2012. Published by Elsevier Inc.

  20. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  2. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Directory of Open Access Journals (Sweden)

    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  3. Characterizing Distributed Concurrent Engineering Teams: A Descriptive Framework for Aerospace Concurrent Engineering Design Teams

    Science.gov (United States)

    Chattopadhyay, Debarati; Hihn, Jairus; Warfield, Keith

    2011-01-01

    As aerospace missions grow larger and more technically complex in the face of ever tighter budgets, it will become increasingly important to use concurrent engineering methods in the development of early conceptual designs because of their ability to facilitate rapid assessments and trades in a cost-efficient manner. To successfully accomplish these complex missions with limited funding, it is also essential to effectively leverage the strengths of individuals and teams across government, industry, academia, and international agencies by increased cooperation between organizations. As a result, the existing concurrent engineering teams will need to increasingly engage in distributed collaborative concurrent design. This paper is an extension of a recent white paper written by the Concurrent Engineering Working Group, which details the unique challenges of distributed collaborative concurrent engineering. This paper includes a short history of aerospace concurrent engineering, and defines the terms 'concurrent', 'collaborative' and 'distributed' in the context of aerospace concurrent engineering. In addition, a model for the levels of complexity of concurrent engineering teams is presented to provide a way to conceptualize information and data flow within these types of teams.

  4. The risk of radiation necrosis following stereotactic radiosurgery with concurrent systemic therapies.

    Science.gov (United States)

    Kim, Joseph M; Miller, Jacob A; Kotecha, Rupesh; Xiao, Roy; Juloori, Aditya; Ward, Matthew C; Ahluwalia, Manmeet S; Mohammadi, Alireza M; Peereboom, David M; Murphy, Erin S; Suh, John H; Barnett, Gene H; Vogelbaum, Michael A; Angelov, Lilyana; Stevens, Glen H; Chao, Samuel T

    2017-06-01

    To investigate late toxicity among patients with newly-diagnosed brain metastases undergoing stereotactic radiosurgery (SRS) with concurrent systemic therapies with or without whole-brain radiation therapy (WBRT). Patients with newly-diagnosed brain metastasis who underwent SRS at a single tertiary-care institution from 1997 to 2015 were eligible for inclusion. The class and timing of all systemic therapies were collected for each patient. The primary outcome was the cumulative incidence of radiographic radiation necrosis (RN). Multivariable competing risks regression was used to adjust for confounding. During the study period, 1650 patients presented with 2843 intracranial metastases. Among these, 445 patients (27%) were treated with SRS and concurrent systemic therapy. Radiographic RN developed following treatment of 222 (8%) lesions, 120 (54%) of which were symptomatic. The 12-month cumulative incidences of RN among lesions treated with and without concurrent therapies were 6.6 and 5.3%, respectively (p = 0.14). Concurrent systemic therapy was associated with a significantly increased rate of RN among lesions treated with upfront SRS and WBRT (8.7 vs. 3.7%, p = 0.04). In particular, concurrent targeted therapies significantly increased the 12-month cumulative incidence of RN (8.8 vs. 5.3%, p therapies, significantly increased rates of RN were observed with VEGFR tyrosine kinase inhibitors (TKIs) (14.3 vs. 6.6%, p = 0.04) and EGFR TKIs (15.6 vs. 6.0%, p = 0.04). Most classes of systemic therapies may be safely delivered concurrently with SRS in the management of newly-diagnosed brain metastases. However, the rate of radiographic RN is significantly increased with the addition of concurrent systemic therapies to SRS and WBRT.

  5. Flight Testing and Real-Time System Identification Analysis of a UH-60A Black Hawk Helicopter with an Instrumented External Sling Load

    Science.gov (United States)

    McCoy, Allen H.

    1998-01-01

    Helicopter external air transportation plays an important role in today's world. For both military and civilian helicopters, external sling load operations offer an efficient and expedient method of handling heavy, oversized cargo. With the ability to reach areas otherwise inaccessible by ground transportation, helicopter external load operations are conducted in industries such as logging, construction, and fire fighting, as well as in support of military tactical transport missions. Historically, helicopter and load combinations have been qualified through flight testing, requiring considerable time and cost. With advancements in simulation and flight test techniques there is potential to substantially reduce costs and increase the safety of helicopter sling load certification. Validated simulation tools make possible accurate prediction of operational flight characteristics before initial flight tests. Real time analysis of test data improves the safety and efficiency of the testing programs. To advance these concepts, the U.S. Army and NASA, in cooperation with the Israeli Air Force and Technion, under a Memorandum of Agreement, seek to develop and validate a numerical model of the UH-60 with sling load and demonstrate a method of near real time flight test analysis. This thesis presents results from flight tests of a U.S. Army Black Hawk helicopter with various external loads. Tests were conducted as the U.S. first phase of this MOA task. The primary load was a container express box (CONEX) which contained a compact instrumentation package. The flights covered the airspeed range from hover to 70 knots. Primary maneuvers were pitch and roll frequency sweeps, steps, and doublets. Results of the test determined the effect of the suspended load on both the aircraft's handling qualities and its control system's stability margins. Included were calculations of the stability characteristics of the load's pendular motion. Utilizing CIFER(R) software, a method for near

  6. MATHEMATICAL MODEL OF THE MOTION OF A LIGHT ATTACK AIRCRAFT WITH EXTERNAL LOAD SLINGS IN THE EXTREME AREA OF FLIGHT MODES ACCORDING TO THE ANGLE OF ATTACK

    Directory of Open Access Journals (Sweden)

    A. Popov Sergey

    2017-01-01

    Full Text Available For the time being, a combat-capable trainer aircraft has already been used as a light attack aircraft. The quality of mission effectiveness evaluation depends on the degree of relevance of mathematical models used. It is known that the mis- sion efficiency is largely determined by maneuvering capabilities of the aircraft which are realized most fully in extreme angle of attack flight modes. The article presents the study of the effect of Reynolds number, angle of attack and position on the external sling on the parameters characterizing the state of separated-vortex flow, which was conducted using soft- ware complexes such as Solid Works and Ansys Fluent. There given the dependences of the observed parameters for sta- tionary and nonstationary cases of light attack aircraft movement. The article considers the influence of time constants, which characterize the response rate and delaying of separated flow development and attached flow recovery on the state of separated-vortex flow. The author mentions how the speed of angle of attack change influences lift coefficient of a light attack aircraft with external slings due to response rate and delaying of separated flow development and attached flow recovery. The article describes the mathematical model invented by the authors. This is the model of the movements of light attack aircraft with external slings within a vertical flight maneuver, considering the peculiarities of separated-vortex flow. Using this model, there has been obtained the parameters of light attack aircraft output path from the pitch using large an- gles of attack. It is demonstrated that not considering the peculiarities of the separated-vortex flow model of light attack aircraft movements leads to certain increase of height loss at the pullout of the maneuver, which accordingly makes it pos- sible to decrease the height of the beginning of the pullout.

  7. A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Halit Diri

    2014-01-01

    Full Text Available Cushing’s syndrome (CS may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH- independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

  8. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

    2016-02-01

    The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  9. [Patients with astigmatism who underwent cataract surgery by phacoemulsification: toric IOL x asferic IOL?].

    Science.gov (United States)

    Torres Netto, Emilio de Almeida; Gulin, Marina Carvalho; Zapparoli, Marcio; Moreira, Hamilton

    2013-01-01

    Compare the visual acuity of patients who underwent cataract surgery by phacoemulsification with IOL AcrySof(®) toric implantation versus AcrySof(®) IQ and evaluate the reduction of cylindrical diopters (CD) in the postoperative period. Analytical and retrospective study of 149 eyes with 1 or more diopters of regular symmetrical keratometric astigmatism, which underwent cataract surgery by phacoemulsification. The eyes were divided into two groups: the toric group with 85 eyes and the non-toric group with 64 eyes. In the pre-operative phase, topographic data and refraction of each eye to be operated were assessed. In the postoperative phase, refraction and visual acuity with and without correction were measured. The preoperative topographic astigmatism ranged from 1.00 to 5.6 DC in both groups. Average reduction of 1.37 CD (p<0.001) and 0.16 CD (p=0.057) was obtained for the toric and non-toric group when compared to the refractive astigmatism, respectively. Considering visual acuity without correction (NCVA), the toric group presented 44 eyes (51.7%) with NCVA of 0 logMAR (20/20) or 0.1 logMAR (20/25) and the toric group presented 7 eyes (10.93%) with these same NCVA values. The results show that patients with a significant keratometric astigmatism presented visual benefits with the toric IOL implantation. The reduction of the use of optical aids may be obtained provided aberrations of the human eye are corrected more accurately. Currently, phacoemulsification surgery has been used not only for functional improvement, but also as a refraction procedure.

  10. Enteral nutrition is superior to total parenteral nutrition for pancreatic cancer patients who underwent pancreaticoduodenectomy.

    Science.gov (United States)

    Liu, Changli; Du, Zhi; Lou, Cheng; Wu, Chenxuan; Yuan, Qiang; Wang, Jun; Shu, Guiming; Wang, Yijun

    2011-01-01

    To determine the effects of total parenteral nutrition (TPN) and enteral nutrition (EN) on biochemical and clinical outcomes in pancreatic cancer patients who underwent pancreaticoduodenectomy. From the year 2006 to 2008, 60 patients who underwent pancreaticoduodenectomy in Tianjin Third Central Hospital were enrolled in this study. They were randomly divided into the EN group and the TPN group. The biochemical and clinical parameters were recorded and analyzed between the two groups. There was no significant difference in the nutritional status, liver and kidney function, and blood glucose levels between the TPN and EN groups on the preoperative day, the 1st and 3 rd postoperative days. However, on the 7th postoperative day, there was significant difference between the two groups in 24 h urinary nitrogen, serum levels of, total protein (TP), transferrin (TF), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transpeptadase (GGT), blood urea nitrogen (BUN) and creatinine (Cr). On the 14th postoperative day, there was a significant difference between the two groups in terms of urinary levels of 24 h nitrogen, TP, TF, retinol binding protein, ALT, AST, ALP, GGT, total bilirubin, direct bilirubin, BUN, Cr, and glucose. The incidence of delayed gastric emptying in the EN and TPN groups was 0% and 20%, respectively. Moreover, the incidence of pancreatic fistulas and hemorrhages in the EN group were 3.6% and 3.6%, versus 26.7% and 30% in the TPN group, respectively. EN is better than TPN for pancreatic cancer patients who received pancreaticoduodenectomy.

  11. Sling, Scoop, and Squirter: Anatomical Features Facilitating Prey Transport, Processing, and Swallowing in Rorqual Whales (Mammalia: Balaenopteridae).

    Science.gov (United States)

    Werth, Alexander J; Ito, Haruka

    2017-11-01

    Much is known about lunge feeding in balaenopterid whales, but many key aspects of structure, function, and behavior have not yet been explained in detail, especially with regard to concentrating, positioning, and swallowing large aggregations of prey. We describe a novel system of three integrated structural components, all of which are involved in sequential feeding activities (intraoral transport, filtration, and swallowing of prey) that follow lunge-feeding engulfment of prey-laden water in rorquals: (1) a hammock-like muscular sling comprising extrinsic lingual musculature along the midline of the ventral pouch; (2) the flattened scoop-like arrangement of caudal-most baleen plates converging in the oropharynx adjacent to the esophageal opening; and (3) a flow-diverting flange at the posterior dorsum of the lip, by a flow channel at the angle of the mouth. Subsequent to contraction of the ventral pouch and concomitant expulsion of the mouthful of ingested water, these three structures together, we contend, aid in (1) channeling prey posteriorly toward the esophageal opening; (2) concentrating prey as excess water is squeezed from (what is presumed to be) the slurry-like mixture of nektonic and/or planktonic prey and water; and (3) guiding prey into the isthmus of the fauces while simultaneously (4) facilitating expulsion of water. These related functions occur along with, and are in part achieved by, elevation and retraction of the tongue and oral floor. Given their presumed functional role, these systems are best described as a suite of integrated structural adaptations. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:2070-2086, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  12. Patients' perspectives on urethral bulk injection therapy and mid-urethral sling surgery for stress urinary incontinence.

    Science.gov (United States)

    Casteleijn, Fenne M; Zwolsman, Sandra E; Kowalik, Claudia R; Roovers, Jan-Paul P W R

    2018-04-19

    The aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option. In a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers. Sixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed 'becoming dry' was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option. Patients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.

  13. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-06-15

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

  14. Using molecular biology to maximize concurrent training.

    Science.gov (United States)

    Baar, Keith

    2014-11-01

    Very few sports use only endurance or strength. Outside of running long distances on a flat surface and power-lifting, practically all sports require some combination of endurance and strength. Endurance and strength can be developed simultaneously to some degree. However, the development of a high level of endurance seems to prohibit the development or maintenance of muscle mass and strength. This interaction between endurance and strength is called the concurrent training effect. This review specifically defines the concurrent training effect, discusses the potential molecular mechanisms underlying this effect, and proposes strategies to maximize strength and endurance in the high-level athlete.

  15. Models for concurrency: towards a classification

    DEFF Research Database (Denmark)

    Sassone, Vladimiro; Nielsen, Mogens; Winskel, Glynn

    1996-01-01

    Models for concurrency can be classified with respect to three relevant parameters: behaviour/ system, interleaving/noninterleaving, linear/branching time. When modelling a process, a choice concerning such parameters corresponds to choosing the level of abstraction of the resulting semantics....... In this paper, we move a step towards a classification of models for concurrency based on the parameters above. Formally, we choose a representative of any of the eight classes of models obtained by varying the three parameters, and we study the formal relationships between them using the language of category...

  16. Authentic And Concurrent Evaluation-refining

    DEFF Research Database (Denmark)

    Eriksson, Carina Ihlström; Åkesson, Maria; Kautz, Karlheinz

    2011-01-01

    This paper addresses the need for more detailed accounts for evaluation in design science research literature. By revisiting a design project regarding the future e-newspaper we give detailed descriptions of its authentic and concurrent evaluation approach by illustrating the what, why and how...... as well as decisions on strategic levels. We emphasize a holistic and concurrent approach to evaluation compared to the general design science research thinking and argue that reflecting on how to seek authenticity is important. By authenticity we refer to the notion of how closely an evaluation captures...

  17. Concurrent sourcing and external supplier opportunism

    DEFF Research Database (Denmark)

    Mols, Niels Peter

    costs of opportunism are determined as a product of four factors. The four factors are: likelihood of discovering supplier opportunism, buyer’s internalized quantity as reaction to supplier opportunism, asset specificity of external supplier’s investments, and multiplicator effects. Each......When a firm simultaneously makes and buys the same components then the firm uses concurrent sourcing. This paper presents an agency model for explaining how and when concurrent sourcing reduces the likelihood of external supplier opportunism. In the proposed model, the external supplier’s expected...

  18. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  19. Assessment of quality of life in patients who underwent minimally invasive cosmetic procedures.

    Science.gov (United States)

    de Aquino, Marcello Simão; Haddad, Alessandra; Ferreira, Lydia Masako

    2013-06-01

    There are increasingly more patients seeking minimally invasive procedures, which have become more effective and safer in reducing the signs of facial aging. This study included 40 female adult patients who voluntarily underwent selected minimally invasive procedures (filling with hyaluronic acid and botulinum toxin injection) for facial rejuvenation. All patients were followed for a period of 6 months. They were evaluated with the use of questionnaires, a quality-of-life questionnaire (DLQI), the self-esteem scale of Rosenberg (EPM/Rosenberg), and a pain scale. The minimally invasive procedures resulted in improvement in quality of life and self-esteem, which were stronger the first 3 months after the procedures but remained at a higher level than that before treatment, even after 6 months. Hyaluronic acid with lidocaine in the formula is more comfortable for the patient as it makes the injection less painful. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  20. Assessment of Patients Who Underwent Nasal Reconstruction After Non-Melanoma Skin Cancer Excision.

    Science.gov (United States)

    Uzun, Hakan; Bitik, Ozan; Kamburoğlu, Haldun Onuralp; Dadaci, Mehmet; Çaliş, Mert; Öcal, Engin

    2015-06-01

    Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction. We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them. There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps. Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

  1. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  2. Influence of perioperative administration of amino acids on thermoregulation response in patients underwent colorectal surgical procedures

    Directory of Open Access Journals (Sweden)

    Zeba Snježana

    2007-01-01

    Full Text Available Background. Hypothermia in the surgical patients can be the consequence of long duration of surgical intervention, general anesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition, but some investigations reported that infusion of aminoacids during surgery can induce thermogenesis and prevent postoperative hypothermia. Case report. We reported two males who underwent major colorectal surgery for rectal carcinoma. One patient received Aminosol 15% solution, 125 ml/h, while the other did not. The esophageal temperatures in both cases were measured every 30 minutes during the operation and 60 minutes after in Intensive Care Unit. We were monitoring blood pressure, heart rate, ECG, and shivering. Patient who received aminoacids showed ameliorated postoperative hypothermia without hypertension, arrhythmia, or shivering, while the other showed all symptoms mentioned above. Conclusion. According to literature data, as well as our findings, we can conclude that intraoperative intravenous treatment with amino acid solution ameliorates postoperative hypothermia along with its complications. .

  3. Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria.

    Science.gov (United States)

    Osifo, O D; Osaigbovo, E O

    2008-06-01

    To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term (P=0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4-6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.

  4. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment.

    Science.gov (United States)

    Cheng, Ching-Yu; Stevenson, Eleanor Lowndes; Yang, Cheng-Ta; Liou, Shwu-Ru

    2018-04-28

    To describe the psychological stress and quality of life experienced by women who underwent fertility treatment in Taiwan. Cross-sectional, correlational study. Recruitment was conducted and questionnaires administered at a reproductive medicine center in Chiayi City, Taiwan. Informed consent to participate was obtained from 126 women who sought fertility treatment at the center. The Chinese Fertility Problem Inventory and Fertility Quality of Life scale were used to measure participants' levels of fertility-related stress and fertility-related quality of life. Descriptive statistics, correlation, and regression analysis were used. Overall, participants reported low levels of fertility-related stress and fertility-related quality of life; however, they had relatively high levels of stress related to need for parenthood. Women who were older, had greater body mass indexes, and consumed coffee regularly had lower fertility-related quality of life. Social and relationship concerns and stress related to need for parenthood were significant predictors of low fertility-related quality of life. In a culture in which childbearing is generally an expectation and an important part of family life, women who experience infertility are at risk to experience fertility-related stress. Social support and family consultation might be offered to improve women's fertility-related quality of life. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  5. 3-Dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female.

    Science.gov (United States)

    Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi

    2017-09-01

    We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). Bronchial asthma is considered an exacerbating factor in infantile period and frequently required treatment with bronchodilator. After the age of 10, the patient had recurrent breathing difficulties during physical activity and during night time, and this condition was assessed to be related to the pressure from the blood vessel on the ring. We repeated the 3D-CT evaluation later and discovered that the internal diameter of the trachea had grown to 5 mm. Eventually, patient's breathing difficulties disappeared after the treatment of bronchial asthma and restriction of physical activities. Our patient remained in stable condition without undergoing any surgical procedures even after she passed the age of 10.

  6. Structural differences and architectural features of two different polypropylene slings (TVT-O and I-STOP) have no impact on biocompatibility and tissue reactions.

    Science.gov (United States)

    Przydacz, Mikolaj; Adli, Oussama El Yazami; Mahfouz, Wally; Loutochin, Oleg; Bégin, Louis R; Corcos, Jacques

    2017-06-30

    To evaluate the impact of design features of the synthetic mid-urethral slings on tissue integrity and inflammatory responses. In total 30 female Sprague-Dawley rats were implanted with type I monofilamentous, macroporous polypropylene meshes: Gynecare TVT-Obturator tape ® (Ethicon Inc., Johnson & Johnson, Somerville, NJ, USA) and I-STOP ® (CL Medical Inc., Lyon, France). All animal groups were sacrificed at set time intervals - 6 weeks, 3 months, 6 months, 9 months and 12 months - and the abdominal wall was harvested with mesh strips for histological evaluation. All mesh strips appeared to be well incorporated into the abdominal wall, and no signs of shrinkage was noticed. All specimens showed a thin/delicate, loose, fibrous interface between the synthetic graft plate and abdominal wall, along with mild inflammatory reactions from 6 weeks to 12 months. Both mesh brands induced comparable, minimal foreign body reactions and integrated well into the host tissues despite differences in architectural features. TVT-O ® and I-STOP ® evoked similar low-grade inflammatory responses up to 12 months in this animal model. Structural differences and architectural features of polypropylene slings used in this study have had no impact on tissue integrity and inflammatory responses.

  7. Formal Derivation of Concurrent Garbage Collectors

    NARCIS (Netherlands)

    Pavlovic, Dusko; Pepper, Peter; Smith, Douglas R.

    Concurrent garbage collectors are notoriously difficult to implement correctly. Previous approaches to the issue of producing correct collectors have mainly been based on posit-and-prove verification or on the application of domain-specific templates and transformations. We show how to derive the

  8. Concurrent training with different aerobic exercises.

    Science.gov (United States)

    Silva, R F; Cadore, E L; Kothe, G; Guedes, M; Alberton, C L; Pinto, S S; Pinto, R S; Trindade, G; Kruel, L F M

    2012-08-01

    The aim of the present study was to compare the effects of using different intensities and types of aerobic exercise (i. e., cycle ergometer or running) during concurrent training on neuromuscular adaptations. A total of 44 young women were randomly assigned to 1 of 4 groups: concurrent strength and continuous running training (SCR, n=10), concurrent strength and interval running training (SIR, n=11), concurrent strength and continuous cycle ergometer training (SCE, n=11), or strength training only (STO, n=12). Each group trained twice a week during 11 weeks. The following strength measurements were made on all subjects before and after training period: maximal strength (1RM) in knee extension, bench press and leg press exercises; local muscular endurance (number of repetitions at 70% of 1 RM) in knee extension and bench press exercises; and isometric and isokinetic peak torque of knee extension. There were significant increases in the upper and lower-body 1 RM, isometric and isokinetic peak torque in all training groups (pconcurrent training performed twice a week promotes similar neuromuscular adaptations to strength training alone, regardless of the type and the intensity in which the aerobic training is performed. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Concurrent Design of Embedded Control Software

    NARCIS (Netherlands)

    Groothuis, M.A.; Frijns, Raymond; Voeten, Jeroen; Broenink, Johannes F.; Margaria, T.; Padberg, J.; Taentzer, G.; Levendovszky, T.; Lengyel, L.; Karsai, G.; Hardebolle, C.

    2009-01-01

    Embedded software design for mechatronic systems is becoming an increasingly time-consuming and error-prone task. In order to cope with the heterogeneity and complexity, a systematic model-driven design approach is needed, where several parts of the system can be designed concurrently. There is

  10. Verified compilation of Concurrent Managed Languages

    Science.gov (United States)

    2017-11-01

    drawings, specifications, or other data does not license the holder or any other person or corporation ; or convey any rights or permission to... explore new proof techniques and methodologies that would enable scalable and modular verification of modern concurrent programming languages like Java...I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2 Proof strategy

  11. Declarative interpretations of session-based concurrency

    DEFF Research Database (Denmark)

    Cano, Mauricio; Rueda, Camilo; López-Acosta, Hugo-Andrés

    2015-01-01

    Session-based concurrency is a type-based approach to the analysis of communication-intensive systems. Correct behavior in these systems may be specified in an operational or declarative style: the former defines how interactions are structured; the latter defines governing conditions...

  12. On run-time exploitation of concurrency

    NARCIS (Netherlands)

    Holzenspies, P.K.F.

    2010-01-01

    The `free' speed-up stemming from ever increasing processor speed is over. Performance increase in computer systems can now only be achieved through parallelism. One of the biggest challenges in computer science is how to map applications onto parallel computers. Concurrency, seen as the set of

  13. Emotion as Opportunity: Reflections on Multiple Concurrent ...

    African Journals Online (AJOL)

    Partner reduction has been shown to be one of the most important aspects of any programme that seeks to contain the spread of HIV. In South Africa, however, multiple concurrent sexual partnerships are a common feature of township life for young people, especially young men. Following on from XXXXX's (2009) study on ...

  14. Integrated concurrent utilization quality review, Part one.

    Science.gov (United States)

    Caterinicchio, R P

    1987-01-01

    This article is the first of a two-part series which argues for the concurrent management of the appropriateness, necessity, and quality of patient care. Intensifying scrutiny by the credentialing groups, the PROs and all third-party payors underscores the vital need to implement cost-effective information systems which integrate the departmentalized functions of patient-physician profiling, DRG case-mix analyses, length of stay monitoring, pre-admission/admission and continued stay review, discharge planning, risk management, incident reporting and quality review. In the domain of physician performance regarding admitting and practice patterns, the ability to exercise concurrent utilization-quality review means early detection and prevention of events which would otherwise result in denials of payment and/or compromised patient care. Concurrent utilization-quality review must, by definition, be managerially invasive and focused; hence, it is integral to maintaining the integrity of the services and product lines offered by the provider. In fact, if PPO status is a marketing agenda, then the institutional objectives of cost-effectiveness, productivity, value, and competitiveness can only be achieved through concurrent utilization-quality review.

  15. Concurrency meets probability: theory and practice (abstract)

    NARCIS (Netherlands)

    Katoen, Joost P.

    Treating random phenomena in concurrency theory has a long tradition. Petri nets [18, 10] and process algebras [14] have been extended with probabilities. The same applies to behavioural semantics such as strong and weak (bi)simulation [1], and testing pre-orders [5]. Beautiful connections between

  16. Concurrent Engineering in seafood product development

    DEFF Research Database (Denmark)

    Jonsdottir, Stella; Vesterager, Johan; Børresen, Torger

    1998-01-01

    Concurrent Engineering (CE) can provide an improved approach to product development for extending the lines of seafood products. Information technology support tools based on product models can provide an integrated and simultaneous approach for specifying new recipes. The seafood industry can...... techniques. it is anticipated that other food industries also can benefit from the more simultaneous approach...

  17. Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction.

    Science.gov (United States)

    Tazuke, Yuko; Okuyama, Hiroomi; Uehara, Shuichiro; Ueno, Takehisa; Nara, Keigo; Yamanaka, Hiroaki; Kawahara, Hisayoshi; Kubota, Akio; Usui, Noriaki; Soh, Hideki; Nomura, Motonari; Oue, Takaharu; Sasaki, Takashi; Nose, Satoko; Saka, Ryuta

    2015-12-01

    The aim of this study was to evaluate the long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal/alimentary reconstruction. We reviewed the medical records of four long-term survivors of tracheal agenesis and collected the following data: age, sex, type of tracheal agenesis, method of reconstruction, nutritional management, and physical and neurological development. The patients consisted of three boys and one girl, who ranged in age from 77 to 109months. The severity of their condition was classified as Floyd's type I (n=2), II (n=1), or III (n=1). Mechanical respiratory support was not necessary in any of the cases. Esophageal/alimentary reconstruction was performed using the small intestine (n=2), a gastric tube (n=1), and the esophagus (n=1). The age at esophageal reconstruction ranged from 41 to 55months. All of the cases required enteral nutrition via gastrostomy. Three of the patients were able to swallow a small amount of liquid and one was able to take pureed food orally. The physical development of the subjects was moderately delayed-borderline in childhood. Neurological development was normal in two cases and slightly delayed in two cases. None of the long-term survivors of tracheal agenesis required the use of an artificial respirator, and their development was close to normal. Future studies should aim to elucidate the optimal method for performing esophageal reconstruction to allow tracheal agenesis patients to achieve their full oral intake. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  19. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis.

    Science.gov (United States)

    de Campos, José Ribas Milanez; Lembrança, Lucas; Fukuda, Juliana Maria; Kauffman, Paulo; Teivelis, Marcelo Passos; Puech-Leão, Pedro; Wolosker, Nelson

    2017-11-01

    Video thoracoscopic sympathectomy is the recommended surgical treatment for primary hyperhidrosis and has a high success rate. Despite this high success rate, some patients are unresponsive and eventually need a resympathectomy. Few studies have previously analysed exclusively the results of these resympathectomies in patients with primary hyperhidrosis. None of the studies have objectively evaluated the degree of response to surgery or the improvement in quality of life after resympathectomies. This is a retrospective study, evaluating 15 patients from an initial group of 2300 patients who underwent resympathectomy after failure of the primary surgical treatment. We evaluated sympathectomy levels of resection, technical difficulties, surgical complications preoperative quality of life, response to treatment and quality-of-life improvement 30 days after each surgery. Regarding gender, 11 (73.3%) patients were women. The average age was 23.2 with SD of 5.17 years, and the mean body mass index was 20.9 (SD 2.12). Ten patients had major complaints about their hands (66%) and 5 (33%) patients about their forearms. A high degree of response to sympathectomy occurred in 73% of patients. In 11 of these patients, the improvement in quality of life was considered high, 3 showed a mild improvement and 1 did not improve. No major complications occurred; the presence of adhesions was reported in 11 patients and pleural drainage was necessary in 4 patients. Resympathectomy is an effective procedure, and it improves the quality of life in patients with primary hyperhidrosis who failed after the first surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  20. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair.

    Science.gov (United States)

    Li, Shoujun; Ma, Kai; Hu, Shengshou; Hua, Zhongdong; Yang, Keming; Yan, Jun; Chen, Qiuming

    2014-09-01

    The study objective was to report the outcomes of biventricular repair in patients with double outlet right ventricle. Patients with double outlet right ventricle who underwent biventricular repair at Fuwai Hospital from January 2005 to December 2012 were included. Patients were excluded if double outlet right ventricle was combined with atrioventricular septal defect, heterotaxy syndrome, atrioventricular discordance, or univentricular physiology. A total of 380 consecutive patients with a mean age of 1.9 ± 2.1 years (range, 1 month to 6 years) were included. Varied types of biventricular repair were customized individually. Follow-up was 90.4% complete, and the mean follow-up time was 3.4 ± 3.9 years. There were 17 (4.5%) early deaths and 7 (2.1%) late deaths. Preoperative pulmonary hypertension was the only risk factor for early mortality. Postoperative significant left ventricular outflow tract obstruction was present in 9 survivors. Patients with noncommitted ventricular septal defect had a longer crossclamp time, longer cardiopulmonary bypass time, and higher incidence of postdischarge left ventricular outflow tract obstruction. There were 4 reoperations, all of which were caused by subaortic left ventricular outflow tract obstruction. All of the pressure gradients were decreased to less than 20 mm Hg after the modified Konno procedure with an uneventful postoperative course. Optimal results of varied types of biventricular repair for double outlet right ventricle have been acquired. Although noncommitted ventricular septal defect is technically difficult, the outcomes of patients are favorable. Late-onset left ventricular outflow tract obstruction is the main reason for reoperation but can be successfully relieved by the modified Konno procedure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Newly Developed Sarcopenia as a Prognostic Factor for Survival in Patients who Underwent Liver Transplantation.

    Directory of Open Access Journals (Sweden)

    Ja Young Jeon

    Full Text Available The relationship between a perioperative change in sarcopenic status and clinical outcome of liver transplantation (LT is unknown. We investigated whether post-LT sarcopenia and changes in sarcopenic status were associated with the survival of patients.This retrospective study was based on a cohort of 145 patients from a single transplant center who during a mean of 1 year after LT underwent computed tomography imaging evaluation. The cross-sectional area of the psoas muscle of LT patients was compared with that of age- and sex-matched healthy individuals. The Cox proportional hazards regression model was used to determine whether post-LT sarcopenia and changes in sarcopenic status affect post-LT survival.The mean age at LT of the 116 male and 29 female patients was 50.2 ± 7.9 years; the mean follow-up duration was 51.6 ± 32.9 months. All pre-LT patients with sarcopenia still had sarcopenia 1 year after LT; 14 (15% patients had newly developed sarcopenia. The mean survival duration was 91.8 ± 4.2 months for non-sarcopenic patients and 80.0 ± 5.2 months for sarcopenic patients (log-rank test, p = 0.069. In subgroup analysis, newly developed sarcopenia was an independent negative predictor for post-LT survival (hazard ratio: 10.53, 95% confidence interval: 1.37-80.93, p = 0.024.Sarcopenia in LT recipients did not improve in any of the previously sarcopenic patients and newly developed within 1 year in others. Newly developed sarcopenia was associated with increased mortality. Newly developed sarcopenia can be used to stratify patients with regard to the risk of post-LT mortality.

  2. Preoperative concurrent chemo-radiation in rectal cancer

    International Nuclear Information System (INIS)

    Berger, C.; Kirscher, S.; Felix-Faure, C.; Chauvet, B.; Vincent, P.; Brewer, Y.; Reboul, F.

    1998-01-01

    To evaluate retrospectively treatment-related morbidity of concurrent radiotherapy and chemotherapy for rectal cancer. Between 1992 and 1995, 38 patients (median age: 60) were treated for locally advanced resectable rectal cancer. Median dose of radiotherapy was 45 Gy/25 fractions/5 weeks. Chemotherapy consisted of two courses of 5-fluorouracil and leucovorin administered during the first and the fifth weeks of radiotherapy. Median dose of 5-fluorouracil was 350 mg/m 2 /day, and median dose of leucovorin was 350 mg/m 2 /day, day 1 to day 5. Surgery was performed 5 weeks after completion of radiotherapy. Before surgery, one patient died of febrile neutropenia and sepsis after two cycles of chemotherapy and 45 Gy. Main pre-operative grade 3-4 toxicities were respectively: neutropenia: 3% ; nausea/vomiting: 3%; diarrhea: 3%; proctitis: 5%; radiation dermatitis: 8%. Twenty-six patients underwent a low anterior resection and 11 an abdomino-perineal resection. A temporary colostomy was performed in 12 patients. Pathologic complete response rate was 27 %. There was one post-operative death due to thrombo-embolic disease. Major post-operative grade 3-4 complications were: pelvic infection: 14 %; abdominal infection : 5%; perineal sepsis: 8%; anastomotic dehiscence: 8%; cardiac failure: 5%. Delayed perineal wound healing was observed in six patients. No significant prognostic factor of post-operative complications has been observed. Median duration of hospitalization was 22 days. With a median follow-up of 24 months, 2-year overall and disease-free survival rates were 82 and 64%. Tolerance of preoperative concurrent chemoradiotherapy was acceptable. Ongoing controlled studies will assess the impact of this combined treatment on survival. (authors)

  3. Preoperative hyperfractionated radiotherapy with concurrent chemotherapy in resectable esophageal cancer

    International Nuclear Information System (INIS)

    Kim, Jong H.; Choi, Eun K.; Kim, Sung B.; Park, Seung I.; Kim, Dong K.; Song, Ho Y.; Jung, Hwoon Y.; Min, Young I.

    2001-01-01

    Purpose: To evaluate the local control rates, survival rates, and patterns of failure for esophageal cancer patients receiving preoperative concurrent chemotherapy and hyperfractionated radiotherapy followed by esophagectomy. Methods and Materials: From May 1993 through January 1997, 94 patients with resectable esophageal cancers received continuous hyperfractionated radiation (4,800 cGy/40 fx/4 weeks), with concurrent FP chemotherapy (5-FU 1 g/m 2 /day, days 2-6, 30-34, CDDP 60 mg/m 2 /day, days 1, 29) followed by esophagectomy 3-4 weeks later. If there was evidence of disease progression on preoperative re-evaluation work-up, or if the patient refused surgery, definitive chemoradiotherapy was delivered. Minimum follow-up time was 2 years. Results: All patients successfully completed preoperative treatment and were then followed until death. Fifty-three patients received surgical resection, and another 30 were treated with definitive chemoradiotherapy. Eleven patients did not receive further treatment. Among 91 patients who received clinical reevaluation, we observed 35 having clinical complete response (CR) (38.5%). Pathologic CR rate was 49% (26 patients). Overall survival rate was 59.8% at 2 years and 40.3% at 5 years. Median survival time was 32 months. In 83 patients who were treated with surgery or definitive chemoradiotherapy, the esophagectomy group showed significantly higher survival, disease-free survival, and local disease-free survival rates than those in the definitive chemoradiation group. Conclusion: Preoperative chemoradiotherapy in this trial showed improved clinical and pathologic tumor response and survival when compared to historical results. Patients who underwent esophagectomy following chemoradiation showed decreased local recurrence and improved survival and disease-free survival rates compared to the definitive chemoradiation group

  4. Problems of concurrent radiotherapy with S-1 for T2 glottic carcinoma

    International Nuclear Information System (INIS)

    Higashino, Masaaki; Kawata, Ryo; Suzuki, Norio; Ichihara, Takahiro; Terada, Tetsuya

    2016-01-01

    The aim of this study was to investigate the effectiveness and problems of concurrent radiotherapy with S-1 for T2 glottic carcinoma. The study included 48 patients (22 patients for radiotherapy alone (RT group), 26 patients for radiotherapy concurrent with S-1 (S-1 group) who underwent initial treatment as outpatients for T2 glottic carcinoma at Osaka Medical College. Six of the 26 patients of the S-1 group were suspected to have local recurrence, but 5 of them had necrosis and one had dysplasia. Three patients suffered bilateral vocal cord paralysis and underwent tracheostomy. On the other hand, 4 of the 22 patients of the RT group suffered local recurrence and one patient suffered unilateral vocal cord paralysis. The local control rate of the S-1 group was significantly higher than that of the RT group. In the S-1 group, 5 patients with laryngeal function disorder tended to develop upper and arytenoid cartilage. The local control rate of radiotherapy for T2 glottic carcinoma was improved by concurrent S-1. In the S-1 group, there was no local recurrence, but some cases suffered laryngeal dysfunction, so efforts should be made to preserve laryngeal function. (author)

  5. Functional morphology of the muscular sling at the pectoral girdle in tree sloths: convergent morphological solutions to new functional demands?

    Science.gov (United States)

    Nyakatura, John A; Fischer, Martin S

    2011-01-01

    Recent phylogenetic analyses imply a diphyly of tree sloths and a convergent evolution of their obligatory suspensory locomotion. In mammals the extrinsic shoulder musculature forms a ‘muscular sling’ to support the trunk in quadrupedal postures. In addition, the extrinsic pectoral muscles are responsible for moving the proximal forelimb elements during locomotion. Due to the inverse orientation of the body in regard to the gravitational force, the muscular sling as configured as in pronograde mammals is unsuited to suspend the weight of the thorax in sloths. We here review the muscular topography of the shoulder in Choloepus didactylus and Bradypus variegatus in the light of presumably convergent evolution to adapt to the altered functional demands of the inverse orientation of the body. In addition, we venture to deduce the effect of the shoulder musculature of C. didactylus during locomotion based on previously published 3D kinematic data. Finally, we assess likely convergences in the muscular topography of both extant sloth lineages to test the hypothesis that convergent evolution is reflected by differing morphological solutions to the same functional demands posed by the suspensory posture. Muscular topography of the shoulder in C. didactylus is altered from the plesiomorphic condition of pronograde mammals, whereas the shoulder in B. variegatus more closely resembles the general pattern. Overall kinematics as well as the muscles suitable for pro- and retraction of the forelimb were found to be largely comparable to pronograde mammals in C. didactylus. We conclude that most of the peculiar topography of extrinsic forelimb musculature can be attributed to the inverse orientation of the body. These characteristics are often similar in both genera, but we also identified different morphological solutions that evolved to satisfy the new functional demands and are indicative of convergent evolution. We suggest that the shared phylogenetic heritage canalized

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

    International Nuclear Information System (INIS)

    Mukai, Y.; Hata, M.; Koike, I.; Inoue, T.; Mitsudo, K.; Koizumi, T.; Oguri, S.; Kioi, M.; Tohnai, I.; Omura, M.

    2014-01-01

    The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma. In all, 34 patients (21 men and 13 women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60 Gy in 30 fractions was delivered to tumors. Of the 34 patients, 29 (85 %) achieved a complete response (CR) and 5 had residual tumors. Of the 29 patients with a CR, 2 had local recurrences and 1 had distant metastasis 1-15 months after treatment. Twenty-six of the 36 patients had survived at a median follow-up time of 36 months (range 12-79 months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5 years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1 patient after treatment. Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma. (orig.) [de

  7. Treatment outcome of radiation therapy and concurrent targeted molecular therapy in spinal metastasis from renal cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sang Joon; Kim, Kyung Hwan; Rhee, Woo Joong; Lee, Jeong Shin; Cho, Yeo Na; Koom, Woong Sub [Dept. of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-06-15

    To evaluate the clinical outcomes of patients who underwent radiation therapy with or without targeted molecular therapy for the treatment of spinal metastasis from renal cell carcinoma (RCC). A total of 28 spinal metastatic lesions from RCC patients treated with radiotherapy between June 2009 and June 2015 were retrospectively reviewed. Thirteen lesions were treated concurrently with targeted molecular therapy (concurrent group) and 15 lesions were not (nonconcurrent group). Local control was defined as lack of radiographically evident local progression and neurological deterioration. At a median follow-up of 11 months (range, 2 to 58 months), the 1-year local progression-free rate (LPFR) was 67.0%. The patients with concurrent targeted molecular therapy showed significantly higher LPFR than those without (p = 0.019). After multivariate analysis, use of concurrent targeted molecular therapy showed a tendency towards improved LPFR (hazard ratio, 0.13; 95% confidence interval, 0.01 to 1.16). There was no difference in the incidence of systemic progression between concurrent and nonconcurrent groups. No grade ≥2 toxicities were observed during or after radiotherapy. Our study suggests the possibility that concurrent use of targeted molecular therapy during radiotherapy may improve LPFR. Further study with a large population is required to confirm these results.

  8. Transactions Concurrency Control in Web Service Environment

    DEFF Research Database (Denmark)

    Alrifai, Mohammad; Dolog, Peter; Nejdl, Wolfgang

    2006-01-01

    an engineering point of view as it does not change the way consumers or clients of web services have to be programmed. Furthermore, it avoids direct communication between transaction coordinators which preserves security by keeping the information about business transactions restricted to the coordinators which......Business transactions in web service environments run with relaxed isolation and atomicity property. In such environments, transactions can commit and roll back independently on each other. Transaction management has to reflect this issue and address the problems which result for example from...... concurrent access to web service resources and data. In this paper we propose an extension to the WS-Transaction Protocol which ensures the consistency of the data when independent business transactions access the data concurrently under the relaxed transaction properties. Our extension is based...

  9. Continuous Activity Monitoring During Concurrent Chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ohri, Nitin, E-mail: ohri.nitin@gmail.com [Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States); Kabarriti, Rafi; Bodner, William R.; Mehta, Keyur J. [Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States); Shankar, Viswanathan [Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (United States); Halmos, Balazs; Haigentz, Missak [Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States); Rapkin, Bruce [Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (United States); Guha, Chandan; Kalnicki, Shalom; Garg, Madhur [Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States)

    2017-04-01

    Purpose: To perform a prospective trial testing the feasibility and utility of acquiring activity data as a measure of health status during concurrent chemoradiotherapy. Methods and Materials: Ambulatory patients who were planned for treatment with concurrent chemoradiotherapy with curative intent for cancers of the head and neck, lung, or gastrointestinal tract were provided with activity monitors before treatment initiation. Patients were asked to wear the devices continuously throughout the radiation therapy course. Step count data were downloaded weekly during radiation therapy and 2 and 4 weeks after radiation therapy completion. The primary objective was to demonstrate feasibility, defined as collection of step counts for 80% of the days during study subjects' radiation therapy courses. Secondary objectives included establishing step count as a dynamic predictor of unplanned hospitalization risk. Results: Thirty-eight enrolled patients were treated with concurrent chemoradiotherapy. Primary diagnoses included head and neck cancer (n=11), lung cancer (n=13), and a variety of gastrointestinal cancers (n=14). Step data were collected for 1524 of 1613 days (94%) during patients' radiation therapy courses. Fourteen patients were hospitalized during radiation therapy or within 4 weeks of radiation therapy completion. Cox regression modeling demonstrated a significant association between recent step counts (3-day average) and hospitalization risk, with a 38% reduction in the risk of hospitalization for every 1000 steps taken each day (hazard ratio 0.62, 95% confidence interval 0.46-0.83, P=.002). Inferior quality of life scores and impaired performance status were not associated with increased hospitalization risk. Conclusion: Continuous activity monitoring during concurrent chemoradiotherapy is feasible and well-tolerated. Step counts may serve as powerful, objective, and dynamic indicators of hospitalization risk.

  10. Continuous Activity Monitoring During Concurrent Chemoradiotherapy

    International Nuclear Information System (INIS)

    Ohri, Nitin; Kabarriti, Rafi; Bodner, William R.; Mehta, Keyur J.; Shankar, Viswanathan; Halmos, Balazs; Haigentz, Missak; Rapkin, Bruce; Guha, Chandan; Kalnicki, Shalom; Garg, Madhur

    2017-01-01

    Purpose: To perform a prospective trial testing the feasibility and utility of acquiring activity data as a measure of health status during concurrent chemoradiotherapy. Methods and Materials: Ambulatory patients who were planned for treatment with concurrent chemoradiotherapy with curative intent for cancers of the head and neck, lung, or gastrointestinal tract were provided with activity monitors before treatment initiation. Patients were asked to wear the devices continuously throughout the radiation therapy course. Step count data were downloaded weekly during radiation therapy and 2 and 4 weeks after radiation therapy completion. The primary objective was to demonstrate feasibility, defined as collection of step counts for 80% of the days during study subjects' radiation therapy courses. Secondary objectives included establishing step count as a dynamic predictor of unplanned hospitalization risk. Results: Thirty-eight enrolled patients were treated with concurrent chemoradiotherapy. Primary diagnoses included head and neck cancer (n=11), lung cancer (n=13), and a variety of gastrointestinal cancers (n=14). Step data were collected for 1524 of 1613 days (94%) during patients' radiation therapy courses. Fourteen patients were hospitalized during radiation therapy or within 4 weeks of radiation therapy completion. Cox regression modeling demonstrated a significant association between recent step counts (3-day average) and hospitalization risk, with a 38% reduction in the risk of hospitalization for every 1000 steps taken each day (hazard ratio 0.62, 95% confidence interval 0.46-0.83, P=.002). Inferior quality of life scores and impaired performance status were not associated with increased hospitalization risk. Conclusion: Continuous activity monitoring during concurrent chemoradiotherapy is feasible and well-tolerated. Step counts may serve as powerful, objective, and dynamic indicators of hospitalization risk.

  11. Two cases of therapy-related myelodysplastic syndrome after concurrent oral cancer chemoradiotherapy

    International Nuclear Information System (INIS)

    Doi, Katsuyuki; Asano, Takanori; Kinoshita, Takashi

    2010-01-01

    Therapy-related myelodysplastic syndrome (t-MDS) and therapy-related leukemia (TRL) are reported increasingly often, and we report two cases of T-MDS after concurrent chemoradiotherapy (CCRT) with oral cancer. Patients underwent CCRT with cisplatin (CDDP) or carboplatin (CBDCA). The interval between primary CCRT and t-MDS was 11 months in 1 case and 14 years in the other. Chromosomal analysis indicated abnormal karyotypes. Platinum has a relatively lower t-MDS risk than alkylating agents or topoisomerase II inhibitors, but our experience supports concurrent use of radiotherapy with platinum affects the risk of t-MDS. If pancytopenia is detected after CCRT, bone marrow and cytogenetic examinations should be conducted to rule out t-MDS. (author)

  12. Concurrent thymoma, thymic carcinoma, and T lymphoblastic leukemia/lymphoma in an anterior mediastinal mass.

    Science.gov (United States)

    Ito, Junko; Yoshida, Akihiko; Maeshima, Akiko Miyagi; Nakagawa, Kazuo; Watanabe, Shun-ichi; Kobayashi, Yukio; Fukuhara, Suguru; Tsuta, Koji

    2015-09-01

    We report a case of a 62-year-old man with concurrent thymoma, thymic carcinoma, and T lymphoblastic leukemia/lymphoma. Computed tomography revealed a 5.5-cm anterior mediastinal mass, and surgical resection was performed. Histologically, the mass showed concurrent thymoma (type AB), thymic carcinoma, and T lymphoblastic leukemia/lymphoma. Lymphoma cells infiltrated in the left lung, pulmonary hilar lymph nodes, and involved bone marrow. The patient underwent chemotherapy for T lymphoblastic leukemia/lymphoma and achieved remission. One year after surgery, he remains free of both thymoma and thymic carcinoma, and T lymphoblastic leukemia/lymphoma remains complete remission under maintenance therapy. Thymoma and T lymphoblastic leukemia/lymphoma can combine in the same mass, although this is quite rare. At the time of the diagnosis of thymoma, additional attention should be directed toward lymphocytes in the background. Copyright © 2015 Elsevier GmbH. All rights reserved.

  13. Paclitaxel and concurrent radiation for gastric cancer

    International Nuclear Information System (INIS)

    Safran, Howard; Wanebo, Harry J.; Hesketh, Paul J.; Akerman, Paul; Ianitti, David; Cioffi, William; Di Petrillo, Thomas; Wolf, Brian; Koness, James; McAnaw, Robert; Moore, Todd; Chen, M.-H.; Radie-Keane, Kathy

    2000-01-01

    Purpose: To determine the activity and toxicity of paclitaxel and concurrent radiation for gastric cancer. Methods and Materials: Twenty-seven patients were studied. Twenty-five had proximal gastric cancers, two had distal cancers. Eight had esophageal extension, 6 had celiac adenopathy, and 7 had retroperitoneal adenopathy. Patients received paclitaxel, 50 mg/m 2 by 3-hour intravenous (IV) infusion, weekly, on days 1, 8, 15, 22, and 29. Radiation was administered concurrently to a total dose of 45.0 Gy, in 1.80 Gy fractions, for 25 treatments. Patients who were medically or surgically inoperable received a sixth week of paclitaxel with a radiation boost to 50.4 Gy. Results: Esophagitis and gastritis were the most important toxicities, Grade 3 in four patients (15%), and Grade 4 in three patients (11%). Five patients (19%) had Grade 3 nausea. The overall response rate was 56%, including three patients (11%) with a complete response. The 2-year progression-free and overall survival rates were 29% and 31%, respectively. Conclusion: Concurrent paclitaxel and radiation demonstrates substantial local-regional activity in gastric cancer. Future investigations combining paclitaxel and radiation with other local-regional and systemic treatments are warranted

  14. Managing Asynchronous Data in ATLAS's Concurrent Framework

    CERN Document Server

    AUTHOR|(INSPIRE)INSPIRE-00100895; The ATLAS collaboration; Baines, John; Bold, Tomasz; Calafiura, Paolo; Cranshaw, Jack; Dotti, Andrea; Farrell, Steven; Malon, David; Stewart, Graeme; Snyder, Scott; van Gemmeren, Peter; Tsulaia, Vakhtang; Wynne, Benjamin

    2016-01-01

    In order to be able to make effective use of emerging hardware, where the amount of memory available to any CPU is rapidly decreasing as the core count continues to rise, ATLAS has begun a migration to a concurrent, multi-threaded software framework, known as AthenaMT. Significant progress has been made in implementing AthenaMT - we can currently run realistic Geant4 simulations on massively concurrent machines. the migration of realistic prototypes of reconstruction workflows is more difficult, given the large amounts of legacy code and the complexity and challenges of reconstruction software. These types of workflows, however, are the types that will most benefit from the memory reduction features of a multi-threaded framework. One of the challenges that we will report on in this paper is the re-design and implementation of several key asynchronous technologies whose behaviour is radically different in a concurrent environment than in a serial one, namely the management of Conditions data and the Detector D...

  15. Orthomodular Lattices Induced by the Concurrency Relation

    Directory of Open Access Journals (Sweden)

    Luca Bernardinello

    2009-11-01

    Full Text Available We apply to locally finite partially ordered sets a construction which associates a complete lattice to a given poset; the elements of the lattice are the closed subsets of a closure operator, defined starting from the concurrency relation. We show that, if the partially ordered set satisfies a property of local density, i.e.: N-density, then the associated lattice is also orthomodular. We then consider occurrence nets, introduced by C.A. Petri as models of concurrent computations, and define a family of subsets of the elements of an occurrence net; we call those subsets "causally closed" because they can be seen as subprocesses of the whole net which are, intuitively, closed with respect to the forward and backward local state changes. We show that, when the net is K-dense, the causally closed sets coincide with the closed sets induced by the closure operator defined starting from the concurrency relation. K-density is a property of partially ordered sets introduced by Petri, on the basis of former axiomatizations of special relativity theory.

  16. Long-term follow-up of the AdVance®/AdVanceXP® sling. What are the surgeons' impressions? What are the patients'?

    Science.gov (United States)

    Romero Hoyuela, A; Reina Alcaina, L; Izquierdo Morejon, E; Rosino Sanchez, A; Carrillo George, C; Rivero Guerra, A; Barcelo Bayonas, I; Pardo Martinez, A; Muñoz Guillermo, V; Pietricica, B; Fernandez Aparicio, T; Hita Villaplana, G; Miñana Lopez, B

    2018-04-01

    To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance ® and AdvanceXP ® slings. The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance ® and AdVanceXP ® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. The Advance ® and AdvanceXP ® system are effective over time in terms of urinary continence and patient satisfaction. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. 28 CFR 0.56 - Exclusive or concurrent jurisdiction.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Exclusive or concurrent jurisdiction. 0... JUSTICE Criminal Division § 0.56 Exclusive or concurrent jurisdiction. The Assistant Attorney General in... Government has exclusive or concurrent jurisdiction over offenses committed upon lands acquired by the United...

  18. Concurrent Endometrial Carcinosarcoma and Thyroid Papillary Carcinoma: PET CT Imaging Findings

    Directory of Open Access Journals (Sweden)

    Mine Genc

    2015-06-01

    Full Text Available The aim of this study is to report a patient who was diagnosed with a concurrent primary tumor by 18-fluoro-2-deoxy-glucose positron emission tomography (FDG PET imaging performed for staging of an endometrial cancer. FDG uptake was detected in the uterus, where the primary cancer was located, and in the left lobe of the thyroid gland. The biopsy sample from the hypermetabolic nodular lesion in thyroid gland revealed intermediate cytology according to Bethesda Classification. The patient underwent hysterectomy and thyroidectomy. An endometrial carcinoma in the uterus and a multicentric thyroid papillary carcinoma in the thyroid gland were diagnosed.

  19. Analysis of 1,000 cases of synthetic midurethral slings used for treatment of female urinary incontinence – a single-center experience

    Science.gov (United States)

    Kasyan, George; Gvozdev, Michail; Sosnowski, Roman

    2011-01-01

    Introduction This study summarized our experience in the treatment of 1,081 women with stress urinary incontinence (SUI) using mid-urethral slings. Material and methods The study included 1,081 operated patients. Pure SUI was diagnosed in 77.80% (841) of the patients; another 18.68% (202) had mixed symptoms. The remaining 3.52% (38) suffered from recurrent SUI. Group 1 included the SUI patients treated with TVT. Group 2 – SUI managed with TVT-O. In Group 3, mixed urinary incontinent (MUI) patients were treated with TVT-O. Results Retropubic TVT was used in 273 patients (25.25%) and TVT-O in 740 (68.45%). Other slings were used in 68 patients (6.3%). Mean follow-up for the groups was 50.1, 31.1, and 32.6 months respectively. For objective evaluation of cure rate we used the cough stress test. Subjective efficacy was studied via a visual analog scale. The complication rate in each group of the patients was used as a secondary end point. A negative cough test was found in 85.58% of patients in Group 1. For the TVT-O group, the objective cure rate was 84.36%. Intra-operative complications for TVT and TVT-O were not related to age, BMI, or parity. Bladder perforation and pelvic hematoma developed more frequently in the TVT group. There is a higher risk of vaginal perforation for TVT-O. The objective and subjective cure rates for MUI patients were 86.15% and 87.69% respectively. Conclusions TVT and TVT-O are equally effective and safe methods of treatment for women suffering from SUI and MUI. PMID:24578904

  20. Concurrent paclitaxel and radiotherapy. Treatment feasibility studies

    International Nuclear Information System (INIS)

    Vogt, H.G.; Martin, T.; Kolotas, C.; Hey, S.; Schneider, L.; Templin, T.; Zamboglou, N.; Dornoff, W.; Kettner, H.

    1997-01-01

    Background: The anti-neoplastic effect of paclitaxel has been demonstrated in various clinical studies in different malignant diseases. Clinical studies have also demonstrated a greater efficacy for simultaneous radio-chemotherapy compared with radiotherapy alone when using radiosensitizing drugs. Based on these clinical and in-vitro data we initiated several pilot studies using paclitaxel as a radiosensitizing agent and we now present our initial experience in its use in a combined modality protocol, radiation and simultaneous chemotherapy with paclitaxel. Methods: I. Concurrent paclitaxel and radiation for locally advanced non-small-cell lung cancer (NSCLC): In a phase-I-study we applicated paclitaxel (45 to 65 mg/m 2 ) as a 3-hour infusion weekly for 3 to 7 weeks simultaneously with primary radiotherapy in shrinking field technique with 5x1.8 Gy/week up to 59.4 Gy. - II. Concurrent paclitaxel and radiation for breast cancer as neoadjuvant or palliative: 50 mg/m 2 paclitaxel as a 3-hour infusion weekly for 6 weeks simultaneous with neoadjuvant or palliative radiotherapy of the breast/chest wall with 5x1.8 Gy/week up to 54.0 Gy. - III./IV. Concurrent paclitaxel/carboplatin and combined radiation (EBRT+brachytherapy) for locally advanced inoperable cancer of the cervix: 50 mg/m 2 paclitaxel as a 3-hour infusion weekly for 5 weeks, 50 mg/m 2 carboplatin at day 1 to 5 in week 1 and 5 simultaneously with external beam radiotherapy of the pelvis with 5x1.8 Gy/week up to 54.0 Gy and endocavitary LDR-brachytherapy (4x5 Gy). - V. Concurrent paclitaxel and radiation for locally advanced inoperable cancer of the bladder: 50 mg/m 2 paclitaxel as a 3-hour infusion weekly for 5 weeks simultaneous with radiotherapy of the pelvis with 5x1.8 Gy/week up to 50.4 Gy. VI. Concurrent paclitaxel and radiation in locally advanced inoperable head and neck cancer: 50 mg/m 2 paclitaxel as a 3-hour infusion weekly for 7 to 8 weeks simultaneous with radiotherapy in shrinking field technique

  1. Concurrent exercise training: do opposites distract?

    Science.gov (United States)

    Coffey, Vernon G; Hawley, John A

    2017-05-01

    Specificity is a core principle of exercise training to promote the desired adaptations for maximising athletic performance. The principle of specificity of adaptation is underpinned by the volume, intensity, frequency and mode of contractile activity and is most evident when contrasting the divergent phenotypes that result after undertaking either prolonged endurance or resistance training. The molecular profiles that generate the adaptive response to different exercise modes have undergone intense scientific scrutiny. Given divergent exercise induces similar signalling and gene expression profiles in skeletal muscle of untrained or recreationally active individuals, what is currently unclear is how the specificity of the molecular response is modified by prior training history. The time course of adaptation and when 'phenotype specificity' occurs has important implications for exercise prescription. This context is essential when attempting to concomitantly develop resistance to fatigue (through endurance-based exercise) and increased muscle mass (through resistance-based exercise), typically termed 'concurrent training'. Chronic training studies provide robust evidence that endurance exercise can attenuate muscle hypertrophy and strength but the mechanistic underpinning of this 'interference' effect with concurrent training is unknown. Moreover, despite the potential for several key regulators of muscle metabolism to explain an incompatibility in adaptation between endurance and resistance exercise, it now seems likely that multiple integrated, rather than isolated, effectors or processes generate the interference effect. Here we review studies of the molecular responses in skeletal muscle and evidence for the interference effect with concurrent training within the context of the specificity of training adaptation. © 2016 The Authors. The Journal of Physiology © 2016 The Physiological Society.

  2. Concurrent conditional clustering of multiple networks: COCONETS.

    Directory of Open Access Journals (Sweden)

    Sabrina Kleessen

    Full Text Available The accumulation of high-throughput data from different experiments has facilitated the extraction of condition-specific networks over the same set of biological entities. Comparing and contrasting of such multiple biological networks is in the center of differential network biology, aiming at determining general and condition-specific responses captured in the network structure (i.e., included associations between the network components. We provide a novel way for comparison of multiple networks based on determining network clustering (i.e., partition into communities which is optimal across the set of networks with respect to a given cluster quality measure. To this end, we formulate the optimization-based problem of concurrent conditional clustering of multiple networks, termed COCONETS, based on the modularity. The solution to this problem is a clustering which depends on all considered networks and pinpoints their preserved substructures. We present theoretical results for special classes of networks to demonstrate the implications of conditionality captured by the COCONETS formulation. As the problem can be shown to be intractable, we extend an existing efficient greedy heuristic and applied it to determine concurrent conditional clusters on coexpression networks extracted from publically available time-resolved transcriptomics data of Escherichia coli under five stresses as well as on metabolite correlation networks from metabolomics data set from Arabidopsis thaliana exposed to eight environmental conditions. We demonstrate that the investigation of the differences between the clustering based on all networks with that obtained from a subset of networks can be used to quantify the specificity of biological responses. While a comparison of the Escherichia coli coexpression networks based on seminal properties does not pinpoint biologically relevant differences, the common network substructures extracted by COCONETS are supported by

  3. Advanced concurrent engineering environment final report

    Energy Technology Data Exchange (ETDEWEB)

    Jortner, J.N.; Friesen, J.A.; Schwegel, J.

    1997-08-01

    Sandia demonstrated large-scale visualization in a conference room environment. Project focused on the installation of hardware for visualization and display, and the integration of software tools for design and animation of 3-dimensional parts. Using a high-end visualization server, 3-dimensional modeling and animation software, and leading edge World Wide Web technology, and advanced concurrent engineering environment was simulated where a design team was able to work collectively, rather than as solely disjoint individual efforts. Finally, a successful animation of a Sandia part was demonstrated, and a computer video generated. This video is now accessible on a Sandia internal web server.

  4. Advanced concurrent-engineering environment. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Jortner, J.N.; Friesen, J.A.

    1997-07-01

    Sandia demonstrated large-scale visualization in a conference room environment. Project focused in the installation of hardware for visualization and display, and the integration of software tools for design and animation of 3-dimensional parts. Using a high-end visualization server, 3-dimensional modeling and animation software, and leading edge World Wide Web technology, an advanced concurrent engineering environment was simulated where a design team was able to work collectively, rather than as solely disjoint individual efforts. Finally, a successful animation of a Sandia part was demonstrated, and a computer video generated. This video is now accessible on a Sandia internal web server.

  5. Relaxed Operational Semantics of Concurrent Programming Languages

    Directory of Open Access Journals (Sweden)

    Gustavo Petri

    2012-08-01

    Full Text Available We propose a novel, operational framework to formally describe the semantics of concurrent programs running within the context of a relaxed memory model. Our framework features a "temporary store" where the memory operations issued by the threads are recorded, in program order. A memory model then specifies the conditions under which a pending operation from this sequence is allowed to be globally performed, possibly out of order. The memory model also involves a "write grain," accounting for architectures where a thread may read a write that is not yet globally visible. Our formal model is supported by a software simulator, allowing us to run litmus tests in our semantics.

  6. Concurrency control in distributed database systems

    CERN Document Server

    Cellary, W; Gelenbe, E

    1989-01-01

    Distributed Database Systems (DDBS) may be defined as integrated database systems composed of autonomous local databases, geographically distributed and interconnected by a computer network.The purpose of this monograph is to present DDBS concurrency control algorithms and their related performance issues. The most recent results have been taken into consideration. A detailed analysis and selection of these results has been made so as to include those which will promote applications and progress in the field. The application of the methods and algorithms presented is not limited to DDBSs but a

  7. The Family of Concurrent Logic Programming Languages

    Science.gov (United States)

    1989-05-01

    we show here examples of manual specializations of meta-interpreters. Using partial evaluation techniques similar to those of [149,1501, the...193]. - 85 - 19.3 Proces to proceso mapping The question of how to map processes to processors is not unique to concurrent logic programming, and any...procinors(N,ToQ) queue(ToQ), -8 7 - procemorie(N,ToQ)Qnext. processors’(0,_). procesos (N,ToQ) - N>O I N’:=N-1, procesior(ToQ), processor’(N’ ,ToQ)Onext

  8. [Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

    Science.gov (United States)

    Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

    2017-11-01

    We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

  9. Concurrent fatigue and potentiation in endurance athletes.

    Science.gov (United States)

    Boullosa, Daniel A; Tuimil, José L; Alegre, Luis M; Iglesias, Eliseo; Lusquiños, Fernando

    2011-03-01

    Countermovement jump (CMJ) and maximum running speed over a distance of 20 m were evaluated for examination of the concurrent fatigue and postactivation potentiation (PAP) in endurance athletes after an incremental field running test. Twenty-two endurance athletes performed two attempts of CMJ on a force plate and maximum running speed test before and following the Université de Montréal Track Test (UMTT). The results showed an improvement in CMJ height (3.6%) after UMTT that correlated with the increment in peak power (3.4%), with a concurrent peak force loss (-10.8%) that correlated with peak power enhancement. The athletes maintained their 20 m sprint performance after exhaustion. Cluster analysis reinforced the association between CMJ and peak power increments in responders with a reported correlation between peak power and sprint performance increments (r = .623; P = .041); nonresponders showed an impairment of peak force, vertical stiffness, and a higher vertical displacement of the center of mass during the countermovement that correlated with lactate concentration (r = -0.717; P = .02). It can be suggested that PAP could counteract the peak force loss after exhaustion, allowing the enhancement of CMJ performance and the maintenance of sprint ability in endurance athletes after the UMTT. From these results, the evaluation of CMJ after incremental running tests for the assessment of muscular adaptations in endurance athletes can be recommended.

  10. ETHYLENE GLYCOL POISONING WITH CONCURRENT ETHANOL INGESTION

    Directory of Open Access Journals (Sweden)

    Mitja Lainščak

    2003-02-01

    Full Text Available Background. Ethylene glycol, usually ingested by coincidence, causes uncommon but serious poisoning which could have fatal consequences without prompt diagnosis and treatment. Ethylene glycol itself has a low toxicity but is rapidly degraded to toxic metabolites, that are responsible for typical clinical presentation. Metabolic acidosis, increased anion and osmolal gap are typical laboratory findings. Application of antidotes ethanol and fomepizol, hemodyalisis and correction of metabolic acidosis are mainstays of therapy.Patients and methods. A case of concurrent ethanol and ethylene glycol ingestion is presented. On admission diagnosis of ethylene glycol poisoning was supported by heteroanamnestic data, typical clinical presentation and laboratory findings and latter confirmed with body fluid analysis. Despite therapy with ethanol, sodium hydrogencarbonate and parenteral hydration patient developed acute renal failure which required hemodyalisis.Conclusions. Concurrent ingestion of spirit improved prognosis of ingestion of lethal ethylene glycol dose. Due to late arrival adequate and immediate in-hospital management could not prevent acute renal failure and subsequent hemodyalisis.

  11. Concurrent hyperadrenocorticism and diabetes mellitus in dogs.

    Science.gov (United States)

    Miceli, D D; Pignataro, O P; Castillo, V A

    2017-12-01

    Hyperadrenocorticism (HAC) and diabetes mellitus (DM) are two diseases that can occur concurrently in dogs. The objective of this study was to evaluate the coexistence of HAC and DM, and the risk factors involved that could contribute to the development of DM in dogs with HAC. A total of 235 dogs with HAC were studied and, according to their fasting glycemia, they were divided into three groups: 10.08mmol/L. The following parameters were evaluated: age, gender, cause of HAC, body condition, glycemia, total cholesterol, triglycerides, urinary cortisol:creatinin ratio (UCCR) and survival time. A 13.61% concurrence of HAC and DM was observed. Dogs with a fasting glycemia >5.6mmol/L, with dislipemia, with Pituitary-Dependent Hyperadrenocorticism, UCCR >100×10 -6 and non-castrated females showed a higher risk of developing DM. The development of DM in dogs with HAC reduces the survival time. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. A concurrent multiscale micromorphic molecular dynamics

    International Nuclear Information System (INIS)

    Li, Shaofan; Tong, Qi

    2015-01-01

    In this work, we have derived a multiscale micromorphic molecular dynamics (MMMD) from first principle to extend the (Andersen)-Parrinello-Rahman molecular dynamics to mesoscale and continuum scale. The multiscale micromorphic molecular dynamics is a con-current three-scale dynamics that couples a fine scale molecular dynamics, a mesoscale micromorphic dynamics, and a macroscale nonlocal particle dynamics together. By choosing proper statistical closure conditions, we have shown that the original Andersen-Parrinello-Rahman molecular dynamics is the homogeneous and equilibrium case of the proposed multiscale micromorphic molecular dynamics. In specific, we have shown that the Andersen-Parrinello-Rahman molecular dynamics can be rigorously formulated and justified from first principle, and its general inhomogeneous case, i.e., the three scale con-current multiscale micromorphic molecular dynamics can take into account of macroscale continuum mechanics boundary condition without the limitation of atomistic boundary condition or periodic boundary conditions. The discovered multiscale scale structure and the corresponding multiscale dynamics reveal a seamless transition from atomistic scale to continuum scale and the intrinsic coupling mechanism among them based on first principle formulation

  13. Evaluation of interaction dynamics of concurrent processes

    Science.gov (United States)

    Sobecki, Piotr; Białasiewicz, Jan T.; Gross, Nicholas

    2017-03-01

    The purpose of this paper is to present the wavelet tools that enable the detection of temporal interactions of concurrent processes. In particular, the determination of interaction coherence of time-varying signals is achieved using a complex continuous wavelet transform. This paper has used electrocardiogram (ECG) and seismocardiogram (SCG) data set to show multiple continuous wavelet analysis techniques based on Morlet wavelet transform. MATLAB Graphical User Interface (GUI), developed in the reported research to assist in quick and simple data analysis, is presented. These software tools can discover the interaction dynamics of time-varying signals, hence they can reveal their correlation in phase and amplitude, as well as their non-linear interconnections. The user-friendly MATLAB GUI enables effective use of the developed software what enables to load two processes under investigation, make choice of the required processing parameters, and then perform the analysis. The software developed is a useful tool for researchers who have a need for investigation of interaction dynamics of concurrent processes.

  14. Concurrent Initialization for Bearing-Only SLAM

    Directory of Open Access Journals (Sweden)

    Antoni Grau

    2010-03-01

    Full Text Available Simultaneous Localization and Mapping (SLAM is perhaps the most fundamental problem to solve in robotics in order to build truly autonomous mobile robots. The sensors have a large impact on the algorithm used for SLAM. Early SLAM approaches focused on the use of range sensors as sonar rings or lasers. However, cameras have become more and more used, because they yield a lot of information and are well adapted for embedded systems: they are light, cheap and power saving. Unlike range sensors which provide range and angular information, a camera is a projective sensor which measures the bearing of images features. Therefore depth information (range cannot be obtained in a single step. This fact has propitiated the emergence of a new family of SLAM algorithms: the Bearing-Only SLAM methods, which mainly rely in especial techniques for features system-initialization in order to enable the use of bearing sensors (as cameras in SLAM systems. In this work a novel and robust method, called Concurrent Initialization, is presented which is inspired by having the complementary advantages of the Undelayed and Delayed methods that represent the most common approaches for addressing the problem. The key is to use concurrently two kinds of feature representations for both undelayed and delayed stages of the estimation. The simulations results show that the proposed method surpasses the performance of previous schemes.

  15. Concurrent initialization for Bearing-Only SLAM.

    Science.gov (United States)

    Munguía, Rodrigo; Grau, Antoni

    2010-01-01

    Simultaneous Localization and Mapping (SLAM) is perhaps the most fundamental problem to solve in robotics in order to build truly autonomous mobile robots. The sensors have a large impact on the algorithm used for SLAM. Early SLAM approaches focused on the use of range sensors as sonar rings or lasers. However, cameras have become more and more used, because they yield a lot of information and are well adapted for embedded systems: they are light, cheap and power saving. Unlike range sensors which provide range and angular information, a camera is a projective sensor which measures the bearing of images features. Therefore depth information (range) cannot be obtained in a single step. This fact has propitiated the emergence of a new family of SLAM algorithms: the Bearing-Only SLAM methods, which mainly rely in especial techniques for features system-initialization in order to enable the use of bearing sensors (as cameras) in SLAM systems. In this work a novel and robust method, called Concurrent Initialization, is presented which is inspired by having the complementary advantages of the Undelayed and Delayed methods that represent the most common approaches for addressing the problem. The key is to use concurrently two kinds of feature representations for both undelayed and delayed stages of the estimation. The simulations results show that the proposed method surpasses the performance of previous schemes.

  16. Concurrent Engineering Working Group White Paper Distributed Collaborative Design: The Next Step in Aerospace Concurrent Engineering

    Science.gov (United States)

    Hihn, Jairus; Chattopadhyay, Debarati; Karpati, Gabriel; McGuire, Melissa; Panek, John; Warfield, Keith; Borden, Chester

    2011-01-01

    As aerospace missions grow larger and more technically complex in the face of ever tighter budgets, it will become increasingly important to use concurrent engineering methods in the development of early conceptual designs because of their ability to facilitate rapid assessments and trades of performance, cost and schedule. To successfully accomplish these complex missions with limited funding, it is essential to effectively leverage the strengths of individuals and teams across government, industry, academia, and international agencies by increased cooperation between organizations. As a result, the existing concurrent engineering teams will need to increasingly engage in distributed collaborative concurrent design. The purpose of this white paper is to identify a near-term vision for the future of distributed collaborative concurrent engineering design for aerospace missions as well as discuss the challenges to achieving that vision. The white paper also documents the advantages of creating a working group to investigate how to engage the expertise of different teams in joint design sessions while enabling organizations to maintain their organizations competitive advantage.

  17. Concurrent chemoradiotherapy with gemcitabine plus regional hyperthermia for locally advanced pancreatic carcinoma. Initial experience

    International Nuclear Information System (INIS)

    Ohguri, Takayuki; Imada, Hajime; Yahara, Katsuya; Morioka, Tomoaki; Nakano, Keita; Korogi, Yukunori; Narisada, Hiroyuki

    2008-01-01

    The aim of this study was to evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CRT) with gemcitabine plus regional hyperthermia (HT) for locally advanced pancreatic carcinoma (LAPC). A total of 29 patients with LAPC treated with concurrent CRT using gemcitabine were retrospectively analyzed. Radiotherapy was administered with a median total dose of 61.2 Gy. Of the 29 patients, 20 (69%) also underwent regional HT during CRT (CRHT group). The remaining 9 patients did not receive regional HT (CRT group) because of a common bile duct stent placement, patient refusal, older age, or obesity. The efficacy and toxicity of the treatments and the predictors of good outcome were evaluated. The median disease progression-free and overall survival times were significantly better for the CRHT group than for the CRT group (8.8 vs. 4.9 months, P=0.02, and 18.6 vs. 9.6 months, P=0.01), respectively. Grade 3-4 hematological toxicities for the CRHT group were detected in eight patients (40%) and grade 3 nonhematologic toxicity in one (diarrhea). Concurrent CRT using gemcitabine with regional HT may be a feasible and promising regimen for LAPC, and the results justified further evaluation in a large number of patients to confirm its definite benefit. (author)

  18. Concurrent radiochemotherapy in advanced hypopharyngeal cancer

    Directory of Open Access Journals (Sweden)

    Lukarski Dusko

    2010-05-01

    Full Text Available Abstract Background Concurrent platinum-based radiochemotherapy has been recommended as a standard of care in patients with locally advanced squamous cell head and neck carcinomas. Unfortunately, there is a lack of level one evidence on best treatment approach for advanced hypopharyngeal cancer. This report aims to summarize the results of our study on concurrent radiochemotherapy in patients with advanced hypopharyngeal cancer. Methods A retrospective analysis of 41 patients with stage III-IV hypopharyngeal cancer was performed. All patients were treated with three dimensional conformal radiotherapy and received 70 Gy in 35 fractions (2 Gy per fraction, 5 fractions per week. In dependence of the period when radiotherapy was realized, two different treatment techniques were used. Concurrent chemotherapy consisted of cisplatin 30 mg/m2 given on a weekly basis. Results The median age was 52 years (range 29-70. Stage IV disease was recognized in 73.2% of the patients. Complete response rates at the primary site and at the metastatic neck lymph nodes were 68.3% and 36.6%, respectively. A complete composite response was present in 27 patients (65.9%. Median follow-up was 13 months (range 7-36. Distant metastases as initial failure occurred in 7 patients (46.7%. The 2-year local relapse-free survival and regional relapse-free survival rates were 55.2% and 75.8%, respectively. The 2-year locoregional relapse-free survival rate was 51.3%. The 2-year disease-free survival and overall survival rates were 29.3% and 32.8%, respectively. Confluent mucositis was developed in 46.3% of patients. Leucopenia grade 1 was the most frequent hematological toxicity. The median weight loss at the end of treatment was 12% (range 5-21. The worst grade of late toxicity was most commonly pronounced in the skin and in the subcutaneous tissue. Conclusions Based on unsatisfactory results in our study we suggest that the use of sequential radiochemotherapy or chemotherapy

  19. Triological thesis: concurrent endoscopic sinus surgery and cosmetic rhinoplasty: rationale, risks, rewards, and reality.

    Science.gov (United States)

    Sclafani, Anthony P; Schaefer, Steven D

    2009-04-01

    To examine the effect of concurrent endoscopic sinus surgery (ESS) on the postoperative course of cosmetic rhinoplasty (CR), identify any specific contraindications, and to develop more useful treatment regimen in patients undergoing concurrent ESS and CR. Retrospective case-control study. Consecutive patients undergoing CR (performed by the principal investigator (PI) in a tertiary care academic practice) at the same operative setting as ESS from June 2004-June 2007 were identified. Additionally, patients undergoing CR (also by the PI) without ESS over the same time period (matched for gender, age, and rhinoplasty approach and techniques) were identified and used as control subjects. The office and hospital charts of these patients were reviewed for details of pre-, intra-, peri-, and postoperative care, preoperative CT scans as well as for patient and physician observations. Specifically noted were details regarding the type of cosmetic changes sought, course of symptoms of chronic sinusitis, prior treatment, surgical techniques used for both ESS and CR, and postoperative treatment with antibiotics and corticosteroids. Additionally, a literature review of articles describing concurrent CR and ESS was performed. Thirteen patients were identified who underwent ESS at the same time as CR. There were no cases of cerebrospinal fluid leak, epistaxis, orbital complications, septal perforation, cellulitis or saddle nose deformity. No correlation was found between sinus surgery performed and need for revision surgery (CR or ESS) or postoperative infections. However, the time to patient reported resolution of postoperative nasal swelling was significantly higher in patients undergoing concurrent ESS/CR compared to CR only (dorsal swelling: 9.62 +/- 6.18 (ESS/CR) vs. 5.85 +/- 1.95 (CR) weeks, P = .0469; nasal tip swelling: 19.31 +/- 13.02 (ESS/CR) vs. 10.38 +/- 2.96 (CR) weeks, P = .0240, unpaired t test). The same relation held true for doctor noted postoperative edema

  20. The fallacies of concurrent climate policy efforts.

    Science.gov (United States)

    Radetzki, Marian

    2010-05-01

    Climate policy has assumed an extreme degree of urgency in the international debate in recent years. This article begins by taking a critical look at the scientific underpinnings of the efforts to stabilize the climate. It points to several serious question marks on the purported relationship between greenhouse gas emissions and global warming, and expresses distrust about claims of impending catastrophes related to rising sea levels, hurricanes, and spread of infectious disease. It then reviews the concurrent climate policy efforts and concludes that they are incoherent, misguided and unduly costly, and that they have so far had no perceptible impact on anthropogenic greenhouse gas emissions. The exceedingly ambitious policy plans currently under preparation suffer from similar fallacies. For these reasons, but also because of the remaining scientific doubts and the exorbitant costs that have to be incurred, skepticism is expressed about the preparedness to implement the climate policy plans currently on the table.

  1. Concurrent hypokalemic periodic paralysis and bipolar disorder

    Directory of Open Access Journals (Sweden)

    Chia-Lin Lin

    2015-01-01

    Full Text Available Primary periodic paralysis is a rare autosomal dominant disorder of ion-channel dysfunction, manifested by episodic flaccid paresis secondary to abnormal sarcolemma excitability. Membrane destabilization involving Na, K-ATPase has been hypothesized to be a biological etiology of the bipolar disorder (BD and the mechanisms underlying lithium therapy have been linked to it. To date, there has been only one reported case of BD comorbid with periodic paralysis. Herein, we reported another case of concurrent bipolar mania and hypokalemic periodic paralysis (HPP, one special form of periodic paralysis. Consistent with the previous case, our patient responded well to lithium treatment for both bipolar mania and HPP. This might provide some support to the hypothesis that the therapeutic effects of lithium in both BD and HPP could be due to the correction of the underlying common pathophysiology.

  2. Concurrent remote entanglement with continuous variables

    Science.gov (United States)

    Zalys-Geller, E.; Narla, A.; Shankar, S.; Hatridge, M.; Silveri, M.; Sliwa, K. M.; Mundhada, S. O.; Girvin, S. M.; Devoret, M. H.

    A necessary ingredient for large scale quantum information processing is the ability to entangle distant qubits on demand. In the field of superconducting quantum information, this process can be achieved by entangling stationary superconducting qubits with flying coherent states of microwave light, which are then co-amplified by a Josephson Parametric Converter (JPC). The JPC also serves as a which-path information eraser, causing the probabilistic continuous measurement process to concurrently entangle the qubits. We discuss the sensitivity of the experiment to the loss of quantum information during the flight of the coherent states, as well as strategies to improve which-path information erasure and reduce information loss to the degree required for entanglement generation. Work supported by ARO, AFOSR, NSF, and YINQE.

  3. Micro-transactions for concurrent data structures

    DEFF Research Database (Denmark)

    Meawad, Fadi; Iyer, Karthik; Schoeberl, Martin

    2013-01-01

    implementation of transactional memory that we call micro-transactions. In particular, we argue that hardware support for micro-transactions allows us to efficiently implement certain data structures. Those data structures are difficult to realize with the atomic operations provided by stock hardware and provide......Transactional memory is a promising technique for enforcing disciplined access to shared data in a multiprocessor system. Transactional memory simplifies the implementation of a variety of concurrent data structures. In this paper, we study the benefits of a modest, real-time aware, hardware...... real-time guarantees for those operations. Our main implementation platform is the Java Optimized Processor system, a field-programmable gate array (FPGA) implementation of the Java virtual machine, optimized for real-time Java. We report on the performance of data structures implemented with locks...

  4. High bandwidth concurrent processing on commodity platforms

    CERN Document Server

    Boosten, M; Van der Stok, P D V

    1999-01-01

    The I/O bandwidth and real-time processing power required for high- energy physics experiments is increasing rapidly over time. The current requirements can only be met by using large-scale concurrent processing. We are investigating the use of a large PC cluster interconnected by Fast and Gigabit Ethernet to meet the performance requirements of the ATLAS second level trigger. This architecture is attractive because of its performance and competitive pricing. A major problem is obtaining frequent high-bandwidth I/O without sacrificing the CPU's processing power. We present a tight integration of a user-level scheduler and a zero-copy communication layer. This system closely approaches the performance of the underlying hardware in terms of both CPU power and I/O capacity. (0 refs).

  5. Distributed Management of Concurrent Web Service Transactions

    DEFF Research Database (Denmark)

    Alrifai, Mohammad; Dolog, Peter; Balke, Wolf-Tilo

    2009-01-01

    in the open and dynamic environment of Web services, where interleaving business transactions enter and exit the system independently, remains an open issue. In this paper, we address this problem and propose an architecture that supports concurrency control on the Web services level. An extension......Business processes involve dynamic compositions of interleaved tasks. Therefore, ensuring reliable transactional processing of Web services is crucial for the success of Web service-based B2B and B2C applications. But the inherent autonomy and heterogeneity of Web services render the applicability...... of conventional ACID transaction models for Web services far from being straightforward. Current Web service transaction models relax the isolation property and rely on compensation mechanisms to ensure atomicity of business transactions in the presence of service failures. However, ensuring consistency...

  6. Does Concurrent Training Intensity Distribution Matter?

    Science.gov (United States)

    Varela-Sanz, Adrián; Tuimil, José L; Abreu, Laurinda; Boullosa, Daniel A

    2017-01-01

    Varela-Sanz, A, Tuimil, JL, Abreu, L, and Boullosa, DA. Does concurrent training intensity distribution matter? J Strength Cond Res 31(1): 181-195, 2017-Previous research has demonstrated the influence of intensity distribution on endurance training adaptations. However, no study has addressed the influence of intensity distribution on the effectiveness of concurrent training (CT). The main objective of this study was to compare the effects of 2 CT programs with different training intensity distribution and externally equated loads on physical fitness. Thirty-one sport science students volunteered and were evaluated for resting heart rate variability (HRV), countermovement jump, bench press, half squat, and maximum aerobic speed (MAS). All were randomly distributed into either a traditional-based training group (TT; n = 11; 65-75% of MAS, combined with 10-12 repetition maximum [RM]), polarized training group (PT; n = 10; 35-40% and 120% of MAS, combined with 5RM and 15RM), or control group (CG; n = 10). After 8 weeks of training (3 daysweek), TT and PT exhibited similar improvements in MAS, bench press, and half squat performances. No differences were observed between TT and PT groups for perceived loads. There were no changes in HRV for any group, although TT exhibited a reduction in resting heart rate. Compared with other groups, the PT group maintained jump capacity with an increment in body mass and body mass index without changes in body fatness. In conclusion, PT induced similar improvements in physical fitness of physically active individuals when compared with TT. However, PT produced a lower interference for jumping capacity despite an increment in body mass, whereas TT induced greater bradycardia. Extended studies with different intensity distributions should be conducted to better determine the dose-response of CT in various populations.

  7. Preoperative Radiation Therapy With Concurrent Capecitabine, Bevacizumab, and Erlotinib for Rectal Cancer: A Phase 1 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Das, Prajnan, E-mail: PrajDas@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eng, Cathy [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rodriguez-Bigas, Miguel A.; Chang, George J.; Skibber, John M.; You, Y. Nancy [Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Maru, Dipen M. [Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Clemons, Marilyn V. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kopetz, Scott E.; Garrett, Christopher R.; Shureiqi, Imad [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-02-01

    Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m{sup 2} to 825 mg/m{sup 2} orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation.

  8. Erlang Programming A Concurrent Approach to Software Development

    CERN Document Server

    Cesarini, Francesco

    2009-01-01

    This book offers you an in-depth explanation of Erlang, a programming language ideal for any situation where concurrency, fault-tolerance, and fast response is essential. You'll learn how to write complex concurrent programs in this language, regardless of your programming background or experience. Erlang Programming focuses on the language's syntax and semantics, and explains pattern matching, proper lists, recursion, debugging, networking, and concurrency, with exercises at the end of each chapter.

  9. Socioeconomic Inequality in Concurrent Tobacco and Alcohol Consumption

    OpenAIRE

    Intarut, Nirun; Pukdeesamai, Piyalak

    2017-01-01

    Background: Whilst several studies have examined inequity of tobacco use and inequity of alcohol drinking individually, comparatively little is known about concurrent tobacco and alcohol consumption. The present study therefore investigated inequity of concurrent tobacco and alcohol consumption in Thailand. Methods: The 2015 Health and Welfare Survey was obtained from Thailand’s National Statistical Office and used as a source of national representative data. Concurrent tobacco and alcohol co...

  10. A Highly Concurrent Replicated Data Structure EAI Endorsed Transactions

    Directory of Open Access Journals (Sweden)

    Mumtaz Ahmad

    2015-12-01

    Full Text Available Well defined concurrent replicated data structure is very important to design collaborative editing system, particularly, certain properties like out-of-order execution of concurrent operations and data convergence. In this paper, we introduce novel linear data structure based on unique identifier scheme required for indexed communication. These identifiers are real numbers holding specific pattern of precision. Based on the uniqueness and the total order of these identifiers, here, we present two concurrency control techniques to achieve high degree of concurrency according to strong and lazy happened-before relations. Our data structure preserves data convergence, yields better performance and avoids overheads as compared to existing approaches.

  11. The Efficacy of an 8-Week Concurrent Strength and Endurance Training Programme on Hand Cycling Performance.

    Science.gov (United States)

    Nevin, Jonpaul; Waldron, Mark; Patterson, Stephen; Smith, Paul; Price, Mike; Hunt, Alex

    2018-03-20

    The aim of the present study was to investigate the effects of an 8-week concurrent strength and endurance training programme in comparison to endurance training only on several key determinants of hand cycling performance. Five H4 and five H3 classified hand cyclists with at least one year's hand cycling training history consented to participate in the study. Subjects underwent a battery of tests to establish body mass, body composition, VO2peak, maximum aerobic power, gross mechanical efficiency, maximal upper body strength, and 30 km time trial performance. Subjects were matched into pairs based upon 30 km time trial performance and randomly allocated to either a concurrent strength and endurance or endurance training only, intervention group. Following an 8-week training programme based upon a conjugated block periodisation model, subjects completed a second battery of tests. A mixed model, 2-way analysis of variance (ANOVA) revealed no significant changes between groups. However, the calculation of effect sizes (ES) revealed that both groups demonstrated a positive improvement in most physiological and performance measures with subjects in the concurrent group demonstrating a greater magnitude of improvement in body composition (ES -0.80 vs. -0.22) maximal aerobic power (ES 0.97 vs. 0.28), gross mechanical efficiency (ES 0.87 vs. 0.63), bench press 1 repetition maximum (ES 0.53 vs. 0.33), seated row 1 repetition maximum (ES 1.42 vs. 0.43), and 30 km time trial performance (ES -0.66 vs. -0.30). In comparison to endurance training only, an 8-week concurrent training intervention based upon a conjugated block periodisation model appears to be a more effective training regime for improving the performance capabilities of hand cyclists.

  12. Weekly paclitaxel with concurrent radiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Hu Wei; Ding Weijun; Yang Haihua; Shao Minghai; Wang Biyun; Wang Jianhua; Wu Sufang; Wu Shixiu; Jin Lihui; Ma, Charlie C.-M.

    2009-01-01

    Purpose: To evaluate the efficacy and toxicity of weekly paclitaxel with concurrent radiotherapy followed by adjuvant chemotherapy (AC) in patients with locally advanced nasopharyngeal carcinoma (NPC). Methods and materials: Between 2004 and 2007, 54 patients with locally advanced NPC were included in this protocol. Patient characteristics: median age 48; 69% male; 52% World Health Organization (WHO) III; 50% stage III, 50% stage IV. The patients underwent a course of definitive conventional radiotherapy (70 Gy in 7 weeks with 2 Gy/fraction), with concurrent weekly paclitaxel 35 mg/m 2 from the first to the sixth week of radiation. AC was started 4 weeks after the end of the radiotherapy (RT), paclitaxel 135 mg/m 2 on day 1 and cisplatin 30 mg/m 2 on days 1-3 were administered every 4 weeks for two cycles. Results: Median follow-up was 32 months. Eighty-five percentage of complete response and 15% partial response were achieved at the time of one month after AC. The 3-year actuarial rate of local regional control was 86%; distant metastases-free survival, progression-free survival and overall survival at 3 years were 81%, 69% and 76%, respectively. Forty-nine (91%) patients completed six courses of concurrent chemotherapy with weekly paclitaxel, and 4 (7%) patients delayed at the second cycle of AC. No patient developed severe acute toxicities. Conclusions: Weekly paclitaxel with concurrent RT followed by AC is a potentially effective and toxicity tolerable method for locally advanced NPC. Further studies are needed to identify the optimal dose of weekly paclitaxel in this strategy.

  13. Improvement in performance status after erythropoietin treatment in lung cancer patients undergoing concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Casas, Francesc; Vinolas, Nuria; Ferrer, Ferran; Farrus, Blanca; Gimferrer, Josep Maria; Agusti, Carles; Belda, Josep; Luburich, Patricio

    2003-01-01

    Purpose: A prospective Phase II trial was carried out to evaluate the effectiveness of erythropoietin in improving or maintaining performance status as determined by the Karnofsky performance status (KPS) score and hemoglobin (Hb) levels in lung cancer patients treated with concurrent chemoradiation (CH-RT). Methods and Materials: A total of 51 patients with lung cancer (11 with small-cell, limited stage and 40 with non-small-cell disease, 17 with Stage IIIA and 23 with Stage IIIB), who underwent three different concurrent CH-RT protocols were enrolled. Baseline Hb and KPS values were recorded, as were the nadir Hb and KPS values before concurrent CH-RT. The final Hb and KPS values were recorded the last week of concurrent CH-RT. An Hb level of ≤11 g/dL before concurrent CH-RT was required before receiving erythropoietin. Prognostic factors for KPS improvement and survival were assessed by univariate and multivariate studies. Results: Of the 51 patients, 47 (92.3%) were men (mean age 63.6 years, range 40-75). The median baseline KPS score was 80, and the mean baseline Hb was 12.2 ± 1.76 g/dL (range 9-16.9). The mean nadir and final Hb value was 9.98±0.67 g/dL (range 8.6-11) and 11.33±1.59 g/dL (range 6.9-14.4), respectively. A significant increase was seen in the Hb and KPS score (p<0.05) in the final measurements. Differences were found between the final and nadir Hb in the predictive value for differences in performance status (p=0.001). On univariate study, pathologic findings (p=0.0234), weight loss (p=0.0049), baseline Hb (p=0.0057), and final Hb improvement (p=0.0237) were prognostic factors for survival. Nadir Hb (p=0.027), final Hb improvement (p=0.0069), pathologic findings (p = 0.0006), and weight loss (p=0.0001) had significant prognostic value for survival in multivariate analysis. Conclusion: In this study, erythropoietin appears to have a significant, beneficial impact on the KPS and Hb of patients undergoing concurrent CH-RT

  14. APACHE II SCORING SYSTEM AND ITS MODIFICATION FOR THE ASSESSMENT OF DISEASE SEVERITY IN CHILDREN WHO UNDERWENT POLYCHEMOTHERAPY

    Directory of Open Access Journals (Sweden)

    А. V. Sotnikov

    2014-01-01

    Full Text Available Short-term disease prognosis should be considered for the appropriate treatment policy based on the assessment of disease severity in patients with acute disease. The adequate assessment of disease severity and prognosis allows the indications for transferring patients to the resuscitation and intensive care department to be defined more precisely. Disease severity of patients who underwent polychemotherapy was assessed using APACHE II scoring system.

  15. Atrioventricular septal defect (AVSD) : A study of 219 patients who underwent surgery for AVSD at Rikshospitalet from 1979 to 1999

    OpenAIRE

    Skraastad, Ingrid Birthe Bendixen; Skraastad, Berit Kristine

    2010-01-01

    Background: The present study evaluates 219 consecutive patients that underwent surgical repair for AVSD in a long term follow-up. Methods: The patients had a surgical correction for AVSD at Rikshospitalet from January 1979 to December 1999. The follow-up was closed in January 2009. AVSD with additional defects and syndromes were included. Results: Forty-two patients died during the observational period. Early mortality was 12.8% and late mortality was 6.4%. Early mortality declined f...

  16. Comparison of libido, Female Sexual Function Index, and Arizona scores in women who underwent laparoscopic or conventional abdominal hysterectomy

    Science.gov (United States)

    Kayataş, Semra; Özkaya, Enis; Api, Murat; Çıkman, Seyhan; Gürbüz, Ayşen; Eser, Ahmet

    2017-01-01

    Objective: The aim of the present study was to compare female sexual function between women who underwent conventional abdominal or laparoscopic hysterectomy. Materials and Methods: Seventy-seven women who were scheduled to undergo hysterectomy without oophorectomy for benign gynecologic conditions were included in the study. The women were assigned to laparoscopic or open abdominal hysterectomy according to the surgeons preference. Women with endometriosis and symptomatic prolapsus were excluded. Female sexual function scores were obtained before and six months after the operation from each participant by using validated questionnaires. Results: Pre- and postoperative scores of three different quationnaires were found as comparable in the group that underwent laparoscopic hysterectomy (p>0.05). Scores were also found as comparable in the group that underwent laparotomic hysterectomy (p>0.05). Pre- and postoperative values were compared between the two groups and revealed similar results with regard to all three scores (p>0.05). Conclusion: Our data showed comparable pre- and the postoperative scores for the two different hysterectomy techniques. The two groups were also found to have similar pre- and postoperative score values. PMID:28913149

  17. Vaginal and pelvic recurrence rates based on vaginal cuff length in patients with cervical cancer who underwent radical hysterectomies.

    Science.gov (United States)

    Kim, K; Cho, S Y; Park, S I; Kim, B J; Kim, M H; Choi, S C; Ryu, S Y; Lee, E D

    2011-09-01

    The objective of this study was to determine the association of vaginal cuff length (VCL) with vaginal and pelvic recurrence rates in patients with cervical cancer who underwent radical hysterectomies. The clinicopathologic characteristics were collected from the medical records of 280 patients with cervical cancer who underwent radical hysterectomies. The association of VCL with 3-year vaginal and pelvic recurrence rates was determined using a Z-test. The association of VCL with other clinicopathologic characteristics was also determined. The VCL was not associated with 3-year vaginal and pelvic recurrence rates. The 3-year vaginal recurrence rate was 0%-2% and the 3-year pelvic recurrence rate was 7%-8%, independent of VCL. The VCL and the age of patients had an inverse relationship. However, the VCL was not associated with histologic type, FIGO stage, clinical tumor size, tumor size in the surgical specimen, depth of invasion, lymphovascular space invasion, parametrial involvement, lymph node involvement, and adjuvant therapy. One-hundred ninety of 280 patients (68%) underwent adjuvant therapies following radical hysterectomies. Although it is limited by the high rate of adjuvant therapy, the current study suggested that the VCL following radical hysterectomy in patients with cervical cancer was not associated with vaginal and pelvic recurrence rates. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Severe complications and failures of incontinence surgery using the Remeex(®) adjustable tension sling (external mechanical regulator).

    Science.gov (United States)

    Lorenzo-Gómez, M F; Padilla-Fernández, B; Virseda-Rodríguez, A J; Collazos-Robles, R E; García-Cenador, M B; Mirón-Canelo, J A

    2015-11-01

    Since 1999, we have performed implantations of Remeex® adjustable prosthetics as rescue treatment for complex or persistent stress urinary incontinence (SUI) after failure of other surgical treatments (Burch colposuspension, Marshall-Marchetti-Krantz (MMK) or tension-free transvaginal tape [TVT] until 2003 and transobturator tape [TOT] since 2003). We present the results of our series, which include cases with severe complications. Retrospective study of women diagnosed with complex or refractory SUI who underwent Remeex(®) implantation between October 1999 and December 2013. In 5 cases, we conducted cystocele correction in the same operation as the placement of the Remeex(®). Sixty women, with a mean age of 66.87 years (range 39-85), underwent operations. The procedure was successful in 68.33% of the cases. The failures consisted of the following: 10% of the women had mixed urinary incontinence (UI) with multiple bladder diverticula; 8.33% had mild SUI; and 13.33% had urgency urination without UI. Thirty-five percent required adjustments. We recorded 3 cases with severe complications: disabling severe UI in a patient who underwent multiple operations, massive pelvic hemorrhage in a patient undergoing standard antiplatelet therapy and infected vaginal calculi measuring 7cm on an extruding Remeex thread in a paraplegic patient 4 years after the implantation. Remeex(®) is an effective and safe procedure for achieving continence in cases of complex or refractory SUI, although it is not exempt from severe complications. Following rigorous protocols can help detect complications and treat them in a timely manner. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Concurrent sexual partnerships among female sex workers and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico

    Science.gov (United States)

    Robertson, Angela M.; Syvertsen, Jennifer L.; Rangel, M. Gudelia; Staines, Hugo S.; Morris, Martina; Patterson, Thomas L.; Ulibarri, Monica D.; Strathdee, Steffanie A.

    2013-01-01

    Objectives To investigate the prevalence and correlates of concurrent (overlapping) sexual partnerships among female sex workers (FSWs) and their non-commercial male partners in two Mexico-U.S. border cities. Methods A cross-sectional survey of FSWs and their non-commercial male partners was conducted in Tijuana and Ciudad Juárez, Mexico (2010–2011). Eligible FSWs and verified non-commercial partners were aged ≥18 years; FSWs had ever used hard drugs (lifetime) and recently exchanged sex for money, drugs, or other goods (past month). Participants underwent baseline questionnaires obtaining dates of sex and condom use with ≤5 other recurring partners, including FSWs’ regular clients. These dates were compared to dates of sex with enrolled study partners to determine overlap (i.e., “recurring” concurrency). Bivariate probit regression identified recurring concurrency correlates. Results Among 428 individuals (214 couples), past-year recurring concurrency prevalence was 16% and was higher among women than their non-commercial male partners (26% vs. 6%). In 10 couples (5%), both partners reported recurring concurrency. The majority of couples (64%) always had unprotected sex, and most of the individuals (70%) with recurring concurrency “sometimes” or “never” used condoms with their concurrent partners. Recurring concurrency was positively associated with FSWs’ income, men’s caballerismo (a form of traditional masculinity), and men’s belief that their FSW-partners had STIs. Conclusions Recurring concurrency, representing sustained periods of overlapping partnerships in which unprotected sex was common, should be addressed by couple-based STI prevention interventions. PMID:23172036

  20. Can concurrent core biopsy and fine needle aspiration biopsy improve the false negative rate of sonographically detectable breast lesions?

    Directory of Open Access Journals (Sweden)

    Chang Tsai-Wang

    2010-07-01

    Full Text Available Abstract Background The aims of this study were to determine the accuracy of concurrent core needle biopsy (CNB and fine needle aspiration biopsy (FNAB for breast lesions and to estimate the false-negative rate using the two methods combined. Methods Over a seven-year period, 2053 patients with sonographically detectable breast lesions underwent concurrent ultrasound-guided CNB and FNAB. The sonographic and histopathological findings were classified into four categories: benign, indeterminate, suspicious, and malignant. The histopathological findings were compared with the definitive excision pathology results. Patients with benign core biopsies underwent a detailed review to determine the false-negative rate. The correlations between the ultrasonography, FNAB, and CNB were determined. Results Eight hundred eighty patients were diagnosed with malignant disease, and of these, 23 (2.5% diagnoses were found to be false-negative after core biopsy. After an intensive review of discordant FNAB results, the final false-negative rate was reduced to 1.1% (p-value = 0.025. The kappa coefficients for correlations between methods were 0.304 (p-value p-value p-value Conclusions Concurrent CNB and FNAB under ultrasound guidance can provide accurate preoperative diagnosis of breast lesions and provide important information for appropriate treatment. Identification of discordant results using careful radiological-histopathological correlation can reduce the false-negative rate.

  1. 38 CFR 21.7673 - Measurement of concurrent enrollments.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Measurement of concurrent... Reserve Course Assessment § 21.7673 Measurement of concurrent enrollments. (a) Conversion of units of... reservist's training time. (Authority: 10 U.S.C. 16136(b); 38 U.S.C. 3688) (b) Conversion of clock hours to...

  2. 38 CFR 21.7172 - Measurement of concurrent enrollments.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Measurement of concurrent... (Montgomery GI Bill-Active Duty) Course Assessment § 21.7172 Measurement of concurrent enrollments. (a..., VA will convert the credit hours to clock hours to determine the veteran's training time. (Authority...

  3. Gender asymmetry in concurrent partnerships and HIV prevalence

    NARCIS (Netherlands)

    Leung, Ka Yin; Powers, Kimberly A.; Kretzschmar, Mirjam

    The structure of the sexual network of a population plays an essential role in the transmission of HIV. Concurrent partnerships, i.e. partnerships that overlap in time, are important in determining this network structure. Men and women may differ in their concurrent behavior, e.g. in the case of

  4. Gender asymmetry in concurrent partnerships and HIV prevalence

    NARCIS (Netherlands)

    Leung, Ka Yin; Powers, Kimberly A.; Kretzschmar, Mirjam

    2017-01-01

    The structure of the sexual network of a population plays an essential role in the transmission of HIV. Concurrent partnerships, i.e. partnerships that overlap in time, are important in determining this network structure. Men and women may differ in their concurrent behavior, e.g. in the case of

  5. Transactions on Petri Nets and Other Models of Concurrency V

    DEFF Research Database (Denmark)

    submission track of ToPNoC. The 12 papers cover a diverse range of topics including model checking and system verification, synthesis, foundational work on specific classes of Petri nets, and innovative applications of Petri nets and other models of concurrency. Thus, this volume gives a good view of ongoing...... concurrent systems and Petri nets research...

  6. Dynamic Frames Based Verification Method for Concurrent Java Programs

    NARCIS (Netherlands)

    Mostowski, Wojciech

    2016-01-01

    In this paper we discuss a verification method for concurrent Java programs based on the concept of dynamic frames. We build on our earlier work that proposes a new, symbolic permission system for concurrent reasoning and we provide the following new contributions. First, we describe our approach

  7. Association of HIV prevalence and concurrency of sexual ...

    African Journals Online (AJOL)

    Association of HIV prevalence and concurrency of sexual partnerships in South Africa's language groups: An ecological analysis. C Kenyon. Abstract. Background. There is considerable variation in HIV prevalence between different language groups in South Africa (SA). Sexual partner concurrency has been linked to the ...

  8. Concurrent Oxytocin in Women Needing Second Dinoprostone

    International Nuclear Information System (INIS)

    Sher, Z.; Ashraf, M.; Irum, N.; Bashir, S.; Khaliq, N.; Yaqub, S.

    2015-01-01

    Objective: To reduce average induction delivery internal in patients with poor Bishop score without compromising fetomaternal outcome (in terms of birth weight, NICU admission, maternal complications and mode of delivery). Study Design: A descriptive study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad, from February to December 2009. Methodology: All patients needing 2nd dinoprostone pessary for induction of labour were included in the study. Patients with gestation below 37 weeks, those with intra-uterine growth restriction, bad obstetric history, previous uterine scar and patients in whom Bishop score improved for amniotomy after 1st dinoprostone pessary, were excluded. Data was collected on a special proforma where all variables were defined. Results:Out of 90 patients, 44 (48.8 percentage) had spontaneous vertex deliveries and 12 (13.3 percentage) had instrumental deliveries so a total vaginal deliveries occurred in 56 (62.2 percentage) patients. Thirty four patients (37.8 percentage) had emergency caesarean sections. Main indication for cesarean was failure to progress in 1st stage of labour followed by fetal distress. There were 3 failed inductions. Only 2 patients had hyperstimulation. NICU admission were 8 and all babies were discharged healthy from nursery with no case of early neonatal death. Conclusion:Concurrent oxytocin with 2nd dinoprostone in patients with poor Bishop scores (initial scores 2 and 3) resulted in more vaginal birth and comparatively shorter induction delivery time with almost negligible fetomaternal complications. (author)

  9. Creatine and Caffeine: Considerations for Concurrent Supplementation.

    Science.gov (United States)

    Trexler, Eric T; Smith-Ryan, Abbie E

    2015-12-01

    Nutritional supplementation is a common practice among athletes, with creatine and caffeine among the most commonly used ergogenic aids. Hundreds of studies have investigated the ergogenic potential of creatine supplementation, with consistent improvements in strength and power reported for exercise bouts of short duration (≤ 30 s) and high intensity. Caffeine has been shown to improve endurance exercise performance, but results are mixed in the context of strength and sprint performance. Further, there is conflicting evidence from studies comparing the ergogenic effects of coffee and caffeine anhydrous supplementation. Previous research has identified independent mechanisms by which creatine and caffeine may improve strength and sprint performance, leading to the formulation of multi-ingredient supplements containing both ingredients. Although scarce, research has suggested that caffeine ingestion may blunt the ergogenic effect of creatine. While a pharmacokinetic interaction is unlikely, authors have suggested that this effect may be explained by opposing effects on muscle relaxation time or gastrointestinal side effects from simultaneous consumption. The current review aims to evaluate the ergogenic potential of creatine and caffeine in the context of high-intensity exercise. Research directly comparing coffee and caffeine anhydrous is discussed, along with previous studies evaluating the concurrent supplementation of creatine and caffeine.

  10. Context Aware Concurrent Execution Framework for Web Browsers

    DEFF Research Database (Denmark)

    Saeed, Aamir; Erbad, Aiman; Olsen, Rasmus Løvenstein

    2016-01-01

    Computing hungry multimedia web applications need to efficiently utilize all the resources of a device. HTML5 web workers is a non-sharing concurrency platform that enables multimedia web application to utilize the available multicore hardware. HTML5 web workers are implemented by major browser v...... the application design, and giving end users better perceived quality of experience for demanding multimedia web based applications.......Computing hungry multimedia web applications need to efficiently utilize all the resources of a device. HTML5 web workers is a non-sharing concurrency platform that enables multimedia web application to utilize the available multicore hardware. HTML5 web workers are implemented by major browser...... vendors to facilitate concurrent execution in web clients and enhance the quality of ambitious web applications. The concurrent execution in web workers allows parallel processing using available cores at the expense of communication overhead and extra computation. The benefits of concurrent execution can...

  11. Effect on Sexual Function of Patients and Patients' Spouses After Midurethral Sling Procedure for Stress Urinary Incontinence: A Prospective Single Center Study.

    Science.gov (United States)

    Ko, Young Hwii; Song, Chang-Hyun; Choi, Ji Woong; Jung, Hee Chang; Song, Phil Hyun

    2016-09-01

    To evaluate the effect on sexual function of patients and their spouses after transobturator tape (TOT) procedure, prospectively. Midurethral sling procedure has been widely performed for treatment of urinary incontinence; however, little has been reported regarding sexual function after surgery. Between September 2012 and June 2013, 65 patients undergoing TOT and their sexual partners were enrolled. An investigation was conducted using validated, self-administered questionnaires, Female Sexual Function Index (FSFI) and satisfaction domain on Male Sexual Health Questionnaire (MSHQ) for evaluation of couple's sexual function. They completed the research on preoperative and postoperative visits at 3, 6, and 12 months. Of 65 couples, 56 couples completed this study. The mean age of patients and their partners were 46.7 ± 5.7 and 49.1 ± 6.2 years, respectively. The mean follow-up period was 16.5 ± 2.9 months. A significant loss of total FSFI score was observed at postoperative 3 months (P = 0.003), which was regained after postoperative 6 months. In comparison with baseline and postoperative 12 months, total FSFI score showed significant improvement (P sexual relationship, quality of sex life, partner's affection during sex, and communication about sex (P = 0.007, sexual function but also sexual satisfaction of partners. © 2015 Wiley Publishing Asia Pty Ltd.

  12. The prognostic significance of preoperatively assessed AST/ALT (De Ritis) ratio on survival in patients underwent radical cystectomy.

    Science.gov (United States)

    Gorgel, Sacit Nuri; Kose, Osman; Koc, Esra Meltem; Ates, Erhan; Akin, Yigit; Yilmaz, Yuksel

    2017-09-01

    We aimed to evaluate prognostic significance of preoperatively assessed aspartate aminotransaminase (AST)/alanine aminotransferase (ALT) (De Ritis) ratio on survival in bladder cancer (BC) patients underwent radical cystectomy (RC). We, respectively, analysed clinical and pathological data of 153 patients who underwent RC for BC between February 2006 and December 2016 at a tertiary level hospital. The potential prognostic value of De Ritis ratio was assessed by using ROC curve analysis. The effect of the De Ritis ratio was analysed by the Kaplan-Meier method and Cox regression hazard models for patients' disease-specific survival (DSS) and overall survival (OAS). We had 149 BC patients, in total. Mean age was 61.65 ± 9.13 years. One hundred and thirty-nine (93.3%) of the patients were men. According to ROC analysis, optimal threshold of De Ritis ratio for DSS was 1.30. In Kaplan-Meier analyses, the high De Ritis ratio group showed worse progression in DSS and OAS (all parameters, p < 0.001). On Cox regression models of clinical and pathological parameters to predict DSS, De Ritis ratio (HR 5.79, 95% CI 2.25-15.13), pathological T stage (HR 15.89, 95% CI 3.92-64.33, in all p < 0.001); and to predict OAS, De Ritis ratio (HR 2.61, 95% CI 1.49-4.56; p < 0.001), pathological T stage (HR 5.42, 95% CI 2.63-11.64; p < 0.001) and age (HR 1.05, 95% CI 1.02-1.08; p = 0.001) were determined as independent prognostic factors. Preoperative elevated De Ritis ratio could be an independent prognostic factor in BC patients underwent RC. Our results should be confirmed by large and properly designed prospective, randomized trials.

  13. Systematic review with network meta-analysis: comparative efficacy of different enteral immunonutrition formulas in patients underwent gastrectomy.

    Science.gov (United States)

    Song, Guo-Min; Liu, Xiao-Ling; Bian, Wei; Wu, Jing; Deng, Yong-Hong; Zhang, Hui; Tian, Xu

    2017-04-04

    Optimal enteral immunonutrition (EIN) regime for gastric cancer (GC) patients underwent gastrectomy remains uncertainty. To assess comparative efficacy of different EIN formulas in GC patients underwent gastrectomy, we performed network meta-analysis. We included 11 RCTs enrolling 840 patients. Pairwise meta-analysis indicated that EIN (RR 0.56, 95% CI 0.36-0.86; MD -0.42, 95% CI -0.74-0.10), Arg+RNA+ω-3-FAs (RR 0.37, 95% CI 0.22-0.63; MD -0.42, 95% CI -0.75-0.07), Arg+Gln+ω-3-FAs (RR 0.22, 95% CI 0.05-0.94; MD -0.69, 95% CI -1.22-1.07) reduced ICs and LOS. Network meta-analysis confirmed the potential of Arg+RNA+ω-3-FAs for ICs (OR 0.27, 95% Crl 0.12-0.49) and Arg+Gln+ω-3-FAs for CIs (OR 0.22, 95% Crl 0.02-0.84) and LOS (SMD -0.63, 95% Crl -1.07-0.13), and indicated that Arg+RNA+ω-3-FAs was superior to Arg+RNA and Arg+Gln for ICs as well. We performed direct and network meta-analyses for randomized controlled trials comparing EIN formulas with each other or standard enteral nutrition (SEN) in reducing infectious complications (ICs), noninfectious complications (NICs) and length of hospital stay (LOS), through January 2016. The surface under the cumulative ranking curve (SCURA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to rank regimes and rate qualities of evidences respectively. As for GC patients underwent gastrectomy, Arg+RNA+ω-3-FAs and Arg+Gln+ω-3-FAs are the optimal regimes of reducing ICs and LOS.

  14. [Four patients with hepatitis A presenting with fulminant hepatitis and acute renal failure and who underwent liver transplantation].

    Science.gov (United States)

    Oh, Se Hoon; Lee, Joon Hyoek; Hwang, Ji Won; Kim, Hye Young; Lee, Chang Hoon; Gwak, Geum Youn; Choi, Moon Seok; Koh, Kwang Chul; Paik, Seung Woon; Yoo, Byung Chul

    2009-09-01

    Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (>/=39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of submassive hepatic necrosis.

  15. Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS– COFFRS study

    Directory of Open Access Journals (Sweden)

    Srinivasa Prasad

    2017-07-01

    Conclusion: In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73. Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03. FFR based revascularization decision appears to be a safe strategy in Indian patients.

  16. [Anesthetic Management of an Infant who Underwent Awake-intubation for Her Pharyngeal Injury Caused by a Toothbrush].

    Science.gov (United States)

    Nakano, Yoko; Suzuki, Hiroaki; Arai, Takero; Hashimoto, Yuichi; Okuda, Yasuhisa

    2016-04-01

    A 2-year-and-4-month-old female infant, 12 kg in weight and 90 cm in height fell off from a table, which was about 1 m height with a toothbrush in her mouth without her parents noticing. Urgent CT scan showed that it penetrated the left side of her oropharyngeal wall to the bifurcation of her right carotid artery. According to the initial assessment, carotid artery seemed intact and there seemed to be no sign of CNS involvement. She underwent general anesthesia for further investigation and operation. We could detect vocal code with ease by inserting Glidescope between her tongue and the toothbrush. After the intubation, we administered fentanyl 25 μg rocuronium 15 mg and sevoflulane 3-5% to her, and then she underwent arteriography. The neurosurgeon found no sign of major arterial injury nor traumatic aneurysm nor CNS involvement. She went to the ICU intubated after the removal of the toothbrush. She was extubated 5 days after operation. One of the benefits of the Glidescope is that we can share the visual image, and we chose it this time. When we expect a difficult airway during management for oropharyngeal trauma, we have to consider the way to manage the airway.

  17. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

    Directory of Open Access Journals (Sweden)

    Lirong Zhang

    2018-01-01

    Full Text Available Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS. Three main components (naringin, naringenin, and hesperetin were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n=47 and control group (CG, received 20 mg placebo daily, n=48. After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group (P>0.01. The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  18. Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Wada, Hideki; Dohi, Tomotaka; Miyauchi, Katsumi; Doi, Shinichiro; Naito, Ryo; Konishi, Hirokazu; Tsuboi, Shuta; Ogita, Manabu; Kasai, Takatoshi; Hassan, Ahmed; Okazaki, Shinya; Isoda, Kikuo; Suwa, Satoru; Daida, Hiroyuki

    2017-06-01

    Malnutrition has been identified as an important predictor of poor clinical outcomes in patients with heart failure. The aim of this study is to examine the prognostic impact of nutritional status in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). The impact of nutrition, assessed using the geriatric nutritional risk index (GNRI) calculated by serum albumin and body mass index, was evaluated in 2,853 patients with CAD who underwent their first PCI between 2000 and 2011. Patients were assigned to tertiles based on their GNRI levels. The incidences of all-cause death and cardiac death were assessed. The median GNRI values were 101 (interquartile range 95 to 106). Lower GNRI levels were associated with older age and higher prevalence of acute coronary syndrome and chronic kidney disease. During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of mortality among tertiles (GNRI nutritional status was associated with long-term clinical outcomes in CAD patients after PCI. Evaluation of GNRI carries important prognostic information and may guide the therapeutic approach to such patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery

    Directory of Open Access Journals (Sweden)

    Abdurrahim Çolak

    Full Text Available Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74 underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90% were in NYHA class III; 34 (85% patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

  20. Concurrent strength and endurance training exercise sequence does not affect neuromuscular adaptations in older men.

    Science.gov (United States)

    Wilhelm, Eurico Nestor; Rech, Anderson; Minozzo, Felipe; Botton, Cintia Ehlers; Radaelli, Regis; Teixeira, Bruno Costa; Reischak-Oliveira, Alvaro; Pinto, Ronei Silveira

    2014-12-01

    Concurrent training is an effective method for increasing skeletal muscle performance in aging individuals, but controversy exists as to whether chronic neuromuscular and functional adaptations are affected by the intra-session exercise sequence. Therefore the aim of this study was to evaluate the effect of concurrent endurance and power-like strength training exercise sequence on muscular and functional adaptations of older participants. Thirty-six healthy older men not engaged in systematic exercise training programs for at least 6 months were divided into a control group (CON; 65.8±5.3 years), or in the training groups: endurance-strength (ES; 63.2±3.3 years), or strength-endurance (SE; 67.1±6.1 years). Training groups underwent 12 weeks of concurrent endurance and power-like strength training, starting every exercise session with either endurance (in ES) or strength (in SE) exercises. Measurements included knee extension one repetition maximum (1RM), knee extension power, 30 second sit-to-stand test (30SS), maximum vastus lateralis surface electromyographic activity, and rectus femoris echo intensity (RFEI). Significant increases in maximal strength (ES +18±11.3%; SE +14.2±6.0%; p≤0.05), peak power (ES +22.2±19.4%; SE +26.3±31.3%; p≤0.05), and 30SS performance (ES +15.2±7.2%; SE +13.2±11.8%; p≤0.05) were observed only in the training groups, with no differences between ES and SE. Maximum muscular activity was greater after 12weeks at training groups (p≤0.05), and reductions in RFEI were found only in ES and SE (p≤0.05). These results demonstrate that concurrent strength and endurance training performed twice a week effectively increases muscular performance and functional capacity in older men, independent of the intra-session exercise sequence. Additionally, the RFEI decreases indicate an additional adaptation to concurrent training. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. A Concurrent Distributed System for Aircraft Tactical Decision Generation

    Science.gov (United States)

    McManus, John W.

    1990-01-01

    A research program investigating the use of artificial intelligence (AI) techniques to aid in the development of a Tactical Decision Generator (TDG) for Within Visual Range (WVR) air combat engagements is discussed. The application of AI programming and problem solving methods in the development and implementation of a concurrent version of the Computerized Logic For Air-to-Air Warfare Simulations (CLAWS) program, a second generation TDG, is presented. Concurrent computing environments and programming approaches are discussed and the design and performance of a prototype concurrent TDG system are presented.

  2. CONCURRENT VALIDITY OF THE STUDENT TEACHER PROFESSIONAL IDENTITY SCALE

    Directory of Open Access Journals (Sweden)

    Predrag Živković

    2018-04-01

    Full Text Available The main purpose of study was to examine concurrent validity of the Student Teachers Professional Identity Scale–STPIS (Fisherman and Abbot, 1998 that was for the first time used in Serbia. Indicators of concurrent validity was established by correlation with student teacher self-reported well-being, self-esteem, burnout stress and resilience. Based on the results we can conclude that the STPIS meets the criterion of concurrent validity. The implications of these results are important for researchers and decisions makers in teacher education

  3. A Case of Type 2 Amiodarone-Induced Thyrotoxicosis That Underwent Total Thyroidectomy under High-Dose Steroid Administration

    Directory of Open Access Journals (Sweden)

    Koshi Hashimoto

    2015-01-01

    Full Text Available Amiodarone is used commonly and effectively in the treatment of arrhythmia; however, it may cause thyrotoxicosis categorized into two types: iodine-induced hyperthyroidism (type 1 amiodarone-induced thyrotoxicosis (AIT and destructive thyroiditis (type 2 AIT. We experienced a case of type 2 AIT, in which high-dose steroid was administered intravenously, and we finally decided to perform total thyroidectomy, resulting in a complete cure of the AIT. Even though steroid had been administered to the patient (maximum 80 mg of prednisolone, the operation was performed safely and no acute adrenal crisis as steroid withdrawal syndrome was found after the operation. Few cases of type 2 AIT that underwent total thyroidectomy with high-dose steroid administration have been reported. The current case suggests that total thyroidectomy should be taken into consideration for patients with AIT who cannot be controlled by medical treatment and even in those under high-dose steroid administration.

  4. Infants with Atypical Presentations of Alveolar Capillary Dysplasia with Misalignment of the Pulmonary Veins Who Underwent Bilateral Lung Transplantation.

    Science.gov (United States)

    Towe, Christopher T; White, Frances V; Grady, R Mark; Sweet, Stuart C; Eghtesady, Pirooz; Wegner, Daniel J; Sen, Partha; Szafranski, Przemyslaw; Stankiewicz, Pawel; Hamvas, Aaron; Cole, F Sessions; Wambach, Jennifer A

    2018-03-01

    To describe disease course, histopathology, and outcomes for infants with atypical presentations of alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) who underwent bilateral lung transplantation. We reviewed clinical history, diagnostic studies, explant histology, genetic sequence results, and post-transplant course for 6 infants with atypical ACDMPV who underwent bilateral lung transplantation at St. Louis Children's Hospital. We compared their histology with infants with classic ACDMPV and compared their outcomes with infants transplanted for other indications. In contrast with neonates with classic ACDPMV who present with severe hypoxemia and refractory pulmonary hypertension within hours of birth, none of the infants with atypical ACDMPV presented with progressive neonatal respiratory failure. Three infants had mild neonatal respiratory distress and received nasal cannula oxygen. Three other infants had no respiratory symptoms at birth and presented with hypoxemia and pulmonary hypertension at 2-3 months of age. Bilateral lung transplantation was performed at 4-20 months of age. Unlike in classic ACDMPV, histopathologic findings were not distributed uniformly and were not diffuse. Three subjects had apparent nonmosaic genetic defects involving FOXF1. Two infants had extrapulmonary anomalies (posterior urethral valves, inguinal hernia). Three transplanted children are alive at 5-16 years of age, similar to outcomes for infants transplanted for other indications. Lung explants from infants with atypical ACDMPV demonstrated diagnostic but nonuniform histopathologic findings. The 1- and 5-year survival rates for infants with atypical ACDMPV are similar to infants transplanted for other indications. Given the clinical and histopathologic spectra, ACDMPV should be considered in infants with hypoxemia and pulmonary hypertension, even beyond the newborn period. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The association between orthostatic hypotension and cognitive state among adults 65 years and older who underwent a comprehensive geriatric assessment

    Science.gov (United States)

    Punchick, Boris; Freud, Tamar; Press, Yan

    2016-01-01

    Abstract The prevalence of cognitive impairment and orthostatic hypotension (OH) increases with age, but the results of studies that assessed possible associations between them are inconsistent. The aim of this study is to assess possible associations between cognitive impairment and OH in patients ≥65 years of age who underwent a comprehensive geriatric assessment. A retrospective analysis was conducted of the computerized medical records of the study population from 2005 to 2013. Data collected included blood pressure measurements that enabled the calculation of OH, results of the mini-mental state examination (MMSE), results of the Montreal cognitive assessment (MoCA) test, and cognitive diagnoses that were determined over the course of the assessment. The rate of OH in the study population of 571 adults was 32.1%. The mean MMSE score was 22.5 ± 5.2 among participants with OH and 21.6 ± 5.8 among those without OH (P = 0.09). The absence of a significant association between OH and MMSE remained after adjusting the MMSE score for age and education level. The mean MoCA score was 16.4 ± 5.0 among participants with OH and 16.4 ± 4.8 among those without (P = 0.33). The prevalence of OH was 39% among participants without cognitive impairment, 28.9% among those with mild cognitive impairment (MCI), and 30.6% among those with dementia (P = 0.13). There was no association between OH and cognitive impairment in adults who underwent a comprehensive geriatric assessment. PMID:27442658

  6. Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention.

    Science.gov (United States)

    Konishi, Hirokazu; Miyauchi, Katsumi; Kasai, Takatoshi; Tsuboi, Shuta; Ogita, Manabu; Naito, Ryo; Katoh, Yoshiteru; Okai, Iwao; Tamura, Hiroshi; Okazaki, Shinya; Daida, Hiroyuki

    2014-09-01

    Limited data exist regarding the long-term prognosis of percutaneous coronary intervention (PCI) in young adults. The aim of this study was to retrospectively assess the long-term clinical outcomes in young patients who underwent PCI. Between 1985 and 2011, 7649 consecutive patients underwent PCI, and data from 69 young adults (age ≤40 years) and 4255 old adults (age ≧65 years) were analyzed. A Cox proportional hazards regression analysis was used to determine the independent predictors of a composite endpoint that included all-cause death and acute coronary syndrome (ACS) during the follow-up period. The mean age of the 69 young patients was 36.1±4.9 years, and 96% of them were men. Approximately 30% were current smokers, and their body mass index (BMI) was 26.7±5.0kg/m(2). The prevalence of diabetes and hypertension was 33% and 48%, respectively. All patients had ≥1 conventional cardiovascular risk factor. At a median follow-up of 9.8 years, the overall death rate was 5.8%, and new-onset ACS occurred in 8.7%. Current smoking was an independent predictor of the composite endpoint (hazard ratio 4.46, confidence interval 1.08-19.1, p=0.04) for young adults. Current smoking and obesity (high BMI) are the important clinical characteristics in young Japanese coronary heart disease patients who undergo PCI. The long-term prognosis in young patients is acceptable, but current smoking is a significant independent predictor of death and the recurrence of ACS in young Japanese coronary heart disease patients who are obese. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  7. Analysis of Ulcer Recurrences After Metatarsal Head Resection in Patients Who Underwent Surgery to Treat Diabetic Foot Osteomyelitis.

    Science.gov (United States)

    Sanz-Corbalán, Irene; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; García-Morales, Esther; Molines-Barroso, Raúl; Alvaro-Afonso, Francisco Javier

    2015-06-01

    Metatarsal head resection is a common and standardized treatment used as part of the surgical routine for metatarsal head osteomyelitis. The aim of this study was to define the influence of the amount of the metatarsal resection on the development of reulceration or ulcer recurrence in patients who suffered from plantar foot ulcer and underwent metatarsal surgery. We conducted a prospective study in 35 patients who underwent metatarsal head resection surgery to treat diabetic foot osteomyelitis with no prior history of foot surgeries, and these patients were included in a prospective follow-up over the course of at least 6 months in order to record reulceration or ulcer recurrences. Anteroposterior plain X-rays were taken before and after surgery. We also measured the portion of the metatarsal head that was removed and classified the patients according the resection rate of metatarsal (RRM) in first and second quartiles. We found statistical differences between the median RRM in patients who had an ulcer recurrence and patients without recurrences (21.48 ± 3.10% vs 28.12 ± 10.8%; P = .016). Seventeen (56.7%) patients were classified in the first quartile of RRM, which had an association with ulcer recurrence (P = .032; odds ratio = 1.41; 95% confidence interval = 1.04-1.92). RRM of less than 25% is associated with the development of a recurrence after surgery in the midterm follow-up, and therefore, planning before surgery is undertaken should be considered to avoid postsurgical complications. © The Author(s) 2015.

  8. [Evaluation of the antithrombotic strategy in low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis].

    Science.gov (United States)

    Aceves-Velázquez, Eduardo; Vieyra-Herrera, Gerardo; Rodríguez-Chávez, Laura; Herrera-Alarcón, Valentín

    2017-07-16

    According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  9. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

    Directory of Open Access Journals (Sweden)

    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  10. Effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery

    Directory of Open Access Journals (Sweden)

    Qing-Hua Xia

    2016-08-01

    Full Text Available Objective: To explore the effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery and its feasibility. Methods: A total of 80 patients who were admitted in ENT department from June, 2012 to June, 2015 for nasal endoscope surgery were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the observation group were given nifedipine delayed-release tablets for advanced blood pressure control before operation, and were given routine blood pressure control during operation; while the patients in the control group were only given blood pressure control during operation. The changes of blood pressure, mean central arterial pressure, and heart rate before anesthesia (T0, after intubation (T1, during operation (T2, extubation when waking (T3, 30 min after extubation (T4, and 3 h after back to wards (T5 in the two groups were compared. The intraoperative situation and the surgical field quality in the two groups were compared. Results: SBP, DBP, and MAP levels at T1-5 in the two groups were significantly lower than those at T0. SBP, DBP, and MAP levels at T2 were significantly lower than those at other timing points, and were gradually recovered after operation, but were significantly lower than those at T0. The effect taking time of blood pressure reducing, intraoperative nitroglycerin dosage, and postoperative wound surface exudation amount in the observation group were significantly less than those in the control group. The surgical field quality scores in the observation group were significantly superior to those in the control group. Conclusions: Advanced blood pressure control with nifedipine delayed-release tablets can stabilize the blood pressure during the perioperative period in patients underwent nasal endoscope surgery, and enhance the surgical field qualities.

  11. Concurrent intrathyroidal thymus and parathyroid in a patient with papillary thyroid carcinoma: a challenging diagnosis

    Directory of Open Access Journals (Sweden)

    Georgios Velimezis

    2017-06-01

    Full Text Available During embryogenesis, the thymus and inferior parathyroid glands develop from the third pharyngeal pouch and migrate to their definite position. During this process, several anatomic variations may arise, with the thyroid being one of the most common sites of ectopic implantation for both organs. Here, we report the case of a young female patient, who underwent total thyroidectomy for papillary carcinoma of the thyroid. The patient’s history was remarkable for disorders of the genitourinary system. Histologic examination revealed the presence of well-differentiated intrathyroidal thymic tissue, containing an inferior parathyroid gland. While each individual entity has been well documented, this is one of the few reports in which concurrent presentation is reported. Given the fact that both the thymus and the inferior parathyroid are derivatives of the same embryonic structure (i.e. the third pharyngeal pouch, it is speculated that the present condition resulted from a failure in separation and migration during organogenesis.

  12. A Retrospective Analysis of Concurrent Pathology in ACL-Reconstructed Knees of Elite Alpine Ski Racers.

    Science.gov (United States)

    Jordan, Matthew J; Doyle-Baker, Patricia; Heard, Mark; Aagaard, Per; Herzog, Walter

    2017-07-01

    Anterior cruciate ligament (ACL) tear is the most frequent injury in alpine ski racing, and there is a high prevalence of ACL reinjury. Limited data exist on the concurrent pathology with primary ACL tears in elite alpine ski racers and the magnitude of injury progression after primary ACL reconstruction (ACLR). To evaluate (1) the involvement of intra-articular and multiligament pathologies at the time of primary ACLR, (2) the subsequent progression in meniscal/chondral injuries, and (3) the occurrence of ACL reinjury in elite alpine ski racers. Case series; Level of evidence, 4. Primary ACLR operative reports (n = 28) were obtained for 32 elite alpine ski racers along with the reports of 20 operative procedures that occurred subsequent to primary ACLR. Operative reports were evaluated to identify the presence/location of multiligament injury, meniscal tears, and chondral lesions. At the time of primary ACLR, a majority of knees (82%; 23/28) demonstrated concurrent injury compared with isolated ACL tears; 32% of knees sustained multiligament injuries (9/28), and 8 involved the ipsilateral medial collateral ligament (MCL). Of the ACL-injured knees, 54% had chondral lesions, of which 73% were sustained in the lateral knee compartment, and 82% of meniscal tears (14/17) were complex in nature. Bilateral ACL tears were seen in 22% of the participants, and 28% underwent ACL revision. In the case of ACL revision or future meniscal/chondral surgery, 60% of meniscal tears and 80% of chondral lesions had worsened since the time of primary ACLR. Concurrent injury was common in this group of elite ski racers. Primary ACL tears were typically accompanied by lateral compartment chondral lesions and complex meniscal tears that worsened over time. ACL/MCL tears were the most common multiligament injury pattern.

  13. Preimplantation Genetic Diagnosis (PGD) for Monogenic Disorders: the Value of Concurrent Aneuploidy Screening.

    Science.gov (United States)

    Goldman, Kara N; Nazem, Taraneh; Berkeley, Alan; Palter, Steven; Grifo, Jamie A

    2016-12-01

    Pre-implantation genetic diagnosis (PGD) has changed the landscape of clinical genetics by helping families reduce the transmission of monogenic disorders. However, given the high prevalence of embryonic aneuploidy, particularly in patients of advanced reproductive age, unaffected embryos remain at high risk of implantation failure or pregnancy loss due to aneuploidy. 24-chromosome aneuploidy screening has become widely utilized in routine in vitro fertilization (IVF) to pre-select embryos with greater pregnancy potential, but concurrent 24-chromosome aneuploidy screening has not become standard practice in embryos biopsied for PGD. We performed a retrospective cohort study of patients who underwent PGD with or without 24-chromosome aneuploidy screening to explore the value of concurrent screening. Among the PGD + aneuploidy-screened group (n = 355 blastocysts), only 25.6 % of embryos were both Single Gene Disorder (SGD)-negative (or carriers) and euploid; thus the majority of embryos were ineligible for transfer due to the high prevalence of aneuploidy. Despite a young mean age (32.4 ± 5.9y), 49.9 % of Blastocysts were aneuploid. The majority of patients (53.2 %) had ≥1 blastocyst that was Single Gene Disorder (SGD)-unaffected but aneuploid; without screening, these unaffected but aneuploid embryos would likely have been transferred resulting in implantation failure, pregnancy loss, or a pregnancy affected by chromosomal aneuploidy. Despite the transfer of nearly half the number of embryos in the aneuploidy-screened group (1.1 ± 0.3 vs. 1.9 ± 0.6, p aneuploidy screening when performed concurrently with PGD provides valuable information for embryo selection, and notably improves single embryo transfer rates.

  14. Visualizing Concurrency Control Algorithms for Real-Time Database Systems

    Directory of Open Access Journals (Sweden)

    Olusegun Folorunso

    2008-11-01

    Full Text Available This paper describes an approach to visualizing concurrency control (CC algorithms for real-time database systems (RTDBs. This approach is based on the principle of software visualization, which has been applied in related fields. The Model-View-controller (MVC architecture is used to alleviate the black box syndrome associated with the study of algorithm behaviour for RTDBs Concurrency Controls. We propose a Visualization "exploratory" tool that assists the RTDBS designer in understanding the actual behaviour of the concurrency control algorithms of choice and also in evaluating the performance quality of the algorithm. We demonstrate the feasibility of our approach using an optimistic concurrency control model as our case study. The developed tool substantiates the earlier simulation-based performance studies by exposing spikes at some points when visualized dynamically that are not observed using usual static graphs. Eventually this tool helps solve the problem of contradictory assumptions of CC in RTDBs.

  15. Human operant learning under concurrent reinforcement of response variability

    NARCIS (Netherlands)

    Maes, J.H.R.; Goot, M.H. van der

    2006-01-01

    This study asked whether the concurrent reinforcement of behavioral variability facilitates learning to emit a difficult target response. Sixty students repeatedly pressed sequences of keys, with an originally infrequently occurring target sequence consistently being followed by positive feedback.

  16. Classes of oppositional-defiant behavior: Concurrent and predictive validity

    NARCIS (Netherlands)

    R.R. Althoff (Robert); A.V. Kuny-Slock (Ana); F.C. Verhulst (Frank); J.J. Hudziak (James); J. van der Ende (Jan)

    2014-01-01

    textabstractBackground: Oppositional defiant disorder (ODD) has components of both irritability and defiance. It remains unclear whether children with variation in these domains have different adult outcomes. This study examined the concurrent and predictive validity of classes of oppositional

  17. Prototyping of concurrent control systems implemented in FPGA devices

    CERN Document Server

    Wiśniewski, Remigiusz

    2017-01-01

    This book focuses on prototyping aspects of concurrent control systems and their further implementation and partial reconfiguration in programmable devices. Further, it lays out a full prototyping flow for concurrent control systems. Based on a given primary specification, a system is described with an interpreted Petri net, which naturally reflects the concurrent and sequential relationships of the design. The book shows that, apart from the traditional option of static configuration of the entire system, the latest programmable devices (especially FPGAs) offer far more sophistication. Partial reconfiguration allows selected parts of the system to be replaced without having to reprogram the entire structure of the device. Approaches to dynamic and static partial reconfiguration of concurrent control systems are presented and described in detail.< The theoretical work is illustrated by examples drawn from various applications, with a milling machine and a traffic-light controller highlighted as representat...

  18. Data Warehouse Maintenance Under Concurrent Schema and Data Updates

    National Research Council Canada - National Science Library

    Zhang, Xin

    1998-01-01

    .... Recently, proposed view maintenance algorithms tackle the problem of (concurrent) data updates happening at different autonomous ISs, whereas the EVE system addresses the maintenance of a data warehouse after schema changes of ISs...

  19. Service-Oriented Synthesis of Distributed and Concurrent Protocol Specifications

    Directory of Open Access Journals (Sweden)

    Jehad Al Dallal

    2008-01-01

    Full Text Available Several methods have been proposed for synthesizing computer communication protocol specifications from service specifications. Some protocol synthesis methods based on the finite state machine (FSM model assume that primitives in the service specifications cannot be executed simultaneously. Others either handle only controlled primitive concurrency or have tight restrictions on the applicable FSM topologies. As a result, these synthesis methods are not applicable to an interesting variety of inherently concurrent applications, such as the Internet and mobile communication systems. This paper proposes a concurrent-based protocol synthesis method that eliminates the restrictions imposed by the earlier methods. The proposed method uses a synthesis method to obtain a sequential protocol specification (P-SPEC from a given service specification (S-SPEC. The resulting P-SPEC is then remodeled to consider the concurrency behavior specified in the S-SPEC, while guaranteeing that P-SPEC provides the specified service.

  20. Love, lust and the emotional context of multiple and concurrent ...

    African Journals Online (AJOL)

    Love, lust and the emotional context of multiple and concurrent sexual partnerships among young Swazi adults. Allison Ruark, Lunga Dlamini, Nonhlanhla Mazibuko, Edward C Green, Caitlin Kennedy, Amy Nunn, Timothy Flanigan, Pamela J Surkan ...

  1. A case for evaluating sensor network protocols concurrently

    KAUST Repository

    Gnawali, Omprakash

    2010-01-01

    Researchers typically evaluate and compare protocols on the testbeds by running them one at a time. This methodology ignores the variation in link qualities and wireless environment across these experiments. These variations can introduce significant noise in the results. Evaluating two protocols concurrently, however, suffers from inter-protocol interactions. These interactions can perturb performance even under very light load, especially timing and timing sensitive protocols. We argue that the benefits of running protocols concurrently greatly outweigh the disadvantages. Protocols rarely run in isolation in real networks, and so considering such interactions is valuable. Although the wireless environment is still uncontrolled, concurrent evaluations make comparisons fair and more statistically sound. Through experiments on two testbeds, we make the case for evaluating and comparing low data-rate sensor network protocols by running them concurrently. Copyright 2010 ACM.

  2. Poverty and sexual concurrency: a case study of STI risk.

    Science.gov (United States)

    Tsui, Emma K; Leonard, Lori; Lenoir, Chavonne; Ellen, Jonathan M

    2008-08-01

    This paper is about sexual concurrency, or maintaining multiple sexual partnerships that overlap in time. Sexual concurrency is a concept that is used in the field of public health to explain the spread of sexually transmitted diseases. Sexual concurrency has also been proposed as a site of intervention to reduce sexually transmitted infection (STI) rates, particularly among those populations who carry the heaviest STI burden: adolescents and African Americans. In this paper, we use ethnographic data collected from a group of African American adolescents living in Baltimore to examine the socially produced configurations of risks and relationships that are obscured by the term sexual concurrency. The data we present show the limits of this concept, and suggest that structural reforms, including improvements to education, drug treatment, and work opportunities, are necessary to reduce racial disparities in STI rates.

  3. A case of Boerhaave's syndrome during concurrent chemoradiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Furukawa, Tatsuya; Iwae, Shigemichi; Hirayama, Yuji; Yonezawa, Koichiro; Morita, Naruhiko

    2014-01-01

    Boerhaave's syndrome is a rare disease involving rupture or perforation of the entire layer of the esophagus caused by rapid increase in pressure. When the proper treatment is delayed, the outcome can be fatal, so early diagnosis is important. We experienced a patient of Boerhaave's syndrome during concurrent chemoradiotherapy for hypopharyngeal cancer. We report a 61-year-old male who underwent concurrent chemoradiotherapy for T3N1M0 hypopharyngeal cancer. He had severe chest pain immediately after vomiting. We initially made a differential diagnosis of cardiovascular disease, which needed emergency treatment. However, his general condition deteriorated markedly, and he went into septic shock. We performed a CT after injection of a contrast medium, and confirmed leakage into the thoracic cavity. We diagnosed Boerhaave's syndrome. We started surgery at 19 hours from the onset and found the rupture site by laparotomy. The ruptured esophagus was repaired by simple suturing and covered by the greater omentum, but the patient was not cured of his leakage even after surgery. Recently antiemetics have improved, but we still experience patients who have difficulty due to vomiting when we use cisplatin (CDDP). Furthermore, gastrostomy and opioids as supportive care cause vomiting. Therefore, we must approach antiemetic therapy cautiously, and we should rule out Boerhaave's syndrome quickly when patients have chest pain. (author)

  4. Organ Preservation With Concurrent Chemoradiation for Advanced Laryngeal Cancer: Are We Succeeding?

    International Nuclear Information System (INIS)

    Lambert, Louise; Fortin, Bernard; Soulieres, Denis; Guertin, Louis; Coulombe, Genevieve; Charpentier, Danielle; Tabet, Jean-Claude; Belair, Manon; Khaouam, Nader; Nguyen-Tan, Phuc Felix

    2010-01-01

    Purpose: To determine the rates of organ preservation and function in patients with advanced laryngeal and hypopharyngeal carcinomas treated with concurrent chemoradiotherapy (CRT). Methods and Materials: Between April 1999 and September 2005, 82 patients with advanced laryngeal (67%) and hypopharyngeal carcinomas (33%) underwent conventional radiotherapy and concurrent platinum-based chemotherapy with curative intent. Sixty-two patients were male (75.6%). The median age was 59 years. Eighteen patients (22%) were in Stage III and 64 (78%) were in Stage IV. The median radiation dose was 70 Gy. The median potential follow-up was 3.9 years. Results: Overall survival and disease-free survival were respectively 63% and 73% at 3 years. Complete response rate from CRT was 75%. Nineteen patients (23%) experienced significant long-term toxicity after CRT: 6 (7.3%) required a percutaneous endoscopic gastrostomy, 5 (6%) had persistent Grade 2 or 3 dysphagia, 2 (2.4%) had pharyngoesophageal stenosis requiring multiple dilations, 2 (2.4%) had chronic lung aspiration, and 7 (8.5%) required a permanent tracheostomy. Four patients (4.9%) underwent laryngectomy without pathologic evidence of disease. At last follow-up, 5 (6%) patients were still dependent on a gastrostomy. Overall, 42 patients (52%) were alive, in complete response, with a functional larynx and no other major complications. Conclusions: In our institution, CRT for advanced hypopharyngeal and laryngeal carcinoma has provided good overall survival and locoregional control in the majority of patients, but a significant proportion did not benefit from this approach because of either locoregional failure or late complications. Better organ preservation approaches are necessary to improve locoregional control and to reduce long-term toxicities.

  5. Reference Capabilities for Trait Based Reuse and Concurrency Control

    OpenAIRE

    Castegren, Elias; Wrigstad, Tobias

    2016-01-01

    The proliferation of shared mutable state in object-orientedprogramming complicates software development as two seeminglyunrelated operations may interact via an alias and produceunexpected results. In concurrent programming this manifestsitself as data-races. Concurrent object-oriented programming further suffers from thefact that code that warrants synchronisation cannot easily bedistinguished from code that does not. The burden is placed solelyon the programmer to reason about alias freedo...

  6. Concurrent object-oriented programming: The MP-Eiffel approach

    OpenAIRE

    Silva, Miguel Augusto Mendes Oliveira e

    2004-01-01

    This article evaluates several possible approaches for integrating concurrency into object-oriented programming languages, presenting afterwards, a new language named MP-Eiffel. MP-Eiffel was designed attempting to include all the essential properties of both concurrent and object-oriented programming with simplicity and safety. A special care was taken to achieve the orthogonality of all the language mechanisms, allowing their joint use without unsafe side-effects (such as inh...

  7. Concurrent emphysematous cholecystitis and emphysematous pancreatitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hee Seok; Lee, Yong Seok; Yoon, Yup [Dongguk University International Hospital, Dongguk University College of Medicine, Goyang (Korea, Republic of); Park, Sung Bin [Ulsan University Hospital, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2008-01-15

    Emphysematous infections of the abdomen and pelvis are potentially life-threatening conditions which require aggressive medical and surgical management. Therefore, early radiographic detection is important in the management of these conditions. Concurrent emphysematous infections involving different organs have been rarely reported, and primarily occur in immunocompromised patients. Here, we report a rare case of concurrent emphysematous cholecystitis and emphysematous pancreatitis in a 97 year old male patient.

  8. Concurrent atypical myopathy and equine dysautonomia in two horses.

    Science.gov (United States)

    Vercauteren, G; van der Heyden, S; Lefère, L; Chiers, K; Laevens, H; Ducatelle, R

    2007-09-01

    This report concerns 2 horses that suffered typical clinical signs of atypical myopathy (AM) and equine grass sickness (EGS) concurrently. Clinical details and pathological lesions of the cases are described. EGS and AM are relatively rare diseases and the concurrency of the diseases in the same animals is therefore considered unlikely to be a coincidence. However, it is not suggested that the evidence shows a common aetiology but rather the existence of common predisposing causes.

  9. Le guide du consommateur sur la concurrence | CRDI - Centre de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Ce guide pratique destiné aux organismes de défense des consommateurs, analyse l'étendue des enjeux que pourrait englober une analyse de la concurrence et souligne les questions qui pourraient poser problème à ceux qui représentent les intérêts des consommateurs dans des cas liés à la concurrence. Le guide ...

  10. Concurrent MR-NIR Imaging for Breast Cancer Diagnosis

    Science.gov (United States)

    2008-06-01

    fibroadenoma , which corresponds to a mass estimated to be 1–2 cm in diameter within a breast of 9 cm diameter located at 6–7 o’clock. Second case (case 2) is...AD_________________ Award Number: W81XWH-04-1-0559 TITLE: Concurrent MR-NIR Imaging for Breast ...CONTRACT NUMBER Concurrent MR-NIR Imaging for Breast Cancer Diagnosis 5b. GRANT NUMBER W81XWH-04-1-0559 5c. PROGRAM ELEMENT NUMBER 6

  11. An Automation-Assisted Empirical Study on Lock Usage for Concurrent Programs

    OpenAIRE

    Xin Rui; Qi Zhengwei; Huang Shiqiu; Xiang Chengcheng; Zheng Yudi; Wang Yin; Guan Haibing

    2013-01-01

    Nowadays concurrent programs are becoming more and more important with the development of hardware and network technologies. However it is not easy for programmers to write reliable concurrent programs. Concurrency characteristics such as thread interleaving make it difficult to debug or maintain concurrent programs. Although there are lots of research work on concurrency such as multi thread testing tools concurrent program verification and data race detection all of them leave open problems...

  12. Contasure-Needleless® single incision sling compared with transobturator TVT-O® for the treatment of stress urinary incontinence: long-term results.

    Science.gov (United States)

    Martinez Franco, Eva; Amat Tardiu, Lluís

    2015-02-01

    This study compared transobturator tension-free vaginal tape (TVT-O®) and Contasure-Needleless (C-NDL®) at long-term follow-up . Non-inferiority, prospective, single-centre , quasi-randomised trial started in September 2006 and finished in April 2011 to compare C-NDL® with transobturator vaginal tape (TVT-O®) mesh in the treatment of stress urinary incontinence (SUI) . Epidemiological information, intraoperative and postoperative complications, subjective estimates of blood loss and pain levels were recorded. We also analysed the postoperative stress test, the subjective impression of improvement using the Sandvik Severity Index and the quality of life during follow-up using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) . Two hundred and fifty-seven women with primary SUI were scheduled to receive TVT-O® or C-NDL® and were followed up at least 3 years after the procedure . One hundred and eleven women in the C-NDL® group (84.7%) had a negative stress test, compared with 54 women (88.9%) in the TVT-O® group (p = 0.0065 for the non-inferiority test). The postoperative Sandvik Severity Index was 0 or better than the preoperative score in 90.7% of patients in the C-NDL® group and 95.4% of patients in the TVT-O® group (p = 0.0022). The complication rate was similar in both groups. There were significant differences (p = 0.02) in postoperative pain within the TVT-O® group. The degree of satisfaction was not statistically significant between the two groups. The outcomes for the C-NDL® group were similar to those of the TVT-O® group, adding the concept of "single incision tape" to the tension-free sling option.

  13. The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence.

    Science.gov (United States)

    Bohlin, Katja Stenström; Ankardal, Maud; Pedroletti, Corinne; Lindkvist, Håkan; Milsom, Ian

    2015-03-01

    The aim of this observational study was to investigate the influence of body mass index (BMI) smoking and age on the cure rate, rate of complications and patient satisfaction with mid-urethral sling (MUS) procedures. Pre-, peri- and postoperative (8 weeks and 1 year) data were retrieved from the Swedish National Register for Gynecological Surgery of MUS procedures (retropubic procedures, n = 4,539; transobturator procedures, n =1,769) performed between January 2006 and December 2011. Multiple logistic regression analyses were performed between the outcome variables and BMI and smoking, presented as adjusted odds ratios (adjOR) with 95 % confidence interval (CI). Subjective 1-year cure rate was 87.4 % for all MUS procedures (88.3 % with the retropubic technique and 85.2 % with the transobturator technique (p = 0.002). Preoperative daily urinary leakage and urgency were more common with increasing BMI, but surgery reduced symptoms in all BMI groups. Lower cure rate was seen in women with a BMI >30 (0.49; CI 0.33-0.73), in diabetics (0.50; CI 0.35-0.74) and women aged > 80 years (0.18; CI 0.06-0.51). Perioperative complications were more common in the retropubic group (4.7 % vs 2.3 % in the transobturator group, p=0.001) and in women with BMI Smoking did not influence any of the outcome variables. The overall 1-year cure rate for MUS procedures was 87 %, but was negatively influenced by BMI >30, diabetes and age > 80 years. Perioperative complications were more common with the retropubic procedure than with the transobturator technique, and in women with a BMI Smoking did not impact on any of the studied outcome variables.

  14. Enhanced skeletal muscle ribosome biogenesis, yet attenuated mTORC1 and ribosome biogenesis-related signalling, following short-term concurrent versus single-mode resistance training

    OpenAIRE

    Fyfe, Jackson J.; Bishop, David J.; Bartlett, Jonathan D.; Hanson, Erik D.; Anderson, Mitchell J.; Garnham, Andrew P.; Stepto, Nigel K.

    2018-01-01

    Combining endurance training with resistance training (RT) may attenuate skeletal muscle hypertrophic adaptation versus RT alone; however, the underlying mechanisms are unclear. We investigated changes in markers of ribosome biogenesis, a process linked with skeletal muscle hypertrophy, following concurrent training versus RT alone. Twenty-three males underwent eight weeks of RT, either performed alone (RT group, n = 8), or combined with either high-intensity interval training (HIT+RT group, ...

  15. Risk factors for concurrent bacteremia in adult patients with dengue.

    Science.gov (United States)

    Thein, Tun-Linn; Ng, Ee-Ling; Yeang, Ming S; Leo, Yee-Sin; Lye, David C

    2017-06-01

    Bacteremia in dengue may occur with common exposure to pathogens in association with severe organ impairment or severe dengue, which may result in death. Cohort studies identifying risk factors for concurrent bacteremia among patients with dengue are rare. We conducted a retrospective case-control study of adult patients with dengue who were admitted to the Department of Infectious Diseases at Tan Tock Seng Hospital, Singapore from 2004 to 2008. For each case of dengue with concurrent bacteremia (within the first 72 hours of admission), we selected four controls without bacteremia, who were matched on year of infection and dengue confirmation method. Conditional logistic regression was performed to identify risk factors for concurrent bacteremia. Among 9,553 patients with dengue, 29 (0.3%) had bacteremia. Eighteen of these patients (62.1%) had concurrent bacteremia. The predominant bacteria were Staphylococcus aureus, one of which was a methicillin-resistant strain. Dengue shock syndrome occurred more frequently and hospital stay was longer among cases than among controls. Three cases did not survive, whereas none of the controls died. In multivariate analysis, being critically ill at hospital presentation was independently associated with 15 times the likelihood of a patient with dengue having concurrent bacteremia. Concurrent bacteremia in adult patients with dengue is uncommon but presents atypically and results in more deaths and longer hospital stay. Given the associated mortality, collection of blood cultures and empiric antibiotic therapy may be considered in patients who are critically ill. Copyright © 2015. Published by Elsevier B.V.

  16. Concurrent eruptions at Etna, Stromboli, and Vulcano: casualty or causality?

    Directory of Open Access Journals (Sweden)

    R. Funiciello

    2008-06-01

    Full Text Available Anecdotes of concurrent eruptions at Etna, Stromboli, and Vulcano (Southern Italy have persisted for more than 2000 years and volcanologists in recent and past times have hypothesized a causal link among these volcanoes. Here this hypothesis is tested. To introduce the problem and provide examples of the type of expected volcanic phenomena, narratives of the most notable examples of concurrent eruptions are provided. Then the frequency of eruptions at each individual volcano is analysed for about the last 300 years and the expected probability of concurrent eruptions is calculated to compare it to the observed probability. Results show that the occurrence of concurrent eruptions is often more frequent than a random probability, particularly for the Stromboli-Vulcano pair. These results are integrated with a statistical analysis of the earthquake catalogue to find evidence of linked seismicity in the Etnean and Aeolian areas. Results suggest a moderate incidence of non-random concurrent eruptions, but available data are temporally limited and do not allow an unequivocal identification of plausible triggers; our results, however, are the first attempt to quantify a more-than-2000-years-old curious observation and constitute a starting point for more sophisticated analyses of new data in the future. We look forward to our prediction of a moderate incidence of concurrent eruptions being confirmed or refuted with the passage of time and occurrence of new events.

  17. Influence of TVT properties on outcomes of midurethral sling procedures: high-stiffness versus low-stiffness tape.

    Science.gov (United States)

    Prien-Larsen, Jens Christian; Prien-Larsen, Thomas; Cieslak, Lars; Dessau, Ram B

    2016-07-01

    Although there is clear consensus on the use of monofilament polypropylene tapes for treating stress urinary incontinence (SUI), tapes differ in weight, stiffness, and elasticity. In this study, we compared outcomes of two tape types: high-stiffness Intramesh SOFT L.I.F.T versus low-stiffness Intramesh L.I.F.T. tape. Our null hypothesis was that in terms of performance, SOFT tape equaled L.I.F.T. tape. Six hundred and sixty women underwent prospective transvaginal tape (TVT) surgery for SUI: 210 had the SOFT tape placed and 450 the L.I.F.T. tape. Follow-ups were scheduled at 3 and 12 months. Objective cure at 3-months' follow-up was 87 % in the SOFT group vs 94 % in the L.I.F.T. group (p = 0.003) and at 12 months 86 vs 96 % (p = 0.0004), respectively. Subjective outcomes were equal. For SOFT tape, the objective failure rate at 3 months was especially pronounced in women older than 70 years: 31 vs 10 % (p = 0.008), and subjective failure was 24 vs 7 % (p = 0.01). At 12 months, objective failure for the SOFT tape was significantly higher in both age groups compared with L.I.F.T. [odds ratio (OR) 2.17]. Multivariate analysis showed that body mass index (BMI) ≥30 (OR 2.41), mixed incontinence (MUI) (OR 2.24), use of SOFT tape (OR 2.17), and age ≥ 70 years are significant independent risk factors for surgical failure. Outcomes with SOFT tape are significantly inferior than with L.I.F.T. tape, especially among elderly women. Therefore, the two variants of monofilament polypropylene tape are not interchangeable.

  18. 65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

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    M. Qasem

    2016-07-01

    Full Text Available Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119 case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2% had normal coronary and normal LV function. Twenty cases (17% of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic, ischemic MR (8.4%, LV apical aneurysm (0.8%, significant pericardial effusion (0.80%. Acute pulmonary edema in 17 cases (14.3%: six cases (5.1% developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′  >20, 9 cases (7.6% develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7% develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8% presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7% with severe fibro degenerative MR, 2 cases (1.7% with mild to moderate AR and 2 cases (1.7% with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.

  19. État de la concurrence et régime de concurrence de l'Éthiopie ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    L'Éthiopie réalise des progrès en ce qui concerne la gestion de l'économie de marché. Toutefois, la concurrence demeure faible, malgré la révision de la loi sur la concurrence. La plupart des entreprises de petite et de grande taille sont habituées à recevoir un soutien de la part de l'État. Elles éprouvent donc maintenant ...

  20. Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

    Directory of Open Access Journals (Sweden)

    Moises Cohen

    2004-12-01

    Full Text Available Introduction: Quality of life can be defined as the expression of aconceptual model that tries to represent patient’s perspectivesand his/her level of satisfaction expressed by numbers. Theobjective of this study is to evaluate the parameters of quality oflife of 23 patients who underwent surgery for anterior cruciateligament reconstruction. Methods: We adopted SF-36, a generichealth-related evaluation questionnaire, to obtain informationregarding several aspects of patients’ health conditions, and theLysholm questionnaire, specific to evaluate the symptoms andfunction of the knee. The questionnaires were applied at two stagesof the treatment: pre- and postoperatively (after the rehabilitationprogram. Results: Before surgery, the Lysholm questionnairepresented the following results: excellent in 4% of the cases, goodin 22%, fair in 22%, and poor in 52%. After surgery (Lysholm e SF-36 the correlation level was approximately 44% (p = 0.041.Discussion: The correlation between the Lysholm and the SF-36questionnaires showed the following: the lower the level of pain,the higher the Lysholm score. The high scores presented by theLysholm questionnaire are directly proportional to physical andemotional aspects, and to functional capacity. Conclusion:Analysis of both questionnaires, as well as of their correlation,showed some improvement in patients´ quality of life. We werealso able to demonstrate the importance and usefulness of applyingthe two questionnaires at three different moments: before, duringand after physiotherapeutic intervention.

  1. The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes.

    Science.gov (United States)

    Terzioglu, Fusun; Turk, Rukiye; Yucel, Cigdem; Dilbaz, Serdar; Cinar, Ozgur; Karahalil, Bensu

    2016-06-01

    The aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes. This study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples' state anxiety scores were re-evaluated after embryo transfer (ET). A significant relationship was found between the depression score of women and pregnancy outcome (p 0.05) and lower depression scores (p positive pregnancy outcome. Study results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.

  2. The Effects of Functional Knee Brace on Postural Control in Patients Who Underwent Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Salehi

    2016-09-01

    Full Text Available Background The current study aimed to evaluate the postural control in patients underwent anterior cruciate ligament reconstruction pre and post wearing functional knee brace. Methods Eighteen athletes undergone unilateral anterior cruciate ligament reconstruction included in the study. They had unilateral anterior cruciate ligament reconstruction at least six months before session test. Postural control was assessed pre and post wearing custom-fit functional knee brace using a posturographic platform prokin 254. The balance tests included: 1 standing on prokin platform with eyes open/closed on anterior cruciate ligament reconstruction limb, 2 standing on prokin platform with eyes open/closed on both limbs. The standard deviation (SD of body sway along the anteroposterior (AP and mediolateral (ML axis, mean velocity of center of pressure (COP along AP/ ML axis and the area ellipse (measured in 2 mm were calculated. Results Results of the paired T-test revealed a significant effect on selected postural control variables for the brace conditions especially in low challengeable conditions (double leg, eyes open test situations (P < 0.05. But in high challengeable conditions this effect was not significant. Conclusions Functional knee brace improved postural control in the simple balancing task in the subjects with anterior cruciate ligament reconstruction. But this improvement in more difficult balancing task was limited.

  3. The Effect of Prazosin and Oxybutynin on the Symptoms Due to Using Double J Catheter in Patients Underwent TUL

    Directory of Open Access Journals (Sweden)

    K. Tavakkoli Tabassi

    2014-01-01

    Full Text Available Background & Aims: Double J catheter has been used for years as an independent practice or a part of other urological practices. Although these catheters have solved many patients’ problems but those can cause symptoms and problems for patients. The aim of this study was the investigation the effect of prazosin and oxybutynin on the degree of symptoms due to using Double J catheter. Methods: In this interventional study, patients who underwent TUL from July 2008 to march 2008 in the lithotripsy ward of Imam Reza hospital were entered to the study and randomly divided in 3 groups randomly. In the first group, placebo, in the second group, oxybutynin, in the third group prazosin were prescribed. Three weeks later standard questionnaire Ureteric Stent Symptom Questionnaire (USSQ was completed. After collecting data, was analyzed using SPSS software. Results: A total of 113 patients (70 men 43 women were included to the study. The mean age was 39 years. There were no significance difference among urinary symptoms score pain of body and physical activity problems in three groups (P>0.05, but there was a significant difference in general health and work problems among them (P<0.05. Conclusion: Oxybutynin caused a low effect on improvement of general health and work problems in patients who were studied. It might Prazosin does not has a sufficient time to affect on urinary symptoms, because of shortness of usage.

  4. Factors associated with late specialized rehabilitation among veterans with lower extremity amputation who underwent immediate postoperative rehabilitation.

    Science.gov (United States)

    Kurichi, Jibby E; Xie, Dawei; Kwong, Pui L; Bates, Barbara E; Vogel, W Bruce; Stineman, Margaret G

    2011-05-01

    The aim of this study was to determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Data were obtained from eight administrative databases for 2,453 patients who underwent lower limb amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazard ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from surgical hospitalization. There were 2304 patients who received only immediate postoperative services, whereas 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared with the Southeast region, and had their surgeries in facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were all more likely to receive late services. The hazard ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt; however, after 3 mos, those who received early specialized rehabilitation were significantly less likely to receive late services. The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding units accredited by the Commission on Accreditation of Rehabilitation Facilities.

  5. Carotid intima-media thickness and ınsulin resistance changes in patients who underwent sleeve gastrectomy: A prospective study.

    Science.gov (United States)

    Yorulmaz, G; Cilekar, M; Bilge, U; Akcan, E; Akalin, A

    2016-01-01

    Our aim was to examine changes in insulin resistance, Carotid Intima-Media Thickness (CIMT), in morbid obese patients without any known associated chronic diseases who underwent sleeve gastrectomy. The subjects of this study were patients with minimum BMI of 40, who did not have any known chronic diseases. Sleeve gastrectomy was performed and perioperative control endoscopy was performed. The following values were measured before the operation and after follow-up period after the operation: Fasting blood glucose and insulin, lipid profile, BMI, liver function tests, right and left CIMT. Furthermore, the patients' insulin resistance was calculated by HOMA method, and the values of 2.7. Six-teen patients (14 women and 2 men, average age: 39.12 ± 10.63 years), who did not have a known additional chronic disease, took part in the study. There was a significant difference between baseline and follow-up values of the patients, and the mean weight loss was 20.5%. Given the statistical evaluation of baseline and follow-up values, there was a significant difference in BMI, insulin resistance rates and right and left CIMT values. Bariatric surgery may provide some additional advantages for the management of cardiovascular risks in obese patients. However, it should be kept in mind that the most important components of fight against obesity are appropriate diet and exercise programs.

  6. Anatomical location of metastatic lymph nodes: an indispensable prognostic factor for gastric cancer patients who underwent curative resection.

    Science.gov (United States)

    Zhao, Bochao; Zhang, Jingting; Zhang, Jiale; Chen, Xiuxiu; Chen, Junqing; Wang, Zhenning; Xu, Huimian; Huang, Baojun

    2018-02-01

    Although the numeric-based lymph node (LN) staging was widely used in the worldwide, it did not represent the anatomical location of metastatic lymph nodes (MLNs) and not reflect extent of LN dissection. Therefore, in the present study, we investigated whether the anatomical location of MLNs was still necessary to evaluate the prognosis of node-positive gastric cancer (GC) patients. We reviewed 1451 GC patients who underwent radical gastrectomy in our institution between January 1986 and January 2008. All patients were reclassified into several groups according to the anatomical location of MLNs and the number of MLNs. The prognostic differences between different patient groups were compared and clinicopathologic features were analyzed. In the present study, both anatomical location of MLNs and the number of MLNs were identified as the independent prognostic factors (p location of MLNs was considered (p location of MLNs had no significant effect on the prognosis of these patients, the higher number of MLNs in the extraperigastric area was correlated with the unfavorable prognosis (p location of MLNs was an important factor influencing the prognostic outcome of GC patients. To provide more accurate prognostic information for GC patients, the anatomical location of MLNs should not be ignored.

  7. Immunometabolic Responses to Concurrent Training: The Effects of Exercise Order in Recreational Weightlifters.

    Science.gov (United States)

    Inoue, Daniela S; Panissa, Valéria L G; Monteiro, Paula A; Gerosa-Neto, José; Rossi, Fabrício E; Antunes, Barbara M M; Franchini, Emerson; Cholewa, Jason M; Gobbo, Luís A; Lira, Fábio S

    2016-07-01

    Inoue, DS, Panissa, VLG, Monteiro, PA, Gerosa-Neto, J, Rossi, FE, Antunes, BMM, Franchini, E, Cholewa, JM, Gobbo, LA, and Lira, FS. Immunometabolic responses to concurrent training: the effects of exercise order in recreational weightlifters. J Strength Cond Res 30(7): 1960-1967, 2016-The relationship between immunometabolic response and performance is not well understood. This study evaluated the influence of concurrent strength and high-intensity aerobic sequence of exercise order between sessions on strength performance, metabolic, and inflammatory response. Eleven recreational weightlifters underwent the following 2 randomized sessions: (a) strength-aerobic exercise order (SA) and (b) aerobic-strength exercise order (AS). Blood samples were collected before (Pre) and immediately after the first exercise (Post-1) and the second exercise (Post-2) of each session. The SA condition presented a higher number of repetitions (SA: 54 ± 15 vs. AS: 43 ± 12) and total volume (SA: 7,265 ± 2,323 vs. AS: 5,794 ± 1846 kg) than the AS condition (both p = 0.001). Glucose was higher in Pre when compared with post-1 in both orders (p ≤ 0.05); changes in lactate were time-dependent in the different orders (p ≤ 0.05); however, AS post-2 lactate was lower when compared with SA post-2 (p ≤ 0.05). Interleukin-6 levels showed time-dependent changes for both exercise orders (p ≤ 0.05). Tumor necrosis factor alpha (TNF-α) level was increased only in AS post-1 (AS: pre = 21.91 ± 35.47, post-1 = 26.99 ± 47.69 pg·ml vs. SA: pre = 25.74 ± 43.64, post-1 = 29.74 ± 46.05 pg·ml, p ≤ 0.05). These results suggest that concurrent training order exhibits different immunometabolic responses and, at least in part, can be associated with the acute decline in strength performance induced by concurrent exercise. Our results point to a possible role of TNF-α (post-1 AS condition) as a trigger to restore the energy demand by providing substrates to help maintain contractile activity

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-02-15

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

  9. Locally-regionally advanced tonsillar squamous cell carcinoma treated with concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Krstevska, Valentina; Stojkovski, Igor

    2013-01-01

    Purpose: To perform a retrospective review of stage III-IV squamous cell carcinoma of the tonsil managed by definitive concurrent chemoradiotherapy (CCRT) in order to analyze the patients’ outcome and to evaluate the acute and late toxic effects of this treatment modality. Material and methods: Between January 2005 and December 2010, 36 patients with locally and/or regionally advanced tonsillar cancer underwent three dimensional conformal radiotherapy (3DCRT) with concurrent platinum-based chemotherapy. The dose prescription of the planning target volume for gross tumor and low-risk subclinical disease was 70 Gy and 50 Gy, respectively. Conventional fractionation with a daily dose of 2.0 Gy, 5 times per week was used. Concurrent chemotherapy consisted of cisplatin 30 mg/m2 given on a weekly basis. Acute and late radiotherapy-related toxicities were recorded using European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group (EORTC/RTOG) grading system. The 3-year locoregional relapse-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. Results: The median follow-up of all patients was 20.5 months (range, 5 to 90 months). The median followup of living patients was 59 months (range, 30 to 90 months). Complete response rates of the primary tumor and of the nodal disease were 72.2% and 64.0%, respectively. A complete composite response was present in 25 patients (69.4%). Treatment failure occurred in 15 out of 25 patients who achieved complete composite response following CCRT. The 3-year LRRFS, DFS, and OS rate was 38.8%, 27.8%, and 27.3%, respectively. Grade 3 mucositis occurred in 58.3% of patients. Xerostomia grade 2 was revealed in 72.2% of patients. Conclusion: Taking into account the low 3-year survival rates observed in our study and the high percentage of grade 2 xerostomia, it can be concluded that in the future, instead of 3DCRT with concurrent

  10. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

    Science.gov (United States)

    Adibi, Atoosa; Nouri, Shadi; Moradi, Maryam; Shahabi, Javad

    2016-01-01

    Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE) who underwent computed tomography pulmonary angiography (CTPA). Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells’ criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1%) of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05). Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05). Frequency of all criteria of Wells’ criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05). The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05). Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences. PMID:28255326

  11. The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

    International Nuclear Information System (INIS)

    Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

    1989-01-01

    The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

  12. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

    Directory of Open Access Journals (Sweden)

    Atoosa Adibi

    2016-01-01

    Full Text Available Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE who underwent computed tomography pulmonary angiography (CTPA. Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells' criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1% of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05. Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05. Frequency of all criteria of Wells' criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05. The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05. Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.

  13. Early prediction of treatment response by serum CRP levels in patients with advanced esophageal cancer who underwent definitive chemoradiotherapy

    International Nuclear Information System (INIS)

    Yoneda, Masayuki; Fujiwara, Hitoshi; Okamura, Shinichi

    2010-01-01

    Serum C reactive protein (CRP) has been shown to be associated with the progression of esophageal cancer. The purpose of this study was to examine the relationship between treatment response and serum CRP levels in time course during definitive chemoradiotherapy (CRT) in terms of early prediction of CRT response by serum CRP. The subjects of this study were 36 patients with cT3/cT4 esophageal squamous cell carcinoma who underwent definitive CRT in our hospital. Serum CRP levels during definitive CRT (pretreatment, 1W, 2W and 3W after CRT initiation) were compared between CR and non-CR group. In addition, partition model was constructed to discriminate CR with non-CR and the prediction accuracy was evaluated. The patients were consisted of 28 males and 8 females. At pretreatment diagnosis, tumors were categorized as T3 (n=21) and T4 (n=15). Thirty four patients received FP-based chemotherapy and 2 patients received docetaxel-based chemotherapy. Treatment responses were categorized as CR (n=8), partial response (PR) (n=14), no change (NC) (n=2) and progressive disease (PD) (n=12). Serum CRP levels at the time of 2W after CRT initiation (CRT2W) in CR group were low compared to those in non-CR group (p=0.071). The partition model was constructed based on CRP levels at CRT2W. The prediction accuracies to discriminate CR from non-CR by CRP ≤0.1 were 50%, 82%, and 75% in sensitivity, specificity and accuracy, respectively. Serum CRP is a useful biomarker for an early prediction of CRT response. (author)

  14. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  15. Posttraumatic Stress Disorder, Orientation to Pain, and Pain Perception in Ex-Prisoners of War Who Underwent Torture.

    Science.gov (United States)

    Tsur, Noga; Defrin, Ruth; Ginzburg, Karni

    Studies suggest that torture survivors often experience long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture or rather the subsequent posttraumatic stress disorder (PTSD) explains these pain problems. Furthermore, although catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations. Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain threshold and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain. Although chronic pain was associated with PTSD (0.44 < β < 0.49, p < .002), increased pain perception was correlated with torture (0.33 < β < 0.65, p < .05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β = 0.18 and 0.19, respectively; p < .05). Fear of pain moderated the association between torture and pain perception (β = 0.41 and 0.42, respectively; p < .017). The findings suggest that chronic pain is contingent upon the psychological toll of torture, that is, PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to previous experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences after trauma.

  16. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Directory of Open Access Journals (Sweden)

    Wang Fang

    2013-02-01

    Full Text Available Abstract Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS. Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p  1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively. The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively. Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.

  17. Periodical assessment of genitourinary and gastrointestinal toxicity in patients who underwent prostate low-dose-rate brachytherapy

    International Nuclear Information System (INIS)

    Tanaka, Nobumichi; Asakawa, Isao; Anai, Satoshi; Hirayama, Akihide; Hasegawa, Masatoshi; Konishi, Noboru; Fujimoto, Kiyohide

    2013-01-01

    To compare the periodical incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicity in patients who underwent prostate low-dose-rate brachytherapy between the monotherapy group (seed implantation alone) and the boost group (in combination with external beam radiation therapy (EBRT)). A total of 218 patients with a median follow-up of 42.5 months were enrolled. The patients were divided into 2 groups by treatment modality, namely, the monotherapy group (155 patients) and the boost group (63 patients). The periodical incidence rates of GU and GI toxicity were separately evaluated and compared between the monotherapy group and the boost group using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0. To elucidate an independent factor among clinical and postdosimetric parameters to predict grade 2 or higher GU and GI toxicity in the acute and late phases, univariate and multivariate logistic regression analyses were carried out. Of all patients, 78.0% showed acute GU toxicity, and 7.8% showed acute GI toxicity, while 63.8% showed late GU toxicity, and 21.1% showed late GI toxicity. The incidence rates of late GU and GI toxicity were significantly higher in the boost group. Multivariate analysis showed that the International Prostate Symptom Score (IPSS) before seed implantation was a significant parameter to predict acute GU toxicity, while there were no significant predictive parameters for acute GI toxicity. On the other hand, combination with EBRT was a significant predictive parameter for late GU toxicity, and rectal volume (mL) receiving 100% of the prescribed dose (R100) was a significant predictive parameter for late GI toxicity. The boost group showed higher incidence rates of both GU and GI toxicity. Higher IPSS before seed implantation, combination with EBRT and a higher R100 were significant predictors for acute GU, late GU and late GI toxicity

  18. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Thomaidis, Tryfon; Charitoudis, Georgios; Kazakos, Konstantinos

    2017-01-01

    Studies describing the efficacy of TPED on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender something that has never been reported before in the literature. The purpose of this study is to evaluate possible differences of the health-related quality of life in patients who underwent TPED for LDH in accordance with sex. Seventy-six patients diagnosed and treated with TPED for LDH with 1 year follow-up were selected and divided into two groups of equal number depending on sex. Their quality of life was evaluated by using the SF-36 before the operation, six weeks, three, six and twelve months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the SF-36 combining each time two chronological phases in the total of patients, in each group and between groups. Fifty-two (68.4%) patients were ≤63 years old, while the rest 24 (31,4%) were >63 years old (mean ±SD = 56,5 ±12,1 years). Apart from the PF domain, the scores were higher in every visit for the two groups, but the change between groups was not significant. Women had a significantly higher increase of PF score in 3 months after TPED and in the interval 6 weeks-3 months comparing with men. However, in the intervals 3 months-6 months and 3 months-12 months men presented significantly higher increase compared to women. Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the two groups. As regards to the physical functioning, it appears to be a significant difference which is counterpoised over time. 2. TPED for LDH does not present major differences in the improvement of quality of life regarding gender.

  19. Treatment outcome of advance staged oral cavity cancer: concurrent chemoradiotherapy compared with primary surgery.

    Science.gov (United States)

    Tangthongkum, Manupol; Kirtsreesakul, Virat; Supanimitjaroenporn, Pasawat; Leelasawatsuk, Peesit

    2017-06-01

    Concurrent chemoradiotherapy (CCRT) has been reported as effective and has become an acceptable treatment in advanced oral cancer. However, to date there is insufficient data to conclude that CCRT provides a good survival outcome. The purpose of this study was to compare survival rates and complications in patients with resectable advanced oral cavity squamous cell carcinoma treated with either CCRT or surgery with adjuvant radiotherapy (RT)/chemoradiotherapy (CRT). Stage III or IVa oral cavity carcinoma patients treated with curative intent by either CCRT or surgery with adjuvant RT were identified over a 7-year period (2009-2015). Survival rates and treatment complications were analyzed and compared between the two groups. 61 patients underwent CCRT and 128 patients underwent surgical excision and received postoperative RT. There was no statistically significant difference in survival outcome between the two treatment groups. 5-year overall survival rates (OS) were 33 versus 24% (P = 0.191) and the disease-specific survival rates (DSS) were 27 versus 25% (P = 0.857) when comparing the CCRT group and surgery with adjuvant RT/CRT group, respectively. Long-term complications were comparable between the two groups. CCRT has comparable survival outcome and complications for the treatment of advanced oral cavity squamous cell carcinoma, compared to surgery with adjuvant RT/CRT.

  20. Endurance Training Intensity Does Not Mediate Interference to Maximal Lower-Body Strength Gain during Short-Term Concurrent Training.

    Science.gov (United States)

    Fyfe, Jackson J; Bartlett, Jonathan D; Hanson, Erik D; Stepto, Nigel K; Bishop, David J

    2016-01-01

    We determined the effect of concurrent training incorporating either high-intensity interval training (HIT) or moderate-intensity continuous training (MICT) on maximal strength, counter-movement jump (CMJ) performance, and body composition adaptations, compared with single-mode resistance training (RT). Twenty-three recreationally-active males (mean ± SD: age, 29.6 ± 5.5 y; [Formula: see text], 44 ± 11 mL kg -1 ·min -1 ) underwent 8 weeks (3 sessions·wk -1 ) of either: (1) HIT combined with RT (HIT+RT group, n = 8), (2) work-matched MICT combined with RT (MICT+RT group, n = 7), or (3) RT performed alone (RT group, n = 8). Measures of aerobic capacity, maximal (1-RM) strength, CMJ performance and body composition (DXA) were obtained before (PRE), mid-way (MID), and after (POST) training. Maximal (one-repetition maximum [1-RM]) leg press strength was improved from PRE to POST for RT (mean change ± 90% confidence interval; 38.5 ± 8.5%; effect size [ES] ± 90% confidence interval; 1.26 ± 0.24; P concurrent training incorporating either HIT or work-matched MICT similarly attenuates improvements in maximal lower-body strength and indices of CMJ performance compared with RT performed alone. This suggests endurance training intensity is not a critical mediator of interference to maximal strength gain during short-term concurrent training.

  1. Responses to concurrent radiotherapy and hormone-therapy and outcome for large breast cancers in post-menopausal women

    International Nuclear Information System (INIS)

    Bollet, Marc A.; Kirova, Youlia M.; Antoni, Guillemette; Pierga, Jean-Yues; Sigal-Zafrani, Brigitte; Laki, Fatima; Campana, Francois; Dendale, Remi; Salmon, Remy; Cottu, Paul; Fourquet, Alain

    2007-01-01

    Introduction: This study aimed to evaluate responses and outcome of hormone-therapy (HT) and radiotherapy (RT) given concurrently for large breast cancers in post-menopausal women. Material and methods: Forty-two breast carcinomas in 41 women were treated with HT and concurrent RT to the breast ± lymph node bearing areas. For 30 tumours this was followed by breast surgery (with axillary lymph node dissection when the axilla had not been irradiated). RT delivered a median dose to the tumour of 50 Gy (48-66) and 75 Gy (65-84) for, respectively, preoperative and exclusive RT-HT. Median follow-up was 64 months. Results: Out of 42 clinically assessable tumours (after a mean dose of 50 Gy), 9 tumours (21%) had complete clinical responses, 24 (57%) partial responses, 9 (21%) stable disease. Breast-conserving surgery or exclusive RT-HT was possible in 74% of tumours. For 29 patients who underwent breast surgery, the rate of pathological complete responses was 17%. At 50 Gy no skin toxicity higher than grade 2 occurred. Five year OS, RFS and local control were, respectively, 85%, 84% and 97%. Lymphoedema occurred in one patient. Conclusion: Concurrent association of RT-HT demonstrated good efficacy, both in terms of clinical and pathological complete responses. It allowed breast conservation with acceptable tolerance and good 5-year local control

  2. Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations

    Directory of Open Access Journals (Sweden)

    Ja Hong Kuh

    2017-06-01

    Full Text Available Background: In elderly patients who have atrial fibrillation (AF, surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP, the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations. Methods: From October 2007 to December 2015, we enrolled 27 patients aged >70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was 8±11 (high risk. Results: Only 1 hospital death occurred (4%. The Kaplan-Meier method showed a high 5‐year cumulative survival rate (92%. At mean follow‐up of 51 months, 23 patients (89% had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium (53.4±7.5 cm and the 19 patients who did not have reduction plasty (48.7±5.7 cm. Conclusion: In patients aged >70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.

  3. Comparison of Standard Catheters Versus Radial Artery-Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access.

    Science.gov (United States)

    Chen, On; Goel, Sunny; Acholonu, Michael; Kulbak, Guy; Verma, Shivani; Travlos, Efstratios; Casazza, Richard; Borgen, Elliot; Malik, Bilal; Friedman, Michael; Moskovits, Norbert; Frankel, Robert; Shani, Jacob; Ayzenberg, Sergey

    2016-08-01

    In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of the study included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter was associated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131 seconds, p = 0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7 Gy·cm(2), p = 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5 ml, p = 0.114), and total procedure time (337 ± 382 vs 434 ± 137 seconds, p = 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be

  4. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  5. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Science.gov (United States)

    2013-01-01

    Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR) to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS). Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p CA-125 biochemical progression prior to clinically-defined relapse was 31 days (ranging from 1 to 391 days). The median number of the negative imaging studies for the clinical relapse findings in patients with a CA-125 level of CA-125 level at relapse was an independent predictor of overall and progression free survival in patients who had shown CCR to primary therapy (p = 0.04 and 0.02 respectively). The overall and progression free survival durations in patients with a CA-125 level ≤ 1.68 × nadir at relapse (69.4 and 13.8 months) were longer than those with a CA-125 level > 1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively). The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively). Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in

  6. Prevalence and correlates of concurrent sexual partnerships among young people in South Africa.

    Science.gov (United States)

    Mah, Timothy L

    2010-02-01

    Concurrent sexual partnerships are an important behavioral driver of HIV epidemics. This analysis examines the prevalence and correlates of concurrency among young adults in the Cape Metropolitan Area, South Africa. 13% reported concurrency during their last sexual partnership with variability by sex and race. Concurrency was associated with race, knowledge of a partner's infidelity, and other risky sexual behaviors.

  7. Prevalence and predictors of concurrent sexual partnerships in a predominantly African American population in Jackson, Mississippi

    Science.gov (United States)

    Nunn, Amy; MacCarthy, Sarah; Barnett, Nancy; Rose, Jennifer; Chan, Philip; Yolken, Annajane; Cornwall, Alexandra; Chamberlain, Nicholas; Barnes, Arti; Riggins, Reginald; Moore, Elya; Simmons, Dantrell; Parker, Sharon; Mena, Leandro

    2014-01-01

    Concurrent sexual partnerships, or sexual partnerships that overlap in time, have been associated with HIV and sexually transmitted infections (STI) infection. How best to measure concurrency and the personal characteristics and predictors of concurrency are not yet well understood. We compared two frequently used concurrency definitions, including a self-reported measure based on participant response regarding overlapping sex with partners, and the UNAIDS measure based on overlapping dates of last sex and intention to have sex again. We performed multivariable logistic regression analyses to identify socio-demographic, behavioral, and structural predictors of concurrency among 1,542 patients at an urban STI clinic in Jackson, Mississippi. Nearly half (44%) reported concurrency based on self-reported sex with other partners, and 26% reported concurrency according to the UNAIDS concurrency measure. Using the self-reported concurrency measure, the strongest predictors of concurrency were perceived partner concurrency, drug use at last sex, having more than 10 lifetime partners, and being recently incarcerated. Strongest predictors of concurrency using the UNAIDS measure were lifetime number of partners and perceived partner concurrency. Concurrency is highly prevalent in this population in the Deep South and social, structural and behavioral factors were important predictors of concurrency for both measures. Future research should use time anchored data collection methods and biomarkers to assess whether both definitions of concurrency are associated with HIV outcomes. PMID:24803130

  8. Mathematical techniques for analyzing concurrent and probabilistic systems

    CERN Document Server

    Rutten, J J M M; Panangaden, Prakash; Panangaden, Prakash; Breugel, Franck van

    2004-01-01

    The book consists of two sets of lecture notes devoted to slightly different methods of analysis of concurrent and probabilistic computational systems. The first set of lectures develops a calculus of streams (a generalization of the set of natural numbers) based on the coinduction principle coming from the theory of coalgebras. It is now well understood that the interplay between algebra (for describing structure) and coalgebra (for describing dynamics) is crucial for understanding concurrent systems. There is a striking analogy between streams and formula calculus reminiscent to those appearing in quantum calculus. These lecture notes will appeal to anyone working in concurrency theory but also to algebraists and logicians. The other set of lecture notes focuses on methods for automatically verifying probabilistic systems using techniques of model checking. The unique aspect of these lectures is the coverage of both theory and practice. The authors have been responsible for one of the most successful experi...

  9. Oligopolistic concurrence and investment: application to electricity markets

    International Nuclear Information System (INIS)

    Meunier, G.

    2008-12-01

    This research aims at analysing investment strategies of firms which are in an oligopolistic situation. After a brief description of the physical characteristics of an electric system, the author describes the reforms and defines the problematic of an investment in electricity production within markets in imperfect concurrence. In a first part, the author analyses the heterogeneity (either exogenous or endogenous) and technology choices of oligopolistic firms. In case of an exogenous heterogeneity, he studies the impact of the number of firms on investment decisions. In the second part, the author examines the regulations introduced in industries in imperfect concurrence: electricity production by a public firm and interaction between emission allowance market and investment

  10. Concurrent sexual partners-A predictor of Chlamydia

    DEFF Research Database (Denmark)

    Jørgensen, Marianne Johansson; Olesen, Frede; Maindal, Helle Terkildsen

    2013-01-01

    Background:Chlamydia trachomatis is the most common sexually transmitted bacterial infection among young Danes and the spread is highly dependent on the population’s sexual behavior. Previous studies have found concurrent partnerships to be a possible predictor for C. trachomatis, but the signifi......Background:Chlamydia trachomatis is the most common sexually transmitted bacterial infection among young Danes and the spread is highly dependent on the population’s sexual behavior. Previous studies have found concurrent partnerships to be a possible predictor for C. trachomatis...

  11. Preliminary Proceedings 15th International Workshop on Expressiveness in Concurrency

    DEFF Research Database (Denmark)

    The EXPRESS workshops aim at bringing together researchers interested in the relations between various formal systems, particularly in the field of Concurrency. More specifically, they focus on the comparison between programming concepts (such as concurrent, functional, imperative, logic and object...... organising committee for hosting EXPRESS '08, and Richard Trefler for the local organization of the workshops and arranging the printing of these preliminary proceedings, which were compiled by Espen Højsgaard. The final proceedings will become available electronically at Elsevier's web site http://www.elsevier.com/locate/entcs....

  12. [Retrospective analysis of 856 cases with stage 0 to III rectal cancer underwent curative surgery combined modality therapy].

    Science.gov (United States)

    Chen, Pengju; Yao, Yunfeng; Zhao, Jun; Li, Ming; Peng, Yifan; Zhan, Tiancheng; Du, Changzheng; Wang, Lin; Chen, Nan; Gu, Jin

    2015-07-01

    To investigate the survival and prognostic factors of stage 0 to III rectal cancer in 10 years. Clinical data and follow-up of 856 rectal cancer patients with stage 0-III underwent curative surgery from January 2000 to December 2010 were retrospective analyzed. There were 470 male and 386 female patients, with a mean age of (58 ± 12) years. Kaplan-Meier method was used to analyze the overall survival and disease free survival. Log-rank test was used to compare the survival between groups. Cox regression was used to analyze the independent prognostic factors of rectal cancer. The patients in each stage were stage 0 with 18 cases, stage I with 209 cases, stage II with 235 cases, and stage III with 394 cases. All patients received curative surgery. There were 296 patients evaluated as cT3, cT4 and any T with N+ received preoperative radiotherapy. 5.4% patients got pathological complete response (16/296), and the recurrence rate was 4.7% (14/296). After a median time of 41.7 months (range 4.1 to 144.0 months) follow-up, the 5-year overall survival rate in stage 0 to I of was 91.0%, stage II 86.2%, and stage III 60.0%, with a significant difference (P=0.000). The cumulative local recurrence rate was 4.8% (41/856), of which 70.7% (29/41) occurred within 3 years postoperatively, 97.6% (40/41) in 5 years. The cumulative distant metastasis rate was 16.4% (140/856), of which 82.9% (129/140) occurred within 3 years postoperatively, 96.4% (135/140) in 5 years. The incidence of abnormal imaging findings was significantly higher in pulmonary than liver and other sites metastases (75.0% vs. 21.7%, χ² =25.691, P=0.000). The incidence of CEA elevation was significantly higher in liver than lung and other sites metastases (56.8% vs. 37.8%, χ² =25.691, P=0.000). Multivariable analysis showed that age (P=0.015, HR=1.385, 95% CI: 1.066 to 1.801), surgical approach (P=0.029, HR=1.337, 95% CI: 1.030 to 1.733), differentiation (P=0.000, HR=1.535, 95% CI: 1.222 to 1.928), TNM stage (P

  13. Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety.

    Science.gov (United States)

    Gurka, Marie K; Collins, Sean P; Slack, Rebecca; Tse, Gary; Charabaty, Aline; Ley, Lisa; Berzcel, Liam; Lei, Siyuan; Suy, Simeng; Haddad, Nadim; Jha, Reena; Johnson, Colin D; Jackson, Patrick; Marshall, John L; Pishvaian, Michael J

    2013-03-01

    Concurrent chemoradiation is a standard option for locally advanced pancreatic cancer (LAPC). Concurrent conventional radiation with full-dose gemcitabine has significant toxicity. Stereotactic body radiation therapy (SBRT) may provide the opportunity to administer radiation in a shorter time frame with similar efficacy and reduced toxicity. This Pilot study assessed the safety of concurrent full-dose gemcitabine with SBRT for LAPC. Patients received gemcitabine, 1000 mg/m2 for 6 cycles. During week 4 of cycle 1, patients received SBRT (25 Gy delivered in five consecutive daily fractions of 5 Gy prescribed to the 75-83% isodose line). Acute and late toxicities were assessed using NIH CTCAE v3. Tumor response was assessed by RECIST. Patients underwent an esophagogastroduodenoscopy at baseline, 2, and 6 months to assess the duodenal mucosa. Quality of life (QoL) data was collected before and after treatment using the QLQ-C30 and QLQ-PAN26 questionnaires. Between September 2009 and February 2011, 11 patients enrolled with one withdrawal during radiation therapy. Patients had grade 1 to 2 gastrointestinal toxicity from the start of SBRT to 2 weeks after treatment. There were no grade 3 or greater radiation-related toxicities or delays for cycle 2 of gemcitabine. On endoscopy, there were no grade 2 or higher mucosal toxicities. Two patients had a partial response. The median progression free and overall survival were 6.8 and 12.2 months, respectively. Global QoL did not change between baseline and immediately after radiation treatment. SBRT with concurrent full dose gemcitabine is safe when administered to patients with LAPC. There is no delay in administration of radiation or chemotherapy, and radiation is completed with minimal toxicity.

  14. The Effect of Two Different Concurrent Training Programs on Strength and Power Gains in Highly-Trained Individuals

    Directory of Open Access Journals (Sweden)

    Henrik Petré, Pontus Löfving, Niklas Psilander

    2018-06-01

    Full Text Available The effects of concurrent strength and endurance training have been well studied in untrained and moderately-trained individuals. However, studies examining these effects in individuals with a long history of resistance training (RT are lacking. Additionally, few studies have examined how strength and power are affected when different types of endurance training are added to an RT protocol. The purpose of the present study was to compare the effects of concurrent training incorporating either low-volume, high-intensity interval training (HIIT, 8-24 Tabata intervals at ~150% of VO2max or high-volume, medium-intensity continuous endurance training (CT, 40-80 min at 70% of VO2max, on the strength and power of highly-trained individuals. Sixteen highly-trained ice-hockey and rugby players were divided into two groups that underwent either CT (n = 8 or HIIT (n = 8 in parallel with RT (2-6 sets of heavy parallel squats, > 80% of 1RM during a 6-week period (3 sessions/wk. Parallel squat performance improved after both RT + CT and RT + HIIT (12 ± 8% and 14 ± 10% respectively, p < 0.01, with no difference between the groups. However, aerobic power (VO2max only improved after RT + HIIT (4 ± 3%, p < 0.01. We conclude that strength gains can be obtained after both RT + CT and RT + HIIT in athletes with a prior history of RT. This indicates that the volume and/or intensity of the endurance training does not influence the magnitude of strength improvements during short periods of concurrent training, at least for highly-trained individuals when the endurance training is performed after RT. However, since VO2max improved only after RT + HIIT and this is a time efficient protocol, we recommend this type of concurrent endurance training.

  15. Reliability and concurrent validity of the Infant Motor Profile

    NARCIS (Netherlands)

    Heineman, Kirsten R.; Middelburg, Karin J.; Bos, Arend F.; Eidhof, Lieke; La Bastide-van Gemert, Sacha; van den Heuvel, Edwin R.; Hadders-Algra, Mijna

    2013-01-01

    The Infant Motor Profile (IMP) is a qualitative assessment of motor behaviour in infancy. It consists of five domains: movement variation, variability, fluency, symmetry, and performance. The aim of this study was to assess interobserver reliability and concurrent validity of the IMP with the

  16. Concurrent Occurrence of Uterovaginal and Rectal Prolapse: An ...

    African Journals Online (AJOL)

    Concurrent Occurrence of Uterovaginal and Rectal Prolapse: An Uncommon Presentation. ... In resource-limited settings with concomitant uterine and rectal prolapse, open abdominal sacrohysteropexy with synthetic mesh and rectopexy is an effective and safe alternative to Manchester operation in the absence of ...

  17. 14 CFR 221.140 - Method of giving concurrence.

    Science.gov (United States)

    2010-01-01

    ...) Conflicting authority to be avoided. Care should be taken to avoid giving authority to two or more carriers... Aviation shall be used by a carrier to give authority to another carrier to issue and file with the... used as authority to file joint fares or charges in which the carrier to whom the concurrence is given...

  18. Effects of Serial and Concurrent Training on Acquisition and Generalization

    Science.gov (United States)

    Wunderlich, Kara L.; Vollmer, Timothy R.; Donaldson, Jeanne M.; Phillips, Cara L.

    2014-01-01

    Despite a large body of research demonstrating that generalization to novel stimuli can be produced by training sufficient exemplars, the methods by which exemplars can be trained remain unclear. The purpose of the current study was to evaluate 2 methods, serial and concurrent presentation of stimuli, to train sufficient exemplars. Five preschool…

  19. Comparative Efficacy of Cisplatin vs. Gemcitabine as Concurrent ...

    African Journals Online (AJOL)

    no previous treatment. Patients were randomized to receive either weekly Cisplatin 40mg/m2 intravenously or Gemcitabine 100mg/m2 intravenously for 5 cycles concurrent with external beam radiation therapy 50Gy/25# as 5# / weeks, followed by single application of medium does rate intracavitory brachytherapy to deliver ...

  20. Towards PCC for Concurrent and Distributed Systems (Work in Progress)

    Science.gov (United States)

    Henriksen, Anders S.; Filinski, Andrzej

    2009-01-01

    We outline some conceptual challenges in extending the PCC paradigm to a concurrent and distributed setting, and sketch a generalized notion of module correctness based on viewing communication contracts as economic games. The model supports compositional reasoning about modular systems and is meant to apply not only to certification of executable code, but also of organizational workflows.

  1. Concurrent control system for the JAERI tandem accelerator

    International Nuclear Information System (INIS)

    Hanashima, S.; Shoji, T.; Horie, K.; Tsukihashi, Y.

    1992-01-01

    Concurrent processing with a multiprocessor system is introduced to the particle accelerator control system region. The control system is a good application in both logical and physical aspects. A renewal plan of the control system for the JAERI tandem accelerator is discussed. (author)

  2. The Relational Concurrence of Global Warming and Economic ...

    African Journals Online (AJOL)

    An attempt has been made to examine the concurrent relationship between global warming and economic development focusing on the danger it inheres in developing countries. To achieve this, the paper commenced with the conceptualization of global warming and economic development, the natural and human causes ...

  3. Bidirectional Interference between Timing and Concurrent Memory Processing in Children

    Science.gov (United States)

    Rattat, Anne-Claire

    2010-01-01

    This study investigated the nature of resources involved in duration processing in 5- and 8-year-olds. The children were asked to reproduce the duration of a visual or auditory stimulus. They performed this task either alone or concurrently with an executive task (Experiment 1) or with a digit or visuospatial memory task (Experiment 2). The…

  4. A Patient Presenting with Concurrent Testis Torsion and Epididymal Leiomyoma

    Directory of Open Access Journals (Sweden)

    E. Arpali

    2013-01-01

    Full Text Available Leiomyomas are the second most common tumors of epididymis. Patients with leiomyomas are sometimes misdiagnosed with testicular tumors. A Case of a patient with a scrotal mass presenting with testicular torsion is reported. Concurrent occurrence of testicular torsion and epididymal leiomyoma is an extremely rare condition.

  5. Perceptions of why Malawians engage in concurrent sexual ...

    African Journals Online (AJOL)

    Concurrent sexual partnerships have been identified as a potential driver in the HIV epidemic in Southern Africa. This study utilised an innovative approach to explore perceptions of why Malawians may engage in these relationships, and their suggestions for reducing the practice among a select population of radio ...

  6. Concurrent Speech Segregation Problems in Hearing Impaired Children

    Directory of Open Access Journals (Sweden)

    Hossein Talebi

    2014-04-01

    Full Text Available Objective: This study was a basic investigation of the ability of concurrent speech segregation in hearing impaired children. Concurrent segregation is one of the fundamental components of auditory scene analysis and plays an important role in speech perception. In the present study, we compared auditory late responses or ALRs between hearing impaired and normal children. Materials & Methods: Auditory late potentials in response to 12 double vowels were recorded in 10 children with moderate to severe sensory neural hearing loss and 10 normal children. Double vowels (pairs of synthetic vowels were presented concurrently and binaurally. Fundamental frequency (F0 of these vowels and the size of the difference in F0 between vowels was 100 Hz and 0.5 semitones respectively. Results: Comparing N1-P2 amplitude showed statistically significant difference in some stimuli between hearing impaired and normal children (P<0.05. This complex indexing the vowel change detection and reflecting central auditory speech representation without active client participation was decreased in hearing impaired children. Conclusion: This study showed problems in concurrent speech segregation in hearing impaired children evidenced by ALRs. This information indicated deficiencies in bottom-up processing of speech characteristics based on F0 and its differences in these children.

  7. Reliability and concurrent validity of the Infant Motor Profile

    NARCIS (Netherlands)

    Heineman, Kirsten R.; Middelburg, Karin J.; Bos, Arend F.; Eidhof, Lieke; La Bastide-Van Gemert, Sacha; Van den Heuvel, Edwin R.; Hadders-Algra, Mijna

    Aim The Infant Motor Profile (IMP) is a qualitative assessment of motor behaviour in infancy. It consists of five domains: movement variation, variability, fluency, symmetry, and performance. The aim of this study was to assess interobserver reliability and concurrent validity of the IMP with the

  8. Concurrent signal combining and channel estimation in digital communications

    Science.gov (United States)

    Ormesher, Richard C [Albuquerque, NM; Mason, John J [Albuquerque, NM

    2011-08-30

    In the reception of digital information transmitted on a communication channel, a characteristic exhibited by the communication channel during transmission of the digital information is estimated based on a communication signal that represents the digital information and has been received via the communication channel. Concurrently with the estimating, the communication signal is used to decide what digital information was transmitted.

  9. Concurrent Validity of Standardized Measures of Written Expression.

    Science.gov (United States)

    Riccio, Cynthia A.; Boan, Candace H.; Staniszewski, Deborah; Hynd, George W.

    1997-01-01

    A study involving 120 school-aged children that investigated the concurrent validity of measures of written language found that the Wechsler Individual Achievement Test Written Expression subtest correlates moderately with the Written Expression subtest of the Peabody Individual Achievement Test-Revised and the Spontaneous Writing Quotient of the…

  10. Concurrent Occurrence of Uterovaginal and Rectal Prolapse: An ...

    African Journals Online (AJOL)

    skin hyper-extensibility, abnormal wound healing, and joint hypermobility, is commonly associated with uterovaginal ... of a live male baby. The concomitant protrusions occurred. Concurrent Occurrence of Uterovaginal and Rectal. Prolapse: An Uncommon PresentaƟon. Umeh UA1, Ugwu EO1,2, Obi SN1,2, Nnagbo JE1.

  11. Investigating the Alignment of Concurrent Design Strategies with Business Strategies

    Directory of Open Access Journals (Sweden)

    Heidar Mirfakhredini

    2013-08-01

    Full Text Available In recent years, managing the interface between design and other activities has received considerable attention. Effective coordination among these areas is therefore vital for effectiveness of the organization. The ideal situation would be continuous interdepartmental contact with well-developed channels of communication. In this study, the best strategy for product design department has been chosen using the strategic formulation framework with fuzzy approach. Subsequently, alignment of each functional design strategy with SAPCO business strategies has been explained. Findings indicate that developing partnerships with global automotive and engineering design companies and building strategic alliances with rival firms to achieve competitive advantages have maximum alignment with business strategies. In addition, findings provide a basis for firms in evaluating the concurrent design strategies and a reference for them to strengthen their concurrent capabilities. There are few reports on sustained use of concurrent design as an on-going strategic process in an organization. This study aims at contributing to the concurrent design solutions.

  12. Transactions on Petri Nets and Other Models of Concurrency V

    DEFF Research Database (Denmark)

    The fifth volume of ToPNoC contains revised versions of selected papers from workshops and tutorials held in conjunction with the 31st International Conference on Application and Theory of Petri Nets and Other Models of Concurrency, as well as a contributed paper selected through the regular subm...

  13. Transactions on Petri Nets and Other Models of Concurrency VI

    DEFF Research Database (Denmark)

    The sixth volume of ToPNoC includes revised versions of selected papers from workshops and tutorials held at the 32nd International Conference on Application and Theory of Petri Nets and Concurrency. It also contains a special section on Networks, Protocols, and Services, as well as a contributed...

  14. Responses of rabbits to concurrent administration of Furosemide ...

    African Journals Online (AJOL)

    The intramuscular (IM) administrations of 5 mg/kg xylazine, followed 30 min later by IM of 35 mg/kg ketamine alone (XK) or concurrently with IM of 1 mg/kg furosemide (XKF), were assessed in six healthy rabbits (4 bucks and 2 does) using selected anaesthetic indices (time to onset of anaesthesia, time to onset of analgesia, ...

  15. Successful integration of industry and education with concurrent engineering projects

    NARCIS (Netherlands)

    Ir. H.E.V. Veenstra; Ir. Peter van Kollenburg

    1998-01-01

    The Department of Electrical and Electronic Engineering at the Fontys University of Professional Education in Eindhoven, The Netherlands, offers a course which is being developed around the principles of Concurrent Engineering. From research we found that in general students are not completely aware

  16. Concurrent engineering and product models in seafood companies

    DEFF Research Database (Denmark)

    Jonsdottir, Stella; Vesterager, Johan; Børresen, Torger

    1998-01-01

    Concurrent Engineering (CE) can provide an improved approach to product development for extending the lines of seafood products. Information technology (IT) support tools based on product models can provide an integrated and simultaneous approach for specifying new recipes. The seafood industry c...

  17. A Symbolic Approach to Permission Accounting for Concurrent Reasoning

    NARCIS (Netherlands)

    Huisman, Marieke; Mostowski, Wojciech

    2015-01-01

    Permission accounting is fundamental to modular, thread-local reasoning about concurrent programs. This paper presents a new, symbolic system for permission accounting. In existing systems, permissions are numeric value-based and refer to the current thread only. Our system is based on symbolic

  18. Selective Impairment of Auditory Selective Attention under Concurrent Cognitive Load

    Science.gov (United States)

    Dittrich, Kerstin; Stahl, Christoph

    2012-01-01

    Load theory predicts that concurrent cognitive load impairs selective attention. For visual stimuli, it has been shown that this impairment can be selective: Distraction was specifically increased when the stimulus material used in the cognitive load task matches that of the selective attention task. Here, we report four experiments that…

  19. Aging and Concurrent Task Performance: Cognitive Demand and Motor Control

    Science.gov (United States)

    Albinet, Cedric; Tomporowski, Phillip D.; Beasman, Kathryn

    2006-01-01

    A motor task that requires fine control of upper limb movements and a cognitive task that requires executive processing--first performing them separately and then concurrently--was performed by 18 young and 18 older adults. The motor task required participants to tap alternatively on two targets, the sizes of which varied systematically. The…

  20. Risk factors for concurrent bacteremia in adult patients with dengue

    Directory of Open Access Journals (Sweden)

    Tun-Linn Thein

    2017-06-01

    Conclusion: Concurrent bacteremia in adult patients with dengue is uncommon but presents atypically and results in more deaths and longer hospital stay. Given the associated mortality, collection of blood cultures and empiric antibiotic therapy may be considered in patients who are critically ill.

  1. Validating Timed Models of Deployment Components with Parametric Concurrency

    Science.gov (United States)

    Broch Johnsen, Einar; Owe, Olaf; Schlatte, Rudolf; Tapia Tarifa, Silvia Lizeth

    Many software systems today are designed without assuming a fixed underlying architecture, and may be adapted for sequential, multicore, or distributed deployment. Examples of such systems are found in, e.g., software product lines, service-oriented computing, information systems, embedded systems, operating systems, and telephony. Models of such systems need to capture and range over relevant deployment scenarios, so it is interesting to lift aspects of low-level deployment concerns to the abstraction level of the modeling language. This paper proposes an abstract model of deployment components for concurrent objects, extending the Creol modeling language. The deployment components are parametric in the amount of concurrency they provide; i.e., they vary in processing resources. We give a formal semantics of deployment components and characterize equivalence between deployment components which differ in concurrent resources in terms of test suites. Our semantics is executable on Maude, which allows simulations and test suites to be applied to a deployment component with different concurrent resources.

  2. Type and Behaviour Reconstruction for Higher-Order Concurrent Programs

    DEFF Research Database (Denmark)

    Amtoft, T.; Nielson, Flemming; Nielson, Hanne Riis

    1997-01-01

    The authors develop a sound and complete type and behaviour inference algorithm for a fragment of CML (Standard ML with primitives for concurrency). Behaviours resemble terms of a process algebra and yield a concise representation of the communications taking place during execution; types...... completeness as well as soundness; this is due to an alternative strategy for generalising over types and behaviours...

  3. The Influence of Concurrent Ascaridia and Heterakis Infections of ...

    African Journals Online (AJOL)

    Blood samples from the same fowls were also collected and analyzed for PCV (%), RBC, Hb and differential white cell count using established standard procedures. Results from the study reveal a concurrent prevalence of 45.5%. Respective prevalence was in the order Ascaridia numida 56.05% and Heterakis gallinarum ...

  4. Concurrent use of Antiretroviral and African traditional medicines ...

    African Journals Online (AJOL)

    Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal. Mncengeli Sibanda,Manimbulu Nlooto M, Panjasaram Naidoo. Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal ...

  5. Partnership duration, concurrency, and HIV in sub-Saharan Africa.

    Science.gov (United States)

    Sawers, Larry; Isaac, Alan

    2017-07-01

    A widely accepted explanation for the exceptionally high HIV prevalence in sub-Saharan Africa is the practice of long-term overlapping heterosexual partnering. This article shows that long-duration concurrent partnering can be protective against HIV transmission rather than promoting it. Monogamous partnering prevents sexual transmission to anyone outside the partnership and, in an initially concordant-seronegative partnership, prevents sexual acquisition of HIV by either partner. Those protections against transmission and acquisition last as long as the partnership persists without new outside partnerships. Correspondingly, these two protective effects characterise polygynous partnerships, whether or not the polygyny is formal or informal, until a partner initiates a new partnership. Stable and exclusive unions of any size protect against HIV transmission, and more durable unions provide a longer protective effect. Survey research provides little information on partnership duration in sub-Saharan Africa and sheds no light on the interaction of duration, concurrency, and HIV. This article shows how assumptions about partnership duration in individual-based sexual-network models affect the contours of simulated HIV epidemics. Longer mean partnership duration slows the pace at which simulated epidemics grow. With plausible assumptions about partnership duration and at levels of concurrency found in the region, simulated HIV epidemics grow slowly or not at all. Those results are consistent with the hypothesis that long-duration partnering is protective against HIV and inconsistent with the hypothesis that long-term concurrency drives the HIV epidemics in sub-Saharan Africa.

  6. Threaded Cognition: An Integrated Theory of Concurrent Multitasking

    Science.gov (United States)

    Salvucci, Dario D.; Taatgen, Niels A.

    2008-01-01

    The authors propose the idea of threaded cognition, an integrated theory of concurrent multitasking--that is, performing 2 or more tasks at once. Threaded cognition posits that streams of thought can be represented as threads of processing coordinated by a serial procedural resource and executed across other available resources (e.g., perceptual…

  7. The risks of concurrent treatment with tenofovir and aminoglycosides ...

    African Journals Online (AJOL)

    The risks of concurrent treatment with tenofovir and aminoglycosides in patients with HIV-associated tuberculosis. C Kenyon, N Wearne, R Burton, G Meintjes. Abstract. The South African public sector antiretroviral treatment (ART) guidelines have recently been changed to include tenofovir in the first-line regimen.1 ...

  8. Concurrent and Predictive Validity of the Galician CDI

    Science.gov (United States)

    Perez-Pereira, Miguel; Resches, Mariela

    2011-01-01

    This paper explores the concurrent and predictive validity of the long and short forms of the Galician version of the MacArthur-Bates CDI (IDHC). Forty-two Galician-speaking children were longitudinally evaluated at age 1 ; 6, 2 ; 0 and 4 ; 0. On the first two occasions, the subjects' vocabulary and grammar skills were assessed through the IDHC.…

  9. Transactions on Petri Nets and Other Models of Concurrency VII

    DEFF Research Database (Denmark)

    nets and other models of concurrency, ranging from theoretical work to tool support and industrial applications. ToPNoC issues are published as LNCS volumes, and hence are widely distributed and indexed. This Journal has its own Editorial Board which selects papers based on a rigorous two...

  10. Arterial oxygen tension and pulmonary ventilation in horses placed in the Anderson Sling suspension system after a period of lateral recumbency and anaesthetised with constant rate infusions of romifidine and ketamine.

    Science.gov (United States)

    François, I; Lalèyê, F-X; Micat, M; Benredouane, K; Portier, K

    2014-09-01

    Some controversy exists over whether or not horses' recovery and cardiopulmonary function are affected by suspension in slings. To measure arterial oxygen tension and pulmonary ventilation in anaesthetised horses placed in a standing position in an Anderson Sling (AS) after a period of right lateral recumbency (RLR). Randomised crossover experimental study. Six Standardbred horses were anaesthetised twice. Catheters were inserted into the right jugular vein and the left carotid artery. After premedication with romifidine, anaesthesia was induced with diazepam and ketamine. Following 50 min in RLR, horses were maintained in either RLR or AS for an additional 60 min through to recovery. Anaesthesia was maintained i.v. with a constant rate infusion of romifidine and ketamine. Heart rate, respiratory rate, mean arterial pressure, expiratory tidal volume, minute volumes and end tidal CO2 were monitored continuously. Venous and arterial bloods were sampled for lactate concentration, creatine kinase activity and blood gas analysis before premedication, after induction, every 20 min for 100 min, as soon as the horse was standing (TR), and 24 h later. The data were averaged within 2 anaesthetic periods: P1, 0-20 min; and P2, 40-100 min. During P2, horses in the RLR group had lower arterial oxygen tension (P = 0.001), higher alveolar-arterial oxygen tension gradient (P = 0.005), higher respiratory rate (P = 0.04) and higher minute volumes (P = 0.04) than horses in the AS group. Arterial CO2 tension and mean arterial pressure increased in the AS group during P2 (P = 0.01 and 0.02 respectively). The recoveries were judged better in the AS group than in the RLR group (P = 0.01). During TR, lactate were higher in the RLR group than in the AS group (P = 0.007). Creatine kinase activities were higher in the AS group at 24 h vs. TR (P = 0.02). Anderson Sling suspension after a period of recumbency improves cardiopulmonary function and recovery quality in horses and

  11. Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Locoregionally Advanced Laryngeal and Hypopharyngeal Cancers

    International Nuclear Information System (INIS)

    Lee, Nancy Y.; O'Meara, William; Chan, Kelvin; Della-Bianca, Cesar; Mechalakos, James G.; Zhung, Joanne; Wolden, Suzanne L.; Narayana, Ashwatha; Kraus, Dennis; Shah, Jatin P.; Pfister, David G.

    2007-01-01

    Purpose: To perform a retrospective review of laryngeal/hypopharyngeal carcinomas treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). Methods and Materials: Between January 2002 and June 2005, 20 laryngeal and 11 hypopharyngeal carcinoma patients underwent IMRT with concurrent platinum-based chemotherapy; most patients had Stage IV disease. The prescription of the planning target volume for gross, high-risk, and low-risk subclinical disease was 70, 59.4, and 54 Gy, respectively. Acute/late toxicities were retrospectively scored using the Common Toxicity Criteria scale. The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rates were calculated using the Kaplan-Meier method. Results: The median follow-up of the living patients was 26 months (range, 17-58 months). The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rate was 86%, 94%, 89%, 92%, and 63%, respectively. Grade 2 mucositis or higher occurred in 48% of patients, and all experienced Grade 2 or higher pharyngitis during treatment. Xerostomia continued to decrease over time from the end of RT, with none complaining of Grade 2 toxicity at this analysis. The 2-year post-treatment percutaneous endoscopic gastrostomy-dependency rate for those with hypopharyngeal and laryngeal tumors was 31% and 15%, respectively. The most severe late complications were laryngeal necrosis, necrotizing fascitis, and a carotid rupture resulting in death 3 weeks after salvage laryngectomy. Conclusion: These preliminary results have shown that IMRT achieved encouraging locoregional control of locoregionally advanced laryngeal and hypopharyngeal carcinomas. Xerostomia improved over time. Pharyngoesophageal stricture with percutaneous endoscopic gastrostomy dependency remains a problem, particularly for patients with hypopharyngeal carcinoma and, to a lesser

  12. Preoperative concurrent chemo-radiation in rectal cancer; Radiochimiotherapie concomitante preoperatoire pour cancer du rectum

    Energy Technology Data Exchange (ETDEWEB)

    Berger, C.; Kirscher, S.; Felix-Faure, C.; Chauvet, B.; Vincent, P.; Brewer, Y.; Reboul, F. [Clinique Sainte-Catherine, 84 - Avignon (France)

    1998-05-01

    To evaluate retrospectively treatment-related morbidity of concurrent radiotherapy and chemotherapy for rectal cancer. Between 1992 and 1995, 38 patients (median age: 60) were treated for locally advanced resectable rectal cancer. Median dose of radiotherapy was 45 Gy/25 fractions/5 weeks. Chemotherapy consisted of two courses of 5-fluorouracil and leucovorin administered during the first and the fifth weeks of radiotherapy. Median dose of 5-fluorouracil was 350 mg/m{sup 2}/day, and median dose of leucovorin was 350 mg/m{sup 2}/day, day 1 to day 5. Surgery was performed 5 weeks after completion of radiotherapy. Before surgery, one patient died of febrile neutropenia and sepsis after two cycles of chemotherapy and 45 Gy. Main pre-operative grade 3-4 toxicities were respectively: neutropenia: 3% ; nausea/vomiting: 3%; diarrhea: 3%; proctitis: 5%; radiation dermatitis: 8%. Twenty-six patients underwent a low anterior resection and 11 an abdomino-perineal resection. A temporary colostomy was performed in 12 patients. Pathologic complete response rate was 27 %. There was one post-operative death due to thrombo-embolic disease. Major post-operative grade 3-4 complications were: pelvic infection: 14 %; abdominal infection : 5%; perineal sepsis: 8%; anastomotic dehiscence: 8%; cardiac failure: 5%. Delayed perineal wound healing was observed in six patients. No significant prognostic factor of post-operative complications has been observed. Median duration of hospitalization was 22 days. With a median follow-up of 24 months, 2-year overall and disease-free survival rates were 82 and 64%. Tolerance of preoperative concurrent chemoradiotherapy was acceptable. Ongoing controlled studies will assess the impact of this combined treatment on survival. (authors)

  13. Concurrent validation of a pressure pain threshold scale for individuals with myofascial pain syndrome and fibromyalgia.

    Science.gov (United States)

    Cheatham, Scott W; Kolber, Morey J; Mokha, G Monique; Hanney, William J

    2018-02-01

    Manual pressure palpation is an examination technique used in the classification of myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there are no validated systems for classifying results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this investigation was to validate a PPTS in individuals diagnosed with MPS and FM. Intra-rater reliability, concurrent validity, minimum cut-off value, and patient responses were evaluated. Eighty-four participants who met the inclusion criteria were placed into three groups of 28 ( N = 84): MPS, FM, and asymptomatic controls. All participants underwent a two-part testing session using the American College of Rheumatology criteria for classifying FM. Part-1 consisted of manual palpation with a digital pressure sensor for pressure consistency and part 2 consisted of algometry. For each tender point (18 total), participants graded tenderness using the visual analog scale (VAS) while the examiner concurrently graded response using a five-point PPTS. The PPTS had good intra-rater reliability (ICC ≥ .88). A moderate to excellent relationship was found between the PPTS and VAS for all groups with the digital pressure sensor and algometer ( ρ  ≥ .61). A minimum cut-off value of 2 on the PPTS differentiated participants with MPS and FM from asymptomatic controls. The results provide preliminary evidence validating the PPTS for individuals with MPS and FM. Future research should further study the clinimetric properties of the PPTS with other chronic pain and orthopedic conditions. 2c. ClinicalTrials.gov registration No. NCT02802202.

  14. Can concurrent teaching promote equal biomechanical adaptations at front crawl and backstroke swimming?

    Science.gov (United States)

    Costa, Mário J; Barbosa, Tiago M; Morais, Jorge E; Miranda, Sérgio; Marinho, Daniel A

    2017-01-01

    The biomechanical adaptations in front crawl and backstroke swimming, as influenced by the implementation of a concurrent teaching programme were analysed. Sixteen participants (19.75 ± 1.13 years) underwent a 30 weeks intervention characterized by an increasing complexity to accomplish motor skills in the following order: (i) lower limbs propulsion; (ii) lower limbs propulsion synchronized with breathing cycle; (iii) lower limbs propulsion synchronized with one upper limb action; (iv) lower limbs propulsion synchronized with both breathing cycle and one upper limb action; (v) full swimming stroke; (vi) motor trajectory of the arms stroke. Performance and biomechanics were measured at front crawl and backstroke during three time points throughout the programme. There were improvements in performance over time at front crawl (21.49 s to 19.99 s, pbackstroke (27.15 s to 24.60 s, p = 0.01). Significant improvements were found for velocity at front crawl (1.13 m/s to 1.22 m/s, pbackstroke (0.92 m/s to 1.00 m/s, pbackstroke (0.64 to 0.73 Hz, p = 0.01), while the intra-cyclic variation of the velocity decreased at front crawl (0.13 to 0.12%, p = 0.02). There was also a moderate-high inter-subject variability in response to the programme. These findings prove that a programme of 30 weeks teaching concurrently front crawl and backstroke is effective to promote similar biomechanical adaptations in low-tier swimmers. However, each subject shows an individual response to better adapt the biomechanical actions and to reach a higher level of expertise.

  15. Thoracoscopy with Concurrent Esophagoscopy for Persistent Right Aortic Arch in 9 Dogs.

    Science.gov (United States)

    Townsend, Sarah; Oblak, Michelle L; Singh, Ameet; Steffey, Michele A; Runge, Jeffrey J

    2016-11-01

    To report the diagnosis, treatment, and short-term outcome in dogs with suspected persistent right aortic arch (PRAA) undergoing thoracoscopy with concurrent esophagoscopy. Multi-institutional retrospective case series. Dogs with suspected PRAA (n=9). Medical records were reviewed from 2012 to 2016. Dogs undergoing thoracoscopy for PRAA at 3 referral hospitals were included. Signalment, clinical signs, diagnostic imaging, anesthesia protocol (including the use of one-lung ventilation), surgical approach, complications, and short-term outcome were recorded. Dogs underwent a left-sided intercostal thoracoscopic approach with concurrent intraoperative esophagoscopy. The ligamentum arteriosum (LA) and constricting fibers were divided using a vessel-sealing device using a 3 or 4 port thoracoscopy technique. Visualization and dissection of the LA was aided by transesophageal illumination by esophagoscopy. Thoracoscopy confirmed PRAA in 9 dogs, with an aberrant left subclavian artery (LS) identified in 5 dogs. Major complications occurred in 2 dogs: postoperative hemorrhage from the LS and esophageal perforation, which resulted in euthanasia. Median follow-up was 250 days (range, 56-1,595). Regurgitation resolved in 4 of 8 surviving dogs. One dog had recurrence of regurgitation 1,450 days postoperatively, esophageal compression by the LS was identified, and regurgitation resolved following LS transection. Esophagoscopy aided identification and dissection of the LA in all cases. Due to the potential for the LS to cause clinical esophageal constriction postoperatively, a recommendation for LS transection may be warranted. Vascular clips can also be considered as an alternative for vessel ligation to avoid complications associated with vessel-sealing device use. © Copyright 2016 by The American College of Veterinary Surgeons.

  16. Uji Ketahanan Beberapa Varietas Dan Pengaruh Jarak Tanam Terhadap Penyakit Karat Daun (Puccinia Polysora Underw) Pada Tanaman Jagung (Zea Mays L.)

    OpenAIRE

    Aditya, Sukma

    2013-01-01

    Sukma Aditya, "Some Resistance Test Plant Varieties and Influence Distance Against Disease Leaf Rust (Puccinia polysora Underw) In the Corn Plantation (Zea mays l.) In the Lowlands". Supervised by Dr. Ir. Hasanuddin, MS, and Ir. Mukhtar Pinem Iskandar, M. Agr. This study aims to determine the resistance of some varieties of maize (Zea mays L.) and plant spacing influence on leaf rust disease (Puccinia polysora Underw.) In the lowlands. Research conducted in the village of Tanjung Selamat, Med...

  17. Genetic algorithm guided population pharmacokinetic model development for simvastatin, concurrently or non-concurrently co-administered with amlodipine.

    Science.gov (United States)

    Chaturvedula, Ayyappa; Sale, Mark E; Lee, Howard

    2014-02-01

    An automated model development was performed for simvastatin, co-administered with amlodipine concurrently or non-concurrently (i.e., 4 hours later) in 17 patients with coexisting hyperlipidemia and hypertension. The single objective hybrid genetic algorithm (SOHGA) was implemented in the NONMEM software by defining the search space for structural, statistical and covariate models. Candidate models obtained from the SOHGA runs were further assessed for biological plausibility and the precision of parameter estimates, followed by traditional backward elimination process for model refinement. The final population pharmacokinetic model shows that the elimination rate constant for simvastatin acid, the active form by hydrolysis of its lactone prodrug (i.e., simvastatin), is only 44% in the concurrent amlodipine administration group compared with the non-concurrent group. The application of SOHGA for automated model selection, combined with traditional model selection strategies, appears to save time for model development, which also can generate new hypotheses that are biologically more plausible. © 2013, The American College of Clinical Pharmacology.

  18. Multi-disciplinary Concurrent Management of Recurrent Hepatocellular Therapy is Superior to Sequential Therapy.

    Science.gov (United States)

    Fields, Tyler D; Philips, Prejesh; Scoggins, Charles R; Tatum, Cliff; Kelly, Lawrence; McMasters, Kelly M; Martin, Robert C G

    2017-05-01

    Recurrent hepatocellular carcinoma after a patient's initial therapy, whether it is transplantation, resection, or ablation, remains a challenging clinical problem. Since recurrence occurs in 70% of all initially treated disease within 5 years, optimal management to treat this recurrence is needed. Currently, a bias exists toward mono-therapy (i.e., ablation alone, hepatic arterial therapy alone, or sorafenib therapy alone) instead of concurrent sequential therapy-as is common in other primary and metastatic disease to the liver. Thus, the aim of our study was to evaluate the overall survival of recurrent HCC based on either mono-therapy or multimodality therapy. A review of our prospective 2245 patient hepato-pancreatico-biliary database was performed for all patients who underwent treatment with curative intent for hepatocellular carcinoma and had complete recurrence treatment data from June 2002 to May 2015. Mono-therapy was defined as initiation of a solitary therapy until disease progression or intolerance. Multimodality therapy was defined as at least 2 therapies that occurred simultaneously or within 4 weeks of each therapy. A total of 281 patients underwent treatment with curative intent for hepatocellular carcinoma, in which 192 experienced recurrence. These patients were treated with either thermal ablation or liver resection (LR) (N = 51), transarterial chemoembolization (TACE) or radiation (N = 68), systemic therapy (N = 26), or multimodality therapy (N = 47). The extent of the first recurrence was similar in regard to the number of tumors (median 1), the type of radiologic HCC, gender, BMI, and percentage of liver involvement. They differed in regard to size (MMT largest, median 5.6 cm, p = 0.02), and MMT had higher Hepatitis C involvement (37% of patients, p = 0.001). In evaluation of first recurrence treatment, after a median follow-up of 24 months, multimodality therapy has a significant improvement in overall survival (median 40

  19. Concurrent chemoradiotherapy for advanced pancreatic cancer. 1,000 mg/m{sup 2} gemcitabine can be administered using limited-field radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Hideya [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Radiation Oncology; National Hospital Organization, Osaka National Hospital, Osaka (Japan). Dept. of Radiology; Nishiyama, Kinji; Koizumi, Masahiko; Tanaka, Eiichi [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Radiation Oncology; Ioka, Tatsuya; Uehara, Hiroyuki; Iishi, Hiroyasu; Nakaizumi, Akihiko [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Internal Medicine; Ohigashi, Hiroaki; Ishikawa, Osamu [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Surgery

    2007-06-15

    Purpose: To examine the feasibility of concurrent use of full-dose gemcitabine (GEM) and radiotherapy for advanced pancreatic cancer. Patient and Methods: 22 patients with advanced pancreatic cancer were subjected to concurrent chemoradiotherapy (GEM 1,000 mg/m2 weekly, three times during 4 weeks). They received limited-field irradiation by three-dimensional radiotherapy planning. Results: Of the 22 patients, 16 (72%) completed the treatment (50 Gy irradiation and at least three times concurrent administration of 1 g/m{sup 2} GEM). One patient with unresectable tail cancer showed peritonitis carcinomatosa and both chemotherapy and radiotherapy had to be stopped. Dose reduction or omission of GEM was necessary in another four patients. In addition, radiotherapy was discontinued in one patient for fatigue. Grade 3 hematologic toxicity was detected in eight patients (36%), and grade 3 nonhematologic toxicity (anorexia) in one patient (5%). In total, the response rate amounted to 32% (seven partial responses), and the median survival time (MST) was 16 months. Among the twelve patients who received preoperative chemoradiotherapy, nine underwent surgery and showed a survival rate of 78% at 1 year. Another 13 patients without surgery showed 14 months of MST. No regional lymph node failure has appeared so far. Conclusion: Limited-field radiotherapy enables the safe concurrent administration of 1,000 mg/m{sup 2} GEM.

  20. Learning from Mistakes --- A Comprehensive Study on Real World Concurrency Bug Characteristics

    International Nuclear Information System (INIS)

    Shan Lu; Soyeon Park; Eunsoo Seo; Yuanyuan Zhou

    2008-01-01

    The reality of multi-core hardware has made concurrent programs pervasive. Unfortunately, writing correct concurrent programs is difficult. Addressing this challenge requires advances in multiple directions, including concurrency bug detection, concurrent program testing, concurrent programming model design, etc. Designing effective techniques in all these directions will significantly benefit from a deep understanding of real world concurrency bug characteristics. This paper provides the first (to the best of our knowledge) comprehensive real world concurrency bug characteristic study. Specifically, we have carefully examined concurrency bug patterns, manifestation, and fix strategies of 105 randomly selected real world concurrency bugs from 4 representative server and client opensource applications (MySQL, Apache, Mozilla and OpenOffice). Our study reveals several interesting findings and provides useful guidance for concurrency bug detection, testing, and concurrent programming language design. Some of our findings are as follows: (1) Around one third of the examined non-deadlock concurrency bugs are caused by violation to programmers order intentions, which may not be easily expressed via synchronization primitives like locks and transactional memories; (2) Around 34% of the examined non-deadlock concurrency bugs involve multiple variables, which are not well addressed by existing bug detection tools; (3) About 92% of the examined concurrency bugs can be reliably triggered by enforcing certain orders among no more than 4 memory accesses. This indicates that testing concurrent programs can target at exploring possible orders among every small groups of memory accesses, instead of among all memory accesses; (4) About 73% of the examined non-deadlock concurrency bugs were not fixed by simply adding or changing locks, and many of the fixes were not correct at the first try, indicating the difficulty of reasoning concurrent execution by programmers.