Science.gov

Sample records for complex tfcc treatment

  1. Reconstruction of Chronic Foveal TFCC Tears with an Autologous Tendon Graft

    PubMed Central

    Bain, Gregory I.; Eng, Kevin; Lee, Yu Chao; Mcguire, Duncan; Zumstein, Matthias

    2015-01-01

    Background?A triangular fibrocartilage complex (TFCC) injury can produce distal radioulnar joint (DRUJ) instability. If the foveal attachment is avulsed, it translates distally. The footprint is separated from its origin and will become covered in synovitis, preventing healing. The authors describe a surgical technique for the treatment of instability of the DRUJ due to chronic foveal detachment of the TFCC. Technique?The procedure utilizes a loop of autologous palmaris longus tendon graft passed through the ulnar aspect of the TFCC and through an osseous tunnel in the distal ulna to reconstruct the fovel attachment. Patients and Methods?We report on nine patients with a mean age of 42. Median follow-up was 13 months. Results?The median pain scores measured were reduced from 8 to 3 postoperatively, and all had a stable DRUJ. Conclusions?This technique provides stability of the distal ulna to the radius and carpus, with potential for biologic healing through osseous integration. It is a robust, anatomically based reconstruction of the TFCC to the fovea that stabilizes the DRUJ and the ulnar-carpal sag. PMID:25709873

  2. TILT Following a TFCC Tear: A Case Report

    PubMed Central

    Wollstein, Ronit; Unadkat, Jignesh; Grand, Aaron

    2012-01-01

    We describe the case of a dorsal proximal triquetral impingement caused by a torn triangular fibrocartilage complex (TFCC) amassed on the repair site at the ulnar styloid. The impinging tissue was removed by simple burring with resultant relief of symptoms. This case illustrates painful impingement of soft tissue on the triquetrum. Possibly, the source of tissue impingement may include different extra-articular or torn intra-articular structures. Soft tissue impingement on the triquetrum may be a cause of ulnar-sided wrist pain following failed TFCC repair. PMID:23904982

  3. [Ulnar-sided wrist pain in sports: TFCC lesions and fractures of the hook of the hamate bone as uncommon diagnosis].

    PubMed

    Plöger, M M; Kabir, K; Friedrich, M J; Welle, K; Burger, C

    2015-06-01

    Injuries to the hand and wrist are common sports injuries. The diagnosis and therapy of wrist injuries are becoming more important, especially in increasingly more popular ball-hitting sports, such as golf, tennis and baseball. Ulnar-sided wrist pain is initially often misdiagnosed and treated as tenosynovitis or tendinitis but tears of the triangular fibrocartilage complex (TFCC) and fractures of the hook of hamate bone, which can also occur in these sports are seldomly diagnosed. The aim of this study was to conduct a systematic review of the literature focussing on TFCC lesions and fractures of the hook of the hamate bone in racquet sports, baseball and golf. A systematic review of the literature was performed in PubMed on the occurrence of TFCC lesions and fractures of the hook of the hamate bone. All studies and case reports were included. Because of the rarity of these injuries there were no exclusion criteria concerning the number of cases. Injuries associated with ball-hitting sports, such as TFCC lesions and fractures of hook of the hamate bone are still underrepresented in the current literature on sports injuries. The diagnosis and treatment of these injuries are often delayed and can severely handicap the performance and career of affected professional as well as amateur athletes. PMID:25956726

  4. Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex

    PubMed Central

    Atzei, Andrea; Luchetti, Riccardo; Braidotti, Federica

    2015-01-01

    Background Foveal disruption of the triangular fibrocartilage complex (TFCC) is associated with distal radioulnar joint (DRUJ) instability. TFCC fixation onto the fovea is the suitable treatment, which is not achieved by conventional arthroscopic techniques. We describe an all-inside arthroscopic technique that uses a suture anchor through distal DRUJ arthroscopy for foveal repair of the TFCC. Materials and Methods Forty-eight patients with TFCC foveal tear and DRUJ instability were selected according to the Atzei–European Wrist Arthroscopy Society (EWAS) algorithm of treatment. Retrospective evaluation included pain, DRUJ instability, range of motion (ROM), grip strength, Modified Mayo Wrist Score (MMWS), and the Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Description of Technique DRUJ arthroscopy was performed to débride the TFCC and the foveal area. Under arthroscopic guidance, a suture anchor was inserted via the distal foveal portal to repair the TFCC onto the fovea. Sutures were tied on the radiocarpal surface of the TFCC. Postoperative immobilization of forearm rotation was maintained for 4 weeks. Heavy tasks were allowed after 3 months. Results After a mean follow-up of 33 months, pain improved significantly but remained moderate in four patients, severe in one. DRUJ instability resolved in 44 patients. Wrist ROM increased. Grip strength, MMWS, and DASH score improved significantly. Excellent and good MMWS equaled 83.3%. Forty-one patients (85.5%) resumed previous work and sport activities. As a postoperative complication, five patients experienced neuroapraxia of the dorsal sensory branch of the ulnar nerve (DSBUN) with full spontaneous recovery. Conclusions With appropriate indications and patient selection, arthroscopic foveal repair of the TFCC may restore DRUJ stability and provide satisfactory results without significant complications. PMID:25709875

  5. Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment.

    PubMed

    Abe, Yukio; Moriya, Atsushi; Tominaga, Yasuhiro; Yoshida, Koji

    2016-03-01

    Background?Several different triangular fibrocartilage complex (TFCC) tear patterns have been classified through the use of wrist arthroscopy. A tear of the dorsal aspect of the TFCC has been previously reported, but it is not included in Palmer original classification. Our purpose was to describe this type of tear pattern along with the clinical presentation. Methods?An isolated dorsal TFCC tear was encountered in seven wrists of six patients (three men and three women; average age was 31 years). All patients were evaluated by physical exam, X-ray, plain axial computed tomography with pronation, neutral and supination position, magnetic resonance imaging (MRI) with coronal, sagittal, and axial section and arthroscopy. Results?The clinical findings varied and included the following: tenderness at the dorsoulnar aspect of the wrist was positive in all wrists, fovea sign was positive in five wrists, and tenderness at the dorsal aspect of the distal radioulnar joint was present in one wrist. Pain with forearm rotation was positive in all wrists. The ulnar head ballottement test induced pain in all wrists, whereas dorsal instability of the ulnar head was present in one wrist with this test. The ulnocarpal stress test was positive in five wrists. Axial and sagittal images on MRI revealed the dorsal tear in five wrists. All wrists were treated with an arthroscopic capsular repair. The final functional outcome at an average follow-up of 16.1 months was four excellent and one good wrist according to the modified Mayo wrist score. Conclusions?The aim of this article is to describe our experiences with tears involving the dorsal aspect of the TFCC, which may be misdiagnosed if the surgeon is not cognizant of this injury. Type of study/level of evidence?Diagnostic/level IV. PMID:26855835

  6. The Clinical Outcome of Anatomical Reattachment of the TFCC to the Ulnar Fovea using an ECU Half-Slip and an Interference Screw.

    PubMed

    Nakamura, T; Obara, Y

    2015-10-01

    We developed an original reattachment technique using a half-slip of the extensor carpi ulnaris (ECU) tendon with a very small titanium interference screw for chronic foveal avulsion of the TFCC. The clinical outcome of 66 wrists with foveal detachment of the TFCC treated by this procedure was examined.A distally based ECU half-slip was harvested, inserted into the TFCC, sutured to the remnant of the TFCC, and pulled out through a 2.5-mm bone tunnel at the centre of the fovea. The ECU half-slip was subsequently anchored to the ulnar fovea with a small titanium interference screw. We evaluated 66 wrists of 65 patients with a minimum follow-up of 1 year. Ulnar variance was neutral in 47 wrists, negative in 5 and positive in 14 wrists. Causes of injury were falls in 34 patients, traffic accidents in 12, sports activities in 9, labour in 2 and unknown in 8 patients. In the positive variance wrists, ulnar shortening was performed before the reattachment. The clinical outcome was evaluated using our original DRUJ evaluating system.Preoperatively, severe wrist pain was reported in 50 wrists and moderate pain in 16 wrists. Severe no-endpoint DRUJ instability was noted in 65 wrists, while 1 wrist demonstrated moderate DRUJ instability. Only 2 wrists had supination loss by 20 degrees. At the final follow-up, no pain was felt in 55 wrists, mild pain in 3 wrists, and 8 patients had moderate pain. One wrist exhibited a 30-degree loss of supination. The DRUJ was stable in 55 wrists, mildly unstable in 3, moderately unstable in 4 and severely unstable in 4 wrists. There were 50 excellent, 9 good, 3 fair and 4 poor results.The technique of anatomical reattachment of the TFCC to the ulnar fovea using an ECU half-slip tendon is effective for chronic foveal avulsion of the TFCC with severe DRUJ instability. PMID:26291393

  7. Arthroscopic all-inside repair of Palmer type 1B triangular fibrocartilage complex tears: a technical note.

    PubMed

    Lee, Choon Key; Cho, Hyung Lae; Jung, Kwang Am; Jo, Jae Yeong; Ku, Jung Hoei

    2008-01-01

    Arthroscopic repair of peripheral dorso-ulnar triangular fibrocartilage complex (TFCC) lesions is now a preferred method. Both outside-in and inside-out techniques are commonly performed for repairing Palmer type 1B TFCC tear. But these techniques have disadvantages of making an additional skin incision to tie knots subcutaneously over the capsule. We performed an arthroscopic all-inside repair technique of Palmer type 1B TFCC tears, which is a modified method of the outside-in technique using a spinal needle. This all-inside technique is as simple as previously described arthroscopic techniques and also has advantages of vertical mattress suture and no additional incision. We recommend this technique as a useful alternative to the others for repairing Palmer type 1B TFCC tear. PMID:17668185

  8. Revision Wrist Arthroscopy after Failed Primary Arthroscopic Treatment

    PubMed Central

    Jang, Eugene; Danoff, Jonathan R.; Rajfer, Rebecca A.; Rosenwasser, Melvin P.

    2014-01-01

    Background?The etiologies and outcomes of cases of failed therapeutic wrist arthroscopy have not been well-described to date. Purpose?The purposes of this study were to identify common preventable patterns of failure in wrist arthroscopy and to report outcomes of a series of revision arthroscopy cases. Patients and Methods?Retrospective review of 237 wrist arthroscopies revealed 21 patients with a prior arthroscopy for the same symptoms, of which 16 were assessed by questionnaires and physical exam for this study. Results?Six of sixteen patients (38%) had unrecognized dynamic ulnar impaction after débridement of triangular fibrocartilage complex (TFCC) tears, which resolved with arthroscopic wafer resection. Five (31%) had persistent distal radioulnar joint (DRUJ) instability after initial treatment of TFCC tears, requiring arthroscopic repair at revision. Four (25%) experienced diffuse dorsal wrist pain initially diagnosed as TFCC tears, but dynamic scapholunate ligament injuries were found and addressed with radiofrequency (RF) shrinkage at reoperation. Two (13%) required further resection of the radial styloid, after initial débridement was insufficient to correct radioscaphoid impingement. At a mean of 4.8 years after repeat arthroscopy (range, 1.5–13.4 years), this cohort had significant improvements in pain and satisfaction with outcomes after revision arthroscopy. Conclusions?The most common indications for repeat wrist arthroscopy were ligamentous instability (of the DRUJ or scapholunate ligament) and osteoarthritis (from dynamic ulnar impaction or radioscaphoid impingement). Although revision wrist arthroscopy may yield acceptable outcomes, careful assessment of stability and cartilage wear at index procedure is crucial. Level of Evidence:?Level IV Therapeutic. PMID:24533243

  9. Ulnar-sided wrist pain. II. Clinical imaging and treatment

    PubMed Central

    Watanabe, Atsuya; Souza, Felipe; Vezeridis, Peter S.; Blazar, Philip

    2009-01-01

    Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed. PMID:20012039

  10. Open Repair of the Triangular Fibrocartilage Complex from Palmar Aspect

    PubMed Central

    Moritomo, Hisao

    2015-01-01

    Background Although foveal tears of the triangular fibrocartilage complex (TFCC) can be surgically reattached to the fovea via a dorsal approach, the foveal lesion is difficult to visualize from the dorsal side because the extensor carpi ulnaris (ECU) sheath floor and the superficial dorsal limb of the radioulnar ligament hinders the view of the fovea. Materials and Methods Twenty-one patients with foveal tears were treated by an open repair method from the palmar aspect. Pain, instability, motion, and grip strength were evaluated after a mean follow-up period of 26 months, and each patient was rated according to the Mayo Modified Wrist Score (MMWS). Description of Technique A 4-cm skin incision is made on the palmar aspect of the ulnar fovea. The ulnar fovea is exposed through a transverse capsulotomy of the distal radioulnar joint. The distal aspect of the TFCC is also exposed between the ECU tendon sheath and the ulnotriquetral ligament. After curettage of the scar tissue in the fovea, the deep palmar and dorsal limbs of the TFCC are sutured back to the fovea using a suture anchor technique. Results Foveal TFCC tears could be repaired via a palmar surgical approach without violating the floor of the ECU tendon sheath and the superficial dorsal limb. Excellent results were achieved in 18 patients, and a good result was achieved in three. Conclusions Our result compared favorably with those reported for dorsal approach. The palmar surgical approach facilitates the inspection and repair of the TFCC foveal tears. Level of Evidence IV PMID:25709872

  11. Complex renal cysts associated with crizotinib treatment

    PubMed Central

    Schnell, Patrick; Bartlett, Cynthia H; Solomon, Benjamin J; Tassell, Vanessa; Shaw, Alice T; de Pas, Tommaso; Lee, Soo-Hyun; Lee, Geon Kook; Tanaka, Kaoru; Tan, Weiwei; Tang, Yiyun; Wilner, Keith D; Safferman, Allan; Han, Ji-Youn

    2015-01-01

    An apparent causal association between crizotinib treatment and renal cyst development emerged during clinical trials in anaplastic lymphoma kinase (ALK)-positive non–small cell lung cancer (NSCLC). Serious adverse event (SAE) reports of renal cysts from a safety database of 1375 patients from four clinical trials were reviewed. A blinded, retrospective, independent radiologic review (IRR) was performed using scans from patients on study for ?6 months in three clinical trials; risk factors for renal cyst development were assessed. Among 17 patients with renal cysts reported as SAEs, evidence of invasion into adjacent structures was noted in seven patients, with no evidence of malignancy found. These patients generally did not require dose reductions, none required permanent crizotinib discontinuation due to this AE, and most continued treatment with clinical benefit. In the blinded IRR, among 255 crizotinib-treated patients, 22%, 3%, and 2% had preexisting simple cysts, complex cysts, or both, respectively. At the 6-month tumor assessment, 9% of all patients had acquired new cysts, and 2% of patients with preexisting cysts had developed new cysts and enlargements (>50%) of preexisting simple cysts. Asians appeared to have an increased risk of developing new cysts on treatment; Koreans in particular had 5.18 times higher odds of developing cysts than non-Asians (95% confidence interval, 1.51–17.78; P = 0.05). Crizotinib treatment appears to be associated with an increased risk of development and progression of renal cysts in patients with ALK-positive NSCLC. While close monitoring is recommended, dosing modification was not generally necessary, allowing patients to remain on crizotinib treatment. PMID:25756473

  12. Complex PTSD and phased treatment in refugees: a debate piece

    PubMed Central

    ter Heide, F. Jackie June; Mooren, Trudy M.; Kleber, Rolf J.

    2016-01-01

    Background Asylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). Consequently, it has been recommended that refugees be treated with present-centred or phased treatment rather than stand-alone trauma-focused treatment. This recommendation has contributed to a clinical practice of delaying or waiving trauma-focused treatment in refugees with PTSD. Objective The aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD. Methods The first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees. Results Research shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high. Conclusions Complex PTSD in refugees should not be assumed to be present on the basis of complex traumatic experiences but should be carefully diagnosed using a validated interview. In line with treatment guidelines for PTSD, a course of trauma-focused treatment should be offered to all refugees seeking treatment for PTSD, including asylum seekers. PMID:26886486

  13. Ilizarov treatment of complex tibial pilon fractures

    PubMed Central

    Rao, Sharath K.

    2006-01-01

    We treated 21 consecutive patients between 1998 and 2002 with complex tibial pilon fractures, eight type B and 13 type C, using percutaneous reduction and fixation with the small diameter Ilizarov apparatus. The average patient age was 34±5.6 years (range 28–52 years). Nine of the patients had open fractures (two type I, four type II, and three type IIIA). The patients were followed up regularly at 6-month intervals for 2 years. All fractures united. The fixator was removed at an average of 26.6±4.2 weeks (range 20–34 weeks). The average American Orthopaedic Foot and Ankle Society ankle-hind foot score was excellent in 11 patients, good in five, fair in four, and poor in one. Thirteen patients were able to squat and climb stairs. PMID:16435148

  14. 12. NORTHEAST VIEW OF THE WASTE WATER TREATMENT COMPLEX FOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. NORTHEAST VIEW OF THE WASTE WATER TREATMENT COMPLEX FOR THE PRIMARY AND 22 BAR MILLS. - U.S. Steel Duquesne Works, Auxiliary Buildings & Shops, Along Monongahela River, Duquesne, Allegheny County, PA

  15. Autism Phenotypes in Tuberous Sclerosis Complex: Diagnostic and Treatment Considerations.

    PubMed

    Gipson, Tanjala T; Poretti, Andrea; Thomas, Emily A; Jenkins, Kosunique T; Desai, Sonal; Johnston, Michael V

    2015-12-01

    Tuberous sclerosis complex is a multisystem, chronic genetic condition characterized by systemic growth of benign tumors and often accompanied by epilepsy, autism spectrum disorders, and intellectual disability. Nonetheless, the neurodevelopmental phenotype of these patients is not often detailed. The authors describe 3 individuals with tuberous sclerosis complex who share common characteristics that can help to identify a distinct profile of autism spectrum disorder. These findings include typical cognitive development, expressive and pragmatic language deficits, and anxiety. The authors also describe features specific to tuberous sclerosis complex that require consideration before diagnosing an autism spectrum disorder. Identifying distinct profiles of autism spectrum disorder in tuberous sclerosis complex can help optimize treatment across the life span. PMID:26303410

  16. Low glycemic index treatment for epilepsy in tuberous sclerosis complex.

    PubMed

    Larson, Anna M; Pfeifer, Heidi H; Thiele, Elizabeth A

    2012-03-01

    Retrospective chart review of 15 patients with tuberous sclerosis complex (TSC) who initiated the low glycemic index treatment (LGIT) for epilepsy management at Massachusetts General Hospital over a five-year period. Prior to dietary therapy, this cohort (average age: 8.5 years) had tried an average of 5.8 anti-epileptic drugs with incomplete seizure control. At 6 months on the LGIT, 7/15 (47%) patients experienced >50% reduction in seizure frequency. PMID:22119636

  17. Maggot Debridement Therapy in the Treatment of Complex Diabetic Wounds

    PubMed Central

    Herrington, Mark T; Swenor, Karen M; Eron, Lawrence J

    2011-01-01

    The growth and aging of the population of Hawai‘i with a high incidence of diabetes mandates a need for more effective strategies to manage the healing of complicated wounds. Maggot debridement therapy (MDT) is one alternative utilized with successful results. Observations have indicated that maggots have the ability to debride wound beds, provide anti-microbial activity and also stimulate wound healing in diabetic patients. None of the patients refused MDT due to aversion of this treatment modality and the majority of patients had minimal discomfort. In 17 of 23 patients with multiple co-morbidities, the treatment of their complex diabetic wounds by MDT resulted in improvement or cure. Maggot debridement therapy is an effective treatment of diabetic wounds. PMID:22162609

  18. [Cytokines in complex treatment of posttraumatic empyema of the pleura].

    PubMed

    Abakumov, M M; Danielian, Sh N; Bulava, G V

    2005-01-01

    Results of treatment of 114 patients with posttraumatic empyema of the pleura (EP) after closed injury of the thorax (62), stab-incised (43) and missile (9) wounds are presented. In complex treatment of 25 patients one of cytokines - recombinant interleukin-1v (betaleukin) -- was administered intravenously (10 patients) and intrapleurally (15 patients). Control group consisted of 35 similar patients treated with traditional methods including drainage and sanitation of empyema's cavity with protheolytic enzymes, antibacterial and detoxication therapy. Comparative analysis has demonstrated that patients of the study group showed fast normalization of immunogram's parameters, decrease of duration of purulent process (51+/-4 days, on the average, in the control group and 28+/-3 days in the study group) due to fast obliteration of purulent cavity, and decrease of rate of chronic forms of EP (from 20 to 4%) which required surgical treatment. PMID:15798721

  19. [PREPARATIONS OF PAMIDRONOVIC ACID IN COMPLEX TREATMENT ON OSTEOGENESIS IMPERFECTA].

    PubMed

    Zyma, A M; Guk, Yu M; Magomedov, O M; Gayko, O G; Kincha-Polishchuk, T A

    2015-07-01

    Modern view of drug therapy in the complex treatment of orthopedic manifestations of osteogenesis imperfecta (OI) was submitted. Developed and tested system of drug correction of structural and functional state of bone tissue (BT) using drugs pamidronovic acid, depending on osteoporosis severity and type of disease. Such therapy is appropriate to apply both independently and in conjunction with surgery to correct deformations of long bones of the lower extremities. Effectiveness and feasibility of the proposed methods of drug therapy was proved, most patients resume features walking and support. PMID:26591224

  20. Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder

    PubMed Central

    Fountoulakis, Konstantinos N; Vieta, Eduard; Siamouli, Melina; Valenti, Marc; Magiria, Stamatia; Oral, Timucin; Fresno, David; Giannakopoulos, Panteleimon; Kaprinis, George S

    2007-01-01

    Background Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment. Methods This article summarizes the current status of our knowledge and practice of its treatment. Results It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling. Conclusion The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule. PMID:17925035

  1. Potential for treatment of severe autism in tuberous sclerosis complex.

    PubMed

    Gipson, Tanjala T; Gerner, Gwendolyn; Wilson, Mary Ann; Blue, Mary E; Johnston, Michael V

    2013-08-01

    The Food and Drug Administration (FDA) has approved two mechanism-based treatments for tuberous sclerosis complex (TSC)-everolimus and vigabatrin. However, these treatments have not been systematically studied in individuals with TSC and severe autism. The aim of this review is to identify the clinical features of severe autism in TSC, applicable preclinical models, and potential barriers that may warrant strategic planning in the design phase of clinical trial development. A comprehensive search strategy was formed and searched across PubMed, Embase and SCOPUS from their inception to 2/21/12, 3/16/12, and 3/12/12 respectively. After the final search date, relevant, updated articles were selected from PubMed abstracts generated electronically and emailed daily from PubMed. The references of selected articles were searched, and relevant articles were selected. A search of clinicaltrials.gov was completed using the search term "TSC" and "tuberous sclerosis complex". Autism has been reported in as many as 60% of individuals with TSC; however, review of the literature revealed few data to support clear classification of the severity of autism in TSC. Variability was identified in the diagnostic approach, assessment of cognition, and functional outcome among the reviewed studies and case reports. Objective outcome measures were not used in many early studies; however, diffusion tensor imaging of white matter, neurophysiologic variability in infantile spasms, and cortical tuber subcategories were examined in recent studies and may be useful for objective classification of TSC in future studies. Mechanism-based treatments for TSC are currently available. However, this literature review revealed two potential barriers to successful design and implementation of clinical trials in individuals with severe autism-an unclear definition of the population and lack of validated outcome measures. Recent studies of objective outcome measures in TSC and further study of applicable preclinical models present an opportunity to overcome these barriers. PMID:25254170

  2. Treatment of complex neurovascular lesions: an interdisciplinary angio suite approach

    PubMed Central

    Breyer, Tobias; Wrede, Karsten H.; Stein, Klaus-Peter; Wanke, Isabel; Grams, Astrid E.; Gizewski, Elke R.; Schlamann, Marc; Forsting, Michael; Sandalcioglu, I. Erol; Sure, Ulrich

    2014-01-01

    Objective: The objective of this study was to analyse our initial experience using an interdisciplinary angio suite approach to neurosurgical treatment of complex neurovascular lesions and expound technical feasibility and possible applications. Subjects: Six out of 451 patients with cranial or spinal neurovascular lesions were surgically treated in the angio suite (biplane angiographic system) during a 28-month observation period. Clinical baseline data, radiological and intraoperative findings as well as clinical and radiological outcome were assessed. Results: A ventral spinal perimedullary arteriovenous malformation, a ventral spinal perimedullary fistula, two diffuse frontal dural arteriovenous fistulas, a multifocal temporal arteriovenous malformation and a partially embolized fronto-temporo-basal dural arteriovenous fistula were successfully treated with angiographically confirmed complete occlusion and unimpaired neurological condition of the patients at the 12-month follow up. Conclusion: This study demonstrates the feasibility of this approach and points out possible indications, namely ventrally located spinal lesions and diffuse, deep seated cranial lesions. PMID:24409203

  3. Activated carbon/enhanced biological treatment of a complex groundwater

    SciTech Connect

    Pugh, L.B.; Rediske, R.R.; Rogers, D.R.; Peden, D.H.

    1996-12-31

    Impacted groundwater at the Ott/Story/Cordova Superfund site near Muskegon, Michigan contains a complex mixture of organic compounds and nitrogen. The remediation plan for the site calls for extraction and treatment of 4,600 cubic meters per day of groundwater, estimated to contain 1,500 mg/L of chemical oxygen demand (COD) and 80 mg/L of ammonia-nitrogen. Approximately 30% of the COD is comprised of a mixture of 50 Appendix IX compounds, including halogenated and aromatic orcanics. The remaining COD is contributed by an unidentified group of process intermediates and degradation products related to historical production at this former chemical production facility. The objectives for discharge of the treated Groundwater to a local surface water body included removal of known organic compounds and ammonia-nitrogen, as well as numerous unidentified compounds in the site groundwater. The purpose of this work was to evaluate the effectiveness of two activated carbon-enhanced biological treatment systems: granular activated Carbon/fluidized bed (GAC/FB) and powdered activated carbon treatment (PACT{reg_sign}) for achieving the expected standards for surface water discharge. GAC/FB and PACT were initially evaluated using laboratory-scale reactors. The GAC/FB reactor achieved consistent, high removals of all organic compounds; however, consistent nitrification could not be maintained. The two-stage PACT system achieved nearly complete removal of all organic compounds and ammonia. A 9.5-L/minute pilot system was subsequently operated at the site to provide additional performance information for the two-stage PACT process. Three of the most highly impacted site wells were used to supply groundwater to the pilot system. Excellent removal of all known and unknown organic compounds, and nearly complete nitrification was consistently achieved. As a result of the on-site pilot study, a two-stage PACT system is being implemented at the site.

  4. Treatment of complex tibial plateau fractures using Ilizarov technique.

    PubMed

    Lalić, Ivica; Daraboš, Nikica; Stanković, Milan; Gojković, Zoran; Obradović, Mirko; Marić, Dušan

    2014-12-01

    Complex tibial plateau fractures are most commonly caused by high-energy trauma and they are often associated with severe soft tissue injuries that can frequently result in severe complications. Ilizarov external circular fixation is an ideal method of treatment for high- energy fractures of the tibial plateau when extensive soft tissue dissection and internal fixation are contraindicated. Our research included 50 consecutive patients and clinical features of the patients were evaluated during the follow up period using the following instruments: Gustillo-Anderson, Sc- hatzker and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/ OTA) classification methods. Bony results were evaluated using the Association of the Study and Application of the Method ofIlizarov (ASAMI) protocol. The mean functional recovery scores were obtained by the modified functional evaluation system of Karlstrom-Olerud. All fractures healed successfully. Circular fixators could be removed without anesthesia for type IV fractures at 16 weeks (range 12-21) and for type V-VI at 18 weeks (range 15-26) after the operation. According to ASA- MI bone results, there were 39 (78%) excellent, 7 (14%) good, 3 (6%) fair results and 1 (2%) poor result. Analysis of data obtained by the Karlstrom-Olerud functional evaluation system in this study yielded a mean value of 24.7 after six months, which implies recovery. Functional recovery at 12 months after surgery revealed satisfactory recovery with a mean value of 27.7, whereas the mean sco- re of 29.8 recorded at the last evaluation suggested good functional status. The treatment of patients with open and closed multiple intra-articular fractures of proximal tibia applying Ilizarov apparatus showed good functional outcome, which had positive impact on our patients' quality of life. PMID:25868312

  5. [Complex treatment of dental plexalgia using physiotherapeutic methods].

    PubMed

    Sharov, M N; Grechko, V E; Puzin, M N

    1988-01-01

    A total of 66 patients with dental plexalgia have been examined and treated at the neurological dentistry department. A multiple-modality scheme for the treatment of this condition is suggested, whose basic methods are physiotherapeutic ones: longitudinal physiotherapy, diadynamic currents with a narcotic mixture, trimecain or lydase + analgin electrophoresis. The treatment was effective in the majority of patients. PMID:3259772

  6. Approximate Multiconfigurational Treatment of Spin-Coupled Metal Complexes.

    PubMed

    Arantes, Guilherme Menegon; Taylor, Peter R

    2010-07-13

    The weak interaction between unpaired electrons in polynuclear transition-metal complexes is often described by exchange and spin polarization mechanisms. The resulting intrinsic multiconfigurational electronic structure for such complexes may be calculated with wave function-based methods (e.g., complete active space configuration interaction and complete active space self-consistent field), but computations become extremely demanding and even unfeasible for polynuclear complexes with a large number of open-shells. Here, several levels of selection of configurations and symmetry considerations that still capture the essential physics of exchange and spin polarization mechanisms are presented. The proposed approximations result in significantly smaller configuration interaction expansions and are equally valid for ab initio and semiempirical methods. Tests are performed in simple molecular systems and in small transition-metal complexes that cover a range of valence and charge states. In particular, superexchange contributions can be calculated to good accuracy using only single ionic excitations. Further reduction in the size of the configuration expansions is possible but restricts the description to low-lying spin ladders. The proposed configuration interaction schemes may be used to resolve space and spin symmetries in the calculation of electronic structures, exchange coupling constants, and other properties pertinent to polynuclear transition-metal complexes. PMID:26615927

  7. Cyclodextrin complexes for treatment improvement in infectious diseases.

    PubMed

    Imperiale, Julieta C; Sosnik, Alejandro D

    2015-05-01

    Infectious diseases are a heterogeneous group of maladies that represent a serious burden to healthcare systems worldwide. Most of the available antimicrobial drugs display poor biopharmaceutical properties that compromise their effectiveness. Cyclodextrins (CDs) are cyclic oligosaccharides of glucopyranose formed by a variable number of repeating units that combine a hydrophilic surface with a hydrophobic cavity. The production of drug/CD complexes has become one of the most extensively investigated technology approaches to improve the stability, solubility, dissolution rate and bioavailability of drugs. The present work overviews the applications of CDs for the formulation of anti-infective agents along with the most relevant administration routes. Finally, an update on the complexes with CDs available on the market to treat infectious diseases is presented. PMID:26008196

  8. Modern Palliative Radiation Treatment: Do Complexity and Workload Contribute to Medical Errors?

    SciTech Connect

    D'Souza, Neil; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario ; Holden, Lori; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario ; Robson, Sheila; Mah, Kathy; Di Prospero, Lisa; Wong, C. Shun; Chow, Edward; Spayne, Jacqueline; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario

    2012-09-01

    Purpose: To examine whether treatment workload and complexity associated with palliative radiation therapy contribute to medical errors. Methods and Materials: In the setting of a large academic health sciences center, patient scheduling and record and verification systems were used to identify patients starting radiation therapy. All records of radiation treatment courses delivered during a 3-month period were retrieved and divided into radical and palliative intent. 'Same day consultation, planning and treatment' was used as a proxy for workload and 'previous treatment' and 'multiple sites' as surrogates for complexity. In addition, all planning and treatment discrepancies (errors and 'near-misses') recorded during the same time frame were reviewed and analyzed. Results: There were 365 new patients treated with 485 courses of palliative radiation therapy. Of those patients, 128 (35%) were same-day consultation, simulation, and treatment patients; 166 (45%) patients had previous treatment; and 94 (26%) patients had treatment to multiple sites. Four near-misses and 4 errors occurred during the audit period, giving an error per course rate of 0.82%. In comparison, there were 10 near-misses and 5 errors associated with 1100 courses of radical treatment during the audit period. This translated into an error rate of 0.45% per course. An association was found between workload and complexity and increased palliative therapy error rates. Conclusions: Increased complexity and workload may have an impact on palliative radiation treatment discrepancies. This information may help guide the necessary recommendations for process improvement for patients who require palliative radiation therapy.

  9. Treatment of complex regional pain syndrome type I with bisphosphonates.

    PubMed

    Giusti, Andrea; Bianchi, Gerolamo

    2015-01-01

    Complex regional pain syndrome type I (CRPS-I) is a common and disabling disorder affecting a peripheral limb, usually developing after a trauma to an extremity. CRPS-I is characterised by presence of spontaneous pain, allodynia and hyperalgesia, disproportionate to the inciting event and by a variety of autonomic disturbances and trophic abnormalities. The pathophysiology of CRPS-I has not been fully understood. Experimental models have suggested that an initial triggering event may produce the release of proinflammatory neuropeptides and cytokines, generating a sort of neurogenic inflammation. Thereafter, increased microvascular permeability and intramedullary pressure, reduced oxygen extraction and cellular hypoxia maintain and make the disease worse, producing metabolic tissue acidosis. In this context, it is probable that, far from being a key player, the sympathetic nervous system contributes interacting with these mechanisms and producing vasomotor disturbances. Bisphosphonates (BPs) are potent inhibitors of osteoclastic activity widely used for the management of osteoporosis and other metabolic bone diseases. Their primary pharmacological action is the reduction of bone turnover. An enhanced osteoclastic activity has never been clearly demonstrated in CRPS-I. Therefore, it is likely that the positive effects of BPs in this condition are not related to their antiresorptive properties, but to a more complex interaction between these pharmacological agents and the pathophysiological mechanisms underlying CRPS-I. Results of several clinical trials have suggested the potential beneficial effects of BPs in CRPS-I. In five randomised controlled trials, oral and intravenous alendronate and intravenous clodronate, pamidronate and neridronate demonstrated to be effective in reducing pain and improving physical function in patients presenting with CRPS-I, with a good profile of safety and tolerability. Although these trials have a number of limitations, including the small samples enrolled, there is sufficient evidence to support the use of BPs as agents of choice in the management of CRPS-I. PMID:26557377

  10. Treatment of complex regional pain syndrome type I with bisphosphonates

    PubMed Central

    Giusti, Andrea; Bianchi, Gerolamo

    2015-01-01

    Complex regional pain syndrome type I (CRPS-I) is a common and disabling disorder affecting a peripheral limb, usually developing after a trauma to an extremity. CRPS-I is characterised by presence of spontaneous pain, allodynia and hyperalgesia, disproportionate to the inciting event and by a variety of autonomic disturbances and trophic abnormalities. The pathophysiology of CRPS-I has not been fully understood. Experimental models have suggested that an initial triggering event may produce the release of proinflammatory neuropeptides and cytokines, generating a sort of neurogenic inflammation. Thereafter, increased microvascular permeability and intramedullary pressure, reduced oxygen extraction and cellular hypoxia maintain and make the disease worse, producing metabolic tissue acidosis. In this context, it is probable that, far from being a key player, the sympathetic nervous system contributes interacting with these mechanisms and producing vasomotor disturbances. Bisphosphonates (BPs) are potent inhibitors of osteoclastic activity widely used for the management of osteoporosis and other metabolic bone diseases. Their primary pharmacological action is the reduction of bone turnover. An enhanced osteoclastic activity has never been clearly demonstrated in CRPS-I. Therefore, it is likely that the positive effects of BPs in this condition are not related to their antiresorptive properties, but to a more complex interaction between these pharmacological agents and the pathophysiological mechanisms underlying CRPS-I. Results of several clinical trials have suggested the potential beneficial effects of BPs in CRPS-I. In five randomised controlled trials, oral and intravenous alendronate and intravenous clodronate, pamidronate and neridronate demonstrated to be effective in reducing pain and improving physical function in patients presenting with CRPS-I, with a good profile of safety and tolerability. Although these trials have a number of limitations, including the small samples enrolled, there is sufficient evidence to support the use of BPs as agents of choice in the management of CRPS-I. PMID:26557377

  11. Boundary treatments for 2D elliptic mesh generation in complex geometries

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This paper presents a boundary treatment method for 2D elliptic mesh generation in complex geometries. Corresponding to Neumann- Dirichlet boundary conditions (sliding boundary conditions), the proposed method aims at achieving orthogonal and smooth nodal distribution along irregular boundaries. In ...

  12. Comparison of Chemical Composition of Complex Disinfection Byproduct (DBP) Mixtures Produced by Different Treatment Methods

    EPA Science Inventory

    Analyses of the chemical composition of complex DBP mixtures, produced by different drinking water treatment processes, are essential to generate toxicity data required for assessing their risks to humans. For mixture risk assessments, whole mixture toxicology studies generally a...

  13. Comparison of Chemical Composition of Complex Disinfection Byproduct (DBP) Mixtures Produced by Different Treatment Methods - slides

    EPA Science Inventory

    Analyses of the chemical composition of complex DBP mixtures, produced by different drinking water treatment processes, are essential to generate toxicity data required for assessing their risks to humans. For mixture risk assessments, whole mixture toxicology studies generally a...

  14. Sodium hydroxide treatment of field water in a biopolymer complex

    SciTech Connect

    Phelps, C.H.; Sampath, K.; Shu, P.

    1990-12-18

    This paper describes a waterflood method for recovering hydrocarbonaceous fluids from an oil reservoir which has zones of varying permeability and which formation is penetrated by an injection and a production well. It comprises: first mixing into water a substantially small amount of an alkali or alkaline earth metal hydroxide sufficient to cause gelation within a substantially effective time period where the hydroxide is contained in an aqueous solution in an amount of from about 1 to about 500 ppm; thereafter placing into the solution a water thickening amount of a water soluble Xanthomonas biopolysaccharide; and complexing subsequently the biopolysaccharide with an amount of a water-soluble compound of a polyvalent metal ion selected from the group consisting of trivalent phosphorus, scandium, titanium, vanadium, chromium, manganese, iron, cobalt, copper, aluminum, arsenic, yttrium, zirconium, niobium, cadmium, tin, antimony, lanthanum, hafnium, tantalum, lead, and mixtures thereof, sufficient to cause substantially quicker gelation of the water soluble biopolysaccharide thereby forming a substantially more stable gel sufficient for use as a mobility or profile control medium in environments having low pH brines wherein the water soluble compound is added to the aqueous solution in an amount of from about 10 to about 1,000 ppm of the active polyvalent metal ion, injecting the stable gel into the reservoir via the injection well; and thereafter injecting water as a drive fluid behind the stable gel and recovering hydrocarbonaceous fluids.

  15. Percutaneous treatment of complex biliary stone disease using endourological technique and literature review.

    PubMed

    Korkes, Fernando; Carneiro, Ariê; Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo; Oliveira, Marcos Belotto de; Macedo, Antônio Luiz de Vasconcellos

    2015-12-01

    Most biliary stone diseases need to be treated surgically. However, in special cases that traditional biliary tract endoscopic access is not allowed, a multidisciplinary approach using hybrid technique with urologic instrumental constitute a treatment option. We report a case of a patient with complex intrahepatic stones who previously underwent unsuccessful conventional approaches, and who symptoms resolved after treatment with hybrid technique using an endourologic technology. We conducted an extensive literature review until October 2012 of manuscripts indexed in PubMed on the treatment of complex gallstones with hybrid technique. The multidisciplinary approach with hybrid technique using endourologic instrumental represents a safe and effective treatment option for patients with complex biliary stone who cannot conduct treatment with conventional methods. PMID:26061073

  16. An efficient immersed boundary treatment for complex moving object

    NASA Astrophysics Data System (ADS)

    Liu, Cheng; Hu, Changhong

    2014-10-01

    An efficient immersed boundary treatment for simulation of flexible moving body immersed in fluid is presented. The level set signed distance function is used to indicate body surface. A simple mapping strategy is proposed to avoid costly signed distance re-initialization computations. The strategy is efficient for both rigid and deformable structures, and can be extended to 3-D case easily. With the use of signed distance function, reconstruction of flow variables on a body surface can be easily implemented through linear, bilinear or quadratic interpolation. In order to suppress the pressure oscillations caused by the role conversion of forcing points and fluid points, a modified interpolation scheme is presented by introducing a dynamic weight term to the fluid point. Together with local grid refinement and using larger time step, the pressure oscillations can be effectively diminished by the modified interpolation scheme. The proposed method is validated by 2-D numerical simulations on a uniform flow past a fixed cylinder, in-line and transversely oscillating cylinders, a flapping wing, a 3-D simulation on a uniform flow past a rectangle plane with an initial attack angle and a moving anguilliform swimmer. Present numerical results are compared with other CFD solutions as well as experimental results.

  17. Successful treatment of pegaspargase-induced acute hepatotoxicity with vitamin B complex and L-carnitine

    PubMed Central

    Karur, Vinit; Herrington, Jon D.; Walker, Mary G.

    2016-01-01

    Pegaspargase is a chemotherapy drug used in the treatment of acute lymphoblastic leukemia (ALL). One of the adverse effects of pegaspargase is hepatotoxicity, which can rapidly lead to liver failure and death. We report a patient with ALL who developed pegaspargase-induced severe hepatotoxicity that was rescued by treatment with vitamin B complex and L-carnitine. Our patient had a quicker response than prior reported cases, suggesting this treatment might be a better regimen. PMID:26722167

  18. Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices.

    PubMed

    Cloitre, Marylene; Courtois, Christine A; Charuvastra, Anthony; Carapezza, Richard; Stolbach, Bradley C; Green, Bonnie L

    2011-12-01

    This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow-up would advance knowledge about both the speed and durability of treatment effects. PMID:22147449

  19. Quantification of beam complexity in intensity-modulated radiation therapy treatment plans

    SciTech Connect

    Du, Weiliang Cho, Sang Hyun; Zhang, Xiaodong; Kudchadker, Rajat J.; Hoffman, Karen E.

    2014-02-15

    Purpose: Excessive complexity in intensity-modulated radiation therapy (IMRT) plans increases the dose uncertainty, prolongs the treatment time, and increases the susceptibility to changes in patient or target geometry. To date, the tools for quantitative assessment of IMRT beam complexity are still lacking. In this study, The authors have sought to develop metrics to characterize different aspects of beam complexity and investigate the beam complexity for IMRT plans of different disease sites. Methods: The authors evaluated the beam complexity scores for 65 step-and-shoot IMRT plans from three sites (prostate, head and neck, and spine) and 26 volumetric-modulated arc therapy (VMAT) plans for the prostate. On the basis of the beam apertures and monitor unit weights of all segments, the authors calculated the mean aperture area, extent of aperture shape irregularity, and degree of beam modulation for each beam. Then the beam complexity values were averaged to obtain the complexity metrics of the IMRT plans. The authors studied the correlation between the beam complexity metrics and the quality assurance (QA) results. Finally, the effects of treatment planning parameters on beam complexity were studied. Results: The beam complexity scores were not uniform among the prostate IMRT beams from different gantry angles. The lateral beams had larger monitor units and smaller shape irregularity, while the anterior-posterior beams had larger modulation values. On average, the prostate IMRT plans had the smallest aperture irregularity, beam modulation, and normalized monitor units; the head and neck IMRT plans had large beam irregularity and beam modulation; and the spine stereotactic radiation therapy plans often had small beam apertures, which may have been associated with the relatively large discrepancies between planned and QA measured doses. There were weak correlations between the beam complexity scores and the measured dose errors. The prostate VMAT beams showed greater complexity than the prostate step-and-shoot IMRT beams. In the treatment planning process, the beam complexity increased as the minimum segment area decreased and as the number of optimization iterations and the maximum number of segments increased. Conclusions: The proposed metrics were effective in characterizing the beam complexity of different disease sites and for different treatment modalities. Efforts should be made to reduce the unnecessary complexity of IMRT beams to minimize the radiation dose uncertainties.

  20. Bioadhesive tablets containing cyclodextrin complex of itraconazole for the treatment of vaginal candidiasis.

    PubMed

    Cevher, Erdal; Açma, Ay?e; Sinani, Genada; Aksu, Buket; Zloh, Mire; Mülaz?mo?lu, Lütfiye

    2014-08-01

    Itraconazole (ITR) is commonly used in the treatment of Candida infections. It has a nephrotoxic effect and low bioavailability in patients who suffer from renal insufficiency, and its poor solubility in water makes ITR largely unavailable. Cyclodextrins (CyDs) are used to form inclusion complexes with drugs to improve their aqueous solubility and to reduce their side effects. In this study, ITR was complexed with ?-cyclodextrin (?-CyD), hydroxypropyl-?-cyclodextrin (HP-?-CyD), methyl-?-cyclodextrin (Met-?-CyD) and sulphobutyl ether-?-cyclodextrin (SBE7-?-CyD) to increase its water solubility and to reduce the side effects of the drug without decreasing antifungal activity. Complex formation between ITR and CyDs was evaluated using SEM, (1)H NMR and XRD studies. The antifungal activity of the complexes was analyzed on Candida albicans strains, and the susceptibility of the strains was found to be higher for the ITR-SBE7-?-CyD complex than for the complexes that were prepared with other CyDs. Vaginal bioadhesive sustained release tablet formulations were developed using the ITR-SBE7-?-CyD inclusion complex to increase the residence time of ITR in the vagina, thereby boosting the efficacy of the treatment. The swelling, matrix erosion and bioadhesion properties of formulations and the drug release rate of these tablets were analyzed, and the most therapeutically effective vaginal formulation was determined. PMID:24857873

  1. Complex Psychiatric Comorbidity of Treatment-Seeking Youth with Autism Spectrum Disorder and Anxiety Symptoms

    ERIC Educational Resources Information Center

    Hepburn, Susan L.; Stern, Jessica A.; Blakeley-Smith, Audrey; Kimel, Lila K.; Reaven, Judith A.

    2014-01-01

    This descriptive study examines the complexity of psychiatric comorbidity in treatment-seeking youth with ASD and anxiety symptoms. Forty-two parents of youth with ASD and anxiety (ages 8-14) completed a structured diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version). Youth…

  2. Complex Psychiatric Comorbidity of Treatment-Seeking Youth with Autism Spectrum Disorder and Anxiety Symptoms

    ERIC Educational Resources Information Center

    Hepburn, Susan L.; Stern, Jessica A.; Blakeley-Smith, Audrey; Kimel, Lila K.; Reaven, Judith A.

    2014-01-01

    This descriptive study examines the complexity of psychiatric comorbidity in treatment-seeking youth with ASD and anxiety symptoms. Forty-two parents of youth with ASD and anxiety (ages 8-14) completed a structured diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version). Youth…

  3. Noninvasive treatments for pediatric complex regional pain syndrome: a focused review.

    PubMed

    Katholi, Benjamin R; Daghstani, Suzanne S; Banez, Gerard A; Brady, Kimberly K

    2014-10-01

    This is a review of current literature of noninvasive treatments for pediatric complex regional pain syndrome (CRPS). There are a variety of noninvasive approaches to the treatment of pain, but few pediatric-focused studies have been published in regard to CRPS. In comparison with adult CRPS, there is a greater need for behavioral approaches in children to enable coping with difficult symptoms. Current gaps in knowledge include mechanisms triggering CRPS, pediatric-focused diagnostic criteria, validated tests that are diagnostically specific, definitive treatment protocols, age-based medication recommendations, and validation of specific noninvasive treatments in pediatric populations. Intensive multidisciplinary treatment is supported by high recovery rates and a family-centered approach that allows continuation of goals into the community environment. PMID:24780851

  4. Cancer treatment decision-making processes for older patients with complex needs: a qualitative study

    PubMed Central

    Hughes, Jane; Farrington, Naomi; Richardson, Alison

    2015-01-01

    Objectives Although older people can experience complex health and social care needs alongside a primary cancer diagnosis, little is understood about how cancer treatment decisions are made for this population. This study aimed to investigate how cancer treatment decisions are formulated for older people with complex health and social care needs and the factors that shape these processes. Design Qualitative study involving semistructured interviews and non-participant observations. Framework approach used for data analysis. Setting Breast and colorectal cancer services in five English NHS hospital trusts. Participants Interviews: purposive sample of 22 clinicians directly involved in a face-to-face clinical role with patients regarding cancer treatment and care, maximising variation across clinical roles, tumour types and trusts. Observations: purposive sample of five cancer multidisciplinary meetings, maximising variation across location, team size and tumour type. Results The initial stages of cancer treatment decision-making are team-based, medically dominated and focused on the cancer. For patients with complex health and social care needs that extend beyond cancer pathology, later and less visible stages in the decision-making process are more haphazard and may result in less effective and workable treatment plans, as individual clinicians struggle to devise and deliver these plans without breaching time-based targets. Conclusions Service targets that focus resources solely on the presenting disease can disadvantage older patients with complex health and social care needs that extend beyond this primary diagnosis. Care should be taken to ensure time-based targets do not disincentivise thorough and timely assessment that can lead to the formulation of treatment plans tailored to individual needs and circumstances. PMID:26667015

  5. Treatment of complex proximal humeral fracture: plate and tension band fixation versus conservative therapy

    PubMed Central

    Sun, Yangbai; Li, Li; Dai, Jiezhi; Wang, Ting

    2015-01-01

    Background: There is no consensus on the optimal treatment for patients with complex proximal humeral fractures. A meta-analysis was performed to evaluate clinical effectiveness of plate and tension band fixation compared with conservative therapy. Methods: We systematically searched electronic databases (Pubmed, Medline, Embase, Cochrane library and Google Scholar) to identify comparative studies and randomized controlled trials in which plate and tension band fixation was compared with conservative treatment of the complex proximal humeral fractures from 1995 to 2013. The quality of the studies was assessed and effective data were pooled for meta-analysis. Results: A total of 222 patients from three RCTs and three comparative studies were included in this meta-analysis (113 fractures treated with plate and tension band and 109 with conservative treatment). The primary and secondary outcomes (Constant Score, nonunion, avascular necrosis and osteoarthritis) were compared and there was no significant difference among these different treatments of this injury. Conclusions: Compared with conservative treatment, internal fixation including plate and tension band did not find better shoulder function, higher rate avascular necrosis of humeral head, lower rate nonunion, and higher rate osteoarthritis. In further, high quality and large randomized trials should be recommended to make a choice between these treatment modalities. PMID:26221252

  6. Polymeric Micelle-Mediated Delivery of DNA-Targeting Organometallic Complexes for Resistant Ovarian Cancer Treatment.

    PubMed

    Duan, Xiaopin; Liu, Demin; Chan, Christina; Lin, Wenbin

    2015-08-26

    Three half-sandwich iridium and ruthenium organometallic complexes with high cytotoxicity are synthesized, and their anticancer mechanisms are elucidated. The organometallic complexes can interact with DNA through coordination or intercalation, thereby inducing apoptosis and inhibiting proliferation of resistant cancer cells. The organometallic complexes are then incorporated into polymeric micelles through the polymer-metal coordination between poly(ethylene glycol)-b-poly(glutamic acid) [PEG-b-P(Glu)] and organometallic complexes to further enhance their anticancer effects as a result of the enhanced permeability and retention effect. The micelles with particle sizes of ?60 nm are more efficiently internalized by cancer cells than the corresponding complexes, and selectively dissociate and release organometallic anticancer agents within late endosomes and lysosomes, thereby enhancing drug delivery to the nuclei of cancer cells and facilitating their interactions with DNA. Thus, the micelles display higher antitumor activity than the organometallic complexes alone with a lack of the systemic toxicity in a mouse xenograft model of cisplatin-resistant human ovarian cancer. These results suggest that the polymeric micelles carrying anticancer organometallic complexes provide a promising platform for the treatment of resistant ovarian cancer and other hard-to-treat solid tumors. PMID:25963931

  7. Complex Psychiatric Comorbidity of Treatment-Seeking Youth With Autism Spectrum Disorder and Anxiety Symptoms

    PubMed Central

    HEPBURN, SUSAN L.; STERN, JESSICA A.; BLAKELEY-SMITH, AUDREY; KIMEL, LILA K.; REAVEN, JUDITH A.

    2015-01-01

    Anxiety disorders and other co-occurring psychiatric disorders significantly impact adaptive functioning for many children with autism spectrum disorder (ASD). This descriptive study examines the complexity of psychiatric comorbidity in treatment-seeking youth with ASD and anxiety symptoms. Forty-two parents of 8- to 14-year-old children with ASD and anxiety symptoms completed a structured psychiatric interview (K-SADS) and provided information about the child’s past and current psychological functioning as part of a screening process to enter an anxiety intervention program. Overall, comorbidity was very complex, with children obtaining an average of 4 psychiatric diagnoses (including anxiety disorders) on a structured clinical interview (range = 0–9). Onset and course differed by psychiatric disorder. Complexity of comorbidity did not differ significantly by age, sex, or autism severity. Despite clinical significance of the symptoms reported, few children were currently (or ever) engaged in mental health treatment or group psychosocial intervention. Although the specificity of the current sample limits the generalizability of these results, findings suggest that treatment-seeking children with ASD and anxiety often present with additional psychiatric symptoms, which supports a transdiagnostic approach to research and intervention in this area. Accurate assessment of comorbidity may provide valuable information for families and clinicians regarding individualized treatment approaches. PMID:25960821

  8. Amputation as an Unusual Treatment for Therapy-Resistant Complex Regional Pain Syndrome, Type 1

    PubMed Central

    Kashy, Babak K.; Abd-Elsayed, Alaa A.; Farag, Ehab; Yared, Maria; Vakili, Roya; Esa, Wael Ali Sakr

    2015-01-01

    Background Complex regional pain syndrome, type 1 (CRPS-1) causes severe pain that can be resistant to multiple treatment modalities. Amputation as a form of long-term treatment for therapy-resistant CRPS-1 is controversial. Case Report We report the case of a 38-year-old man who failed all treatment modalities for CRPS-1, including medication, steroid injections, and spinal cord stimulator implantation. Below-the-knee amputation to relieve intractable foot and ankle pain resulted in a favorable outcome for this patient. Conclusion Select patients with severe CRPS-1 who are unresponsive to all forms of treatment for pain may benefit from amputation as a last option for relief of suffering. Larger studies are needed to prove the efficacy of amputation.

  9. The responsive amygdala: treatment-induced alterations in functional connectivity in pediatric complex regional pain syndrome.

    PubMed

    Simons, L E; Pielech, M; Erpelding, N; Linnman, C; Moulton, E; Sava, S; Lebel, A; Serrano, P; Sethna, N; Berde, C; Becerra, L; Borsook, D

    2014-09-01

    The amygdala is a key brain region with efferent and afferent neural connections that involve complex behaviors such as pain, reward, fear, and anxiety. This study evaluated resting state functional connectivity of the amygdala with cortical and subcortical regions in a group of chronic pain patients (pediatric complex regional pain syndrome) with age-sex matched control subjects before and after intensive physical-biobehavioral pain treatment. Our main findings include (1) enhanced functional connectivity from the amygdala to multiple cortical, subcortical, and cerebellar regions in patients compared with control subjects, with differences predominantly in the left amygdala in the pretreated condition (disease state); (2) dampened hyperconnectivity from the left amygdala to the motor cortex, parietal lobe, and cingulate cortex after intensive pain rehabilitation treatment within patients with nominal differences observed among healthy control subjects from time 1 to time 2 (treatment effects); (3) functional connectivity to several regions key to fear circuitry (prefrontal cortex, bilateral middle temporal lobe, bilateral cingulate, hippocampus) correlated with higher pain-related fear scores; and (4) decreases in pain-related fear associated with decreased connectivity between the amygdala and the motor and somatosensory cortex, cingulate, and frontal areas. Our data suggest that there are rapid changes in amygdala connectivity after an aggressive treatment program in children with chronic pain and intrinsic amygdala functional connectivity activity serving as a potential indicator of treatment response. PMID:24861582

  10. The Responsive Amygdala: Treatment-induced Alterations in Functional Connectivity in Pediatric Complex Regional Pain Syndrome

    PubMed Central

    Simons, LE; Pielech, M; Erpelding, N; Linnman, C; Moulton, E; Sava, S; Lebel, A; Serrano, P; Sethna, N; Berde, C; Becerra, L; Borsook, D

    2014-01-01

    The amygdala is a key brain region with efferent and afferent neural connections that involve complex behaviors such as pain, reward, fear and anxiety. This study evaluated resting state functional connectivity of the amygdala with cortical and subcortical regions in a group of chronic pain patients (pediatric complex regional pain syndrome) with age-gender matched controls before and after intensive physical-biobehavioral pain treatment. Our main findings include (1) enhanced functional connectivity from the amygdala to multiple cortical, subcortical, and cerebellar regions in patients compared to controls, with differences predominantly in the left amygdala in the pre-treated condition (disease state); (2) dampened hyperconnectivity from the left amygdala to the motor cortex, parietal lobe, and cingulate cortex after intensive pain rehabilitation treatment within patients with nominal differences observed among healthy controls from Time 1 to Time 2 (treatment effects); (3) functional connectivity to several regions key to fear circuitry (prefrontal cortex, bilateral middle temporal lobe, bilateral cingulate, hippocampus) correlated with higher pain-related fear scores and (4) decreases in pain-related fear associated with decreased connectivity between the amygdala and the motor and somatosensory cortex, cingulate, and frontal areas. Our data suggest that there are rapid changes in amygdala connectivity following an aggressive treatment program in children with chronic pain and intrinsic amygdala functional connectivity activity serving as a potential indicator of treatment response. PMID:24861582

  11. Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome

    PubMed Central

    Becerra, Lino; Sava, Simona; Simons, Laura E.; Drosos, Athena M.; Sethna, Navil; Berde, Charles; Lebel, Alyssa A.; Borsook, David

    2014-01-01

    Pediatric complex regional pain syndrome (P-CRPS) offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (median = 3 weeks) but intensive physical and psychological treatment program, and compared them to matched healthy controls. Differences in intrinsic brain networks were observed in P-CRPS compared to controls before treatment (disease state) with the most prominent differences in the fronto-parietal, salience, default mode, central executive, and sensorimotor networks. Following treatment, behavioral measures demonstrated a reduction of symptoms and improvement of physical state (pain levels and motor functioning). Correlation of network connectivities with spontaneous pain measures pre- and post-treatment indicated concomitant reductions in connectivity in salience, central executive, default mode and sensorimotor networks (treatment effects). These results suggest a rapid alteration in global brain networks with treatment and provide a venue to assess brain changes in CRPS pre- and post-treatment, and to evaluate therapeutic effects. PMID:25379449

  12. Factors that lessen the burden of treatment in complex patients with chronic conditions: a qualitative study

    PubMed Central

    Ridgeway, Jennifer L; Egginton, Jason S; Tiedje, Kristina; Linzer, Mark; Boehm, Deborah; Poplau, Sara; de Oliveira, Djenane Ramalho; Odell, Laura; Montori, Victor M; Eton, David T

    2014-01-01

    Purpose Patients with multiple chronic conditions (multimorbidity) often require ongoing treatment and complex self-care. This workload and its impact on patient functioning and well-being are, together, known as treatment burden. This study reports on factors that patients with multimorbidity draw on to lessen perceptions of treatment burden. Patients and methods Interviews (n=50) and focus groups (n=4 groups, five to eight participants per group) were conducted with patients receiving care in a large academic medical center or an urban safety-net hospital. Interview data were analyzed using qualitative framework analysis methods, and themes and subthemes were used to identify factors that mitigate burden. Focus groups were held to confirm these findings and clarify any new issues. This study was part of a larger program to develop a patient-reported measure of treatment burden. Results Five major themes emerged from the interview data. These included: 1) problem-focused strategies, like routinizing self-care, enlisting support of others, planning for the future, and using technology; 2) emotion-focused coping strategies, like maintaining a positive attitude, focusing on other life priorities, and spirituality/faith; 3) questioning the notion of treatment burden as a function of adapting to self-care and comparing oneself to others; 4) social support (informational, tangible, and emotional assistance); and 5) positive aspects of health care, like coordination of care and beneficial relationships with providers. Additional subthemes arising from focus groups included preserving autonomy/independence and being proactive with providers. Conclusion Patients attempt to lessen the experience of treatment burden using a variety of personal, social, and health care resources. Assessing these factors in tandem with patient perceptions of treatment burden can provide a more complete picture of how patients fit complex self-care into their daily lives. PMID:24672228

  13. GHOST Protocol: Greatest Healing Opportunity for Soft Tissue, a Treatment Paradigm for Complex Sarcoma Reconstruction.

    PubMed

    Kobraei, Edward M; Eberlin, Kyle R; Ricci, Joseph A; Reish, Richard G; Winograd, Jonathan M; Cetrulo, Curtis L

    2015-06-01

    Modern sarcoma treatment has created new challenges for plastic surgeons. This study was designed to review the recent experience and practice patterns following complex sarcoma resection at a large sarcoma center. All cases from October 2013 to October 2014 involving rare nonepithelial tumors, a multidisciplinary surgical team, radiation and/or chemotherapy treatments, and plastic surgical reconstruction were included in the analysis. In addition to evaluating clinical outcomes, cases were reviewed to identify factors associated with excellent or poor patient care. Review of these cases formed the basis of the greatest healing opportunity for soft tissue (GHOST) protocol. Our patient population included seven males (64%) and four females (36%). All except one patient was exposed to radiotherapy, chemotherapy, or some combination. Diverse procedures were used for reconstruction. Early complications occurred in two patients (18%), and late complications in four patients (36%). Sarcoma resection was found to be highly morbid in our series. Patients with poor preoperative nutritional status were more likely to experience complications postoperatively. The decision to stage a reconstruction was complex and influenced by several factors. Multimodal sarcoma treatments may involve highly morbid procedures and create complex wounds. The GHOST protocol is a useful reference for plastic surgeons. PMID:26031266

  14. Treatment of Complex Fistula in Ano with Cable-Tie Seton: A Prospective Case Series

    PubMed Central

    Memon, Ayaz Ahmad; Murtaza, Ghulam; Azami, Rizwan; Zafar, Hasnain; Chawla, Tabish; Laghari, Altaf Ali

    2011-01-01

    Objective. To determine the fecal incontinence and recurrence rate in patients with complex fistula in ano managed with cable tie seton at a tertiary care teaching hospital. Methods. This is a prospective case series of patients with complex anal fistula i.e. recurrent fistula or encircling >30% of external anal sphincter, managed with cable tie seton from March 2003 to March 2009. Patients were seen in the clinic after 72 hours of seton insertion under anesthesia and then every other week. Each time the cable-tie was tightened if found loose without anesthesia and incontinence was inquired according to wexner's score. Results. Seventy nine patients were treated during the study period with the age (mean ± standard deviation) of 41 ± 10.6 years and. The seton was tightened with a median of six times (3–15 times range). Complete healing was achieved in 11.2 ± 5.7 weeks. All the patients were followed for a minimum period of one year and none of the patients had any incontinence. Recurrence was found in 4 (5%) patients. Conclusion. The cable tie seton is safe, cost effective and low morbidity option for the treatment of complex fistulae-in-ano. It can, therefore, be recommended as the standard of treatment for complex fistulae-in-ano requiring the placement of a seton. PMID:22084768

  15. The operative treatment of complex pilon fractures: A strategy of soft tissue control

    PubMed Central

    He, Xianfeng; Hu, Yong; Ye, Penghan; Huang, Lei; Zhang, Feng; Ruan, Yongping

    2013-01-01

    Background: Pilon fractures are challenging to manage because of the complexity of the injury pattern and the risk of significant complications. The soft tissue injury and handling of the soft tissue envelope are crucial in pilon fracture outcomes. The purpose of this study was to evaluate the early rate of complications using the strategy of “soft tissue control” for operative treatment of complex pilon fractures. Materials and Methods: 36 complex pilon fractures were treated with the “soft tissue control” strategy. Patients followed the standard staged protocol, anterolateral approach to the distal tibia, the “no-touch” technique and incisional negative pressure wound therapy for pilon fractures. Patients were examined clinically at 2-3 weeks and then 8 weeks for complications associated with the surgical technique. Results: All fractures were AO/OTA (Orthopaedic Trauma Association) type C fractures (61% C3, 22% C2 and 16% C1). Only one patient developed superficial infection and resolved with antibiotics and local wound care. None developed deep infection. Conclusions: The strategy of soft tissue control for treatment of pilon fractures resulted in relatively low incidence of early wound complications in patients with complex pilon fractures. PMID:24133309

  16. Emerging treatments for complex perianal fistula in Crohn’s disease

    PubMed Central

    Taxonera, Carlos; Schwartz, David A; García-Olmo, Damián

    2009-01-01

    Complex perianal fistulas have a negative impact on the quality of life of sufferers and should be treated. Correct diagnosis, characterization and classification of the fistulas are essential to optimize treatment. Nevertheless, in the case of patients whose fistulas are associated with Crohn’s disease, complete closure is particularly difficult to achieve. Systemic medical treatments (antibiotics, thiopurines and other immunomodulatory agents, and, more recently, anti-tumor necrosis factor-? agents such as infliximab) have been tried with varying degrees of success. Combined medical (including infliximab) and less aggressive surgical therapy (drainage and seton placement) offer the best outcomes in complex Crohn’s fistulas while more aggressive surgical procedures such as fistulotomy or fistulectomy may increase the risk of incontinence. This review will focus on emerging novel treatments for perianal disease in Crohn’s patients. These include locally applied infliximab or tacrolimus, fistula plugs, instillation of fibrin glue and the use of adult expanded adipose-derived stem cell injection. More well-designed controlled studies are required to confirm the effectiveness of these emerging treatments. PMID:19750568

  17. DRESS syndrome presenting after initiation of mycobacterium avium complex osteomyelitis treatment.

    PubMed

    Blair, Paul W; Herrin, Douglas; Abaalkhail, Nawaf; Fiser, Wesley

    2015-01-01

    Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is characterised by fever, rash, eosinophilia and organ damage that develops 2-6 weeks after the initiation of a medication. We report a case of DRESS syndrome in a 79-year-old man that developed after the introduction of rifabutin, ethambutol and clarithromycin used to treat Mycobacterium avium complex (MAC) vertebral osteomyelitis. This case highlights treatment and management challenges in a patient with known MAC vertebral osteomyelitis requiring prolonged steroids. Steroids are the mainstays of treatment for moderate to severe cases of DRESS syndrome. Initiation of steroids for the treatment of DRESS syndrome among patients with concomitant infections requires multidisciplinary collaboration for optimal management. PMID:26438676

  18. Neurocognitive considerations in the treatment of attachment and complex trauma in children.

    PubMed

    Zilberstein, Karen

    2014-07-01

    Accumulating evidence suggests that children suffering deprivation and maltreatment at critical times in their development often pay a cognitive toll. While children vary to the extent that neurocognitive domains are affected, those factors influence how children process, manage and understand traumatic and attachment experiences as well as how they respond to treatment. Current research on trauma and attachment favor some aspects of cognition over others. The literature discusses attention, memory, cognitive biases, internal working models, beliefs and attributions as ways that impact an individual's understanding of experience. Other categories such as working memory, processing speed, verbal, auditory or perceptual processing, metacognitive skills, and cognitive rigidity or flexibility rarely surface. This paper examines what is and is not known about the interface of cognition with attachment and complex trauma and how that knowledge can inform treatment. It explores existing research and offers a case vignette as an example of how that knowledge can be integrated into treatment strategies. PMID:23661787

  19. Pulsed radiofrequency treatment of complex regional pain syndrome: A case series

    PubMed Central

    Djuric, Vlad

    2014-01-01

    BACKGROUND: Various forms of sympathetic chain neurolysis (sympathectomy) have, at one time or another, held promise as effective treatment options for complex regional pain syndrome (CRPS). Complications, such as worsening pain and the development of new pain syndromes, have prevented sympathectomy from emerging as a standard intervention. In an effort to avoid poor outcomes associated with neurolysis, pulsed radiofrequency (PRF) has been proposed as a potential treatment alternative for a number of chronic neuropathic pain states, including some forms of CRPS. METHODS: The present report describes three cases in which patients diagnosed with lower extremity CRPS type I obtained substantial and lasting intervals of pain relief following PRF of the lumbar sympathetic chain. Over a period of four years, 14 fluoroscopically guided procedures using PRF lesioning of the lumbar sympathetic chain at L2, L3 and L4 were performed in three individuals with CRPS type I of the lower limb. Outcome measures included pre- and post-treatment self-reported pain and medication requirements. RESULTS: Substantial pain relief (>50%) was achieved in 91.7% of PRF applications at three months and 83.3% at six months, with some treatments resulting in persistent relief well beyond 12 months. Medication use decreased to a comparable degree, with discontinuation of opiates after all but three treatments. CONCLUSIONS: PRF lesioning of the lumbar sympathetic chain can be an effective treatment for patients with CRPS type I of the lower extremity, with the potential to provide ?6 months of substantial pain relief. PMID:24945285

  20. Treatment for lexical retrieval using abstract and concrete words in persons with aphasia: Effect of complexity

    PubMed Central

    Kiran, Swathi; Sandberg, Chaleece; Abbott, Karen

    2009-01-01

    Background The significance of imageability and concreteness as factors for lexical tasks in aphasic individuals is under debate. No previous treatment studies have looked specifically at training abstract words compared to concrete for improved lexical retrieval in patients with chronic aphasia. Aim The goal of the present study was to determine the efficacy of a treatment for lexical retrieval that is based on models of lexical processing by utilizing abstractness as a mode of complexity. It was hypothesized that training abstract words in a category will result in improvement of those words and generalization to untrained target concrete words in the same category. Training concrete words in a category, however, will result in the retrieval of trained concrete words, but not generalization to target abstract words. Methods & Procedures A single subject experimental design across participants and behaviors was used to examine treatment and generalization. Generative naming for three categories (church, hospital, courthouse) was tested during baseline and treatment. Each treatment session was carried out in five steps: (1) category sorting, (2) feature selection, (3) yes/no feature questions, (4) word recall, and (5) free generative naming. Results Although participant 1 demonstrated neither significant learning nor generalization during abstract or concrete word training, participants 2, 3, and 4 showed significant learning during abstract word training and generalization to untrained concrete words. Participants 3 and 4 were also trained on concrete words which they improved on but did not show generalization to untrained abstract words. Conclusions The results of the present experiment support our hypothesis that training abstract words would result in greater learning and generalization to untrained concrete words. They also tentatively support the idea that generalization is facilitated by treatment focusing on more complex constructions (Kiran & Thompson, 2003; Thompson, Shapiro, Kiran, & Sobecks, 2003). PMID:19816590

  1. Mixed modality treatment planning of accelerated partial breast irradiation: to improve complex dosimetry cases

    PubMed Central

    2011-01-01

    Background Although 3D-conformal accelerated partial breast irradiation (APBI) is widely used, several questions still remain such as what are the optimal treatment planning modalities. Indeed, some patients may have an unfavorable anatomy and/or inadequate dosimetric constraints could be fulfilled ("complex cases"). In such cases, we wondered which treatment planning modality could be applied to achieve 3D-conformal APBI (2 mini-tangents and an "en face" electron field or non-coplanar photon multiple fields; or a mixed technique combining non-coplanar photon multiple fields with an "en face" electron beam). Methods From October 2007 to March 2010, 55 patients with pT1N0 breast cancer were enrolled in a phase II APBI trial. Among them, 7 patients were excluded as they were considered as "complex cases". A dosimetric comparison was performed according to the 3 APBI modalities mentioned above and assessed: planning treatment volume (PTV) coverage, PTV/whole breast ratio, lung and heart distance within irradiated field and exposure of organs at risk (OAR). Results Adequate PTV coverage was obtained with the 3 different treatment planning. Regarding OAR exposure, the "mixed technique" seemed to reduce the volume of non-target breast tissue in 4 cases compared to the other techniques (in only 1 case), with the mean V50% at 44.9% (range, 13.4 - 56.9%) for the mixed modality compared to 51.1% (range, 22.4 - 63.4%) and 51.8% (range, 23.1 - 59.5%) for the reference and non-coplanar techniques, respectively. The same trend was observed for heart exposure. Conclusions The mixed technique showed a promising trend of reducing the volume of non-target breast tissue and heart exposure doses in APBI "complex cases". PMID:22074547

  2. Cutting through the Complexities of mTOR for the Treatment of Stroke

    PubMed Central

    Maiese, Kenneth

    2014-01-01

    On a global basis, at least 15 million individuals suffer some form of a stroke every year. Of these individuals, approximately 800,000 of these cerebrovascular events occur in the United States (US) alone. The incidence of stroke in the US has declined from the third leading cause of death to the fourth, a result that can be attributed to multiple factors that include improved vascular disease management, reduced tobacco use, and more rapid time to treatment in patients that are clinically appropriate to receive recombinant tissue plasminogen activator. However, treatment strategies for the majority of stroke patients are extremely limited and represent a critical void for care. A number of new therapeutic considerations for stroke are under consideration, but it is the mammalian target of rapamycin (mTOR) that is receiving intense focus as a potential new target for cerebrovascular disease. As part of the phosphoinositide 3-kinase (PI 3-K) and protein kinase B (Akt) cascade, mTOR is an essential component of mTOR Complex 1 (mTORC1) and mTOR Complex 2 (mTORC2) to govern cell death involving apoptosis, autophagy, and necroptosis, cellular metabolism, and gene transcription. Vital for the consideration of new therapeutic strategies for stroke is the ability to understand how the intricate and complex pathways of mTOR signaling sometimes lead to disparate clinical outcomes. PMID:24712647

  3. Ammonium chloride complex formation during downstream microwave ammonia plasma treatment of parylene-C

    SciTech Connect

    Pruden, K.G.; Beaudoin, S.P.

    2005-11-15

    In this work, parylene-C is exposed to the effluent from a microwave ammonia plasma with a goal of producing primary amine groups on the parylene-C. These amine groups are desired as sites for the attachment of various biomolecules that will influence the biocompatibility of the parylene-C. Ammonia plasma treatment is an effective approach for creating amine species on polymers. In this work, attenuated total reflectance infrared spectroscopy studies showed that no primary amine groups resulted from this treatment of parylene-C. Instead, reactive nitrogen-bearing radicals from the plasma appear to have been complexed by chlorine in the polymer. The formation of these complexes scavenged nitrogen-bearing radicals from the plasma and prevented the formation of nitrogenous species, such as the desired primary amines, on the parylene-C. These results are consistent with results of ammonia plasma treatment of other chlorinated polymers and suggest that alternative approaches are required to create nitrogen-bearing species on parylene-C.

  4. Maggot therapy in treatment of a complex hand injury complicated by mycotic infection.

    PubMed

    Bohac, M; Cambal, M; Zamborsky, R; Takac, P; Fedeles, J

    2015-01-01

    Complex injuries of the hand remain a therapeutic challenge for surgeons. We present the case of a male who suffered a devastating injury of the hand caused by a conveyor belt. The patient developed a progressive Absidia corymbifera infection of the affected soft tissues. Initial treatments with serial surgical debridement and topical and intravenous itraconazole were unsuccessful in eliminating the infection. We decided to use maggot debridement therapy in a new special design to debride all necrotic, devitalized tissue and preserve only healthy tissue and functioning structures. This maneuverer followed by negative pressure therapy allowed progressive healing. In such complex hand injuries, maggot debridement combined with negative pressure therapy could be considered to achieve effective and considerable results, although future functional morbidity may occur (Fig. 4, Ref. 18). PMID:26621165

  5. A dual wavelength-activatable gold nanorod complex for synergistic cancer treatment

    NASA Astrophysics Data System (ADS)

    Pacardo, Dennis B.; Neupane, Bhanu; Rikard, S. Michaela; Lu, Yue; Mo, Ran; Mishra, Sumeet R.; Tracy, Joseph B.; Wang, Gufeng; Ligler, Frances S.; Gu, Zhen

    2015-07-01

    A multifunctional gold nanorod (AuNR) complex is described with potential utility for theranostic anticancer treatment. The AuNR was functionalized with cyclodextrin for encapsulation of doxorubicin, with folic acid for targeting, and with a photo-responsive dextran-azo compound for intracellular controlled drug release. The interaction of a AuNR complex with HeLa cells was facilitated via a folic acid targeting ligand as displayed in the dark-field images of cells. Enhanced anticancer efficacy was demonstrated through the synergistic combination of promoted drug release upon ultraviolet (UV) light irradiation and photothermal therapy upon infrared (IR) irradiation. This multifunctional AuNR-based system represents a novel theranostic strategy for spatiotemporal delivery of anticancer therapeutics.A multifunctional gold nanorod (AuNR) complex is described with potential utility for theranostic anticancer treatment. The AuNR was functionalized with cyclodextrin for encapsulation of doxorubicin, with folic acid for targeting, and with a photo-responsive dextran-azo compound for intracellular controlled drug release. The interaction of a AuNR complex with HeLa cells was facilitated via a folic acid targeting ligand as displayed in the dark-field images of cells. Enhanced anticancer efficacy was demonstrated through the synergistic combination of promoted drug release upon ultraviolet (UV) light irradiation and photothermal therapy upon infrared (IR) irradiation. This multifunctional AuNR-based system represents a novel theranostic strategy for spatiotemporal delivery of anticancer therapeutics. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr01568e

  6. Treatment of Complex Regional Pain Syndrome (CRPS) using low dose naltrexone (LDN).

    PubMed

    Chopra, Pradeep; Cooper, Mark S

    2013-06-01

    Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms. PMID:23546884

  7. [Complex health service for treatment of patients with diabetic foot syndrome].

    PubMed

    Kosul'nikov, S O; Tarnopol'sky?, S O; Besedyn, A M; Karpenko, S I

    2014-11-01

    Complex service for treatment for patients, suffering diabetic foot syndrome, was created on the base of Dnipropetrovskiy Regional Clinical Hospital with the objective for application of high technologies. Creation of such a service have permitted to improve the results of the patients treatment. Enhancement of the performance rate of small operations on the foot have permitted to increase by 34.4% the quantity of patients, in whom a supportive function of the foot was preserved, and to reduce the conduction rate of the lower extremity amputation on a hip level, preserving a knee joint, by 39.5%, what is very important for the prosthesis. Widespread propaganda among population and primary link of the health service permit to reveal and eliminate complications of diabetes mellitus on earlier stages. PMID:25675744

  8. Staged Mucosal Advancement Flap versus Staged Fibrin Sealant in the Treatment of Complex Perianal Fistulas

    PubMed Central

    van der Hagen, S. J.; Baeten, C. G.; Soeters, P. B.; van Gemert, W. G.

    2011-01-01

    Background. In this prospective randomised study, the staged mucosal advancement flap is compared with staged fibrin sealant application in the treatment of perianal fistulas. Methods. All patients with high complex cryptoglandular fistulas were randomised to closure of the internal opening by a mucosal advancement flap (MF) or injection with fibrin sealant (FS) after treatment with setons. Recurrence rate and incontinence disorders were explored. Results. The MF group (5 females and 10 males) with a median age of 51 years and a median followup of 52 months. The FS group (4 females and 11 males) with a median age of 45 years and a median followup of 49 months. Three (20%) patients of the MF group had a recurrent fistula compared to 9 (60%) of the FS group (P = 0.03). No new continence disorders developed. Conclusion. Staged FS injection has a much lower success rate compared to MF. PMID:21808642

  9. Comparison of daunorubicin and daunorubicin-DNA complex in the treatment of acute nonlymphoblastic leukemia.

    PubMed

    Paul, C; Björkholm, M; Christenson, I; Engstedt, L; Gahrton, G; Hast, R; Holm, G; Killander, A; Lantz, B; Lockner, D; Lönnqvist, B; Mellstedt, H; Palmblad, J; Peterson, C; Simonsson, B; Stalfelt, A M; Udén, A M; Wadman, B; Oberg, G

    1981-01-01

    Sixty consecutive patients, 15-60 years old, with ANLL were divided randomly into three groups for induction treatment with one of the following regimens: R1, daunorubicin (DNR) 1.5 mg/kg on day 1 + ARA-C 2 mg/kg body weight on days 1-5; R2, DNR 1.5 mg/kg on days 1 and 2 + ARA-C 2 mg/kg on days 4-8; R3, DNR-DNA complex 1.5 mg/kg on days 1 and 2 + ARA-C 2 mg/kg on days 4-8. Maintenance treatment consisted of monthly courses of DNR 1.5 mg/kg (R1, R2) or DNR-DNA 1.5 mg/kg (R3) combined with ARA-C 1 mg/kg on days 1-5, alternating with thioguanine 2 mg/kg PO on days 1-5 combined with ARA-C 1 mg/kg IV on days 1-5. Fourteen patients of 20 went into complete remission with R1, 13 or 18 with R2, and 15 of 22 with R3. The overall remission frequency was 70% and there was no significant difference between the different groups. The median time in first remission and the median survival time were 300 and 510 days, respectively, with R1; 335 and 495 days with R2; and 295 and 677 days with R3. There was no statistically significant difference between the groups treated according to the different regimens concerning the time in first remission. Survival was slightly better with R3 than with R1. Treatment with the DNR-DNA complex caused less pronounced thrombocytopenia and fewer 'minor' cardiac abnormalities than treatment with free DNR in the same dosage schedule. PMID:7023715

  10. Dental Treatment Considerations for Children with Complex Medical Histories: A Case of Townes-Brock Syndrome.

    PubMed

    Elkaiali, Lujayn; Ratliff, Katelin; Oueis, Hassan

    2016-01-01

    It is common for oral health and dental care to be considered a lesser priority for children with complex medical histories than other aspects of their health care. Often, these patients are at a high risk for caries and infection due to poor oral health practices at home, special or restricted diets, and no early establishment of a dental home for routine dental care. Unfortunately, many of these patients present to their first dental visits with caries and require aggressive treatment, such as extractions instead of pulp therapy, or crowns instead of fillings, due to their high caries risk and the difficulty in safely managing them medically during treatment. A unique example of this occurred at the Children's Hospital of Michigan, where a patient with Townes-Brock syndrome (TBS) presented to the dental clinic with advanced caries. TBS is a rare autosomal dominant disorder characterized by major findings such as anomalies of the external ear, imperforate anus, renal malformations, and malformations of the hand. Like many medically complex cases, dental anomalies are not a direct consequence of TBS; however, due to the necessity of high calorie and high sugar feeding supplementation, many of these patients are at high risk for advanced dental caries. Due to this high caries risk, a more aggressive treatment plan is necessary to minimize the risk of recurrent decay and infection. It is critical to stress that even if the disease, syndrome, etc., of a patient does not have inherent dental consequences, it is imperative for regular dental care to be part of the comprehensive treatment plan for these patients. This includes the establishment of a dental home at a young age and proper oral health education of the patient's caregivers and their physicians. In the case of the patient with TBS, recommendations for daily brushing, especially after high sugar feedings was stressed, as well as the reduction of any other sweets within the diet. PMID:26882646

  11. Natural History and Current Treatment Options for Subependymal Giant Cell Astrocytoma in Tuberous Sclerosis Complex.

    PubMed

    Jó?wiak, Sergiusz; Mandera, Marek; M?ynarski, Wojciech

    2015-12-01

    Subependymal giant cell astrocytoma (SEGA) is a benign brain tumor associated with tuberous sclerosis complex (TSC). Since there were some discrepancies in SEGA classification, in 2012, a consensus statement defined SEGA as a lesion at the caudothalamic groove with either a size of more than 1cm in any direction or a subependymal lesion at any location that has shown serial growth on consecutive imaging regardless of size. This pointed that the documented tumor growing is an important diagnostic feature. Currently, there are 2 therapeutic options: surgical and medical with mammalian target of rapamycin (mTOR) inhibitors. Neurosurgery should consider a localization and size of the tumor, presence of hydrocephalus and surgeon's experience. Patients who are not qualified for surgery and require therapeutic intervention are subjected to mTOR inhibitors therapy. Everolimus, one of the mTOR inhibitors, has been recently approved in the US and Europe for treatment of patients with TSC and SEGA. Treatment with everolimus results in a rapid initial reduction in tumor volume, followed by a phase of slower reduction or stabilization of residual mass. mTOR inhibitor dose de-escalation strategy seems to be also logical in long-term SEGA treatment to reduce the risk of adverse effects while maintaining the therapeutic effect. However, duration of the treatment and the efficacy of dose reduction are still questionable. Thus, this review covers the various approaches that are currently being made toward improving the outcome of management of SEGA among patients with TSC. PMID:26706014

  12. Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

    PubMed Central

    Kaiser, Edelgard Anna; Lotze, Ulrich; Schäfer, Hans Hendrik

    2014-01-01

    Treatment of hypertension in the elderly is expected to become more complex in the coming decades. Based on the current landscape of clinical trials, guideline recommendations remain inconclusive. The present review discusses the latest evidence derived from studies available in 2013 and investigates optimal blood pressure (BP) and preferred treatment substances. Three common archetypes are discussed that hamper the treatment of hypertension in the very elderly. In addition, this paper presents the current recommendations of the NICE 2011, JNC7 2013-update, ESH/ESC 2013, CHEP 2013, JNC8 and ASH/ISH guidelines for elderly patients. Advantages of the six main substance classes, namely diuretics, beta-blockers (BBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRIs) are discussed. Medical and economic implications of drug administration in the very elderly are presented. Avoidance of treatment-related adverse effects has become increasingly relevant. Current substance classes are equally effective, with similar effects on cardiovascular outcomes. Selection of substances should therefore also be based on collateral advantages of drugs that extend beyond BP reduction. The combination of ACEIs and diuretics appears to be favorable in managing systolic/diastolic hypertension. Diuretics are a preferred and cheap combination drug, and the combination with CCBs is recommended for patients with isolated systolic hypertension. ACEIs and CCBs are favorable for patients with dementia, while CCBs and ARBs imply substantial cost savings due to high adherence. PMID:24711696

  13. Esthetic orthodontic treatment using the invisalign appliance for moderate to complex malocclusions.

    PubMed

    Boyd, Robert L

    2008-08-01

    In this report, three patients were treated with a new treatment protocol for Invisalign to demonstrate that a variety of complex malocclusions can be successfully treated using this protocol, including correction of moderate crowding, correction of moderate Class II division 1, and deep overbite. Previous studies of Invisalign showed significant limitations for more complex orthodontic treatment, although a few recent case reports have shown successfully completed moderate to difficult orthodontic malocclusions. One reason for the discrepancy is that the earlier studies were done during the first four years of the appliance development (now ten years of clinical use), when significant problems existed with accomplishing bodily movement, torquing of roots, extrusions, and rotations of premolars and canines. The new protocol included new methods for anterior/posterior corrections, showing on the computer the effect of elastics for Class II treatment simulated as a one-stage anterior/posterior movement at the end of treatment. Staging for interproximal reduction (IPR) is now automatically staged when there is better access to interproximal contacts to avoid IPR where significant overlap between teeth is present to avoid performing IPR on surfaces that may be damaged by instruments such as burs, strips, and disks when cut on a sharp angle. Staging for tooth movements is now also done to enable combination movements to occur simultaneously for each tooth with the tooth that needs to move the most (the lead tooth) determining the minimum number of stages required. All other teeth move at a slower rate than the lead tooth throughout the duration of treatment. Attachments are now placed in the middle of the crown automatically for rotation and automatically sized in proportion to the clinical crown. Use of 1 mm thick (buccal-lingual dimension) horizontal beveled rectangular attachments is standard on premolars for retention of aligners during intrusive movements, such as leveling the lower curve of Spee in deep overbite for extrusions and for control of the tooth long axis during torquing movements. Staging of tooth movements now track linear and rotational velocities of teeth separately with the number of treatment stages determined by the lead tooth based on its rotational or linear maximum velocities at no more than two degrees of rotation per stage. Simultaneous movements are done for all teeth providing visible space (approximately 0.05 mm) between teeth during movements past other teeth using expansion instead of IPR as a primary way to increase space available for correction of crowding. PMID:18676803

  14. The role of extra- and intracranial bypass in the treatment of complex aneurysms.

    PubMed

    Cenzato, Marco; Bortolotti, Carlo

    2016-03-01

    The availability of flow diverters and new endovascular techniques has greatly reduced the need and indications for bypass surgery. Nevertheless, there are situations where a bypass is the best option for a complex cerebrovascular problem. Generally, typical indications are giant aneurysms with a wide neck and/or partially calcified aneurysms with main branches or perforating arteries arising directly from the sac or from the neck itself, or fusiform aneurysms, partially calcified aneurysms. In this paper we discuss the following issues as they apply to the modern use of bypass techniques. In case of fusiform aneurysms involving the proximal bifurcations of the media or the internal carotid artery combined and coordinated evaluations and efforts by a team which includes neurosurgeons and endovascular specialists is essential. Treatment with bypass alone may not be sufficient and the combination of one or more bypasses with an endovascular treatment of occlusion, partial aneurysm embolization or flow diversion may be the best strategy. Addressing complex and fusiform aneurysm surgery requires a problem solving attitude and in this lies both the challenging and the fun side of this surgery. PMID:26947783

  15. Prolonged anti-bacterial activity of ion-complexed doxycycline for the treatment of osteomyelitis.

    PubMed

    Oh, Se Heang; Nam, Bo Ra; Lee, In Soo; Lee, Jin Ho

    2016-01-01

    The main purposes of the present study are the fabrication of an ion-complexed antibiotic which allows for the continuous release of the drug for sufficient periods of time without any additional matrix leading to unfavorable tissue responses, and the feasibility study of the ion-complexed antibiotic as a therapeutic system for osteomyelitis using an animal model. An ion-complexed doxycycline (icDX) as an antibiotic was prepared by simple mixing of positively charged doxycycline hyclate (DX) and negatively charged multivalent Na2HPO4 (2Na(+) HPO4(2-)) aqueous solutions. The icDX showed a controlled release of the DX up to 6weeks. From the in vivo feasibility study using an osteomyelitis rat model, the icDX group showed a more effective therapeutic effect for the osteomyelitis, at 3 and 6weeks, compared to the non-treated control and free DX groups. This was due to the sustained release of DX from the icDX in the osteomyelitis bone (medullary cavity) without migration. These findings suggest that the icDX may be a promising local delivery system in the clinical field for the treatment of the osteomyelitis. PMID:26598206

  16. Successful treatment of complex cholangiolithiasis following orthotopic liver transplantation with interventional radiology.

    PubMed

    Zhou, Chuan-Guo; Wei, Bao-Jie; Gao, Kun; Dai, Ding-Ke; Zhai, Ren-You

    2015-02-14

    Bile duct stones are a serious and the third most common complication of the biliary system that can occur following liver transplantation. The incidence rate of bile duct stones after liver transplantation is 1.8%-18%. The management of biliary stones is usually performed with endoscopic techniques; however, the technique may prove to be challenging in the treatment of the intrahepatic bile duct stones. We herein report a case of a 40-year-old man with rare, complex bile duct stones that were successfully eliminated with percutaneous interventional techniques. The complex bile duct stones were defined as a large number of bile stones filling the intra- and extrahepatic bile tracts, resulting in a cast formation within the biliary tree. Common complications such as hemobilia and acute pancreatitis were not present during the perioperative period. The follow-up period was 20 mo long. During the postoperative period, the patient maintained normal temperature, and normal total bilirubin and direct bilirubin levels. The patient is now living a high quality life. This case report highlights the safety and efficacy of the percutaneous interventional approach in the removal of complex bile duct stones following liver transplantation. PMID:25684970

  17. Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review

    PubMed Central

    Dorrepaal, Ethy; Thomaes, Kathleen; Hoogendoorn, Adriaan W.; Veltman, Dick J.; Draijer, Nel; van Balkom, Anton J. L. M.

    2014-01-01

    Introduction Effective first-line treatments for posttraumatic stress disorder (PTSD) are well established, but their generalizability to child abuse (CA)-related Complex PTSD is largely unknown. Method A quantitative review of the literature was performed, identifying seven studies, with treatments specifically targeting CA-related PTSD or Complex PTSD, which were meta-analyzed, including variables such as effect size, drop-out, recovery, and improvement rates. Results Only six studies with one or more cognitive behavior therapy (CBT) treatment conditions and one with a present centered therapy condition could be meta-analyzed. Results indicate that CA-related PTSD patients profit with large effect sizes and modest recovery and improvement rates. Treatments which include exposure showed greater effect sizes especially in completers’ analyses, although no differential results were found in recovery and improvement rates. However, results in the subgroup of CA-related Complex PTSD studies were least favorable. Within the Complex PTSD subgroup, no superior effect size was found for exposure, and affect management resulted in more favorable recovery and improvement rates and less drop-out, as compared to exposure, especially in intention-to-treat analyses. Conclusion Limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations. Moreover, we propose that future research should focus on direct comparisons between types of treatment for Complex PTSD patients, thereby increasing generalizability of results. PMID:25563302

  18. Enhancement of Auditory Fear Conditioning after Housing in a Complex Environment Is Attenuated by Prior Treatment with Amphetamine

    ERIC Educational Resources Information Center

    Briand, Lisa A.; Robinson, Terry E.; Maren, Stephen

    2005-01-01

    Prior exposure to drugs of abuse has been shown to occlude the structural plasticity associated with living in a complex environment. Amphetamine treatment may also occlude some cognitive advantages normally associated with living in a complex environment. To test this hypothesis we examined the influence of prior exposure to amphetamine on fear…

  19. Enhancement of Auditory Fear Conditioning after Housing in a Complex Environment Is Attenuated by Prior Treatment with Amphetamine

    ERIC Educational Resources Information Center

    Briand, Lisa A.; Robinson, Terry E.; Maren, Stephen

    2005-01-01

    Prior exposure to drugs of abuse has been shown to occlude the structural plasticity associated with living in a complex environment. Amphetamine treatment may also occlude some cognitive advantages normally associated with living in a complex environment. To test this hypothesis we examined the influence of prior exposure to amphetamine on fear…

  20. Study of edema reduction patterns during the treatment phase of complex decongestive physiotherapy for extremity lymphedema.

    PubMed

    Yamamoto, T; Todo, Y; Kaneuchi, M; Handa, Y; Watanabe, K; Yamamoto, R

    2008-06-01

    Shortening the treatment phase of complex decongestive physiotherapy (CDP) is extremely important both for individual patients and medical economics. In 83 patients with stage II unilateral secondary extremity lymphedema (31 upper extremities and 52 lower extremities), the daily changes in the volume of affected extremities during the treatment phase of CDP were prospectively investigated. For the upper extremity lymphedemas, the biggest change was seen between days 1 (100% residual edema rate) and 2 (46.0 +/- 2.7%; mean +/- SD) of therapy with a 54.0% reduction (p < 0.0001). Between days 2 and 3 (38.0 +/- 2.6%) of therapy, there was an 8.0% reduction (p < 0.05). From days 3 to 6 of therapy, slight changes ranging from 0.2 to 3.2%/day were seen. For the lower extremity lymphedemas, the biggest change was seen between days 1 (100%) and 2 (44.5 +/- 2.1%) of therapy with a 55.5% reduction (p < 0.0001). Between days 2 and 3 (33.5 +/- 2.6%) of therapy, there was an 11.0% reduction (p < 0.001). The daily volume changes from days 4 to 6 were slight, ranging from 0.1 to 1.0%/day. During the treatment phase of CDP, the largest volume changes were seen soon after the start of therapy. PMID:18720915

  1. A 10-year analysis of the "Amsterdam" protocol in the treatment of zygomatic complex fractures.

    PubMed

    Forouzanfar, Tymour; Salentijn, Erik; Peng, Gina; van den Bergh, Bart

    2013-10-01

    Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4-87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures. PMID:23375533

  2. [Incidence of pulmonary tuberculosis associated with chronic alcoholism and a complex treatment of those diseases].

    PubMed

    Rudo?, N M; Pilipchuk, N S; Stadnikova, A V; Dzhokhadze, V A

    1989-01-01

    It was shown that the prevalence of alcoholism among pulmonary tuberculosis patients was high and the outcomes of both the diseases proceeding in the presence of lowered immunity were often unfavourable, including the results of long-term follow-ups. The use of a specially constructed instrument for investigating the neurodynamic characteristics of the cerebral cortex and determination of gamma-glutamyl transpeptidase in the serum promoted diagnosis of prenosological entities of alcoholism. Higher efficacy of alcoholism treatment in the patients with tuberculosis was achieved with narcotic psychotherapy using the mixture of nitrous oxide and oxygen, esperal implantation and application of rifusal, a new preparation, as well as application of extracorporeal hemosorption and enterosorption for eliminating the intoxication. Higher efficacy of tuberculosis treatment in the alcoholic patients was achieved with intravenous drop-wise infusion of antituberculous drugs along with other routes of administration. For increasing the cellular immunity, the patients were treated with chlorophylliptum or T-activin. Continuation of the complex antialcoholic and antituberculous treatment of outpatients along with simultaneous observation by phthisiologists and narcologists provided higher results. PMID:2594712

  3. Fast 3D medial axis transformation to reduce computation and complexity in radiosurgery treatment planning

    NASA Astrophysics Data System (ADS)

    Wu, Qingrong J.; Bourland, J. Daniel; Robb, Richard A.

    1996-04-01

    The medial axis analysis of an object can be used to effectively guide and optimize radiosurgery treatment planning. In this paper, a fast Euclidean medial axis transformation in three dimensions based on dynamic grassfire simulation and ridge extraction is presented. A ridge occurs when fire fronts collapse during grassfire propagation. Iso-contours (2D) or iso- surfaces (3D) can be obtained from dynamic grassfire transforms. They are locally smooth everywhere except at ridge locations. Ridges are detected by measuring local curvature at each point. This process is invariant under spatial translations and rotations. The algorithm yields the true Euclidean skeleton of the objects and is several orders of magnitude faster than other thinning methods. In radiosurgery treatment planning, optimal shots are only placed on the medial axis of the 3D target, which reduces optimization time and complexity. An example of a treatment planning process is presented and the relationship between skeleton disks and the dose distributions which they predict are discussed.

  4. Effect of complex treatment using visual and auditory stimuli on the symptoms of attention deficit/hyperactivity disorder in children

    PubMed Central

    Park, Mi-Sook; Byun, Ki-Won; Park, Yong-Kyung; Kim, Mi-Han; Jung, Sung-Hwa; Kim, Hong

    2013-01-01

    We investigated the effects of complex treatment using visual and auditory stimuli on the symptoms of attention deficit/hyperactivity disorder (ADHD) in children. Forty-seven male children (7–13 yr old), who were clinically diagnosed with ADHD at the Balance Brain Center in Seoul, Korea, were included in this study. The complex treatment consisted of visual and auditory stimuli, core muscle exercise, targeting ball exercise, ocular motor exercise, and visual motor integration. All subjects completed the complex treatment for 60 min/day, 2–3 times/week for more than 12 weeks. Data regarding visual and auditory reaction time and cognitive function were obtained using the Neurosync program, Stroop Color-Word Test, and test of nonverbal intelligence (TONI) at pre- and post-treatment. The complex treatment significantly decreased the total reaction time, while it increased the number of combo actions on visual and auditory stimuli (P< 0.05). The Stroop color, word, and color-word scores were significantly increased at post-treatment compared to the scores at pretreatment (P< 0.05). There was no significant change in the TONI scores, although a tendency toward an increase in these scores was observed. In conclusion, complex treatment using visual and auditory stimuli alleviated the symptoms of ADHD and improved cognitive function in children. In addition, visual and auditory function might be possible indicators for demonstrating effective ADHD intervention. PMID:24278878

  5. Narrative exposure therapy: an evidence-based treatment for multiple and complex trauma.

    PubMed

    Jongedijk, Ruud A

    2014-01-01

    Narrative exposure therapy (NET) is a recently developed, short-term treatment for patients with a posttraumatic stress disorder (PTSD) as a result of multiple trauma. NET can be applied very successfully in patients with complex trauma complaints (Jongedijk, 2014; Schauer, Neuner, & Elbert, 2011). An important feature of NET is that trauma processing is never an isolated event but is always embedded in the context of a traumatic event and in the life history as a whole. At the start, the lifeline is laid. The lifeline is made up of a rope, with flowers (happy events), stones (traumatic events), sometimes candles (grief), or recently also sticks for aggressive acts (NET for offenders; see Stenmark, Cuneyt Guzey, Elbert, & Holen, 2014). These symbols are laid down along the rope, in chronological order. Subsequently, in the subsequent therapy sessions the lifeline is processed in chronological order, giving attention to all the important events a person has experienced in his or her life, both the adverse as well as the pleasurable ones. The narration ends with a written testimony. To date, there is good evidence NET is effective in the treatment of PTSD patients, with support from 18 RCTs (N=950). For culturally diverse populations, NET is recommended as the most evidence-based trauma treatment, besides culturally adapted CBT. NET has been investigated in different populations in Africa, Europe, and Asia. In Asia, research has been carried out in Sri Lanka as well as in China. In China, NET was conducted and investigated with survivors of the Sichuan earthquake (Zang, Hunt, & Cox, 2013, 2014). NET is understandable, even appealing and also supportive for patients with multiple trauma. In this presentation, the treatment principles and the practice of NET will be explained. PMID:25511727

  6. Narrative exposure therapy: an evidence-based treatment for multiple and complex trauma

    PubMed Central

    Jongedijk, Ruud A.

    2014-01-01

    Narrative exposure therapy (NET) is a recently developed, short-term treatment for patients with a posttraumatic stress disorder (PTSD) as a result of multiple trauma. NET can be applied very successfully in patients with complex trauma complaints (Jongedijk, 2014; Schauer, Neuner, & Elbert, 2011). An important feature of NET is that trauma processing is never an isolated event but is always embedded in the context of a traumatic event and in the life history as a whole. At the start, the lifeline is laid. The lifeline is made up of a rope, with flowers (happy events), stones (traumatic events), sometimes candles (grief), or recently also sticks for aggressive acts (NET for offenders; see Stenmark, Cuneyt Guzey, Elbert, & Holen, 2014). These symbols are laid down along the rope, in chronological order. Subsequently, in the subsequent therapy sessions the lifeline is processed in chronological order, giving attention to all the important events a person has experienced in his or her life, both the adverse as well as the pleasurable ones. The narration ends with a written testimony. To date, there is good evidence NET is effective in the treatment of PTSD patients, with support from 18 RCTs (N=950). For culturally diverse populations, NET is recommended as the most evidence-based trauma treatment, besides culturally adapted CBT. NET has been investigated in different populations in Africa, Europe, and Asia. In Asia, research has been carried out in Sri Lanka as well as in China. In China, NET was conducted and investigated with survivors of the Sichuan earthquake (Zang, Hunt, & Cox, 2013, 2014). NET is understandable, even appealing and also supportive for patients with multiple trauma. In this presentation, the treatment principles and the practice of NET will be explained. PMID:25511727

  7. Finalizing a measurement framework for the burden of treatment in complex patients with chronic conditions

    PubMed Central

    Eton, David T; Ridgeway, Jennifer L; Egginton, Jason S; Tiedje, Kristina; Linzer, Mark; Boehm, Deborah H; Poplau, Sara; Ramalho de Oliveira, Djenane; Odell, Laura; Montori, Victor M; May, Carl R; Anderson, Roger T

    2015-01-01

    Purpose The workload of health care and its impact on patient functioning and well-being is known as treatment burden. The purpose of this study was to finalize a conceptual framework of treatment burden that will be used to inform a new patient-reported measure of this construct. Patients and methods Semi-structured interviews were conducted with 50 chronically ill patients from a large academic medical center (n=32) and an urban safety-net hospital (n=18). We coded themes identifying treatment burden, with the themes harmonized through discussion between multiple coders. Four focus groups, each with five to eight participants with chronic illness, were subsequently held to confirm the thematic structure that emerged from the interviews. Results Most interviewed patients (98%) were coping with multiple chronic conditions. A preliminary conceptual framework using data from the first 32 interviews was evaluated and was modified using narrative data from 18 additional interviews with a racially and socioeconomically diverse sample of patients. The final framework features three overarching themes with associated subthemes. These themes included: 1) work patients must do to care for their health (eg, taking medications, keeping medical appointments, monitoring health); 2) challenges/stressors that exacerbate perceived burden (eg, financial, interpersonal, provider obstacles); and 3) impacts of burden (eg, role limitations, mental exhaustion). All themes and subthemes were subsequently confirmed in focus groups. Conclusion The final conceptual framework can be used as a foundation for building a patient self-report measure to systematically study treatment burden for research and analytical purposes, as well as to promote meaningful clinic-based dialogue between patients and providers about the challenges inherent in maintaining complex self-management of health. PMID:25848328

  8. Stabilizing Group Treatment for Complex Posttraumatic Stress Disorder Related to Childhood Abuse Based on Psycho-Education and Cognitive Behavioral Therapy: A Pilot Study

    ERIC Educational Resources Information Center

    Dorrepaal, Ethy; Thomaes, Kathleen; Smit, Johannes H.; van Balkom, Anton J. L. M.; van Dyck, Richard; Veltman, Dick J.; Draijer, Nel

    2010-01-01

    Objective: This study tests a Stabilizing Group Treatment protocol, designed for the management of the long-term sequelae of child abuse, that is, Complex Posttraumatic Stress Disorder (Complex PTSD). Evidence-based treatment for this subgroup of PTSD patients is largely lacking. This stabilizing treatment aims at improving Complex PTSD using…

  9. Resolution of Crohn's disease and complex regional pain syndrome following treatment of paratuberculosis.

    PubMed

    Kuenstner, J Todd; Chamberlin, William; Naser, Saleh A; Collins, Michael T; Dow, Coad Thomas; Aitken, John M; Weg, Stuart; Telega, Grzegorz; John, Kuruvilla; Haas, David; Eckstein, Torsten M; Kali, Maher; Welch, Christine; Petrie, Thomas

    2015-04-01

    A cohort of family members with various chronic diseases including Crohn's disease, asthma, complex regional pain syndrome, hypothyroidism, type 1 diabetes mellitus, and lymphangiomatosis and/or evidence of infection by Mycobacterium avium subsp. paratuberculosis (MAP) are described in this series of case reports. MAP was cultured from the blood of three members affected by the first five diseases and there was accompanying elevated anti-MAP IgG in two members. The patient affected by the sixth disease has a markedly elevated anti-MAP titer. The two patients affected by the first four diseases have been treated with a combination of anti-MAP antibiotics and ultraviolet blood irradiation therapy with resolution of the disease symptomatology and inability to culture MAP in post treatment blood samples. These case reports of patients with MAP infections provide supportive evidence of a pathogenic role of MAP in humans. PMID:25852293

  10. Resolution of Crohn's disease and complex regional pain syndrome following treatment of paratuberculosis

    PubMed Central

    Kuenstner, J Todd; Chamberlin, William; Naser, Saleh A; Collins, Michael T; Dow, Coad Thomas; Aitken, John M; Weg, Stuart; Telega, Grzegorz; John, Kuruvilla; Haas, David; Eckstein, Torsten M; Kali, Maher; Welch, Christine; Petrie, Thomas

    2015-01-01

    A cohort of family members with various chronic diseases including Crohn’s disease, asthma, complex regional pain syndrome, hypothyroidism, type 1 diabetes mellitus, and lymphangiomatosis and/or evidence of infection by Mycobacterium avium subsp. paratuberculosis (MAP) are described in this series of case reports. MAP was cultured from the blood of three members affected by the first five diseases and there was accompanying elevated anti-MAP IgG in two members. The patient affected by the sixth disease has a markedly elevated anti-MAP titer. The two patients affected by the first four diseases have been treated with a combination of anti-MAP antibiotics and ultraviolet blood irradiation therapy with resolution of the disease symptomatology and inability to culture MAP in post treatment blood samples. These case reports of patients with MAP infections provide supportive evidence of a pathogenic role of MAP in humans. PMID:25852293

  11. Targeting the mitochondrial electron transport chain complexes for the induction of apoptosis and cancer treatment.

    PubMed

    Rohlena, Jakub; Dong, Lan-Feng; Neuzil, Jiri

    2013-01-01

    Treatment of cancer is by no means universally successful and often manifests harmful side effects. The best way to improve the success rate and reduce the side effects would be to develop compounds that are able to kill cancer cells while leaving normal cells unaffected. In this respect, mitocans (an acronym from 'mitochondria' and 'cancer'), a summary term we proposed for compounds that induce cell death by targeting mitochondria, show an encouraging trend. Here we provide an overview of mitocans specific for the mitochondrial electron transport chain. These mitocans are particularly interesting, because a frequent consequence of electron transport chain inhibition is the induction of superoxide formation resulting in the preferential killing of cancer cells, as these tend to be more sensitive than normal cells to sudden increases in oxidative stress. Furthermore, macromolecular complexes of the electron transport chain only rarely mutate in cancer, and represent useful targets for anti-cancer drug development when widely-applicable agents are sought. PMID:22201598

  12. Treatment of Uncertainties: Output Updating in Complex Thermal-Hydraulics (TH) Computational Codes

    SciTech Connect

    Pourgol-Mohamad, Mohammad; Mosleh, Ali; Modarres, Mohammad

    2006-07-01

    Uncertainty analysis methodology in complex system models requires a comprehensive treatment of many different types and sources of uncertainty sources. Proposed methodology as part of a broader research by the authors for an integrated methodology for uncertainty analysis of TH computational codes, allows updating of uncertainties upon availability of new information about inputs, models or output. This methodology is a statistical approach for output-based updating, with non-paired data. The proposed method employs a Gibbs MCMC sampler to estimate output distribution. Winbugs code was developed to implement the Bayesian solution proposed in this paper. The methodology is applied to the data from 200% cold leg LBLOCA test of LOFT facility. (authors)

  13. Resistant mutations and quasispecies complexity of hepatitis B virus during telbivudine treatment.

    PubMed

    Yin, Feifei; Wu, Zeguang; Fang, Wei; Wu, Chunchen; Rayner, Simon; Han, Meifang; Deng, Fei; Du, Ruikun; Liu, Jinliang; Wang, Manli; Wang, Hualin; Ning, Qin; Hu, Zhihong

    2015-11-01

    Ultra-deep pyrosequencing (UDPS) was used to analyse the dynamics of quasispecies and resistant mutations during telbivudine (LDT) treatment of hepatitis B patients. Twenty-six HBeAg-positive chronic hepatitis B patients were treated with LDT for a period of 104?weeks and were characterized as 16 responders, six partial responders and four viral breakthrough patients based on hepatitis B virus (HBV) DNA levels. The plasma samples were subjected to UDPS of the reverse transcriptase (RT) region of HBV. Mutations rtM204I, rtL80I and rtL80V were detected in at least three of the four viral breakthrough patients, indicating the significant roles of the mutations in resistance to LDT. The degree of complexity of viral quasispecies remained in a steady state in the absence of selection pressure, but increased after the LDT treatment. The complexity in the responder group at week 12 was significantly higher than that in the group comprising partial responders and viral breakthrough patients. In vitro replication efficiency analyses showed that the RT mutations had different impacts on HBV replication, with a tendency of rtM204I>rtL80V>rtL80I. Furthermore, double mutations rtL80I/M204I and rtL80V/M204V had replication efficiency similar to that of rtL80I and rtL80V, respectively. Consistent with previous studies, mutation rtM204I was found to be highly resistant to LDT. However, in contrast with their sensitivity to lamivudine, rtL80I and rtL80V were moderately resistant to LDT. Our results indicated that rtL80I and rtL80V may not only serve as replication complementary mutations to rtM204I, but also directly contribute to the LDT resistance. PMID:26382925

  14. Low-intensity laser radiation in complex treatment of inflammatory diseases of parodontium

    NASA Astrophysics Data System (ADS)

    Sokolova, Irina A.; Erina, Stanislava V.

    1995-04-01

    The problem of complex treatment of inflammatory disease of parodontium has become very acute and actual at the moment. The diseases of inflammatory nature are considered to be the most vital issues of the day. The state of the local immune system of oral cavity plays the most important role in the complicated mechanism of inflammatory process development in the tissues of parodontium. Recently physical factors have become predominant in the system of complex therapy of parodontitis. The application of low-intense laser radiation (LLR) is considered to be the most important and up-to-date method in the preventive dentistry. There were 60 patients of average damage rate suffering from chronic generalizing parodontitis at the age of 25 up to 55 under observation. The major goal of examination was to get the objective results of the following methods' application: parodontium index (Russel, 1956), hygiene index (Fyodorov, Volodkina, 1971), Bacterioscopy of dental-gingival pockets content, simple and broadened stomatoscopy (Kunin, 1970), SIgA level determination in mixed saliva (Manchini et all, 1965) and R-protein level in gingival blood (Kulberg, 1990). All the patients were split into 2 groups. The first group (30 patients) has undergone the laser therapy course while the second group of 30 patients couldn't get it (LLR). Despite the kind of therapy they have undergone, all the patients have got the local anti-inflammatory medicamental therapy. The results of clinical observations have proved the fact that laser therapy application makes it possible to shorten the course of treatment in 1.5 times. The shifts of oral cavity local resistance take place in case of chronic generalizing parodontitis. The direct immunostimulating effect could be observed as a result of LLR- therapy application. The close connection of both anti-inflammatory medicamental and LLR-therapy has proved the possibility of purposeful local immune status correction in case of parodontitis.

  15. Fusariosis, a complex infection caused by a high diversity of fungal species refractory to treatment.

    PubMed

    Guarro, J

    2013-12-01

    In recent years the number of opportunistic invasive fusariosis has increased significantly, the main factors involved in these infections being reviewed here. In spite of the extensive literature published the advances in the management of disseminated fusariosis have been very poor and it remains a severe infection, refractory to treatment and with a high mortality rate. There are no ideal therapies and the presence of neutropenia has a critical part to play in the outcome of the infection. At least 70 species have been involved in fusariosis. Fusarium solani species complex is responsible for nearly 60% of the cases and F. oxysporum species complex for approximately 20% of them. Most of the infections are caused by four species, i.e. F. petroliphilum, F. keratoplasticum and other two unnamed phylogenetic species. The efficacy of amphotericin B and voriconazole, the most used antifungal drugs, for treating invasive fusariosis are controversial but in general the percentage of patients cured in the different clinical trials is low. Infections by Fusarium verticillioides seem to have the best prognosis. The recent release of complete genome sequences of the most clinically relevant species and the emergence of fungal genomics offer excellent opportunities for examining the multifactorial processes of Fusarium pathogenicity. Using knockout mutants of genes encoding sequence-specific proteins, several virulence factors have been characterized. PMID:23934595

  16. Staff Engagement During Complex Pediatric Medical Care: The Role of Patient, Family, and Treatment Variables

    PubMed Central

    Meltzer, Lisa J.; Steinmiller, Elizabeth; Simms, Steve; Grossman, Michael; Li, Yuelin

    2009-01-01

    Objective To examine the role of patient, family, and treatment variables on self-reported engagement for physicians and nurses working with pediatric complex care patients. Methods Sixty-eight physicians and 85 registered nurses at a children’s hospital reviewed eight case scenarios that varied by the patient and patient’s family (each cooperative vs. difficult) and the length of hospitalization (<30 vs. >30 days). Participants rated their engagement from highly engaged/responsive to distancing/disconnected behaviors. Results Nurses were more likely than physicians to engage in situations with a difficult patient/cooperative family but less likely to engage in situations with a cooperative patient/difficult family. Nurses were more likely to consult a colleague regarding the care of a difficult patient/difficult family, while physicians were more likely to refer a difficult patient/difficult family to a psychosocial professional. Conclusions Differences were found for engagement with “difficult” patients/families, with physicians more likely to distance themselves or refer to a psychosocial professional, while nurses were more likely to consult with a colleague. Practice Implications Communication between health care team members is essential for optimal family centered health care. Thus, interventions are needed that focus on communication and support for health care teams working with pediatric complex care patients and their families. PMID:19209401

  17. Treatment with at Homeopathic Complex Medication Modulates Mononuclear Bone Marrow Cell Differentiation

    PubMed Central

    Cesar, Beatriz; Abud, Ana Paula R.; de Oliveira, Carolina C.; Cardoso, Francolino; Bernardi, Raffaello Popa Di; Guimarães, Fernando S. F.; Gabardo, Juarez; de Freitas Buchi, Dorly

    2011-01-01

    A homeopathic complex medication (HCM), with immunomodulatory properties, is recommended for patients with depressed immune systems. Previous studies demonstrated that the medication induces an increase in leukocyte number. The bone marrow microenvironment is composed of growth factors, stromal cells, an extracellular matrix and progenitor cells that differentiate into mature blood cells. Mice were our biological model used in this research. We now report in vivo immunophenotyping of total bone marrow cells and ex vivo effects of the medication on mononuclear cell differentiation at different times. Cells were examined by light microscopy and cytokine levels were measured in vitro. After in vivo treatment with HCM, a pool of cells from the new marrow microenvironment was analyzed by flow cytometry to detect any trend in cell alteration. The results showed decreases, mainly, in CD11b and TER-119 markers compared with controls. Mononuclear cells were used to analyze the effects of ex vivo HCM treatment and the number of cells showing ring nuclei, niche cells and activated macrophages increased in culture, even in the absence of macrophage colony-stimulating factor. Cytokines favoring stromal cell survival and differentiation in culture were induced in vitro. Thus, we observe that HCM is immunomodulatory, either alone or in association with other products. PMID:19736221

  18. Tailoring fly ash activated with bentonite as adsorbent for complex wastewater treatment

    NASA Astrophysics Data System (ADS)

    Visa, Maria

    2012-12-01

    Used as adsorbent, alkali fly ash represents a low cost solution for advanced wastewater treatment. The alkali treatment raises sustainability issues therefore, in this research we aim to replace alkali fly ash with washed fly ash (FAw). For improving the adsorption capacity of washed fly ash, bentonite powder (B) was added, as a natural adsorbent with a composition almost identical to the fly ash. The new adsorbent was characterized by AFM, XRD, FTIR, SEM, EDS and the surface energy was evaluated by contact angle measurements. For understanding the complex adsorption process on this mixed substrate, preliminary tests were developed on synthetic wastewaters containing a single pollutant system (heavy metal), binary (two-heavy metals) and ternary (dye and two heavy metals) systems. Experiments were done on synthetic wastewaters containing methylene blue, cadmium and copper, using FAw, B and their powder mixtures. The pseudo-second order kinetics could well model all the processes, indicating a good adsorbent material which can be used for the pollutants removal from wastewater. After adsorption the substrates loaded with pollutants, annealed at 500 °C can be reused for padding in stone blocks.

  19. A new concept: the use of vanadium complexes in the treatment of diabetes mellitus.

    PubMed

    Sakurai, Hiromu

    2002-01-01

    In the 21st century, patients suffering from diabetes mellitus (DM), a lifestyle-related disease, will increase more than in the 20th century. DM is threatening because of the development of many severe secondary complications, including atherosclerosis, microangiopathy, renal dysfunction and failure, cardiac abnormalities, diabetic retinopathy, and ocular disorders. Generally, DM is classified as either insulin-dependent type 1 or noninsulin-dependent type 2 DM. Type 1 DM is treated only by daily insulin injections; type 2 DM is treated by several types of synthetic therapeutic substances together with a controlled diet and physical exercise. Even with these measures, the daily necessity for several insulin injections can be painful both physically and mentally, whereas the synthetic therapeutic substances used over the long term often have side effects. For those reasons, the creation and development of a new class of pharmaceuticals for treatment of DM in the 21st century would be extremely desirable. In the last half of the 20th century, investigations of the relationships among diseases and micronutrients, such as iron, copper, zinc, and selenium, have been numerous. Research into the development of metallopharmaceuticals involving the platinum-containing anticancer drug, cisplatin, and the gold-containing rheumatoid arthritis drug, auranofin, has also been widespread. Such important findings prompted us to develop therapeutic reagents based on a new concept to replace either insulin injections or the use of synthetic drugs. After many trials, we noticed that vanadium might be very useful in the treatment of DM. Before the discovery of insulin by Banting and Best in 1921 and its clinical trial for treating DM, the findings in 1899, in which orally administered sodium vanadate (NaVO(3)) was reported to improve human DM, gave us the idea to use vanadium to treat DM. However, it has taken a long time to obtain a scientific explanation as to why the metal ion exhibits insulin-mimetic or blood-glucose lowering effects in in vitro and in vivo experiments. After investigations from many perspectives involving biochemistry and bioinorganic chemistry, vanadyl sulfate (VOSO(4)) and its complexes with several types of ligands have been proposed as useful for treating DM in experimental diabetic animals. On the basis of a mechanistic study, this article reports on recent progress regarding the development of antidiabetic vanadyl complexes, emphasizing that the vanadyl ion and its complexes are effective not only in treating or relieving both types of DM but also in preventing the onset of DM. PMID:12203906

  20. Antianxiety medications for the treatment of complex agoraphobia: pharmacological interventions for a behavioral condition

    PubMed Central

    Perna, Giampaolo; Daccò, Silvia; Menotti, Roberta; Caldirola, Daniela

    2011-01-01

    Background Although there are controversial issues (the “American view” and the “European view”) regarding the construct and definition of agoraphobia (AG), this syndrome is well recognized and it is a burden in the lives of millions of people worldwide. To better clarify the role of drug therapy in AG, the authors summarized and discussed recent evidence on pharmacological treatments, based on clinical trials available from 2000, with the aim of highlighting pharmacotherapies that may improve this complex syndrome. Methods A systematic review of the literature regarding the pharmacological treatment of AG was carried out using MEDLINE, EBSCO, and Cochrane databases, with keywords individuated by MeSH research. Only randomized, placebo-controlled studies or comparative clinical trials were included. Results After selection, 25 studies were included. All the selected studies included patients with AG associated with panic disorder. Effective compounds included selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, selective noradrenergic reuptake inhibitors, and benzodiazepines. Paroxetine, sertraline, citalopram, escitalopram, and clomipramine showed the most consistent results, while fluvoxamine, fluoxetine, and imipramine showed limited efficacy. Preliminary results suggested the potential efficacy of inositol; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy. More studies with the latter compounds are needed before drawing definitive conclusions. Conclusion No studies have been specifically oriented toward evaluating the effect of drugs on AG; in the available studies, the improvement of AG might have been the consequence of the reduction of panic attacks. Before developing a “true” psychopharmacology of AG it is crucial to clarify its definition. There may be several potential mechanisms involved, including fear-learning processes, balance system dysfunction, high light sensitivity, and impaired visuospatial abilities, but further studies are warranted. PMID:22090798

  1. Differentiating the mTOR inhibitors everolimus and sirolimus in the treatment of tuberous sclerosis complex.

    PubMed

    MacKeigan, Jeffrey P; Krueger, Darcy A

    2015-12-01

    Tuberous sclerosis complex (TSC) is a genetic autosomal dominant disorder characterized by benign tumor-like lesions, called hamartomas, in multiple organ systems, including the brain, skin, heart, kidneys, and lung. These hamartomas cause a diverse set of clinical problems based on their location and often result in epilepsy, learning difficulties, and behavioral problems. TSC is caused by mutations within the TSC1 or TSC2 genes that inactivate the genes' tumor-suppressive function and drive hamartomatous cell growth. In normal cells, TSC1 and TSC2 integrate growth signals and nutrient inputs to downregulate signaling to mammalian target of rapamycin (mTOR), an evolutionarily conserved serine-threonine kinase that controls cell growth and cell survival. The molecular connection between TSC and mTOR led to the clinical use of allosteric mTOR inhibitors (sirolimus and everolimus) for the treatment of TSC. Everolimus is approved for subependymal giant cell astrocytomas and renal angiomyolipomas in patients with TSC. Sirolimus, though not approved for TSC, has undergone considerable investigation to treat various aspects of the disease. Everolimus and sirolimus selectively inhibit mTOR signaling with similar molecular mechanisms, but with distinct clinical profiles. This review differentiates mTOR inhibitors in TSC while describing the molecular mechanisms, pathogenic mutations, and clinical trial outcomes for managing TSC. PMID:26289591

  2. Treatment of a complex thoracoabdominal aneurysm and dissection with a branched graft.

    PubMed

    Piazza, Kristen M; Black, James H; Glebova, Natalia O

    2015-12-01

    This article describes the management of a patient with a complex symptomatic thoracoabdominal aneurysm and discusses the branched graft approach to surgical repair of complex aortic aneurysms. The case highlights the importance of a team approach during a complex, high-risk surgery and the perioperative period. PMID:26595694

  3. [Selective adsorption of endotoxin in the complex treatment of patients with severe sepsis].

    PubMed

    Khubutiia, M Sh; Abakumov, M M; Aleksandrova, I V; ReÄ­, S I; Il'inskiÄ­, M E; Khvatov, V B; Borovkova, N V; Pertsev, A S; Zinkin, V Iu

    2010-01-01

    Severe sepsis and septic shock remain the most serious problem of critical care medicine today with a mortality of 25-80%. Bacterial endotoxin is of considerable importance in the pathogenesis of sepsis. A selective hemosorbent in which endotoxin adsorption is accomplished via its binding to a synthetic peptide (LPS-A) has been recently designed in Sweden. The purpose of the study was to evaluate the efficiency of using the LPS-A in the complex treatment of patients with severe sepsis. Eight patients in whom the course of the underlying disease was complicated by the development of gram-negative sepsis in the postoperative period were examined. The patients had an APACHE II score of 20.4 +/- 4.5 LPS-A was performed using the hemosorbent Alteco LPS (Lund, Sweden) and an Aquarius hemoprocessor (Edwards Lifesciences) (U.S.A.). The use of LPS-A caused a significant reduction in endotoxin levels by 2.9 times. The level of procalcitonin was increased in all patients; after a LPS-A session, it was significantly decreased by 1.9 times. The use of LPS-A resulted in diminished tachycardia, elevated blood pressure and could reduce the doses of vasopressor amines. There was an improvement in lung gas exchange parameters. A study of the effect of LPS-A on the immune system showed a significant reduction (36.6%) in neutrophil oxygen-dependent metabolism according to the data of the spontaneous HCT test, a 2.4-fold decrease in large circulating immune complexes, and a rise in the count of mononuclear cells that died both by necrosis and apoptosis, the count of the cells significantly increased by 5.3 times in late apoptosis. A LPS-A session caused a significant drop in the blood level of endotoxin and procalcitonin and it was accompanied by a trend toward better hemodynamics and lung gas exchange and alleviated organ dysfunction. At the same time LPS-A showed the ambiguous effect on immune system parameters, which calls for further study. PMID:21395145

  4. Computer-aided patch planning for treatment of complex coarctation of the aorta

    NASA Astrophysics Data System (ADS)

    Rietdorf, Urte; Riesenkampff, Eugénie; Kuehne, Titus; Huebler, Michael; Meinzer, Hans-Peter; Wolf, Ivo

    2009-02-01

    Between five and eight percent of all children born with congenitally malformed hearts suffer from coarctations of the aorta. Some severe coarctations can only be treated by surgical repair. Untreated, this defect can cause serious damage to organ development or even lead to death. Patch repair requires open surgery. It can affect patients of any age: newborns with severe coarctation and/or hypoplastic aortic arch as well as older patients with late diagnosis of coarctation of the aorta. Another patient group are patients of varying age with re-coarctation of the aorta or hypoplastic aortic arch after surgical and/or interventional repair. If anatomy is complex and interventional treatment by catheterization, balloon angioplasty or stent placement is not possible, surgery is indicated. The choice of type of surgery depends not only on the given anatomy but also on the experience the surgical team has with each method. One surgical approach is patch repair. A patch of a suitable shape and size is sewed into the aorta to expand the aortic lumen at the site of coarctation. At present, the shape and size of the patch are estimated intra-operatively by the surgeon. We have developed a software application that allows planning of the patch pre-operatively on the basis of magnetic resonance angiographic data. The application determines the diameter of the coarctation and/or hypoplastic segment and constructs a patch proposal by calculating the difference to the normal vessel diameter pre-operatively. Evaluation of MR angiographic datasets from 12 test patients with different kinds of aortic arch stenosis shows a divergence of only (1.5+/-1.2) mm in coarctation diameters between manual segmentations and our approach, with comparable time expenditure. Following this proposal the patch can be prepared and adapted to the patient's anatomy pre-operatively. Ideally, this leads to shorter operation times and a better long-term outcome with a reduced rate of residual stenosis and re-stenosis and aneurysm formation.

  5. Generalization of the Activated Complex Theory of Reaction Rates. I. Quantum Mechanical Treatment

    DOE R&D Accomplishments Database

    Marcus, R. A.

    1964-01-01

    In its usual form activated complex theory assumes a quasi-equilibrium between reactants and activated complex, a separable reaction coordinate, a Cartesian reaction coordinate, and an absence of interaction of rotation with internal motion in the complex. In the present paper a rate expression is derived without introducing the Cartesian assumption. The expression bears a formal resemblance to the usual one and reduces to it when the added assumptions of the latter are introduced.

  6. Formulation, characterization and evaluation of cyclodextrin-complexed bendamustine-encapsulated PLGA nanospheres for sustained delivery in cancer treatment.

    PubMed

    Gidwani, Bina; Vyas, Amber

    2016-03-01

    PLGA nanospheres are considered to be promising drug carrier in the treatment of cancer. Inclusion complex of bendamustine (BM) with epichlorohydrin beta cyclodextrin polymer was prepared by freeze-drying method. Phase solubility study revealed formation of AL type complex with stability constant (Ks?=?645?M(-1)). This inclusion complex was encapsulated into PLGA nanospheres using solid-in-oil-in-water (S/O/W) technique. The particle size and zeta potential of PLGA nanospheres loaded with cyclodextrin-complexed BM were about 151.4?±?2.53?nm and?-?31.9?±?(-3.08)?mV. In-vitro release study represented biphasic release pattern with 20% burst effect and sustained slow release. DSC studies indicated that inclusion complex incorporated in PLGA nanospheres was not in a crystalline state but existed in an amorphous or molecular state. The cytotoxicity experiment was studied in Z-138 cells and IC50 value was found to be 4.3?±?0.11?µM. Cell viability studies revealed that the PLGA nanospheres loaded with complex exerts a more pronounced effect on the cancer cells as compared to the free drug. In conclusion, PLGA nanospheres loaded with inclusion complex of BM led to sustained drug delivery. The nanospheres were stable after 3 months of storage conditions with slight change in their particle size, zeta potential and entrapment efficiency. PMID:25391288

  7. Systems Pharmacology Dissecting Holistic Medicine for Treatment of Complex Diseases: An Example Using Cardiocerebrovascular Diseases Treated by TCM

    PubMed Central

    Wang, Yonghua; Zheng, Chunli; Huang, Chao; Li, Yan; Chen, Xuetong; Wu, Ziyin; Wang, Zhenzhong; Xiao, Wei; Zhang, Boli

    2015-01-01

    Holistic medicine is an interdisciplinary field of study that integrates all types of biological information (protein, small molecules, tissues, organs, external environmental signals, etc.) to lead to predictive and actionable models for health care and disease treatment. Despite the global and integrative character of this discipline, a comprehensive picture of holistic medicine for the treatment of complex diseases is still lacking. In this study, we develop a novel systems pharmacology approach to dissect holistic medicine in treating cardiocerebrovascular diseases (CCDs) by TCM (traditional Chinese medicine). Firstly, by applying the TCM active ingredients screened out by a systems-ADME process, we explored and experimentalized the signed drug-target interactions for revealing the pharmacological actions of drugs at a molecule level. Then, at a/an tissue/organ level, the drug therapeutic mechanisms were further investigated by a target-organ location method. Finally, a translational integrating pathway approach was applied to extract the diseases-therapeutic modules for understanding the complex disease and its therapy at systems level. For the first time, the feature of the drug-target-pathway-organ-cooperations for treatment of multiple organ diseases in holistic medicine was revealed, facilitating the development of novel treatment paradigm for complex diseases in the future. PMID:26101539

  8. Quality assurance for high dose rate brachytherapy treatment planning optimization: using a simple optimization to verify a complex optimization

    NASA Astrophysics Data System (ADS)

    Deufel, Christopher L.; Furutani, Keith M.

    2014-02-01

    As dose optimization for high dose rate brachytherapy becomes more complex, it becomes increasingly important to have a means of verifying that optimization results are reasonable. A method is presented for using a simple optimization as quality assurance for the more complex optimization algorithms typically found in commercial brachytherapy treatment planning systems. Quality assurance tests may be performed during commissioning, at regular intervals, and/or on a patient specific basis. A simple optimization method is provided that optimizes conformal target coverage using an exact, variance-based, algebraic approach. Metrics such as dose volume histogram, conformality index, and total reference air kerma agree closely between simple and complex optimizations for breast, cervix, prostate, and planar applicators. The simple optimization is shown to be a sensitive measure for identifying failures in a commercial treatment planning system that are possibly due to operator error or weaknesses in planning system optimization algorithms. Results from the simple optimization are surprisingly similar to the results from a more complex, commercial optimization for several clinical applications. This suggests that there are only modest gains to be made from making brachytherapy optimization more complex. The improvements expected from sophisticated linear optimizations, such as PARETO methods, will largely be in making systems more user friendly and efficient, rather than in finding dramatically better source strength distributions.

  9. Antiangiogenic activity of mononuclear copper(II) polypyridyl complexes for the treatment of cancers.

    PubMed

    Nagababu, Penumaka; Barui, Ayan Kumar; Thulasiram, Bathini; Devi, C Shobha; Satyanarayana, S; Patra, Chitta Ranjan; Sreedhar, Bojja

    2015-07-01

    A series of four new mononuclear copper(II) polypyridyl complexes (1-4) have been designed, developed, and thoroughly characterized by several physicochemical techniques. The CT-DNA binding properties of 1-4 have been investigated by absorption, emission spectroscopy, and viscosity measurements. All the complexes especially 1 and 4 exhibit cytotoxicity toward several cancer cell lines, suggesting their anticancer properties as observed by several in vitro assays. Additionally, the complexes show inhibition of endothelial cell (HUVECs) proliferation, indicating their antiangiogenic nature. In vivo chick embryo angiogenesis assay again confirms the antiangiogenic properties of 1 and 4. The formation of excessive intracellular ROS (H2O2 and O2(•-)) and upregulation of BAX induced by copper(II) complexes may be the plausible mechanisms behind their anticancer activities. The present study may offer a basis for the development of new transition metal complexes through suitable choice of ligands for cancer therapeutics by controlling tumor angiogenesis. PMID:26068145

  10. Treatment of metal-containing wastewater by adsorption of metal-chelate complexes onto activated carbon

    SciTech Connect

    Shay, M.A.

    1989-01-01

    To eliminate difficulties associated with interference of chelating or complexing agents on precipitation of heavy metals from wastewaters, the feasibility of a process which utilized chelating agents in the removal of the heavy metals was investigated. Heavy metal ions were removed from simulated metal plating wastewater by sorption of a heavy metal chelate complex onto activated carbon. In this process, a chelate which might be present in a wastewater could be used in removal of a heavy metal, rather than interfere with its removal. System development of a continuous flow process consisted of bench scale column tests to answer questions about key adsorption column operating parameters. The metals investigated were Cu(II), Ni(II) and Zn(II). Hydrogen ion concentration had the largest effect on removal of heavy metalchelate complexes, but contact time and heavy metal:chelate ratio were important. The normal contact time for activated carbon columns of 30 to 60 minutes was found adequate to achieve heavy metal-chelate removals of at least 90% for citrate or EDTA complexes. For citrate complexes better removals were achieved at heavy metal:chelate ratios greater than 1:1. For EDTA, there was no advantage to ratios greater than 1:1. Increasing pH, at least to pH 9.0, increased the heavy metal chelate removal; however, for EDTA, removals greater than 90% could be achieved at a pH as low as 3.0. The maximum amount of Cu(II)-citrate complex that could be removed was 2.8 mg per gram of carbon, the maximum amount for Zn(II)citrate complex was 1.2 mg per gram of carbon, and for Ni(II)-citrate, the maximum was 1.3 mg per gram of carbon. For the EDTA complexes, the maximum removal was 2.1 mg of Cu(II)-EDTA complex per gram of carbon, 6.9 mg of Zn(II)-EDTA complex per gram of carbon, and 3.2 mg of Ni(II)-EDTA complex per gram of carbon.

  11. Technology Evaluation for the Big Spring Water Treatment System at the Y-12 National Security Complex, Oak Ridge, Tennessee

    SciTech Connect

    Becthel Jacobs Company LLC

    2002-11-01

    The Y-12 National Security Complex (Y-12 Complex) is an active manufacturing and developmental engineering facility that is located on the U.S. Department of Energy (DOE) Oak Ridge Reservation. Building 9201-2 was one of the first process buildings constructed at the Y-12 Complex. Construction involved relocating and straightening of the Upper East Fork Poplar Creek (UEFPC) channel, adding large quantities of fill material to level areas along the creek, and pumping of concrete into sinkholes and solution cavities present within the limestone bedrock. Flow from a large natural spring designated as ''Big Spring'' on the original 1943 Stone & Webster Building 9201-2 Field Sketch FS6003 was captured and directed to UEFPC through a drainpipe designated Outfall 51. The building was used from 1953 to 1955 for pilot plant operations for an industrial process that involved the use of large quantities of elemental mercury. Past operations at the Y-12 Complex led to the release of mercury to the environment. Significant environmental media at the site were contaminated by accidental releases of mercury from the building process facilities piping and sumps associated with Y-12 Complex mercury handling facilities. Releases to the soil surrounding the buildings have resulted in significant levels of mercury in these areas of contamination, which is ultimately transported to UEFPC, its streambed, and off-site. Bechtel Jacobs Company LLC (BJC) is the DOE-Oak Ridge Operations prime contractor responsible for conducting environmental restoration activities at the Y-12 Complex. In order to mitigate the mercury being released to UEFPC, the Big Spring Water Treatment System will be designed and constructed as a Comprehensive Environmental Response, Compensation, and Liability Act action. This facility will treat the combined flow from Big Spring feeding Outfall 51 and the inflow now being processed at the East End Mercury Treatment System (EEMTS). Both discharge to UEFPC adjacent to Bldg. 9201-2. The EEMTS treats mercury-contaminated groundwater that collects in sumps in the basement of Bldg. 9201-2. A pre-design study was performed to investigate the applicability of various treatment technologies for reducing mercury discharges at Outfall 51 in support of the design of the Big Spring Water Treatment System. This document evaluates the results of the pre-design study for selection of the mercury removal technology for the treatment system.

  12. Long-term effects of a complex behavioral treatment of essential hypertension.

    PubMed

    Lehnert, H; Kaluza, K; Vetter, H; Losse, H; Dorst, K

    1987-01-01

    A multidimensional behavioral program was developed for the treatment of essential hypertension. Over a course of 6 weeks, 108 patients of a rehabilitation center were treated with this program consisting of health education, self-monitoring of blood pressure, relaxation techniques, and a social skill training in addition to standard medical treatment alone. Blood pressure and other cardiovascular risk factors were monitored for a period of 12 months. Blood pressure levels became normotensive in both groups at the end of the 6-week training program. However, the blood pressure reduction in the behavioral treatment group was achieved with fewer patients taking antihypertensive medication than in the control group. The number of patients taking antihypertensive drugs in the treatment group was 60.2% prior to treatment and 44.4% after treatment; figures for the control group were 68% and 73.8%, respectively (p less than or equal to 0.01). Almost identical data were obtained at the 6- and 23-month follow-up examinations. No consistent changes were observed in weight, smoking, or blood lipids. These results demonstrate beneficial and long-lasting effects of a combined medical and psychologic treatment of essential hypertension as compared to medical treatment alone. PMID:3615770

  13. Typicality of Inanimate Category Exemplars in Aphasia Treatment: Further Evidence for Semantic Complexity

    ERIC Educational Resources Information Center

    Kiran, Swathi

    2008-01-01

    Purpose: The typicality treatment approach on improving naming was investigated within 2 inanimate categories ("furniture" and "clothing") using a single-subject experimental design across participants and behaviors in 5 patients with aphasia. Method: Participants received a semantic feature treatment to improve naming of either typical or…

  14. [Usefulness of Uro-Vaxom in complex treatment of recurrent urinary tract infections in girls].

    PubMed

    Go?abek, Bozena; Nowakowska, Krystyna; S?owik, Ma?gorzata; Paruszkiewicz, Grzegorz

    2002-04-01

    Uro-Vaxom was used in the treatment of recurrent urinary tract infections in 35 girls. Most of them (34/35) tolerated the drug very well, no side effect were observed. We stopped administration of the Uro-Vaxom in one girl, during the first month of treatment because of vomiting. This way efficiency of Uro-Vaxom was evaluated in the treatment of recurrent urinary tract infections in 34 girls. Uro-Vaxom was found to be a valuable drug, supporting antibiotic therapy in recurrent urinary tract infections caused by E. coli. PMID:12089885

  15. [Complex treatment of a large radicular cyst in the anterior region of the maxilla. Case report].

    PubMed

    Szekeres, Györgyi; Tamás, Würsching; Nemes, Júlia; Tóth, Zsuzsanna

    2015-09-01

    As opposed to other odontogenic cysts, the radicular cyst is always produced by intraradicular infection, therefore it is important to eliminate the cause of the inflammation as well. During the healing of the radicular cyst, the infected tooth should be treated by extraction or root canal treatment completed by surgical intervention. The presented case is a 77 year-old male patient with Type II Diabetes, who required oral surgery and endodontic treatment. Despite of the age and diabetes of the patient, the bone regeneration was rapid and complete. Seven months after starting the treatment, the size of the cyst decresed significantly and by 12th month it was perfectly healed. PMID:26731964

  16. Strength and Formability Improvement of Al-Cu-Mn Aluminum Alloy Complex Parts by Thermomechanical Treatment with Sheet Hydroforming

    NASA Astrophysics Data System (ADS)

    Chen, Yi-Zhe; Liu, Wei; Yuan, Shi-Jian

    2015-05-01

    Normally, the strength and formability of aluminum alloys can be increased largely by severe plastic deformation and heat treatment. However, many plastic deformation processes are more suitable for making raw material, not for formed parts. In this article, an experimental study of the thermomechanical treatment by using the sheet hydroforming process was developed to improve both mechanical strength and formability for aluminum alloys in forming complex parts. The limiting drawing ratio, thickness, and strain distribution of complex parts formed by sheet hydroforming were investigated to study the formability and sheet-deformation behavior. Based on the optimal formed parts, the tensile strength, microhardness, grain structure, and strengthening precipitates were analyzed to identify the strengthening effect of thermomechanical treatment. The results show that in the solution state, the limiting drawing ratio of cylindrical parts could be increased for 10.9% compared with traditional deep drawing process. The peak values of tensile stress and microhardness of formed parts are 18.0% and 12.5% higher than that in T6 state. This investigation shows that the thermomechanical treatment by sheet hydroforming is a potential method for the products manufacturing of aluminum alloy with high strength and good formability.

  17. [The role of intraoperative photodynamic therapy in complex treatment of cerebral metastases].

    PubMed

    Kurzhupov, M I; Zaitsev, A M; Loshakov, V A; Filonenko, E V

    2010-01-01

    Cerebral metastases are the most common brain tumors in adults and are characterized by poor prognosis. Despite application of modern methods of treatment (microsurgery, radiation therapy, chemotherapy) survival rates of these patients remain low. This fact triggers development of new therapeutic options which are able to increase recurrence-free period and consequently overall survival. The article contains review of literature dealing with photodynamic therapy which is a newly introduced technique for treatment of cerebral metastases. PMID:21254577

  18. Complex I Disorders: Causes, Mechanisms, and Development of Treatment Strategies at the Cellular Level

    ERIC Educational Resources Information Center

    Valsecchi, Federica; Koopman, Werner J. H.; Manjeri, Ganesh R.; Rodenburg, Richard J.; Smeitink, Jan A. M.; Willems, Peter H. G. M.

    2010-01-01

    Mitochondrial oxidative phosphorylation (OXPHOS) represents the final step in the conversion of nutrients into cellular energy. Genetic defects in the OXPHOS system have an incidence between 1:5,000 and 1:10,000 live births. Inherited isolated deficiency of the first complex (CI) of this system, a multisubunit assembly of 45 different proteins,…

  19. The Prescribed Pediatric Center: A Medical Day Treatment Program for Children with Complex Medical Conditions.

    ERIC Educational Resources Information Center

    Ruppert, Elizabeth S.; Karst, Thomas O.; Brogan, Mark G.

    1998-01-01

    The Prescribed Pediatric Center (Toledo, Ohio) is a community-based, multidisciplinary program for infants and children with chronic, complex medical conditions. This article describes program beginnings; the planning process; and the program's growth, development, and components. Initial program evaluation indicates positive effects on some…

  20. Complex I Disorders: Causes, Mechanisms, and Development of Treatment Strategies at the Cellular Level

    ERIC Educational Resources Information Center

    Valsecchi, Federica; Koopman, Werner J. H.; Manjeri, Ganesh R.; Rodenburg, Richard J.; Smeitink, Jan A. M.; Willems, Peter H. G. M.

    2010-01-01

    Mitochondrial oxidative phosphorylation (OXPHOS) represents the final step in the conversion of nutrients into cellular energy. Genetic defects in the OXPHOS system have an incidence between 1:5,000 and 1:10,000 live births. Inherited isolated deficiency of the first complex (CI) of this system, a multisubunit assembly of 45 different proteins,…

  1. Generalization of the Activated Complex Theory of Reaction Rates. II. Classical Mechanical Treatment

    DOE R&D Accomplishments Database

    Marcus, R. A.

    1964-01-01

    In its usual classical form activated complex theory assumes a particular expression for the kinetic energy of the reacting system -- one associated with a rectilinear motion along the reaction coordinate. The derivation of the rate expression given in the present paper is based on the general kinetic energy expression.

  2. Operative versus non-operative treatment in complex proximal humeral fractures: a meta-analysis of randomized controlled trials.

    PubMed

    Xie, Lin; Ding, Fan; Zhao, Zhigang; Chen, Yan; Xing, Danmou

    2015-01-01

    Whether operative treatment for complex proximal humeral fractures (CPHFs) has a greater benefit over non-operative treatment remains controversial. There is no consensus on the optimal treatment in elderly patients with CPHFs. This updated meta-analysis of randomized controlled trials (RCTs) aims to investigate whether operative treatment is superior to non-operative treatment in CPHFs. The authors searched RCTs in the electronic databases (Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Medline, Embase, Springer Link, Web of Knowledge, OVID and Google Scholar) from their establishment to July 2015. Researches on operative and non-operative treatment for CPHFs were selected in this meta-analysis. The quality of all studies was assessed and effective data was pooled for this meta-analysis. Outcome measurements were functional status include constant scores (CS scores) and disabilities of the arm, shoulder and hand scores (DASH scores), total complication rates and healthy-related quality of life. The meta-analysis was performed with software revman 5.3. Nine articles with a total 518 patients (average age 70.93) met inclusion criteria. Patients were followed up for at least 1 year in all the studies. No statistical differences were found between operative and non-operative treatment in CS scores at 12 mo (months) [MD 1.06 95 % CI (-3.51, 5.62)] and 24 mo [MD -0.61 95 % CI (-5.87, 4.65)]. There are also no statistical differences between operative and non-operative treatment in DASH scores at 12 mo [MD -4.51 95 % CI (-13.49, 4.47)] and 24 mo [MD -7.43 95 % CI (-16.14, 1.27)]. Statistical differences were found between operative and non-operative treatment in total complication rates [RR 1.55, 95 % CI (1.24, 1.94)]. Statistical differences in EQ-5D at 24 mo [MD 0.15, 95 % CI (0.05, 0.24)] were found between operative and non-operative treatment but no statistical differences were found in ED-5D at 12 mo [MD 0.08, 95 % CI (-0.01, 0.17)], 15D at 12 mo [MD 0.02, 95 % CI (-0.68, 0.73)] and 15D at 24 mo [MD 0.02, 95 % CI (-0.07, 0.83)]. Operative treatments did not significantly improve the functional outcome and healthy-related quality of life in elderly patients. Instead, Operative treatment for CPHFs led to higher incidence of postoperative complications. PMID:26636016

  3. Outcomes of a Simple Treatment for Complex Regional Pain Syndrome Type I in Children

    PubMed Central

    Dietz, Frederick R.; Compton, Stephen P.

    2015-01-01

    Background Chronic Regional Pain Syndrome type I (CRPSI) in children is a disorder of unknown etiology. No standard diagnostic criteria or treatment exists. Published treatment protocols are often time and resource intensive. Nonetheless, CRPSI is not rare and can be disabling. This reports the results of a simple and inexpensive treatment protocol involving no medicines, nerve blockades, physical therapy resources or referrals to pain specialists. The patient is instructed in a self-administered massage and mobilization program. The diagnosis required allodynia (pain on light touch of the skin) and signs or the history of signs of autonomic dysfunction. Methods A chart review of patient coded for “reflex sympathetic dystrophy” or ‘autonomic dysfunction” was performed yielding a cohort of eighty-three patients treated by a common protocol. Most patients were identified in the last 15 years. Most patients with this CRPSI were doubtless coded simply as “foot pain” or “knee pain”, etc and were not identified in this search. Charts were reviewed for patient demographics and outcomes. A subset of patients filled out the Pediatric Outcomes Data Collection Instrument (PODCI) giving a validated pre-treatment disability measure. Results The cohort characteristics were similar to prior reports with respect to age, gender, location, and history of trauma. Of the 26 patients who completed the PODCI before treatment the Pain/Comfort Core Scale score mean was 20.81(0–63). The Global Functioning Scale score mean was 52.11(27–83.5). Eighty-nine percent of 51 patients who attended clinic until their outcome was definite had no or minimal residual pain. Treatment averaged 2.2 visits per patient, typically over a six-week period. Conclusions A simple, inexpensive protocol can be effective in treating CRPSI in children. The protocol is risk free, inexpensive to families and conservative of physician and physical therapy resources. Level of Evidence Therapeutic Level IV. PMID:26361462

  4. Efficacy of transcranial magnetotherapy in the complex treatment of alcohol withdrawal syndrome.

    PubMed

    Staroverov, A T; Zhukov, O B; Raigorodskii, Yu M

    2009-11-01

    A total of 54 patients with alcoholism were studied during abstinence. Of these, 29 patients in the experimental group received basal therapy supplemented with physical treatment consisting of transcranial dynamic magnetotherapy (TcDMT), while the control group of 25 patients received only basal therapy. Comparison of the status of patients in the experimental and control groups during treatment demonstrated advantages of TcDMT in relation to improving the functional state of the CNS, memory, and attention, the autonomic nervous system, and the psychoemotional status of the patients (with decreases in the severity of anxiety and depression). PMID:19830574

  5. Modified Plug Repair with Limited Sphincter Sparing Fistulectomy in the Treatment of Complex Anal Fistulas

    PubMed Central

    Köckerling, Ferdinand; von Rosen, Thomas; Jacob, Dietmar

    2014-01-01

    Purpose: New technical approaches involving biologically derived products have been used to treat complex anal fistulas in order to avoid the risk of fecal incontinence. The least invasive methods involve filling out the fistula tract with fibrin glue or introduction of an anal fistula plug into the fistula canal following thorough curettage. A review shows that the new techniques involving biologically derived products do not confer any significant advantages. Therefore, the question inevitably arises as to whether the combination of a partial or limited fistulectomy, i.e., of the extrasphincteric portion of the fistula, and preservation of the sphincter muscle by repairing the section of the complex anal fistula running through the sphincter muscle and filling it with a fistula plug produces better results. Methods: A modified plug technique was used, in which the extrasphincteric portion of the complex anal fistula was removed by means of a limited fistulectomy and the remaining section of the fistula in the sphincter muscle was repaired using the fistula plug with fixing button. Results: Of the 52 patients with a complex anal fistula, who had undergone surgery using a modified plug repair with limited fistulectomy of the extrasphincteric part of the fistula and use of the fistula plug with fixing button, there are from 40 patients (follow-up rate: 77%) some kind of follow-up informations, after a mean of 19.32?±?6.9?months. Thirty-two were men and eight were women, with a mean age of 52.97?±?12.22?years. Surgery was conducted to treat 36 transsphincteric, 1 intersphincteric, and 3 rectovaginal fistulas. In 36 of 40 patients (90%), the complex anal fistulas or rectovaginal fistulas were completely healed without any sign of recurrence. None of these patients complained about continence problems. Conclusion: A modification of the plug repair of complex anal fistulas with limited fistulectomy of the extrasphincteric part of the fistula and use of the plug with fixing button seems to increase the healing rate in comparison to the standard plug technique. PMID:25593941

  6. Intermittent pneumatic compression acts synergistically with manual lymphatic drainage in complex decongestive physiotherapy for breast cancer treatment-related lymphedema.

    PubMed

    Szolnoky, G; Lakatos, B; Keskeny, T; Varga, E; Varga, M; Dobozy, A; Kemény, L

    2009-12-01

    The application of intermittent pneumatic compression (IPC) as a part of complex decongestive physiotherapy (CDP) remains controversial. The aim of this study was to investigate whether the combination of IPC with manual lymph drainage (MLD) could improve CDP treatment outcomes in women with secondary lymphedema after breast cancer treatment. A randomized study was undertaken with 13 subjects receiving MLD (60 min) and 14 receiving MLD (30 min) plus IPC (30 min) followed by standardized components of CDP including multilayered compression bandaging, physical exercise, and skin care 10 times in a 2-week-period. Efficacy of treatment was evaluated by limb volume reduction and a subjective symptom questionnaire at end of the treatment, and one and two months after beginning treatment. The two groups had similar demographic and clinical characteristics. Mean reductions in limb volumes for each group at the end of therapy, and at one and two months were 7.93% and 3.06%, 9.02% and 2.9%, and 9.62% and 3.6%, respectively (p < 0.05 from baseline for each group and also between groups at each measurement). Although a significant decrease in the subjective symptom survey was found for both groups compared to baseline, no significant difference between the groups was found at any time point. The application of IPC with MLD provides a synergistic enhancement of the effect of CDP in arm volume reduction. PMID:20218087

  7. [Treatment of complex cryptoglandular anal fistulas. Does it still require an experienced surgeon?].

    PubMed

    Roig, José V; García-Armengol, Juan

    2013-02-01

    There is still controversy on the management of complex cryptoglandular fistulas, even after employing the newest, theoretically simple, techniques. A critical review of the literature was performed, in order to clarify the role of the surgeon, where the precarious balance between eradicating sepsis and maintaining anorectal influences the choice. Techniques, such as fistulotomy, immediate sphincter repair or ligature of the inter-sphincter trajectory, are discussed. The new sphincter preserving techniques, such as sealing, use of plugs and cell therapy are also analysed. However, with a few exceptions, the scientific evidence is low or zero, due to the lack of clinical trials and to the large variation in the presentations and technical details that could influence the results. For this reason, experience in treating complex cryptoglandular fistulas is still essential. PMID:22425511

  8. Density functional treatment of water-carbon dioxide van der Waals complex

    SciTech Connect

    Abashkin, Y.; Mele, F.; Russo, N.; Toscano, M.

    1994-12-31

    LCGTO-LSD and LCGTO-NLSD methods have been tested for the study of water-carbon dioxide weakly bound binary complex. Different local and nonlocal exchange-correlation energy functionals and many grid radial points have been used. Results show that both nonlocal corrections and a large number of radial points in the grid are mandatory for well reproducing then experimental data. 19 refs., 1 fig., 2 tabs.

  9. Transcranial magnetotherapy in the complex treatment of affective disorders in patients with alcoholism.

    PubMed

    Staroverov, A T; Vil'yanov, V B; Raigorodskii, Yu M; Rogozina, M A

    2009-06-01

    Transcranial magnetotherapy (TMT) was used in 32 patients with alcoholism (study group) on the background of basal treatment (nootropes, hepatoprotectors, vitamin/mineral formulations, etc.). The influence of this treatment was compared with a control group (30 subjects), in which TMT was replaced with an appropriate (placebo) procedure. All patients, who were aged from 35 to 64 years, had second-degree alcoholism with disease durations of 4-12 years. Patients were in a post-abstinence state during the treatment period. Courses of TMT consisted of 10 daily procedures with exposures of 10-20 min. Somatic, neurological, and laboratory studies were performed before and after treatment and included cardiointervalography, electroencephalography, assessments of the state of the autonomic nervous system, and use of psychometric scales to evaluate levels of anxiety and depression. TMT was followed by improvements in wellbeing, mood, and sleep, with increases in physical exercise tolerance and decreases in alcohol craving in 75% of patients in the study group and 30% of patients in the control group. Improvements in patients' status were supported by paraclinical investigations (electrophysiological, measures of the state of the autonomic nervous system, etc.) and psychometric scales. PMID:19430982

  10. Simple and Complex Post-Traumatic Stress Disorder: Strategies for Comprehensive Treatment in Clinical Practice.

    ERIC Educational Resources Information Center

    Williams, Mary Beth; Sommer, John F., Jr.

    This book delivers state-of-the-art techniques and information for practitioners to help individuals, groups, families, and communities suffering from post-traumatic stress disorder (PTSD). It addresses concerns about the efficacy of critical incident stress debriefing, examines the value of a variety of innovative treatment methods, and explores…

  11. Simple and Complex Post-Traumatic Stress Disorder: Strategies for Comprehensive Treatment in Clinical Practice.

    ERIC Educational Resources Information Center

    Williams, Mary Beth; Sommer, John F., Jr.

    This book delivers state-of-the-art techniques and information for practitioners to help individuals, groups, families, and communities suffering from post-traumatic stress disorder (PTSD). It addresses concerns about the efficacy of critical incident stress debriefing, examines the value of a variety of innovative treatment methods, and explores…

  12. Semantic complexity in treatment of naming deficits in aphasia: Evidence from well-defined categories

    PubMed Central

    Kiran, Swathi; Johnson, Lauren

    2009-01-01

    Purpose Our previous work on manipulating typicality of category exemplars during treatment of naming deficits has shown that training atypical examples generalizes to untrained typical examples but not vice versa. In contrast to natural categories that consist of fuzzy boundaries, well-defined categories (e.g., shapes) have rigid category boundaries. Whether these categories illustrate typicality effects similar to natural categories is under debate. The present study addressed this question in the context of treatment for naming deficits in aphasia. Methods Using a single subject experiment design, three participants with aphasia received a semantic feature treatment to improve naming of either typical or atypical items of shapes, while generalization was tested to untrained items of the category. Results For two of the three participants, training naming of atypical examples of shapes resulted in improved naming of untrained typical examples. Training typical examples in one participant did not improve naming of atypical examples. All three participants, however, showed weak acquisition trends. Conclusions Results of the present study show equivocal support for manipulating typicality as a treatment variable within well defined categories. Instead, these results indicate that acquisition and generalization effects within well defined categories such as shapes are overshadowed by their inherent abstractness. PMID:18845698

  13. Anoxic bio-electrochemical system for treatment of complex chemical wastewater with simultaneous bioelectricity generation.

    PubMed

    Velvizhi, G; Goud, R Kannaiah; Venkata Mohan, S

    2014-01-01

    Bioelectrochemical treatment system (BET) with anoxic anodic microenvironment was studied with chemical wastewater (CW) in comparison with anoxic treatment (AxT, sequencing batch reactor (SBR)) with same parent anaerobic consortia. BET system documented relatively higher treatment efficiency at higher organic load (5.0 kg COD/m(3)) accounting for COD removal efficiency of (90%) along with nitrate (48%), phosphate (51%), sulphates (68%), colour (63%) and turbidity (90%) removal, compared to AxT operation (COD, 47%; nitrate, 36%; phosphate, 32%; sulphate, 35%; colour, 45% and turbidity, 54%). The self-induced bio-potential developed due to the electrode assembly in BET resulted in effective treatment with simultaneous bioelectricity generation (631 mA/m(2)). AxT operation showed persistent reduction behaviour, while simultaneous redox behaviour was observed with BET indicating balanced electron transfer. BET operation illustrated higher wastewater toxicity reduction compared to the AxT system which documents the variation in bio-electrocatalytic behaviour of same consortia under different microenvironment. PMID:24240180

  14. Outcomes of Zilver PTX stent implantation for the treatment of complex femoropopliteal artery disease.

    PubMed

    Fujihara, Masahiko; Utsunomiya, Makoto; Higashimori, Akihiro; Yokoi, Yoshiaki; Nakamura, Masato

    2016-02-01

    The purpose of this study was to evaluate the efficacy of Zilver PTX, the first drug-eluting stent, in patients with complex femoropopliteal (FP) artery disease. Between July 2012 and March 2013, 60 consecutive patients (39 males; mean age: 72.5 ± 8.6 years) with complex risk factors including TASC II C/D lesions, in-stent restenosis (ISR) and/or on haemodialysis underwent successful Zilver PTX implantation for symptomatic FP artery disease. The primary outcome was primary patency, which was defined as freedom from restenosis at 12 months, as verified by duplex ultrasound. Secondary outcomes included the technical success rate, the freedom from target lesion revascularisation (TLR) rate and the amputation-free survival (AFS) rate. The average follow-up period was 13.2 ± 5.3 months. 62 % of the patients had TASC II C/D lesions, 35.0 % experienced ISR, and 41.6 % were on haemodialysis. The mean lesion length was 188 ± 96 mm. The technical success rate was 98.3 %. The primary patency rate was 50.2 %, the freedom from clinically driven TLR rate was 68.6 %, and the AFS rate was 83.2 % at 12 months. In conclusion, Zilver PTX stent implantation for complex FP artery disease did not affect long-term durability. PMID:25351136

  15. Terminal ventriculostomy as an adjuvant treatment of complex syringomyelia: a case report and review of the literature.

    PubMed

    Wilson, David A; Fusco, David J; Rekate, Harold L

    2011-07-01

    Complex syringomyelia is multifactorial, and treatment strategies are highly individualized. In refractory cases, sectioning of the filum terminale, also known as terminal ventriculostomy, has been described as a potential adjuvant treatment to alleviate syrinx progression. A 10-year-old boy with a history of arachnoiditis presented with complex syringomyelia, progressive lower extremity motor weakness, and spasticity. Previously, he had failed spinal cord detethering and direct syrinx shunting. Imaging studies demonstrated a holocord syrinx extending to the level of his conus medullaris and into the filum terminale. The patient underwent an uncomplicated lumbar laminectomy and transection of the filum terminale. Operative pathologic specimens demonstrated a dilated central canal within the filum. Postoperative imaging demonstrated significant reduction in the diameter of the syrinx. At follow-up, the patient's motor symptoms had improved. Terminal ventriculostomy may be a useful adjuvant in treating caudally placed syringes refractory to other treatments. This procedure carries low neurological risk and involves no hardware implantation. In select cases, terminal ventriculostomy may help preserve neurological function in the face of otherwise progressive syringomyelia. PMID:21523358

  16. A rational approach towards successful crystallization and crystal treatment of human cytomegalovirus protease and its inhibitor complex.

    PubMed

    Qian, C; Lagacé, L; Massariol, M J; Chabot, C; Yoakim, C; Déziel, R; Tong, L

    2000-02-01

    The crystallization and subsequent crystal treatment of both free human cytomegalovirus (hCMV) protease and its inhibitor complexes are reported. For free-enzyme crystals, diffraction was greatly improved by optimizing the crystallization conditions, raising the precipitant concentration in the reservoir and soaking the crystals in artificial mother liquors. Each of the six components in the final crystallization formula (16% PEG 4000, 0.1 M MES pH 6.0, 0.4 M LiCl, 10% glycerol, 5% t-butanol and 5 mM Na(2)S(2)O(3)) plays a distinctive role and is indispensable. A synergistic effect of Na(2)SO(4) and t--butanol on diffraction was observed and studied. A 2.0 A multiwavelength anomalous diffraction (MAD) data set was collected using a synchrotron-radiation source, leading to the elucidation of the three-dimensional structure of the enzyme. For the inhibitor-complex crystals, initial attempts with co-crystallization and soaking experiments at pH 6.0 did not produce conclusive results. Subsequently, experiments were designed to co-crystallize the complex at pH 8.0, the optimal pH for the enzyme and the inhibitor activity. Using 20-50 mM spermine in the crystallization buffer, crystals of two peptidomimetic inhibitor complexes were obtained at pH 7.5 and 8.0. Spermine was required for the inhibitor complexes to be crystallized at pH 8.0, possibly neutralizing net negative charges of hCMV protease owing to its acidic pI of 5.5. A 2.7 A data set was collected from one of the inhibitor complexes and the structure was determined using the molecular-replacement method. PMID:10666597

  17. Autonomous Modeling, Statistical Complexity and Semi-annealed Treatment of Boolean Networks

    NASA Astrophysics Data System (ADS)

    Gong, Xinwei

    This dissertation presents three studies on Boolean networks. Boolean networks are a class of mathematical systems consisting of interacting elements with binary state variables. Each element is a node with a Boolean logic gate, and the presence of interactions between any two nodes is represented by directed links. Boolean networks that implement the logic structures of real systems are studied as coarse-grained models of the real systems. Large random Boolean networks are studied with mean field approximations and used to provide a baseline of possible behaviors of large real systems. This dissertation presents one study of the former type, concerning the stable oscillation of a yeast cell-cycle oscillator, and two studies of the latter type, respectively concerning the statistical complexity of large random Boolean networks and an extension of traditional mean field techniques that accounts for the presence of short loops. In the cell-cycle oscillator study, a novel autonomous update scheme is introduced to study the stability of oscillations in small networks. A motif that corrects pulse-growing perturbations and a motif that grows pulses are identified. A combination of the two motifs is capable of sustaining stable oscillations. Examining a Boolean model of the yeast cell-cycle oscillator using an autonomous update scheme yields evidence that it is endowed with such a combination. Random Boolean networks are classified as ordered, critical or disordered based on their response to small perturbations. In the second study, random Boolean networks are taken as prototypical cases for the evaluation of two measures of complexity based on a criterion for optimal statistical prediction. One measure, defined for homogeneous systems, does not distinguish between the static spatial inhomogeneity in the ordered phase and the dynamical inhomogeneity in the disordered phase. A modification in which complexities of individual nodes are calculated yields vanishing complexity values for networks in the ordered and critical phases and for highly disordered networks, peaking somewhere in the disordered phase. Individual nodes with high complexity have, on average, a larger influence on the system dynamics. Lastly, a semi-annealed approximation that preserves the correlation between states at neighboring nodes is introduced to study a social game-inspired network model in which all links are bidirectional and all nodes have a self-input. The technique developed here is shown to yield accurate predictions of distribution of players' states, and accounts for some nontrivial collective behavior of game theoretic interest.

  18. Bronchoscopic treatment of complex persistent air leaks with endobronchial one-way valves.

    PubMed

    Fiorelli, Alfonso; Costanzo, Saveria; Carelli, Emanuele; Di Costanzo, Emilio; Santini, Mario

    2016-04-01

    We reported a case series including 5 patients with persistent air-leaks refractory to standard treatment. All patients were unfit for surgery for the presence of co-morbidities and/or severe respiratory failure due to underlying lung diseases. They were successfully treated with bronchoscopic placement of endobronchial one-way valves. Air-leaks stopped in the first 24 h after the procedure in three patients and 3 and 5 days later, respectively, in the remaining two. No complications were observed and follow-up was uneventful in all patients but one died 25 days after the procedure for systemic sepsis due to peritonis. Patients with important, refractory air leaks having clinical repercussions and unfit for surgery should be early reviewed for bronchoscopic valves treatment. PMID:25245055

  19. [Pathogenetic aspects of complex treatment of Dupuytren's contracture in patients with chronic hepatitis].

    PubMed

    Iskra, N I; Hur'iev, S O; Kuz'min, V Iu; Kukuruz, Ia S

    2011-03-01

    The results of Dupuytren's contracture treatment in patients, suffering chronic hepatitis with the hand deformity grade II and III, in the injured persons and liquidators of the Chernobyl disaster consequences, conducted in 2000-2010 yrs., were adduced. Beginning from the third week, when an active movements had emerged, the patients were treated locally, including lidase and solution, which consisted of dimexid, isotonic saline and furazolidon. PMID:21695974

  20. [Effect of complex sanatorium treatment including magnetotherapy on hemodynamics in patients with arterial hypertension].

    PubMed

    Efremushkin, G G; Duruda, N V

    2003-01-01

    Forty nine patients with arterial hypertension of stage I-II received combined sanatorium treatment. Of them, 21 had adjuvant total magnetotherapy. All the patients were examined for parameters of central, cerebral hemodynamics and microcirculation. The adjuvant magnetotherapy produced a beneficial effect on hypertension: clinical symptoms attenuated, arterial pressure became more stable, hemodynamics improved, duration of hospitalization reduced, requirement in hypotensive drugs diminished. PMID:12852007

  1. [Use of adaptogens for antioxidant system correction in complex treatment of mandibular fractures].

    PubMed

    Ushnitsky, I D; Terenteva, Z V; Kerschengolts, B M; Vinocurov, M M; Voronov, I V; Egorova, L I

    2015-01-01

    Antioxidatic protection has been studied in 84 patients with mandibular fractures between the ages of 21 and 40; the patients were divided into two groups. Activation of lipid peroxidation in both groups was revealed. The increase of antioxidant's activity system in 37.18% in the main study group that along with traditional treatment received Epsorin was determined. No complications in the main group during the post-surgery period were recorded. PMID:26271700

  2. Typicality of Inanimate Category Exemplars in Aphasia Treatment: Further Evidence for Semantic Complexity

    PubMed Central

    Kiran, Swathi

    2009-01-01

    Purpose The typicality treatment approach on improving naming was investigated within two inanimate categories (furniture and clothing) using a single subject experimental design across participants and behaviors in five patients with aphasia. Method Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results Results indicated that two out of four patients trained on naming of atypical examples demonstrated generalization to naming untrained typical examples. One patient showed trends towards generalization but did not achieve criterion. Further, four out of four patients trained on typical examples demonstrated no generalized naming to untrained atypical examples within the category. Also, analysis of errors indicated an evolution of errors as a result of treatment, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Conclusions These results extend our previous findings (Kiran & Thompson, 2003) to patients with nonfluent aphasia and to inanimate categories such as furniture and clothing. Additionally, the results provide support for the claim that training atypical examples is a more efficient method to facilitating generalization to untrained items within a category than training typical examples (Kiran, 2007). PMID:18695023

  3. AB061. Trickier and tips for surgical treatment of complex male urethral fistula

    PubMed Central

    Wang, Kunjie; Li, Hong

    2015-01-01

    The male urethral fistula is the common and difficult complication of the surgical treatments of urethral stricture, hypospadias and prostate disease. Surgical reconstruction remains the mainstay in the management. Sometime the surgical therapy of the male urethral fistula is still a challenge. The key point of the treatment of anterior urethral fistula is using Dartos Fascia flap to overlapping it in one-two layer fashion. For posterior urethra, rectourethral fistula is great challenge. But unfortunately, the rectourethral fistula is becoming increasingly common with earlier diagnosis of prostate cancer, which is amenable to treatment with radical prostatectomy. Surgical approaches for definitive repair include the perineal, transanal, and combined abdominoperineal approaches. Perineal approach is good for rectourethral fistula with posterior urethral stricture. Transanal approach, the York-Mason approach, is good choice for small rectourethral fistula without posterior urethral stricture. We also use a new approach with combine perineal approach with transanal approach for some big rectourethral fistula without posterior urethral stricture. Among the numerous methods for closure of rectourinary fistulae, no single procedure has been proved most efficacious. However, it has become clear that a more aggressive surgical approach is necessary when local tissue integrity is dubious.

  4. [Local ozone therapy in the complex surgical treatment of pulmonary and pleural tuberculosis patients].

    PubMed

    Dobkin, V G; Sadovnikova, S S; Kuz'min, G P; Bondarev, G B

    2001-01-01

    The found bactericidal activity of ozone and oxygen mixture containing ozone, 10 mg/l, and ozoned solutions of furacilin (dilution 1:5000) and chlorohexidine (0.05%) against the nonspecific microflora and Mycobacteria tuberculosis allowed them to be used in the treatment of 55 patients with pleural empyema. Analyzing the outcomes of treatment in these patients versus 59 matched patients indicated that local ozone therapy accelerated sanitation and stimulation of reparative processes in this disease on the average by a fortnight. Local ozone therapy used in the preoperative preparation of patients with pulmonary tuberculosis and pleural empyema reduced the number of purulent postoperative complication to 17.7% versus 30.4% in the controls, enhanced the efficiency of multimodality treatment by 15.6% and reduced mortality by 9.5%. Analyzing the results of prevention of purulent bronchopleural complications after pleuropulmonectomy in 31 patients in the experimental group and in 35 in the control one showed that with local ozone therapy, complications occurred in 16.1 and 28.6%, respectively, and the efficiency of surgical management increased by 13.1% and mortality rates reduced by 9.6%. PMID:11763554

  5. Evolving Strategies in the Treatment of Tuberous Sclerosis Complex-associated Angiomyolipomas (TSC-AML).

    PubMed

    Kapoor, Anil; Girard, Louis; Lattouf, Jean-Baptiste; Pei, York; Rendon, Ricardo; Card, Paul; So, Alan

    2016-03-01

    Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder characterized by the development of numerous benign tumors that occur in multiple organ systems throughout the lifetime of the affected individuals. Renal angiomyolipomas occur in up to 80% of TSC patients, and chronic kidney disease from increasing tumor burden is the primary cause of TSC-related mortality. Our review evaluates evidence for localized and systemic therapy in the management of TSC-angiomyolipomas. Urologists or nephrologists experienced in TSC disease should coordinate the care of TSC patients with renal involvement to improve care and reduce costs. PMID:26723178

  6. Treatment of VGKC complex antibody-associated limbic encephalitis: a systematic review.

    PubMed

    Radja, Guirindhra Koumar; Cavanna, Andrea Eugenio

    2013-01-01

    Limbic encephalitis is an autoimmune neuropsychiatric condition characterized by subacute cognitive symptoms, seizures, and affective changes. Although limbic encephalitis is usually caused by an immune reaction secondary to neoplasms, different types of potentially treatable non-paraneoplastic limbic encephalitis (nPLE) have recently been described. In particular, published studies have reported variable responses to immunosuppressive therapy in Voltage-Gated Potassium Channel (VGKC) complex antibody-associated nPLE. This systematic literature review found that the most significant improvements were reported by patients presenting with affective symptoms and consistent neuroradiological changes. In these patients, improved clinical outcomes correlated with the largest decreases in antibody titers. PMID:24247853

  7. DIAGNOSIS AND SURGICAL TREATMENT OF A COMPLEX ANGULAR HIND LIMB DEFORMITY IN A SERVAL (FELIS SERVAL).

    PubMed

    Summa, Noémie M; Eshar, David; Bichot, Sylvain; Smith, Dale A; Moens, Noel M M

    2015-09-01

    A 2-yr-old neutered male pet serval (Felis serval) was presented for progressive hind limb lameness that started at 6 mo of age. Previous therapy included only nutritional supplementation. Direct and video gait analysis confirmed bilateral hind limb lameness, more severe on the right. Physical examination and radiography revealed a multifocal complex bilateral angular deformity with a significant rotational component. A right tibial corrective osteotomy was followed by internal rotation and stabilization with a 2.7-mm eight-hole locking compression plate and locking screws. Other deformities were not corrected. Clinical improvement was noted immediately and has been maintained over the 16-mo follow-up. PMID:26352971

  8. Carpal contusions in an elite platform diver.

    PubMed

    Berkoff, David; Boggess, Blake

    2011-01-01

    Wrist and hand injuries are common in elite divers, as all correctly performed dives end with a head first entry into the water with the hands extended above the head. This case presentation was an Olympic level diver with 3 months of persistent dorsal wrist pain. MRI findings showed contiguous contusions to the lunate, capitate, hamate and distal radius and also a peripheral tear of the ulnar attachment of the triangular fibrocartilage complex (TFCC). The repeated dorsiflexion stress of entry into the water likely caused these injuries. Although the authors had suspected a TFCC injury and did find an isolated ulnar-sided peripheral tear, the complicating carpal contusions led us to choose a conservative treatment plan, which was the only intervention the patient ultimately required. PMID:22707598

  9. Carpal contusions in an elite platform diver

    PubMed Central

    Berkoff, David; Boggess, Blake

    2011-01-01

    Wrist and hand injuries are common in elite divers, as all correctly performed dives end with a head first entry into the water with the hands extended above the head. This case presentation was an Olympic level diver with 3 months of persistent dorsal wrist pain. MRI findings showed contiguous contusions to the lunate, capitate, hamate and distal radius and also a peripheral tear of the ulnar attachment of the triangular fibrocartilage complex (TFCC). The repeated dorsiflexion stress of entry into the water likely caused these injuries. Although the authors had suspected a TFCC injury and did find an isolated ulnar-sided peripheral tear, the complicating carpal contusions led us to choose a conservative treatment plan, which was the only intervention the patient ultimately required. PMID:22707598

  10. Treatment of complex dissociative disorders: a comparison of interventions reported by community therapists versus those recommended by experts.

    PubMed

    Myrick, Amie C; Chasson, Gregory S; Lanius, Ruth A; Leventhal, Barry; Brand, Bethany L

    2015-01-01

    There is a paucity of empirical data to assist clinicians in choosing interventions to use with patients with complex dissociative disorder (DD; i.e., dissociative identity disorder and dissociative disorder not otherwise specified) at different stages in treatment. This study compared interventions used by a sample of international outpatient therapists treating DD clients in the 1st 2 stages of treatment with those recommended by expert DD therapists. There were many similarities between therapists' and experts' interventions, including the use of several emotion regulation and dissociation-focused interventions. However, community therapists reported significantly less focus on relationally oriented interventions, teaching and using grounding and containment skills, and stabilizing patients after revictimization by alleged perpetrators. This study has important implications for the development and implementation of training opportunities for DD therapists. PMID:25365637

  11. The Role of Semantic Complexity in Treatment of Naming Deficits: Training Semantic Categories in Fluent Aphasia by Controlling Exemplar Typicality

    PubMed Central

    Kiran, Swathi; Thompson, Cynthia K.

    2007-01-01

    The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed. PMID:12959459

  12. Postoperative evaluation of the surgical treatment of accessory teat and gland cistern complexes in dairy cows.

    PubMed Central

    Schmit, K A; Arighi, M; Dobson, H

    1994-01-01

    The purpose of this study was the long-term evaluation of a method of surgically repairing the abnormal condition of accessory teat and gland cistern complexes in dairy cattle. A prospective evaluation of three cows that had undergone the procedure was done. These cows were evaluated from four months to one year, postoperatively. A thorough history, physical examination, contrast radiography, and ultrasonic examination were done on each cow. A retrospective evaluation of an additional 13 cows that had also undergone the procedure was obtained four months to three years following the surgery, via owner communication. The prospective portion of this study demonstrated patency of the communication between main and accessory teat cisterns. Postoperative complications included initial slow milking and mild swelling of the involved teat. These problems resolved in all cows one to two months postoperatively. None of the 16 cows that had undergone the surgery either developed or was treated for mastitis. Likewise, none of these cows was sold or slaughtered as a result of postoperative teat problems or unsatisfactory milk production. Our study demonstrated that this particular method of surgical correction of accessory teat and gland cistern complexes is effective, is esthetically acceptable, produces minimal associated complications, and preserves the milk production capacity of the gland. Images Figure 2. Figure 4. Figure 5. Figure 6. PMID:8044754

  13. Finite Element Modeling of Endovascular Intervention Enables Hemodynamic Prediction of Complex Treatment Strategies for Coiling and Flow Diversion

    PubMed Central

    Damiano, Robert J.; Ma, Ding; Xiang, Jianping; Siddiqui, Adnan H.; Snyder, Kenneth V.; Meng, Hui

    2016-01-01

    Endovascular interventions using coil embolization and flow diversion are becoming the mainstream treatment for intracranial aneurysms (IAs). To help assess the effect of intervention strategies on aneurysm hemodynamics and treatment outcome, we have developed a finite-element-method (FEM)-based technique for coil deployment along with our HiFiVS technique for flow diverter (FD) deployment in patient-specific IAs. We tested four clinical intervention strategies: coiling (1–8 coils), single FD, FD with adjunctive coils (1–8 coils), and overlapping FDs. By evaluating post-treatment hemodynamics using computational fluid dynamics (CFD), we compared the flow-modification performance of these strategies. Results show that a single FD provides more reduction in inflow rate than low PD coiling, but less reduction in average velocity inside the aneurysm. Adjunctive coils add no additional reduction of inflow rate beyond a single FD until coil PD exceeds 11%. This suggests that the main role of FDs is to divert inflow, while that of coils is to create stasis in the aneurysm. Overlapping FDs decreases inflow rate, average velocity, and average wall shear stress (WSS) in the aneurysm sac, but adding a third FD produces minimal additional reduction. In conclusion, our FEM-based techniques for virtual coiling and flow diversion enable recapitulation of complex endovascular intervention strategies and detailed hemodynamics to identify hemodynamic factors that affect treatment outcome. PMID:26169778

  14. Finite element modeling of endovascular coiling and flow diversion enables hemodynamic prediction of complex treatment strategies for intracranial aneurysm.

    PubMed

    Damiano, Robert J; Ma, Ding; Xiang, Jianping; Siddiqui, Adnan H; Snyder, Kenneth V; Meng, Hui

    2015-09-18

    Endovascular interventions using coil embolization and flow diversion are becoming the mainstream treatment for intracranial aneurysms (IAs). To help assess the effect of intervention strategies on aneurysm hemodynamics and treatment outcome, we have developed a finite-element-method (FEM)-based technique for coil deployment along with our HiFiVS technique for flow diverter (FD) deployment in patient-specific IAs. We tested four clinical intervention strategies: coiling (1-8 coils), single FD, FD with adjunctive coils (1-8 coils), and overlapping FDs. By evaluating post-treatment hemodynamics using computational fluid dynamics (CFD), we compared the flow-modification performance of these strategies. Results show that a single FD provides more reduction in inflow rate than low packing density (PD) coiling, but less reduction in average velocity inside the aneurysm. Adjunctive coils add no additional reduction of inflow rate beyond a single FD until coil PD exceeds 11%. This suggests that the main role of FDs is to divert inflow, while that of coils is to create stasis in the aneurysm. Overlapping FDs decreases inflow rate, average velocity, and average wall shear stress (WSS) in the aneurysm sac, but adding a third FD produces minimal additional reduction. In conclusion, our FEM-based techniques for virtual coiling and flow diversion enable recapitulation of complex endovascular intervention strategies and detailed hemodynamics to identify hemodynamic factors that affect treatment outcome. PMID:26169778

  15. Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy alone and in combination with intermittent pneumatic compression.

    PubMed

    Haghighat, S; Lotfi-Tokaldany, M; Yunesian, M; Akbari, M E; Nazemi, F; Weiss, J

    2010-03-01

    There is no cure for breast cancer related lymphedema. This study was conducted to compare two treatment methods for postmastectomy lymphedema: Complex Decongestive Therapy (CDT) and Modified CDT (MCDT) combined with Intermittent Pneumatic Compression (IPC). One hundred and twelve patients referred to the Lymphedema Clinic of the Iranian Center for Breast Cancer in 2008, were included in a randomized clinical trial. They were randomly allocated into two equal groups receiving daily CDT alone or in combination with IPC. The volume reduction of the upper limb was measured by water displacement volumetry. No statistically significant differences in demographic and clinical variables between the two groups were observed. During the intensive phase (phase I) of treatment, CDT alone yielded a significantly higher mean volume reduction than the combination modality (43.1% vs. 37.5%; p = 0.036). Limb volume measured three months following treatment, showed 16.9% volume reduction by CDT alone, and 7.5% reduction by MCDT plus IPC. This study demonstrated that the use of CDT alone, or in combination with IPC significantly reduced limb volume in patients with post mastectomy lymphedema. CDT alone provided better results in both treatment phases. Further studies will help to define the role of multidisciplinary approaches in the management of postmastectomy lymphedema. PMID:20552817

  16. Combination treatment with atorvastatin plus niacin provides effective control of complex dyslipidemias: a literature review.

    PubMed

    McKenney, James M

    2012-01-01

    Patients with dyslipidemia receive a cardiovascular benefit from lowering low-density lipoprotein cholesterol (LDL-C). Atorvastatin is currently one of the most effective approved medications for lowering LDL-C, and has been shown to significantly reduce cardiovascular risk in many patient groups. However, even with substantial lowering of LDL-C with atorvastatin, patients still have a residual risk for coronary heart disease. Elevated triglyceride levels and low high-density lipoprotein cholesterol (HDL-C) levels may contribute to this risk. Approved medications targeting these secondary lipid parameters include fibrates, omega-3 fatty acids, and niacin. Among these medications, niacin provides the optimal increase in HDL-C levels and has efficacy similar to the other medications in lowering triglyceride levels. However, there are challenges to adherence with niacin treatment. The most common challenge during niacin treatment is flushing, although it typically decreases with ongoing use and can be ameliorated by pretreatment with aspirin and counseling by the prescriber. A combination of atorvastatin and niacin may provide more complete normalization of the lipid profile and increased cardiovascular benefits. A literature review of the PubMed and Embase databases was conducted for clinical studies that reported on the lipid-modifying efficacy of the atorvastatin plus niacin combination. Identified studies involved patients at risk for coronary heart disease and patients with established coronary heart disease. Overall, the studies were small but indicated that atorvastatin in combination with niacin was efficacious in normalizing lipid parameters. Larger lipid studies as well as studies evaluating cardiovascular outcomes during atorvastatin plus niacin treatment are warranted. PMID:22314110

  17. Complex Dynamics of an SIR Epidemic Model with Saturated Incidence Rate and Treatment.

    PubMed

    Jana, Soovoojeet; Nandi, Swapan Kumar; Kar, T K

    2016-03-01

    This paper describes a traditional SIR type epidemic model with saturated infection rate and treatment function. The dynamics of the model is studied from the point of view of stability and bifurcation. Basic reproduction number is obtained and it is shown that the model system may possess a backward bifurcation. The global asymptotic stability of the endemic equilibrium is studied with the help of a geometric approach. Optimal control problem is formulated and solved. Some numerical simulation works are carried out to validate our analytical results. PMID:26566620

  18. [Using cycloferon in the complex treatment of herpetic infection in patients with atopic dermatitis].

    PubMed

    Barkhatova, T S; Shul'diakov, A A; Gavrilova, I B; Sretenskaia, D A

    2014-01-01

    Clinical efficacy of including cycloferon liniment in combined treatment of herpetic infection in a group of 40 patients with atopic dermatitis has been analyzed. It is concluded that the administration of cycloferon favors dynamic disappearance of general infectious syndrome, reduces timeline of rash as well as length of local inflammation, accelerates epithelization of erosions (on the average 1.2 - 1.4 times, p < 0.05), decreases frequency of recurrent infections, and reduces the level of pro-inflammatory cytokines in the blood of patients. PMID:24800525

  19. Complex PTSD: research directions for nosology/assessment, treatment, and public health

    PubMed Central

    Ford, Julian D.

    2015-01-01

    Complex posttraumatic stress disorder (CPTSD) in children and adolescents extends beyond the core PTSD symptoms to dysregulation in three psychobiological domains: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational functioning. CPTSD research directions for the next decade and beyond are identified in three areas: (1) diagnostic classification (establishing the empirical integrity of CPTSD as a distinct form of psychopathology) and psychometric assessment [validation and refinement of measures of childhood polyvictimization and developmental trauma disorder (DTD)], (2) rigorous evaluation and refinement of interventions (and algorithms for their delivery) developed or adapted for CPTSD and DTD, and (3) the epidemiology of CPTSD and DTD, and their public health and safety impact, across the lifespan and intergenerationally, for populations, nations, and cultures. PMID:25994023

  20. Complex PTSD: research directions for nosology/assessment, treatment, and public health.

    PubMed

    Ford, Julian D

    2015-01-01

    Complex posttraumatic stress disorder (CPTSD) in children and adolescents extends beyond the core PTSD symptoms to dysregulation in three psychobiological domains: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational functioning. CPTSD research directions for the next decade and beyond are identified in three areas: (1) diagnostic classification (establishing the empirical integrity of CPTSD as a distinct form of psychopathology) and psychometric assessment [validation and refinement of measures of childhood polyvictimization and developmental trauma disorder (DTD)], (2) rigorous evaluation and refinement of interventions (and algorithms for their delivery) developed or adapted for CPTSD and DTD, and (3) the epidemiology of CPTSD and DTD, and their public health and safety impact, across the lifespan and intergenerationally, for populations, nations, and cultures. PMID:25994023

  1. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.

    PubMed Central

    Marin, M L; Veith, F J; Cynamon, J; Sanchez, L A; Lyon, R T; Levine, B A; Bakal, C W; Suggs, W D; Wengerter, K R; Rivers, S P

    1995-01-01

    OBJECTIVES: Complex arterial occlusive, traumatic, and aneurysmal lesions may be difficult or impossible to treat successfully by standard surgical techniques when severe medical or surgical comorbidities exist. The authors describe a single center's experience over a 2 1/2-year period with 96 endovascular graft procedures performed to treat 100 arterial lesions in 92 patients. PATIENTS AND METHODS: Thirty-three patients had 36 large aortic and/or peripheral artery aneurysms, 48 had 53 multilevel limb-threatening aortoiliac and/or femoropopliteal occlusive lesions, and 11 had traumatic arterial injuries (false aneurysms and arteriovenous fistulas). Endovascular grafts were placed through remote arteriotomies under local (16[17%]), epidural (42[43%]), or general (38[40%]) anesthesia. RESULTS: Technical and clinical successes were achieved in 91% of the patients with aneurysms, 91% with occlusive lesions, and 100% with traumatic arterial lesions. These patients and grafts have been followed from 1 to 30 months (mean, 13 months). The primary and secondary patency rates at 18 months for aortoiliac occlusions were 77% and 95%, respectively. The 18-month limb salvage rate was 98%. Immediately after aortic aneurysm exclusion, a total of 6 (33%) perigraft channels were detected; 3 of these closed within 8 weeks. Endovascular stented graft procedures were associated with a 10% major and a 14% minor complication rate. The overall 30-day mortality rate for this entire series was 6%. CONCLUSIONS: This initial experience with endovascular graft repair of complex arterial lesions justifies further use and careful evaluation of this technique for major arterial reconstruction. Images Figure 1. Figure 4. Figure 5. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 11. PMID:7574926

  2. Numerical optimization of targeted delivery of charged nanoparticles to the ostiomeatal complex for treatment of rhinosinusitis

    PubMed Central

    Xi, Jinxiang; Yuan, Jiayao Eddie; Si, Xiuhua April; Hasbany, James

    2015-01-01

    Background Despite the prevalence of rhinosinusitis that affects 10%–15% of the population, current inhalation therapy shows limited efficacy. Standard devices deliver <5% of the drugs to the sinuses due to the complexity of nose structure, secluded location of the sinus, poor ventilation, and lack of control of particle motions inside the nasal cavity. Methods An electric-guided delivery system was developed to guide charged particles to the ostiomeatal complex (OMC). Its performance was numerically assessed in an MRI-based nose–sinus model. Key design variables related to the delivery device, drug particles, and patient breathing were determined using sensitivity analysis. A two-stage optimization of design variables was conducted to obtain the best performance of the delivery system using the Nelder-Mead algorithm. Results and discussion The OMC delivery system exhibited high sensitivity to the applied electric field and electrostatic charges carried by the particles. Through the synthesis of electric guidance and point drug release, the new delivery system eliminated particle deposition in the nasal valve and turbinate regions and significantly enhanced the OMC doses. An OMC delivery efficiency of 72.4% was obtained with the optimized design, which is one order of magnitude higher than the standard nasal devices. Moreover, optimization is imperative to achieve a sound delivery protocol because of the large number of design variables. The OMC dose increased from 45.0% in the baseline model to 72.4% in the optimized system. The optimization framework developed in this study can be easily adapted for the delivery of drugs to other sites in the nose such as the ethmoid sinus and olfactory region. PMID:26257521

  3. Multimodal treatment strategies for complex pediatric cerebral arteriovenous fistulas: contemporary case series at Barrow Neurological Institute.

    PubMed

    Zaidi, Hasan A; Kalani, M Yashar S; Spetzler, Robert F; McDougall, Cameron G; Albuquerque, Felipe C

    2015-06-01

    OBJECT Pediatric cerebral arteriovenous fistulas (AVFs) are rare but potentially lethal vascular lesions. Management strategies for these lesions have undergone considerable evolution in the last decade with the advent of new endovascular, surgical, and radiosurgical technologies. This study sought to review current treatment strategies and long-term clinical outcomes at a high-volume cerebrovascular institute. METHODS A retrospective chart review was performed on patients with a diagnosis of cerebral AVF from 1999 to 2012. Patients with carotid-cavernous fistulas, vein of Galen malformations, and age > 18 years were excluded from final analysis. Medical history, surgical and nonsurgical treatment, and clinical outcomes were documented. Pre- and postoperative angiograms were analyzed to assess for obliteration of the fistula. RESULTS Seventeen patients with pial AVFs (29.4%), dural AVFs (64.7%), or mixed pial/dural AVFs (5.9%) were identified. The majority of lesions were paramedian (70.6%) and supratentorial (76.5%). The study population had a mean age of 6.4 years, with a slight male predominance (52.9%), and the most common presenting symptoms were seizures (23.5%), headaches (17.6%), congestive heart failure (11.7%), and enlarging head circumference (11.7%). Among patients who underwent intervention (n = 16), 56.3% were treated with endovascular therapy alone, 6.3% were treated with open surgery alone, and 37.5% required a multimodal approach. Overall, 93.8% of the treated patients received endovascular treatment, 43.8% received open surgery, and 12.5% received radiosurgery. Endovascular embolysates included Onyx (n = 5), N-butyl cyanoacrylate (NBCA; n = 4), or coil embolization (n = 7) with or without balloon assistance (n = 2). Complete angiographic obliteration was achieved in 87.5% at the last follow-up evaluation (mean follow-up 3.1 years). One infant with incomplete AVF obliteration died of congestive heart failure, and 1 patient with complete obliteration died of acute sinus thrombosis, with an overall complication rate of 18.8%. CONCLUSIONS Pediatric cerebral AVFs are challenging neurosurgical lesions. Although advancements in endovascular therapy in the last decade have greatly changed the natural course of this disease, a multidisciplinary approach remains necessary for a large subset of patients. Surgeon experience with a thorough analysis of preoperative imaging is paramount to achieving acceptable clinical outcomes. PMID:25815632

  4. [Surgical correction of damage in complex treatment of patients with metabolic syndrome].

    PubMed

    Sedov, V M; Fishman, M B; Kuprin, P E; Solov'eva, M O; Muzhikov, S P

    2011-01-01

    The authors have analyzed results of treatment of 407 patients subjected to different bariatric interventions. In 359 out of them there were different bariatric operations, in 48 patients intragastric balloons were placed. Correcting plastic operations were fulfilled in 36 patients within 1-2 years after bariatric intervention. It was found that bariatric intervention fulfilled in earlier age groups would prevent the development of metabolic syndrome (MS) in patients with obesity at later date. Combined operations are most effective bariatric intervention compared with all main elements of MS. Correcting plastic operations are expedient after bariatric interventions against the background of stabilized decrease of body mass that allows getting valuable therapeutic and esthetic effect, improvement of quality of life of patients. PMID:21674931

  5. Evaluation of polyelectrolyte complex-based scaffolds for mesenchymal stem cell therapy in cardiac ischemia treatment.

    PubMed

    Ceccaldi, Caroline; Bushkalova, Raya; Alfarano, Chiara; Lairez, Olivier; Calise, Denis; Bourin, Philippe; Frugier, Celine; Rouzaud-Laborde, Charlotte; Cussac, Daniel; Parini, Angelo; Sallerin, Brigitte; Fullana, Sophie Girod

    2014-02-01

    Three-dimensional (3D) scaffolds hold great potential for stem cell-based therapies. Indeed, recent results have shown that biomimetic scaffolds may enhance cell survival and promote an increase in the concentration of therapeutic cells at the injury site. The aim of this work was to engineer an original polymeric scaffold based on the respective beneficial effects of alginate and chitosan. Formulations were made from various alginate/chitosan ratios to form opposite-charge polyelectrolyte complexes (PECs). After freeze-drying, the resultant matrices presented a highly interconnected porous microstructure and mechanical properties suitable for cell culture. In vitro evaluation demonstrated their compatibility with mesenchymal stell cell (MSC) proliferation and their ability to maintain paracrine activity. Finally, the in vivo performance of seeded 3D PEC scaffolds with a polymeric ratio of 40/60 was evaluated after an acute myocardial infarction provoked in a rat model. Evaluation of cardiac function showed a significant increase in the ejection fraction, improved neovascularization, attenuated fibrosis as well as less left ventricular dilatation as compared to an animal control group. These results provide evidence that 3D PEC scaffolds prepared from alginate and chitosan offer an efficient environment for 3D culturing of MSCs and represent an innovative solution for tissue engineering. PMID:24211733

  6. Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches.

    PubMed

    Leung, Donald Y M; Guttman-Yassky, Emma

    2014-10-01

    Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It often precedes the development of food allergy and asthma. Recent insights into AD reveal abnormalities in terminal differentiation of the epidermal epithelium leading to a defective stratum corneum, which allows enhanced allergen penetration and systemic IgE sensitization. Atopic skin is also predisposed to colonization or infection by pathogenic microbes, most notably Staphylococcus aureus and herpes simplex virus. Causes of this abnormal skin barrier are complex and driven by a combination of genetic, environmental, and immunologic factors. These factors likely account for the heterogeneity of AD onset and the severity and natural history of this skin disease. Recent studies suggest prevention of AD can be achieved through early interventions to protect the skin barrier. Onset of lesional AD requires effective control of local and systemic immune activation for optimal management. Early intervention might improve long-term outcomes for AD and reduce the systemic allergen sensitization that leads to associated allergic diseases in the gastrointestinal and respiratory tract. PMID:25282559

  7. A boundary collocation meshfree method for the treatment of Poisson problems with complex morphologies

    NASA Astrophysics Data System (ADS)

    Soghrati, Soheil; Mai, Weijie; Liang, Bowen; Buchheit, Rudolph G.

    2015-01-01

    A new meshfree method based on a discrete transformation of Green's basis functions is introduced to simulate Poisson problems with complex morphologies. The proposed Green's Discrete Transformation Method (GDTM) uses source points that are located along a virtual boundary outside the problem domain to construct the basis functions needed to approximate the field. The optimal number of Green's functions source points and their relative distances with respect to the problem boundaries are evaluated to obtain the best approximation of the partition of unity condition. A discrete transformation technique together with the boundary point collocation method is employed to evaluate the unknown coefficients of the solution series via satisfying the problem boundary conditions. A comprehensive convergence study is presented to investigate the accuracy and convergence rate of the GDTM. We will also demonstrate the application of this meshfree method for simulating the conductive heat transfer in a heterogeneous materials system and the dissolved aluminum ions concentration in the electrolyte solution formed near a passive corrosion pit.

  8. Deciphering the Complexities of Atopic Dermatitis: Shifting Paradigms in Treatment Approaches

    PubMed Central

    Leung, Donald Y. M.; Guttman-Yassky, Emma

    2014-01-01

    Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It often precedes the development of food allergy and asthma. Recent insights into AD reveal abnormalities in terminal differentiation of the epidermal epithelium leading to a defective stratum corneum, which allows enhanced allergen penetration and systemic IgE sensitization. Atopic skin is also predisposed to colonization or infection by pathogenic microbes, most notably Staphylococcus aureus and herpes simplex virus (HSV). Causes of this abnormal skin barrier are complex and driven by a combination of genetic, environmental and immunologic factors. These factors likely account for the heterogeneity of AD onset, severity and natural history of this skin disease. Recent studies suggest prevention of AD can be achieved by early interventions protecting the skin barrier. Onset of lesional AD requires effective control of local and systemic immune activation for optimal management. Early intervention may improve long term outcomes for AD and reduce the systemic allergen sensitization leading to associated allergic diseases in the gastrointestinal and respiratory tract. PMID:25282559

  9. Efficacy investigation of transpostceliac single-port 3-channel laparoscope in the treatment of complex renal cyst

    PubMed Central

    Mai, Haixing; Liu, Junle; Zhao, Li; Qu, Nan; Wang, Yalin; Huang, Cheng; Chen, Biao; Li, Yanshuai; Chen, Lijun; Zhang, Xu

    2015-01-01

    This study aims to investigate the surgical method and long-term efficacy of transpostceliac single-port 3-channel laparoscope in the treatment of complex renal cyst. A retrospective analysis was performed towards the 37 patients who underwent renal cyst unroofing decompression with single-port laparoscope from Jun. 2012 to Jul. 2013. The surgery was performed through the postceliac approach, a 2.5 cm incision was made 4-5 cm away from the iliac spine of midaxillary line, the Olympus single-port TriPort was then implanted, with the laparoscopic channel and the other two operation channels all as 5 mm. The operation was completed with the forceps and scissors which had flexible fronts. The cysts of the 37 patients were performed the appropriate surgical treatments according to their subtype grouping, on case was transferred to the open surgery, and there was no blood transfusion case. The operation time was 11-42 min, with the mean time as 23 min; the bleeding volume was 10-50 ml, with the mean volume as 26 ml; the postoperative follow-up was 1-6 months, and the ultrasound review did not find the recurrence of cyst; the postoperative lumbar scar was approximately 2.5 cm, and the patients could leave the bed and perform some acts on the exact day of the surgery; the hospitalization time was 1-2 d, with the average time as 1.2 d. The efficacy of the transpostceliac single-port 3-channel laparoscope in the treatment of complex renal cyst was positive, with low recurrence rate, and worthy of further promotion. PMID:26309695

  10. Alternative Techniques for Treatment of Complex Below-the Knee Arterial Occlusions in Diabetic Patients With Critical Limb Ischemia

    SciTech Connect

    Gandini, Roberto; Uccioli, Luigi; Spinelli, Alessio; Del Giudice, Costantino Ros, Valerio Da; Volpi, Tommaso; Meloni, Marco; Simonetti, Giovanni

    2013-02-15

    The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access. Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 {+-} 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56 patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted. Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 {+-} 1.1 vs. 15.7 {+-} 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively). The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.

  11. Direct access to the middle meningeal artery for embolization of complex dural arteriovenous fistula: a hybrid treatment approach.

    PubMed

    Lin, Ning; Brouillard, Adam M; Mokin, Maxim; Natarajan, Sabareesh K; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H

    2014-01-01

    Endovascular embolization has become increasingly favored over microsurgical resection for treatment of complex dural arteriovenous fistulas (DAVFs). However, endovascular treatment can be restricted by tortuous transarterial access and a transvenous approach is not always feasible. We present a Borden III DAVF treated by direct access to the middle meningeal artery (MMA) and Onyx embolization performed in a hybrid operating room-angiography suite. A middle-aged patient with pulsatile headaches was found to have left transverse sinus occlusion and DAVF with retrograde cortical venous drainage fed by multiple external carotid artery (ECA) feeders. Endovascular attempts via conventional transvenous and transarterial routes were unsuccessful, and the major MMA feeder was accessed directly after temporal craniotomy was performed under neuronavigation. Onyx embolization was performed; complete occlusion of the fistula was achieved. Three-month follow-up angiography showed no residual filling; the patient remains complication-free. A combined surgical-endovascular technique in a hybrid operating room-angiography suite can be an effective treatment for DAVFs complicated by inaccessible arterial and transvenous approaches. PMID:24903968

  12. Direct access to the middle meningeal artery for embolization of complex dural arteriovenous fistula: a hybrid treatment approach.

    PubMed

    Lin, Ning; Brouillard, Adam M; Mokin, Maxim; Natarajan, Sabareesh K; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H

    2015-07-01

    Endovascular embolization has become increasingly favored over microsurgical resection for treatment of complex dural arteriovenous fistulas (DAVFs). However, endovascular treatment can be restricted by tortuous transarterial access and a transvenous approach is not always feasible. We present a Borden III DAVF treated by direct access to the middle meningeal artery (MMA) and Onyx embolization performed in a hybrid operating room-angiography suite. A middle-aged patient with pulsatile headaches was found to have left transverse sinus occlusion and DAVF with retrograde cortical venous drainage fed by multiple external carotid artery (ECA) feeders. Endovascular attempts via conventional transvenous and transarterial routes were unsuccessful, and the major MMA feeder was accessed directly after temporal craniotomy was performed under neuronavigation. Onyx embolization was performed; complete occlusion of the fistula was achieved. Three-month follow-up angiography showed no residual filling; the patient remains complication-free. A combined surgical-endovascular technique in a hybrid operating room-angiography suite can be an effective treatment for DAVFs complicated by inaccessible arterial and transvenous approaches. PMID:24916414

  13. Azithromycin, rifabutin, and rifapentine for treatment and prophylaxis of Mycobacterium avium complex in rats treated with cyclosporine.

    PubMed Central

    Brown, S T; Edwards, F F; Bernard, E M; Tong, W; Armstrong, D

    1993-01-01

    Azithromycin, rifabutin, and rifapentine were used to treat or prevent disseminated Mycobacterium avium complex (MAC) infections produced in rats immunosuppressed with cyclosporine. Animals with bacteremic infections were treated 1 week after intravenous inoculation with 10(7) CFU of MAC with azithromycin, 100 mg/kg of body weight administered subcutaneously for 5 days and then 75 mg/kg on Monday, Wednesday, and Friday, or with rifabutin or rifapentine, 20 mg/kg administered intraperitoneally on Monday through Friday. All three drugs showed efficacy after 1 and 2 months. Rifabutin cleared the organisms from tissues more rapidly than azithromycin or rifapentine. To approximate prophylaxis, treatment was started 2 weeks before intravenous inoculation with 10(4) organisms. MAC infections were undetectable in treated animals after 4 months, while control animals had disseminated infections. These findings support the rationale for clinical trials of treatment and prophylaxis with these agents. The cyclosporine-treated rat appears to be a useful model in which to evaluate compounds for the treatment and prophylaxis of disseminated MAC infections. PMID:8384809

  14. Ligation of intersphincteric fistula tract and its modification: Results from treatment of complex fistula

    PubMed Central

    Sirikurnpiboon, Siripong; Awapittaya, Burin; Jivapaisarnpong, Paiboon

    2013-01-01

    AIM: To compare healing rates between intersphincteric fistula tract (LIFT) and LIFT plus partial fistulectomy procedures. METHODS: A study of complex fistula-in-ano patients was carried out from 1st March 2010 to 31th January 2012. All operations were done by colorectal surgeons at a referral center in a Ministry of Public Health hospital. Data collected included patients’ demographic details, fistula type determined by endorectal-ultrasonography, preoperative and postoperative continence status, previous operations, time between diagnosis of fistula-in-ano and operation, type of surgery, healing rates, recurrence rates, and types of failure examined by endorectal-ultrasosnography, re-operation in recurrence or failure cases, and complications. RESULTS: The study involved 41 patients whose average age was 40.78 ± 11.84 years (range: 21-71 years). The major fistula type was high-transsphincteric type fistula. The median follow-up period was 24 wk. The overall success rate was 83%: in the LIFT (Ligation intersphincteric fistula tract) group the success rate was 81% and in the LIFT plus (LIFT with partial coreout fistulectomy) group it was 85% (P = 0.529). The median wound-healing time was 4 wk in both groups (P = 0.262). The median time to recurrence was 12 wk. Neither group had incontinence (Wexner incontinence score-0) and the difference in healing rates between the two groups was not statistically significant. CONCLUSION: There was no difference in results between LIFT and LIFT plus operations. The LIFT procedure is a good option for maintaining continence in management of fistula-in-ano. PMID:23671739

  15. Clinical application of operative hysteroscopy in treatment of complex hydrosalpinx prior to IVF

    PubMed Central

    Bao, Hong-Chu; Wang, Mei-Mei; Wang, Xin-Rong; Wang, Wen-Juan; Hao, Cui-Fang

    2015-01-01

    Background: In vitro fertilization and embryo transfer (IVF-ET) is the best option for patients with hydrosalpinx. However, if hydrosalpinges is not pre-treated, the therapeutic outcomes of IVF-ET would be compromised. Objective: This study aims to investigate the safety and effects of operative hysteroscopy in the treatment of patients with hydrosalpinx prior to IVF-ET, who were not indicated for laparotomy due to extensive pelvic adhesion. Materials and Methods: The study analyses retrospectively data from 10 women with hydrosalpinx, who were unable to undergo laparotomy due to extensive pelvic adhesion and treated by operative hysteroscopy prior to IVF-ET, and was assessed the effects and safety of the procedure. Results: Postoperative Hystero-salpingography demonstrated complete tubal occlusion of the diseased side in all cases. Being applied with IVF-ET for fertility after their hysteroscopy operation, 5 out of 10 patients acquired clinical pregnancy. Conclusion: Hysteroscopic tubal occlusion of the proximal part of the hydrosalpinx can effectively prevent the hydrops backflow to endometrial cavity and benefit subsequent implantation in the course of assisted reproduction without significant complications. PMID:26221131

  16. The complexity of biosorption treatments for oxyanions in a multi-element mine effluent.

    PubMed

    Johansson, Charlotte L; Paul, Nicholas A; de Nys, Rocky; Roberts, David A

    2015-03-15

    Selenium (Se) is a contaminant in effluents from coal mines and coal-fired power stations, where it is encountered as the oxyanion selenate (SeO4(2-), hereafter Se(VI)). Se(VI) can be removed from solution with Fe-treated biosorbents, but the efficacy of these treatments in effluents with multiple contaminants is unclear. This study investigates the interactions between Se(VI) and the oxyanions SO4(2-) and NO3(-). We produce a sustainable biosorbent, Gracilaria Modified Biochar (GMB), by treating a waste product generated after the commercial extraction of agar from cultivated seaweeds with ferric chloride (FeCl3) and converting it to biochar through pyrolysis. We then test interactions between Se(VI) and competing oxyanions in mock solutions and a real-world mine effluent with high concentrations of SO4(2-) and NO3(-). GMB immediately removed 98% of the Se(VI) from the mock solution, but only 3% from the mine effluent with the same initial Se(VI) concentration. Notably, 83-89% of the Se(VI) was removed by GMB when concentrations of Se(VI) and SO4(2-) were less than or equimolar in mock solutions. Higher concentrations of SO4(2-) reduced the uptake of Se(VI). There was no interference from NO3(-) on the biosorption of Se(VI). GMB is a successful biosorbent for Se(VI), however, high concentrations of SO4(2-) will compromise the biosorption of Se(VI). PMID:25590609

  17. Synthesis and biological evaluation of novel folic acid receptor-targeted, ?-cyclodextrin-based drug complexes for cancer treatment.

    PubMed

    Yin, Juan-Juan; Sharma, Sonali; Shumyak, Stepan P; Wang, Zhi-Xin; Zhou, Zhi-Wei; Zhang, Yangde; Guo, Peixuan; Li, Chen-Zhong; Kanwar, Jagat R; Yang, Tianxin; Mohapatra, Shyam S; Liu, Wanqing; Duan, Wei; Wang, Jian-Cheng; Li, Qi; Zhang, Xueji; Tan, Jun; Jia, Lee; Liang, Jun; Wei, Ming Q; Li, Xiaotian; Zhou, Shu-Feng

    2013-01-01

    Drug targeting is an active area of research and nano-scaled drug delivery systems hold tremendous potential for the treatment of neoplasms. In this study, a novel cyclodextrin (CD)-based nanoparticle drug delivery system has been assembled and characterized for the therapy of folate receptor-positive [FR(+)] cancer. Water-soluble folic acid (FA)-conjugated CD carriers (FACDs) were successfully synthesized and their structures were confirmed by 1D/2D nuclear magnetic resonance (NMR), matrix-assisted laser desorption ionization time-of-flight mass spectrometer (MALDI-TOF-MS), high performance liquid chromatography (HPLC), Fourier transform infrared spectroscopy (FTIR), and circular dichroism. Drug complexes of adamatane (Ada) and cytotoxic doxorubicin (Dox) with FACD were readily obtained by mixed solvent precipitation. The average size of FACD-Ada-Dox was 1.5-2.5 nm. The host-guest association constant K a was 1,639 M(-1) as determined by induced circular dichroism and the hydrophilicity of the FACDs was greatly enhanced compared to unmodified CD. Cellular uptake and FR binding competitive experiments demonstrated an efficient and preferentially targeted delivery of Dox into FR-positive tumor cells and a sustained drug release profile was seen in vitro. The delivery of Dox into FR(+) cancer cells via endocytosis was observed by confocal microscopy and drug uptake of the targeted nanoparticles was 8-fold greater than that of non-targeted drug complexes. Our docking results suggest that FA, FACD and FACD-Ada-Dox could bind human hedgehog interacting protein that contains a FR domain. Mouse cardiomyocytes as well as fibroblast treated with FACD-Ada-Dox had significantly lower levels of reactive oxygen species, with increased content of glutathione and glutathione peroxidase activity, indicating a reduced potential for Dox-induced cardiotoxicity. These results indicate that the targeted drug complex possesses high drug association and sustained drug release properties with good biocompatibility and physiological stability. The novel FA-conjugated ?-CD based drug complex might be promising as an anti-tumor treatment for FR(+) cancer. PMID:23658721

  18. Preliminary engineering evaluation of heat and digest treatment for in-tank removal of radionuclides from complexed waste

    SciTech Connect

    Klem, M.J.

    1995-09-29

    This report uses laboratory data from low temperature-ambient pressure digestion of actual complexed supernatant to evaluate digestion as a pretreatment method for waste in double-shell tanks 241-AN-102, 241-AN-107 and 241-AY-101. Digestion time requirements were developed at 100 degrees celsius to remove organic and meet NRC Class C criterion for TRU elements and NRC Class B criterion for 90Sr. The incidental waste ruling will establish the need for removal of 90Sr. Digestion pretreatment precipitates non radioactive metal ions and produces additional high-level waste solids and canisters of high level glass. This report estimates the amount of additional high-level waste produced and preliminary capital and operating costs for in-tank digestion of waste. An overview of alternative in-tank treatment methods is included

  19. Impact of reclamation treatment on the biological activity of soils of the solonetz complex in Western Siberia

    NASA Astrophysics Data System (ADS)

    Berezin, L. V.; Khamova, O. F.; Paderina, E. V.; Gindemit, A. M.

    2014-11-01

    The abundance and activity of the soil microflora were studied in a field experiment with the use of green manure crops to assess the impact of reclamation measures on the biological activity of soils of the solonetz complex. The number of microorganisms in the plow soil horizon increased in the background of the green fallows as compared to the black ones. Coefficients of mineralization, immobilization, and transformation of organic compounds were calculated for different variants of the soil treatment. The value of the mineralization coefficient indicates the intense decomposition of the green manure that entered the soil. In the first year, peas were actively decomposed, while oats, in the second year (aftereffect). The activity of the soil enzymes (invertase, urease, and catalase) was determined. A close relationship between the catalase activity and the intensity of the microbiological processes in the soils was revealed.

  20. Multidimensional treatment of stochastic solvent dynamics in photoinduced proton-coupled electron transfer processes: Sequential, concerted, and complex branching mechanisms

    NASA Astrophysics Data System (ADS)

    Soudackov, Alexander V.; Hazra, Anirban; Hammes-Schiffer, Sharon

    2011-10-01

    A theoretical approach for the multidimensional treatment of photoinduced proton-coupled electron transfer (PCET) processes in solution is presented. This methodology is based on the multistate continuum theory with an arbitrary number of diabatic electronic states representing the relevant charge distributions in a general PCET system. The active electrons and transferring proton(s) are treated quantum mechanically, and the electron-proton vibronic free energy surfaces are represented as functions of multiple scalar solvent coordinates corresponding to the single electron and proton transfer reactions involved in the PCET process. A dynamical formulation of the dielectric continuum theory is used to derive a set of coupled generalized Langevin equations of motion describing the time evolution of these collective solvent coordinates. The parameters in the Langevin equations depend on the solvent properties, such as the dielectric constants, relaxation time, and molecular moment of inertia, as well as the solute properties. The dynamics of selected intramolecular nuclear coordinates, such as the proton donor-acceptor distance or a torsional angle within the PCET complex, may also be included in this formulation. A surface hopping method in conjunction with the Langevin equations of motion is used to simulate the nonadiabatic dynamics on the multidimensional electron-proton vibronic free energy surfaces following photoexcitation. This theoretical treatment enables the description of both sequential and concerted mechanisms, as well as more complex processes involving a combination of these mechanisms. The application of this methodology to a series of model systems corresponding to collinear and orthogonal PCET illustrates fundamental aspects of these different mechanisms and elucidates the significance of proton vibrational relaxation and nonequilibrium solvent dynamics.

  1. Midterm Results of a Combined Biological and Mechanical Approach for the Treatment of a Complex Knee Lesion

    PubMed Central

    Filardo, G.; Di Martino, A.; Delcogliano, M.; Marcacci, M.

    2012-01-01

    Objective: Complex fractures of the tibial plateau are difficult to treat and present a high complication rate. The goal of this report is to describe a combined biological and mechanical approach to restore all morphological and functional knee properties. Methods: We treated a 50-year-old woman, who was affected by a posttraumatic osteochondral lesion and depression of the lateral tibial plateau with knee valgus deviation. The mechanical axis was corrected with a lateral tibial plateau elevation osteotomy, the damaged joint surface was replaced by a recently developed biomimetic osteochondral scaffold, and a hinged dynamic external fixator was applied to protect the graft and at the same time to allow postoperative joint mobilization. Results: A marked clinical improvement was documented at 12 months and further improved up to 5 years, with pain-free full range of motion and return to previous activities. The MRI evaluation at 12 and 24 months showed that the implant remained in site with a hyaline-like signal and restoration of the articular surface. Conclusion: This case report describes a combined surgical approach for complex knee lesions that could represent a treatment option to avoid or at least delay posttraumatic osteoarthritis and more invasive procedures. PMID:26069639

  2. Redox-active injectable gel using thermo-responsive nanoscale polyion complex flower micelle for noninvasive treatment of local inflammation.

    PubMed

    Pua, Min Ley; Yoshitomi, Toru; Chonpathompikunlert, Pennapa; Hirayama, Aki; Nagasaki, Yukio

    2013-12-28

    Reactive oxygen species (ROS) scavengers have not been widely used for treatment of local inflammatory reactions such as arthritis and periodontal disease because they are rapidly eliminated from the inflamed site, which results in a low therapeutic effect. Therefore, to enhance the local retention time of ROS scavengers, we developed a redox-active injectable gel (RIG) system by using poly[4-(2,2,6,6-tetramethylpiperidine-N-oxyl)aminomethylstyrene]-b-poly(ethylene glycol)-b-poly[4-(2,2,6,6-tetramethylpiperidine-N-oxyl)aminomethylstyrene] (PMNT-PEG-PMNT) triblock copolymer, which possesses ROS scavenging nitroxide radicals as side chains of the PMNT segment. Cationic PMNT segment in PMNT-PEG-PMNT forms polyion complexes with anionic poly(acrylic acid) (PAAc) to form a flower-like micelle (ca. 79 nm), which exhibits in situ thermo-irreversible gelation under physiological conditions. We confirmed the prolonged site-specific retention time of RIG by performing in vivo noninvasive electron spin resonance imaging and quantitative evaluation. In contrast to low-molecular-weight nitroxide radical compounds that disappeared from injection sites in less than 1h after subcutaneous injection, 40% of the RIG remained even at 3 days. We also found that RIG inhibits neutrophil infiltration and cytokine production, which leads to suppression of hyperalgesia. These findings indicate the potential of RIG as an innovative approach for treatment of local inflammation. PMID:24157475

  3. Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial

    PubMed Central

    Barnhoorn, Karlijn J; van de Meent, Henk; van Dongen, Robert T M; Klomp, Frank P; Groenewoud, Hans; Samwel, Han; Nijhuis-van der Sanden, Maria W G; Frölke, Jan Paul M; Staal, J Bart

    2015-01-01

    Objective To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor. Setting The study was conducted at a level 1 trauma centre in the Netherlands. Participants 56 adult patients with CRPS-1 participated. Three patients were lost to follow-up. Interventions Patients received either PEPT in a maximum of five treatment sessions, or conventional treatment following the Dutch multidisciplinary guideline. Measurements Outcomes were assessed at baseline and at 3, 6 and 9 months after randomisation. The primary outcome measure was the Impairment level Sum Score—Restricted Version (ISS-RV), consisting of visual analogue scale for pain (VAS-pain), McGill Pain Questionnaire, active range of motion (AROM) and skin temperature. Secondary outcome measures included Pain Disability Index (PDI); muscle strength; Short Form 36 (SF-36); disability of arm, shoulder and hand; Lower Limb Tasks Questionnaire (LLTQ); 10 m walk test; timed up-and-go test (TUG) and EuroQol-5D. Results The intention-to-treat analysis showed a clinically relevant decrease in ISS-RV (6.7 points for PEPT and 6.2 points for conventional treatment), but the between-group difference was not significant (0.96, 95% CI −1.56 to 3.48). Participants allocated to PEPT experienced a greater improvement in AROM (between-group difference 0.51, 95% CI 0.07 to 0.94; p=0.02). The per protocol analysis showed larger and significant between-group effects on ISS-RV, VAS-pain, AROM, PDI, SF-36, LLTQ and TUG. Conclusions We cannot conclude that PEPT is superior to conventional treatment for patients with CRPS-1. Further high-quality research on the effects of PEPT is warranted given the potential effects as indicated by the per protocol analysis. Trial registration numbers NCT00817128 and NTR 2090. PMID:26628523

  4. Biofilm-Grown Burkholderia cepacia Complex Cells Survive Antibiotic Treatment by Avoiding Production of Reactive Oxygen Species

    PubMed Central

    Van Acker, Heleen; Sass, Andrea; Bazzini, Silvia; De Roy, Karen; Udine, Claudia; Messiaen, Thomas; Riccardi, Giovanna; Boon, Nico; Nelis, Hans J.; Mahenthiralingam, Eshwar; Coenye, Tom

    2013-01-01

    The presence of persister cells has been proposed as a factor in biofilm resilience. In the present study we investigated whether persister cells are present in Burkholderia cepacia complex (Bcc) biofilms, what the molecular basis of antimicrobial tolerance in Bcc persisters is, and how persisters can be eradicated from Bcc biofilms. After treatment of Bcc biofilms with high concentrations of various antibiotics often a small subpopulation survived. To investigate the molecular mechanism of tolerance in this subpopulation, Burkholderia cenocepacia biofilms were treated with 1024 µg/ml of tobramycin. Using ROS-specific staining and flow cytometry, we showed that tobramycin increased ROS production in treated sessile cells. However, approximately 0.1% of all sessile cells survived the treatment. A transcriptome analysis showed that several genes from the tricarboxylic acid cycle and genes involved in the electron transport chain were downregulated. In contrast, genes from the glyoxylate shunt were upregulated. These data indicate that protection against ROS is important for the survival of persisters. To confirm this, we determined the number of persisters in biofilms formed by catalase mutants. The persister fraction in ΔkatA and ΔkatB biofilms was significantly reduced, confirming the role of ROS detoxification in persister survival. Pretreatment of B. cenocepacia biofilms with itaconate, an inhibitor of isocitrate lyase (ICL), the first enzyme in the glyoxylate shunt, reduced the persister fraction approx. 10-fold when the biofilms were subsequently treated with tobramycin. In conclusion, most Bcc biofilms contain a significant fraction of persisters that survive treatment with high doses of tobramycin. The surviving persister cells downregulate the TCA cycle to avoid production of ROS and at the same time activate an alternative pathway, the glyoxylate shunt. This pathway may present a novel target for combination therapy. PMID:23516582

  5. Bortezomib (PS-341) Treatment Decreases Inflammation and Partially Rescues the Expression of the Dystrophin-Glycoprotein Complex in GRMD Dogs

    PubMed Central

    Araujo, Karla P. C.; Bonuccelli, Gloria; Duarte, Caio N.; Gaiad, Thais P.; Moreira, Dayson F.; Feder, David; Belizario, José E.; Miglino, Maria A.; Lisanti, Michael P.; Ambrosio, Carlos E.

    2013-01-01

    Golden retriever muscular dystrophy (GRMD) is a genetic myopathy corresponding to Duchenne muscular dystrophy (DMD) in humans. Muscle atrophy is known to be associated with degradation of the dystrophin-glycoprotein complex (DGC) via the ubiquitin-proteasome pathway. In the present study, we investigated the effect of bortezomib treatment on the muscle fibers of GRMD dogs. Five GRMD dogs were examined; two were treated (TD- Treated dogs) with the proteasome inhibitor bortezomib, and three were control dogs (CD). Dogs were treated with bortezomib using the same treatment regimen used for multiple myeloma. Pharmacodynamics were evaluated by measuring the inhibition of 20S proteasome activity in whole blood after treatment and comparing it to that in CD. We performed immunohistochemical studies on muscle biopsy specimens to evaluate the rescue of dystrophin and dystrophin-associated proteins in the muscles of GRMD dogs treated with bortezomib. Skeletal tissue from TD had lower levels of connective tissue deposition and inflammatory cell infiltration than CD as determined by histology, collagen morphometry and ultrastructural analysis. The CD showed higher expression of phospho-NF?B and TGF-?1, suggesting a more pronounced activation of anti-apoptotic factors and inflammatory molecules and greater connective tissue deposition, respectively. Immunohistochemical analysis demonstrated that dystrophin was not present in the sarcoplasmic membrane of either group. However, bortezomib-TD showed higher expression of ?- and ?-dystroglycan, indicating an improved disease histopathology phenotype. Significant inhibition of 20S proteasome activity was observed 1 hour after bortezomib administration in the last cycle when the dose was higher. Proteasome inhibitors may thus improve the appearance of GRMD muscle fibers, lessen connective tissue deposition and reduce the infiltration of inflammatory cells. In addition, proteasome inhibitors may rescue some dystrophin-associated proteins in the muscle fiber membrane. PMID:23579193

  6. Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: a double-blind randomized controlled study.

    PubMed

    Rocha, Roberto de Oliveira; Teixeira, Manoel Jacobsen; Yeng, Lin Tchia; Cantara, Mirlene Gardin; Faria, Viviane Gentil; Liggieri, Victor; Loduca, Adrianna; Müller, Barbara Maria; Souza, Andrea C M S; de Andrade, Daniel Ciampi

    2014-11-01

    Pain relief in complex regional pain syndrome (CRPS) remains a major challenge, in part due to the lack of evidence-based treatment trials specific for this condition. We performed a long-term randomized, double-blinded active-control study to evaluate the efficacy of thoracic sympathetic block (TSB) for upper limb type I CRPS. The study objective was to evaluate the analgesic effect of TSB in CRPS. Patients with CRPS type I were treated with standardized pharmacological and physical therapy and were randomized to either TSB or control procedure as an add-on treatment. Clinical data, pain intensity, and interference (Brief Pain Inventory), pain dimensions (McGill Pain Questionnaire [MPQ]), neuropathic characteristics (Neuropathic Pain Symptom Inventory [NPSI]), mood, upper limb function (Disabilities of Arm, Shoulder and Hand), and quality of life were assessed before, and at 1 month and 12 months after the procedure. Thirty-six patients (19 female, 44.7 ± 11.1 years of age) underwent the procedure (17 in the TSB group). Average pain intensity at 1 month was not significantly different after TSB (3.5 ± 3.2) compared to control procedure (4.8 ± 2.7; P=0.249). At 12 months, however, the average pain item was significantly lower in the TSB group (3.47 ± 3.5) compared to the control group (5.86 ± 2.9; P=0.046). Scores from the MPQ, evoked-pain symptoms subscores (NPSI), and depression scores (Hospital Anxiety and Depression Scale) were significantly lower in the TSB group compared to the control group at 1 and at 12 months. Other measurements were not influenced by the treatment. Quality of life was only slightly improved by TSB. No major adverse events occurred. Larger, multicentric trials should be performed to confirm these original findings. PMID:25149143

  7. Oral treatment of pressure ulcers with polaprezinc (zinc L-carnosine complex): 8-week open-label trial.

    PubMed

    Sakae, Kensaku; Yanagisawa, Hiroyuki

    2014-06-01

    Polaprezinc (zinc L-carnosine complex) is a tablet commonly prescribed for gastric ulcers in Japan. Recently, we reported the effects of polaprezinc on pressure ulcer healing at 4-week follow-up. We aimed to further evaluate the efficacy and safety of polaprezinc in 8-week treatment for chronic pressure ulcers. Patients with stage II-IV pressure ulcers for ? 8 weeks received 150 mg/day polaprezinc (containing 116 mg L-carnosine and 34 mg zinc) per os for a maximum of 8 weeks. We measured the severity of pressure ulcers weekly using the Pressure Ulcer Scale for Healing (PUSH) score and monitored blood biochemistry. Fourteen patients (nine men; 68.4?±?11.8 years) were enrolled. Pressure ulcer stages were II (one patient; 7 %), III (nine; 64 %), and IV (four; 29 %). The PUSH score improved significantly from 8.1 [95 % CI, 6.0-10.3] at baseline to -1.4 [-4.0 to 1.1] after 8 weeks (P?treatment of pressure ulcers and could be a candidate for their oral treatment. PMID:24691900

  8. An approach to using conventional brachytherapy software for clinical treatment planning of complex, Monte Carlo-based brachytherapy dose distributions

    SciTech Connect

    Rivard, Mark J.; Melhus, Christopher S.; Granero, Domingo; Perez-Calatayud, Jose; Ballester, Facundo

    2009-06-15

    Certain brachytherapy dose distributions, such as those for LDR prostate implants, are readily modeled by treatment planning systems (TPS) that use the superposition principle of individual seed dose distributions to calculate the total dose distribution. However, dose distributions for brachytherapy treatments using high-Z shields or having significant material heterogeneities are not currently well modeled using conventional TPS. The purpose of this study is to establish a new treatment planning technique (Tufts technique) that could be applied in some clinical situations where the conventional approach is not acceptable and dose distributions present cylindrical symmetry. Dose distributions from complex brachytherapy source configurations determined with Monte Carlo methods were used as input data. These source distributions included the 2 and 3 cm diameter Valencia skin applicators from Nucletron, 4-8 cm diameter AccuBoost peripheral breast brachytherapy applicators from Advanced Radiation Therapy, and a 16 mm COMS-based eye plaque using {sup 103}Pd, {sup 125}I, and {sup 131}Cs seeds. Radial dose functions and 2D anisotropy functions were obtained by positioning the coordinate system origin along the dose distribution cylindrical axis of symmetry. Origin:tissue distance and active length were chosen to minimize TPS interpolation errors. Dosimetry parameters were entered into the PINNACLE TPS, and dose distributions were subsequently calculated and compared to the original Monte Carlo-derived dose distributions. The new planning technique was able to reproduce brachytherapy dose distributions for all three applicator types, producing dosimetric agreement typically within 2% when compared with Monte Carlo-derived dose distributions. Agreement between Monte Carlo-derived and planned dose distributions improved as the spatial resolution of the fitted dosimetry parameters improved. For agreement within 5% throughout the clinical volume, spatial resolution of dosimetry parameter data {<=}0.1 cm was required, and the virtual brachytherapy source data set included over 5000 data points. On the other hand, the lack of consideration for applicator heterogeneity effect caused conventional dose overestimates exceeding an order of magnitude in regions of clinical interest. This approach is rationalized by the improved dose estimates. In conclusion, a new technique was developed to incorporate complex Monte Carlo-based brachytherapy dose distributions into conventional TPS. These results are generalizable to other brachytherapy source types and other TPS.

  9. 2-Deoxy-D-glucose treatment changes the Golgi apparatus architecture without blocking synthesis of complex lipids.

    PubMed

    Ranftler, Carmen; Meisslitzer-Ruppitsch, Claudia; Stangl, Herbert; Röhrl, Clemens; Fruhwürth, Stefanie; Neumüller, Josef; Pavelka, Margit; Ellinger, Adolf

    2015-04-01

    The classic Golgi apparatus organization, an arrangement of highly ordered cisternal stacks with tubular-vesicular membrane specializations on both sides, is the functional image of a continuous flow of contents and membranes with input, metabolization, and output in a dynamic steady state. In response to treatment with 2-deoxy-D-glucose (2-DG), which lowers the cellular ATP level by about 70% within minutes, this organization is rapidly replaced by tubular-glomerular membrane convolutes described as Golgi networks and bodies. 2-DG is a non-metabolizable glucose analogue and competitive inhibitor of glycolysis, which has become attractive in the context of therapeutic approaches for several kinds of tumors specifically targeting glycolysis in cancer. With the question of whether the functions of the Golgi apparatus in lipid synthesis would be influenced by the 2-DG-induced Golgi apparatus reorganization, we focused on lipid metabolism within the Golgi bodies. For this, we applied a fluorophore-labeled short-chain ceramide (BODIPY-Cer) in various combinations with 2-DG treatment to HepG2 cell cultures and followed uptake, enrichment and metabolization to higher ordered lipids. The cellular ATP status in each experiment was controlled with a bioluminescence assay, and the response of the Golgi apparatus was tracked by immunostaining of the trans-Golgi network protein TGN46. For electron microscopy, the fluorescent BODIPY-Cer signals were converted into electron-dense precipitates by photooxidation of diaminobenzidine (DAB); DAB precipitates labeled trans-Golgi areas in control cultures but also compartments at the periphery of the Golgi bodies formed in response to 2-DG treatment, thus indicating that concentration of ceramide takes place in spite of the Golgi apparatus reorganization. Lipid analyses by thin-layer chromatography (TLC) performed in parallel showed that BODIPY-Cer is not only concentrated in compartments of the 2-DG-induced Golgi bodies but is partly metabolized to BODIPY-sphingomyelin. Both, uptake and condensation of BODIPY-Cer and its conversion to complex lipids indicate that functions of the Golgi apparatus in the cellular lipid metabolism persist although the classic Golgi apparatus organization is abolished. PMID:25422148

  10. Outlook for the use of focused shock waves and pulsed electric fields in the complex treatment of malignant neoplasms.

    PubMed

    Garilevich, B A; Andrianov, Yu V; Olefir, Yu V; Zubkov, A D; Rotov, A E

    2006-01-01

    The experimental studies the synchronous action of electric field microsecond range with amplitude within the range of 1-7 kV/sm and shock waves with pressure before 100 MPa on cells membrane permeability of the mouse's ascitic tumors in vitro have shown the intensification the efficiency of the forming the irreversible pores under synchronous action. Thereby, enabling the electric field in the compression phase of shock wave pulse which can essentially reduce the electric field intensity required for breakdown cell membrane. In usual condition at amplitude of electric field, specified above, electric breakdown membrane carries basically reversible nature. At the same time in the pressure field tension phase of shock-wave pulse reversible pores, created by electric field, can grow before sizes, under which wholeness membrane is not restored. Under simultaneous action on cellular suspension the shock wave and electric field with moderate intensity cells survival is reduced in 5 once in contrast with occuring at different time's action, and in 10 once in contrast with checking. The most sensitive to influence by under study fields are cells in phase of the syntheses DNA, preparation to fission and in phase of the mitosis. Thereby, continuation of the studies on use synchronous action shock waves and pulsed electric fields in complex treatment of the tumors introduces perspective. PMID:17946761

  11. Treatment with Cationic Liposome-DNA Complexes (CLDC) Protects Mice from Lethal Western Equine Encephalitis Virus (WEEV) Challenge

    PubMed Central

    Logue, Christopher H.; Phillips, Aaron T.; Mossel, Eric C.; Ledermann, Jeremy P.; Welte, Thomas; Dow, Steve W.; Olson, Ken E.; Powers, Ann M.

    2012-01-01

    Having recently characterized a CD-1 outbred mouse model of pathogenesis for Western equine encephalitis virus, we examined the possible protective effects of cationic lipid DNA complexes (CLDC) against encephalitic arboviral infection. In this investigation, mice were pre-treated, co-treated, or post-treated with CLDC then challenged with a subcutaneous or aerosol dose of the highly virulent WEEV McMillan strain, lethal in mice 4-5 days after inoculation. Pre-treatment with CLDC provided a significant protective effect in mice, which was reflected in significantly increased survival rates. Further, in some instances a therapeutic effect of CLDC administration up to 12 hours after WEEV challenge was observed. Mice treated with CLDC had significantly increased serum IFN-?, TNF-?, and IL-12, suggesting a strong Th1-biased antiviral activation of the innate immune system. In virus-infected animals, large increases in production of IFN-?, TNF-?, MCP-1, IL-12, and IL-10 in the brain were observed by 72 hours after infection, consistent with neuroinvasion and viral replication in the CNS. These results indicate that strong non-specific activation of innate immunity with an immune therapeutic such as CLDC is capable of eliciting significant protective immunity against a rapidly lethal strain of WEEV and suggest a possible prophylactic option for exposed individuals. PMID:20452378

  12. Regulation of hippocampal Fas receptor and death-inducing signaling complex after kainic acid treatment in mice.

    PubMed

    Keller, Benjamin; García-Sevilla, Jesús A

    2015-12-01

    Kainic acid (KA)-induced brain neuronal cell death (especially in the hippocampus) was shown to be mainly mediated by the intrinsic (mitochondrial) apoptotic pathway. This study investigated the regulation of the extrinsic apoptotic pathway mediated by Fas ligand/Fas receptor and components of the indispensable death-inducing signaling complex (DISC) in the hippocampus (marked changes) and cerebral cortex (modest changes) of KA-treated mice. KA (45mg/kg) induced a severe behavioral syndrome with recurrent motor seizures (scores; maximal at 60-90min; minimal at 72h) with activation of hippocampal pro-apoptotic JNK (+2.5 fold) and increased GFAP (+57%) and nuclear PARP-1 fragmentation (+114%) 72h post-treatment (delayed neurotoxicity). In the extrinsic apoptotic pathway (hippocampus), KA (72h) reduced Fas ligand (-92%) and Fas receptor aggregates (-24%). KA (72h) also altered the contents of major DISC components: decreased FADD adaptor (-44%), reduced activation of initiator caspase-8 (-47%) and increased survival FLIP-S (+220%). Notably, KA (72h) upregulated the content of anti-apoptotic p-Ser191 FADD (+41%) and consequently the expression of p-FADD/FADD ratio (+1.9-fold), a neuroplastic index. Moreover, the p-FADD dependent transcription factor NF-?B was also increased (+61%) in the hippocampus after KA (72h). The convergent adaptation of the extrinsic apoptotic machinery 72h after KA in mice (with otherwise normal gross behavior) is a novel finding which suggests the induction of survival mechanisms to partly counteract the delayed neuronal death in the hippocampus. PMID:26044520

  13. Temporal changes of symbiont density and host fitness after rifampicin treatment in a whitefly of the Bemisia tabaci species complex.

    PubMed

    Shan, Hong-Wei; Zhang, Chang-Rong; Yan, Ting-Ting; Tang, Hai-Qin; Wang, Xiao-Wei; Liu, Shu-Sheng; Liu, Yin-Quan

    2016-04-01

    Microbial symbionts are essential or important partners to phloem-feeding insects. Antibiotics have been used to selectively eliminate symbionts from their host insects and establish host lines with or without certain symbionts for investigating functions of the symbionts. In this study, using the antibiotic rifampicin we attempted to selectively eliminate certain symbionts from a population of the Middle East-Asia Minor 1 whitefly of the Bemisia tabaci species complex, which harbors the primary symbiont "Candidatus Portiera aleyrodidarum" and two secondary symbionts "Candidatus Hamiltonella defensa" and Rickettsia. Neither the primary nor the secondary symbionts were completely depleted in the adults (F0) that fed for 48 h on a diet treated with rifampicin at concentrations of 1-100 μg/mL. However, both the primary and secondary symbionts were nearly completely depleted in the offspring (F1) of the rifampicin-treated adults. Although the F1 adults produced some eggs (F2), most of the eggs failed to hatch and none of them reached the second instar, and consequently the rifampicin-treated whitefly colony vanished at the F2 generation. Interestingly, quantitative polymerase chain reaction assays showed that in the rifampicin-treated whiteflies, the density of the primary symbiont was reduced at an obviously slower pace than the secondary symbionts. Mating experiments between rifampicin-treated and untreated adults demonstrated that the negative effects of rifampicin on host fitness were expressed when the females were treated by the antibiotic, and whether males were treated or not by the antibiotic had little contribution to the negative effects. These observations indicate that with this whitefly population it is not feasible to selectively eliminate the secondary symbionts using rifampicin without affecting the primary symbiont and establish host lines for experimental studies. However, the extinction of the whitefly colony at the second generation after rifampicin treatment indicates the potential of the antibiotic as a control agent of the whitefly pest. PMID:26412633

  14. IL-2/anti-IL-2 antibody complex treatment inhibits the development but not the progression of herpetic stromal keratitis

    PubMed Central

    Gaddipati, Subhash; Estrada, Kathleen; Rao, Pushpa; Jerome, Andrew David; Suvas, Susmit

    2014-01-01

    Interleukin-2 (IL-2) and anti-IL-2 antibody immune complex has recently been shown to expand the naturally occurring pool of CD4+Foxp3+ regulatory T cells (Foxp3+ Tregs). In this report, we showed that administration of IL-2/anti-IL-2 antibody immunocomplex to C57BL/6 mice, prior to corneal herpes simplex virus-1 (HSV-1) infection, significantly increased the pool of Foxp3+ Tregs when measured at early time-points post-infection. Increased numbers of Foxp3+ Tregs on day 2 and day 4 post-infection resulted in a marked reduction in the development of severe HSK. When compared to corneas from the control group, corneas from the immunocomplex-treated group showed a significant reduction in the amount of infectious virus on day 2 but not on day 4 post-infection. Reduced viral load was associated with two-fold increase in NK cell numbers in corneas from the immunocomplex-treated group of mice. Moreover, a dramatic reduction in the influx of CD4 T cells in inflamed corneas was determined on days 7 and 16 post-infection in the immunocomplex-treated group of infected mice. Immunocomplex treatment given on days 5, 6 and 7 post-infection significantly increased Foxp3+ Tregs in draining lymph nodes and in the spleen but failed to reduce the severity of HSK. In terms of the influx of CD4 T cells and granulocytes into inflamed corneas, no significant differences were noted between both groups of mice on day 16 post-infection. Our findings demonstrate that increasing Foxp3+ Tregs early but not late after infection in secondary lymphoid tissues is more efficacious in controlling the severity of HSK. PMID:25411200

  15. Clinical Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE): A Pragmatic Trial of Complex Treatment for a Complex Disorder

    PubMed Central

    Nierenberg, Andrew A.; Sylvia, Louisa G.; Leon, Andrew C.; Reilly-Harrington, Noreen; Shesler, Leah W.; McElroy, Susan L.; Friedman, Edward S.; Thase, Michael E.; Shelton, Richard C.; Bowden, Charles; Tohen, Mauricio; Singh, Vivek; Deckersbach, Thilo; Ketter, Terence; Kocsis, James; McInnis, Melvin G.; Schoenfeld, David; Bobo, William V.; Calabrese, Joseph R.

    2015-01-01

    Background Classic and second generation antipsychotic mood stabilizers are recommended for treatment of bipolar disorder, yet there are no randomized comparative effectiveness studies that have examined the “real-world” advantages and disadvantages of these medications Purpose We describe the strategic decisions in the design of the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE). This paper outlines the key issues and solutions the investigators faced in designing a clinical trial that would maximize generalizability and inform real-world clinical treatment of bipolar disorder. Methods Bipolar CHOICE was a 6-month, multi-site, prospective, randomized clinical trial of outpatients with bipolar disorder. This study compares the effectiveness of quetiapine versus lithium, each with adjunctive personalized treatments. The co-primary outcomes selected are the overall benefits and harms of the study medications (as measured by the Clinical Global Impression-Efficacy Index) and the Necessary Clinical Adjustments (a measure of the number of medication changes). Secondary outcomes are continuous measures of mood, the Framingham General Cardiovascular Risk Score and the Longitudinal Interval Follow up Evaluation Range of Impaired Functioning Tool. Results The final study design consisted of a single-blind, randomized comparative effectiveness trial of quetiapine versus lithium, plus adjunctive personalized treatment (APT), across ten sites. Other important study considerations included limited exclusion criteria to maximize generalizability, flexible dosing of APT medications to mimic real-world treatment, and an intent-to-treat analysis plan. 482 participants were randomized to the study and 364 completed. Limitations The potential limitations of the study include the heterogeneity of APT, selection of study medications, lack of a placebo-control group, and participants’ ability to pay for study medications. Conclusion We expect that this study will inform our understanding of the benefits and harms of lithium, a classic mood stabilizer, compared to quetiapine, a second generation antipsychotic with broad-spectrum activity in bipolar disorder and will provide an example of a well-designed and well-conducted randomized comparative effectiveness clinical trial. PMID:24346608

  16. Control Point Analysis comparison for 3 different treatment planning and delivery complexity levels using a commercial 3-dimensional diode array

    SciTech Connect

    Abdellatif, Ady; Gaede, Stewart

    2014-07-01

    To investigate the use of “Control Point Analysis” (Sun Nuclear Corporation, Melbourne, FL) to analyze and compare delivered volumetric-modulated arc therapy (VMAT) plans for 3 different treatment planning complexity levels. A total of 30 patients were chosen and fully anonymized for the purpose of this study. Overall, 10 lung stereotactic body radiotherapy (SBRT), 10 head-and-neck (H and N), and 10 prostate VMAT plans were generated on Pinnacle{sup 3} and delivered on a Varian linear accelerator (LINAC). The delivered dose was measured using ArcCHECK (Sun Nuclear Corporation, Melbourne, FL). Each plan was analyzed using “Sun Nuclear Corporation (SNC) Patient 6” and “Control Point Analysis.” Gamma passing percentage was used to assess the differences between the measured and planned dose distributions and to assess the role of various control point binning combinations. Of the different sites considered, the prostate cases reported the highest gamma passing percentages calculated with “SNC Patient 6” (97.5% to 99.2% for the 3%, 3 mm) and “Control Point Analysis” (95.4% to 98.3% for the 3%, 3 mm). The mean percentage of passing control point sectors for the prostate cases increased from 51.8 ± 7.8% for individual control points to 70.6 ± 10.5% for 5 control points binned together to 87.8 ± 11.0% for 10 control points binned together (2%, 2-mm passing criteria). Overall, there was an increasing trend in the percentage of sectors passing gamma analysis with an increase in the number of control points binned together in a sector for both the gamma passing criteria (2%, 2 mm and 3%, 3 mm). Although many plans passed the clinical quality assurance criteria, plans involving the delivery of high Monitor Unit (MU)/control point (SBRT) and plans involving high degree of modulation (H and N) showed less delivery accuracy per control point compared with plans with low MU/control point and low degree of modulation (prostate)

  17. Theoretical treatment of double photoionization of helium using a B-spline implementation of exterior complex scaling

    SciTech Connect

    McCurdy, C. William; Horner, Daniel A.; Rescigno, Thomas N.; Martin, Fernando

    2004-02-19

    Calculations of absolute triple differential and single differential cross sections for helium double photoionization are performed using an implementation of exterior complex scaling in B-splines. Results for cross sections, well-converged in partial waves, are presented and compared with both experiment and earlier theoretical calculations. These calculations establish the practicality and effectiveness of the complex B-spline approach to calculations of double ionization of atomic and molecular systems.

  18. Colletotrichum truncatum species complex: Treatment considerations and review of the literature for an unusual pathogen causing fungal keratitis and endophthalmitis

    PubMed Central

    Squissato, Victoria; Yucel, Yeni H.; Richardson, Susan E.; Alkhotani, Alaa; Wong, David T.; Nijhawan, Navdeep; Chan, Clara C.

    2015-01-01

    We present a case of Colletotrichum truncatum species complex fungal keratitis and endophthalmitis in an 87-year-old immunocompetent male in whom oral triazole antifungals were contraindicated. The patient had recently returned from 4 months in Jamaica with a one month history of progressively increasing pain and inflammation in his left eye. Corneal samples grew a filamentous fungus and internal transcribed spacer sequencing polymerase chain reaction confirmed the presence of C. truncatum species complex. Samples showed no microbial growth. PMID:26137437

  19. Operation of a two-stage treatment train for the remediation of volatile organic compounds (VOCs) from a complex air stream

    SciTech Connect

    Manninen, M.R.; Kleinheinz, G.T.; Niemi, B.A.; Hose, J.T.

    1999-07-01

    The use of aqueous biological systems to remove contaminants from waste streams has been well documented. However, in complex waste streams containing compounds of varying chemical properties, the use of only one type of treatment system may not be the best alternative. When treating a complex waste stream, the use of treatment trains, or coupled systems, may be advantageous when compared with any single technology. The purpose of this project was to design and operate a treatment train for the effective removal and biodegradation of a complex mixture of VOCs with varying chemical properties. A bench-scale system was designed consisting of a liquid bioreactor coupled to a biofilter for removal of acetone, methanol, methyl ethyl ketone, naphthalene, alpha-pinene, and toluene. The liquid bioreactor contained an aqueous medium and an inert solid support (polystyrene bioballs) which immobilized a characterized microbial population. The biofiltration portion of the system utilized the same microbial inoculum, but employed Douglas fir bark as its solid support. As the air stream bubbled into the liquid bioreactor, the VOCs were made available to the bacteria for destruction in the aqueous medium or on the polystyrene solid support. The fugitive VOCs from the liquid bioreactor were then subsequently treated by the biofiltration unit. The six-compound VOC mixture was added to the air stream via in-line syringe pump injection. Concentrations of the VOC mixture in the main influent air stream, the effluent air stream from the liquid bioreactor, the aqueous medium in the liquid bioreactor, and the effluent air stream from the biofilter were monitored on a regular basis via an on-line gas chromatograph with a flame ionization detector (GC-FID). Successful biodegradation of the complex VOC mixture was accomplished with this treatment train, the average total VOC removal efficiency being 96.2% ({+-}2.6).

  20. Budesonide-hydroxypropyl-?-cyclodextrin inclusion complex in binary poloxamer 407/403 system for ulcerative colitis treatment: A physico-chemical study from micelles to hydrogels.

    PubMed

    Santos Akkari, Alessandra Cristina; Ramos Campos, Estefânia Vangelie; Keppler, Artur Franz; Fraceto, Leonardo Fernandes; de Paula, Eneida; Tófoli, Giovana Radomille; de Araujo, Daniele Ribeiro

    2016-02-01

    Budesonide (BUD) is a glucocorticoid widely used for the treatment of ulcerative colitis. In this work, we propose the study of the system BUD-HP-?-CD inclusion complex incorporated into PL 407 and PL407-PL403 thermoreversible hydrogels, considering physico-chemical and pharmaceutical aspects. Complexation between BUD and HP-?-CD was confirmed by phase solubility studies (1:1 stoichiometry, Kc=8662.8M(-1)), DSC, FTIR and microscopy analyzes. BUD solubility in simulated upper and lower colon fluids was improved in a dependence of HP-?-CD and PL 407 or PL407-PL403 association. Micellar hydrodynamic diameter studies showed the interaction between HP-?-CD and PL blocks, as well as the reorganization of the micellar system in the presence of BUD and its inclusion complex. Micellization temperature (Tm) was not shifted, but sol-gel phase transition studies showed that in the presence of BUD, HP-?-CD or BUD:HP-?-CD complex, the association PL407-PL403 favored the gel formation close to the physiological temperature. Physico-chemical and in vitro release assays studies revealed no competitive displacement of BUD from the HP-?-CD cavity evoked by PL407 or PL407-PL403 addition. These findings point out the BUD-HP-?-CD in PL-based hydrogels as strategies for future investigations on development of new pharmaceutical formulations for the treatment of ulcerative colitis. PMID:26674842

  1. The effect of multileaf collimator leaf width on the radiosurgery planning for spine lesion treatment in terms of the modulated techniques and target complexity

    PubMed Central

    2014-01-01

    Purpose We aim to evaluate the effects of multileaf collimator (MLC) leaf width (5 mm vs. 2.5 mm) on the radiosurgery planning for the treatment of spine lesions according to the modulated techniques (intensity-modulated radiotherapy [IMRT] vs. volumetric-modulated arc therapy [VMAT]) and the complexity of the target shape. Methods For this study, artificial spinal lesions were contoured and used for treatment plans. Three spinal levels (C5, T5, and L2 spines) were selected, and four types of target shapes reflecting the complexity of lesions were contoured. The treatment plans were performed using 2.5-mm and 5-mm MLCs, and also using both static IMRT and VMAT. In total, 48 treatment plans were established. The efficacy of each treatment plan was compared using target volume coverage (TVC), conformity index (CI), dose gradient index (GI), and V30%. Results When the 5-mm MLC was replaced by the 2.5-mm MLC, TVC and GI improved significantly by 5.68% and 6.25%, respectively, while CI did not improve. With a smaller MLC leaf width, the improvement ratios of the TVC were larger in IMRT than VMAT (8.38% vs. 2.97%). In addition, the TVC was improved by 14.42-16.74% in target type 4 compared to the other target types. These improvements were larger in IMRT than in VMAT (27.99% vs. 6.34%). The V30% was not statistically different between IMRT and VMAT according to the MLC leaf widths and the types of target. Conclusion The smaller MLC leaf width provided improved target coverage in both IMRT and VMAT, and its improvement was larger in IMRT than in VMAT. In addition, the smaller MLC leaf width was more effective for complex-shaped targets. PMID:24606890

  2. Application of C60 Fullerene-Doxorubicin Complex for Tumor Cell Treatment In Vitro and In Vivo.

    PubMed

    Panchuk, R R; Prylutska, S V; Chumakl, V V; Skorokhyd, N R; Lehka, L V; Evstigneev, M P; Prylutskyy, Yu I; Berger, W; Heffeter, P; Scharff, P; Ritter, U; Stoika, R S

    2015-07-01

    Development of nanocarriers for effective drug delivery to molecular targets in tumor cells is a real problem in modern pharmaceutical chemistry. In the present work we used pristine C60 fullerene as a platform for delivery of anticancer drug doxorubicin (Dox) to its biological targets. The formation of a complex of C60 fullerene with Dox (C60 + Dox) is described and physico-chemical characteristics of such complex are presented. It was found that Dox conjugation with C60 fullerene leads to 1.5-2-fold increase in Dox toxicity towards various human tumor cell lines, compared with such effect when the drug is used alone. Cytotoxic activity of C60 + Dox complex is accompanied by an increased level of cell produced hydrogen peroxide at early time point (3 h) after its addition to cultured cells. At the same time, cellular production of superoxide radicals does not change in comparison with the effect of Dox alone. Cytomorphological studies have demonstrated that C60 + Dox complexes kill tumor cells by apoptosis induction. The results of in vivo experiments using Lewis lung carcinoma in mice confirmed the enhancement of the Dox toxicity towards tumor cells after drug complexation with C60 fullerene. The effect of such complex towards tumor-bearing mice was even more pronounced than that in the in vitro experiment with targeting human tumor cells. The tumor volume decreased by 2.5 times compared with the control, and an average life span of treated animals increased by 63% compared with control. The obtained results suggest a great perspective of application of C60 + Dox complexes for chemotherapy of malignant tumors. PMID:26307837

  3. Treatment of simple and complex endometrial non-atypical hyperplasia with natural progesterone: response rate to different doses.

    PubMed

    Marra, Chiara; Penati, Cristina; Ferrari, Luisa; Cantù, Maria Grazia; Bargossi, Lorena; Fruscio, Robert

    2014-09-25

    The aim of this study is to evaluate the response rate to natural progesterone in non-atypical endometrial hyperplasia and to identify the lowest effective dose. A total of 197 patients of childbearing age with simple or complex hyperplasia were retrospectively identified. The women were treated with a cyclic administration of progesterone at different dosages (100 versus 200 versus 300?mg daily). Endometrial biopsies were performed at 6, 12, 18 months. In comparing progesterone to a regimen of no therapy, a significantly higher remission rate was observed in the progesterone group than in the latter (95 versus 75%, p?=?0.05 for simple hyperplasia; 89 versus 35%, p?complex hyperplasia). Out of 60 women with simple hyperplasia, remission was observed in 9/11 (81.8%), 40/41 (97.5%) and 8/8 (100%) patients treated, respectively, with progesterone 100, 200 and 300?mg daily. Out of 72 women with complex hyperplasia, remission was observed in 3/5 (60%), 49/53 (92.4%) and 12/14 (85.7%) patients treated with progesterone 100, 200 and 300?mg daily, respectively. There was no statistically significant difference in the response rate in the two groups, neither with simple nor with complex hyperplasia. In conclusion, progesterone increased the regression rate of both simple and complex hyperplasia. PMID:25111756

  4. Complex decongestive physical therapy and low-level laser therapy for the treatment of pediatric congenital lymphedema: a case report.

    PubMed

    Hwang, Woon Taek; Chung, Sin Ho; Lee, Ju Sang

    2015-06-01

    [Purpose] We report the case of a pediatric patient with congenital lymphedema treated with complex decongestive physical therapy and low-level laser therapy. [Subjects and Methods] The patient was a 2?year-old girl who had lymphedema in the left upper limb since birth. Complex decongestive physical therapy and low-level laser therapy were administered for 7 sessions. [Results] The circumferences of the middle of the forearm, elbow joint, wrist, and hand of the left upper limb decreased 0.5, 3, 0.5, and 2?cm, respectively. The moisture content of the left upper limb decreased 70?mL (6.66%), while moisture ratio increased by 0.007%. [Conclusion] Complex decongestive physical therapy and low-level laser therapy are effective for reducing lymphedema in pediatric patients. PMID:26180372

  5. Complex decongestive physical therapy and low-level laser therapy for the treatment of pediatric congenital lymphedema: a case report

    PubMed Central

    Hwang, Woon Taek; Chung, Sin Ho; Lee, Ju Sang

    2015-01-01

    [Purpose] We report the case of a pediatric patient with congenital lymphedema treated with complex decongestive physical therapy and low-level laser therapy. [Subjects and Methods] The patient was a 2?year-old girl who had lymphedema in the left upper limb since birth. Complex decongestive physical therapy and low-level laser therapy were administered for 7 sessions. [Results] The circumferences of the middle of the forearm, elbow joint, wrist, and hand of the left upper limb decreased 0.5, 3, 0.5, and 2?cm, respectively. The moisture content of the left upper limb decreased 70?mL (6.66%), while moisture ratio increased by 0.007%. [Conclusion] Complex decongestive physical therapy and low-level laser therapy are effective for reducing lymphedema in pediatric patients. PMID:26180372

  6. Photo-activatable ternary complex based on a multifunctional shielding material for targeted shRNA delivery in cancer treatment.

    PubMed

    Park, Sin-Jung; Park, Wooram; Na, Kun

    2013-11-01

    A photo-activatable ternary complex (PTC) consisting of multifunctional shielding material (MSM) with photosensitizer (PS)-conjugated chondroitin sulfate and polyethyleneimine based binary complexes containing epidermal growth factor receptor (EGFR)-shRNA delivery for CD44 targeted cancer therapy has been developed. The PTC has a negative surface charge of -37.9 mV, and a size of approximately 90 nm, and the ternary complexes were found to be stable against plasma proteins. The stable nanostructure of PTC especially could enable CD44-receptor mediated tumor-targeted delivery and PS-mediated endosomal disruption for efficient gene silencing, and an enhanced rate of cancer cell death was achieved both in vitro and in vivo. This suggests that PTC could represent a promising strategy for the delivery of other therapeutic genes for cancer therapy. PMID:23968856

  7. ??Topical Treatment With Liposomal Sodium Copper Chlorophyllin Complex in Subjects With Facial Redness and Erythematotelangiectatic Rosacea: Case Studies.

    PubMed

    Vasily, David B

    2015-10-01

    Physicians are often presented with patients complaining of facial redness and difficult to control rosacea. The water soluble sodium copper chlorophyllin complex has been shown to have anti-oxidant, anti-inflammatory, and anti-bacterial activities in vitro and anti-redness, pore reduction, and anti-acne activities in pilot clinical studies. In these case studies, the safety and efficacy of a topical gel containing a liposomal suspension of sodium copper chlorophyllin complex was assessed in subjects with facial redness and erythematotelangiectatic rosacea. PMID:26461829

  8. Complex application of preparation containing ultralow doses of antibodies for the treatment of anemia caused by pubertal uterine bleedings.

    PubMed

    Sotnikova, L S; Shevtsova, N M; Sherstoboev, E Yu; Zhdanov, V V; Dygai, A M

    2009-09-01

    Poetam and anaferon (pediatric formulation) administered in combination with iron preparation to patients with anemia induce pronounced positive shifts in metabolic and morphological status of mature erythrocytes: the number of sulfhydryl groups and lipoprotein complexes in cell membranes and dry weight of erythrocytes increased, while the number of forms at different stages of degeneration decreased. PMID:20396724

  9. A clinical study to identify the possible etiology of complex partial seizures using magnetic resonance imaging brain findings and its implications on treatment

    PubMed Central

    Jeniffer, V. Nancy; Udayakumar, S.; Pushpalatha, K.

    2015-01-01

    Context: Epilepsy is one of the common neurological disorders worldwide. Fundamentally, there are two types of epilepsy—primary generalized epilepsy and localization-related epilepsy. Partial seizures account for about 40% of childhood seizures in some series and can be classified as simple or complex.[1] Partial seizures, more so the complex partial seizures (CPSs), are presumed to have a structural etiology. Aims: (1) To study the magnetic resonance imaging (MRI) brain findings in CPSs in children aged 1–18 years. (2) To identify treatable causes of CPSs based on MRI findings and institute appropriate treatment. Statistical Analysis: Statistical analysis was performed using percentages and proportions. Methods: Hospital based prospective study in which MRI brain was done on all newly diagnosed children with complex partial seizures, aged 1 to 18 yrs, during the study period. Final diagnosis was made correlating clinical features, radiological features and other supportive evidences, and appropriate treatment instituted. Follow up of cases was done until the completion of treatment (maximum 6 months). Results: Among the 64 children who were clinically diagnosed to have CPSs and subjected to MRI study of the brain, 40(62.5%) children were detected to have structural lesions, of which neurocysticercosis (NCC) was noted in 17 (42.5%), tuberculoma in 12 (30%), hippocampal sclerosis (HS) in 6 (15%), gliosis in 4 (10%), and tumor in 1 (2.5%) patient. Sixty-two (96.8%) children were treated medically, and 2 (3.2%) children underwent surgery. Conclusions: Etiology of CPS based on MRI findings showed a substantial number of medically- and surgically-treatable pathologies. This study done on South Indian children showed neuro infections to be the most common cause of CPS, followed by HS, with NCC being the most common lesion noted. MRI not only identifies specific epileptogenic substrates, but also determines the specific treatment and predicts prognosis and should be the imaging modality of choice in the evaluation of CPS. PMID:26962341

  10. Illustrating idiographic methods for translation research: moderation effects, natural clinical experiments, and complex treatment-by-subgroup interactions.

    PubMed

    Ridenour, Ty A; Wittenborn, Andrea K; Raiff, Bethany R; Benedict, Neal; Kane-Gill, Sandra

    2016-03-01

    A critical juncture in translation research involves the preliminary studies of intervention tools, provider training programs, policies, and other mechanisms used to leverage knowledge garnered at one translation stage into another stage. Potentially useful for such studies are rigorous techniques for conducting within-subject clinical trials, which have advanced incrementally over the last decade. However, these methods have largely not been utilized within prevention or translation contexts. The purpose of this manuscript is to demonstrate the flexibility, wide applicability, and rigor of idiographic clinical trials for preliminary testing of intervention mechanisms. Specifically demonstrated are novel uses of state-space modeling for testing intervention mechanisms of short-term outcomes, identifying heterogeneity in and moderation of within-person treatment mechanisms, a horizontal line plot to refine sampling design during the course of a clinic-based experimental study, and the need to test a treatment's efficacy as treatment is administered along with (e.g., traditional 12-month outcomes). PMID:27012260

  11. Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee – study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Traditional Indian Ayurvedic medicine uses complex treatment approaches, including manual therapies, lifestyle and nutritional advice, dietary supplements, medication, yoga, and purification techniques. Ayurvedic strategies are often used to treat osteoarthritis (OA) of the knee; however, no systematic data are available on their effectiveness in comparison with standard care. The aim of this study is to evaluate the effectiveness of complex Ayurvedic treatment in comparison with conventional methods of treating OA symptoms in patients with knee osteoarthritis. Methods and design In a prospective, multicenter, randomized controlled trial, 150 patients between 40 and 70 years, diagnosed with osteoarthritis of the knee, following American College of Rheumatology criteria and an average pain intensity of ≥40 mm on a 100 mm visual analog scale in the affected knee at baseline will be randomized into two groups. In the Ayurveda group, treatment will include tailored combinations of manual treatments, massages, dietary and lifestyle advice, consideration of selected foods, nutritional supplements, yoga posture advice, and knee massage. Patients in the conventional group will receive self-care advice, pain medication, weight-loss advice (if overweight), and physiotherapy following current international guidelines. Both groups will receive 15 treatment sessions over 12 weeks. Outcomes will be evaluated after 6 and 12 weeks and 6 and 12 months. The primary endpoint is a change in the score on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) after 12 weeks. Secondary outcome measurements will use WOMAC subscales, a pain disability index, a visual analog scale for pain and sleep quality, a pain experience scale, a quality-of-life index, a profile of mood states, and Likert scales for patient satisfaction, patient diaries, and safety. Using an adapted PRECIS scale, the trial was identified as lying mainly in the middle of the efficacy-effectiveness continuum. Discussion This trial is the first to compare the effectiveness of a complex Ayurvedic intervention with a complex conventional intervention in a Western medical setting in patients with knee osteoarthritis. During the trial design, aspects of efficacy and effectiveness were discussed. The resulting design is a compromise between rigor and pragmatism. Trial registration NCT01225133 PMID:23701973

  12. Thermal treatment effects imposed on solid DNA cationic lipid complex with hexadecyltrimethylammonium chloride, observed by variable angle spectroscopic ellipsometry

    NASA Astrophysics Data System (ADS)

    Nizioł, Jacek

    2014-12-01

    DNA cationic lipid complexes are materials of properties required for applications in organic electronics and optoelectronics. Often, their thermal stability demonstrated by thermogravimetry is cited in the literature as important issue. However, little is known about processes occurring in heated solid DNA cationic lipid complexes. In frame of this work, thin films of Deoxyribonucleic acid-hexadecyltrimethylammonium chloride (DNA-CTMA) were deposited on silicon wafers. Samples were thermally annealed, and simultaneously, their optical functions were measured by spectroscopic ellipsometry. At lower temperatures, thermal expansion coefficient of solid DNA-CTMA was negative, but at higher temperatures positive. Thermally induced modification of absorption spectrum in UV-vis was observed. It occurred at a range of temperatures higher than this of DNA denaturation in solution. The observed phenomenon was irreversible, at least in time scale of the experiment (one day).

  13. Thermal treatment effects imposed on solid DNA cationic lipid complex with hexadecyltrimethylammonium chloride, observed by variable angle spectroscopic ellipsometry

    SciTech Connect

    Nizioł, Jacek

    2014-12-21

    DNA cationic lipid complexes are materials of properties required for applications in organic electronics and optoelectronics. Often, their thermal stability demonstrated by thermogravimetry is cited in the literature as important issue. However, little is known about processes occurring in heated solid DNA cationic lipid complexes. In frame of this work, thin films of Deoxyribonucleic acid-hexadecyltrimethylammonium chloride (DNA-CTMA) were deposited on silicon wafers. Samples were thermally annealed, and simultaneously, their optical functions were measured by spectroscopic ellipsometry. At lower temperatures, thermal expansion coefficient of solid DNA-CTMA was negative, but at higher temperatures positive. Thermally induced modification of absorption spectrum in UV-vis was observed. It occurred at a range of temperatures higher than this of DNA denaturation in solution. The observed phenomenon was irreversible, at least in time scale of the experiment (one day)

  14. Theoretical treatment of helix-coil transition of complexes DNA with two different ligands having different binding parameters.

    PubMed

    Karapetian, Armen T; Grigoryan, Zareh A; Mamasakhlisov, Yevgeni Sh; Minasyants, Mikayel V; Vardevanyan, Poghos O

    2016-01-01

    The melting transition of DNA-ligand complexes, allowing for two binding mechanisms to different DNA conformations is treated theoretically. The obtained results express the behavior of the experimentally measurable quantities, degree of denaturation, and concentrations of bound ligands on the temperature. The range of binding parameters is obtained, where denaturation curves become multiphasic. The possible application to the nanocomposites crystallization is discussed. PMID:25723721

  15. A Unified Treatment of the Relationship Between Ligand Substituents and Spin State in a Family of Iron(II) Complexes.

    PubMed

    Kershaw Cook, Laurence J; Kulmaczewski, Rafal; Mohammed, Rufeida; Dudley, Stephen; Barrett, Simon A; Little, Marc A; Deeth, Robert J; Halcrow, Malcolm A

    2016-03-18

    The influence of ligands on the spin state of a metal ion is of central importance for bioinorganic chemistry, and the production of base-metal catalysts for synthesis applications. Complexes derived from [Fe(bpp)2 ](2+) (bpp=2,6-di{pyrazol-1-yl}pyridine) can be high-spin, low-spin, or spin-crossover (SCO) active depending on the ligand substituents. Plots of the SCO midpoint temperature (T1/2 ) in solution vs. the relevant Hammett parameter show that the low-spin state of the complex is stabilized by electron-withdrawing pyridyl ("X") substituents, but also by electron-donating pyrazolyl ("Y") substituents. Moreover, when a subset of complexes with halogeno X or Y substituents is considered, the two sets of compounds instead show identical trends of a small reduction in T1/2 for increasing substituent electronegativity. DFT calculations reproduce these disparate trends, which arise from competing influences of pyridyl and pyrazolyl ligand substituents on Fe-L σ and π bonding. PMID:26929084

  16. Efficacy of sclerotherapy with radio-opaque foam guided by digital subtraction angiography for the treatment of complex venous malformations of the head and neck.

    PubMed

    Chen, A-W; Liu, Y-R; Li, K; Zhang, K; Wang, T; Liu, S-H

    2015-11-01

    Our aim was to evaluate the efficacy of sclerotherapy using radio-opaque foam and guided by digital subtraction angiography (DSA) for complex venous malformations in the head and neck in 11 selected patients between 2011 and 2013. The sclerosing foam was manufactured by the classic Tessari method and consisted of air, 1% polidocanol, and radio-opaque media iopromide (Ultravist(®)300) in a ratio of 7:2:1. We recorded the site and size of the lesion, time and duration of treatment, and therapeutic response. The lesions were on the face, cheek, temporal region, parotid region, neck, tongue, floor of the mouth, parapharyngeal space, and soft palate. The sclerosing foam was radio-opaque under DSA, and the mean (range) dose was 21 (3-65) ml. A mean (range) of 4 (2-7) treatments was required, and 10 of the 11 patients responded well. In 4 of the 11 cases the lesion resolved completely and in 6 there was a good response. Only one lesion recurred. Early complications included immediate swelling in injected areas, snoring, and pain on swallowing, but there were no air emboli or signs of cutaneous necrosis, and the complications were self-limiting. DSA-guided sclerotherapy with radio-opaque foam was safe and effective for the treatment of complex vascular malformations of the head and neck. PMID:26113044

  17. Ab initio treatment of the chemical reaction precursor complex Br(2P)-HCN. 1. Adiabatic and diabatic potential surfaces.

    PubMed

    Fishchuk, Anna V; Merritt, Jeremy M; van der Avoird, Ad

    2007-08-01

    The three adiabatic potential surfaces of the Br(2P)-HCN complex that correlate to the 2P ground state of the Br atom were calculated ab initio. With the aid of a geometry-dependent diabatic mixing angle, also calculated ab initio, these adiabatic potential surfaces were transformed into a set of four diabatic potential surfaces required to define the full 3 x 3 matrix of diabatic potentials. Each of these diabatic potential surfaces was expanded in terms of the appropriate spherical harmonics in the atom-linear molecule Jacobi angle theta. The dependence of the expansion coefficients on the distance R between Br and the HCN center of mass and on the CH bond length was fit to an analytic form. For HCN in its equilibrium geometry, the global minimum with De = 800.4 cm(-1) and Re = 6.908a0 corresponds to a linear Br-NCH geometry, with an electronic ground state of Sigma symmetry. A local minimum with De = 415.1 cm-1, Re = 8.730a0, and a twofold degenerate Pi ground state is found for the linear Br-HCN geometry. The binding energy, De, depends strongly on the CH bond length for the Br-HCN complex and much less strongly for the Br-NCH complex, with a longer CH bond giving stronger binding for both complexes. Spin-orbit coupling was included and diabatic states were constructed that correlate to the ground 2P3/2 and excited 2P1/2 spin-orbit states of the Br atom. For the ground spin-orbit state with electronic angular momentum j = (3/2) the minimum in the potential for projection quantum number omega = +/-(3/2) coincides with the local minimum for linear Br-HCN of the spin-free case. The minimum in the potential for projection quantum number omega = +/-(1/2) occurs for linear Br-NCH but is considerably less deep than the global minimum of the spin-free case. According to the lowest spin-orbit coupling included adiabatic potential the two linear isomers, Br-NCH and Br-HCN, are about equally stable. In the subsequent paper, we use these potentials in calculations of the rovibronic states of the Br-HCN complex. PMID:17567108

  18. Fertility-preserving treatment in complex atypical hyperplasia and early endometrial cancer in young women with oral progestin: Is it effective?

    PubMed Central

    Baek, Ji Sun; Lee, Wan Ho; Kang, Woo Dae

    2016-01-01

    Objective The aim of this study is to assess the effectiveness of oral progestin treatment in women diagnosed with complex atypical hyperplasia (CAH) or grade 1 endometrial cancer (G1EC), who desire to preserve their fertility, as alternative treatment to a hysterectomy. Methods We reviewed the medical records of women younger than 45 years old that had been diagnosed with CAH or G1EC, who expressed a desire to preserve their fertility using alternative treatment at our institution. Women without evidence of myometrial invasion on pelvic magnetic resonance imaging scans were included. The study period was between 2004 and 2014. Endometrial biopsies were taken at follow-up appointments. Results We identified 31 young women with CAH or G1EC. The median age was 33 years old (range, 20 to 41), and the median period of time undertaking the treatment was 5 months (range, 1 to 12). Twenty-three patients (74.2%) achieved complete remission (CR; median time to CR was 3 months; range, 1 to 22), 16 patients (88.9%) with CAH and 7 (53.8%) with G1EC achieved CR. 6 patients (26.1%) who had achieved CR, had recurrence of the disease (median time from CR to recurrence was 12.5 months; range, 4 to 18). Eight patients (25.8%) finally underwent a hysterectomy. Conclusion Oral progestin therapy is an alternative treatment for women with CAH or G1EC who desire fertility preservation. However, more prospective studies are needed for standard progestin regimen. Also, there still remains a risk of disease progression and recurrence. Therefore, close follow-up is important during treatment and after CR. In addition, a hysterectomy is recommended as a definitive treatment after completion of childbearing. PMID:26866032

  19. WE-F-16A-06: Using 3D Printers to Create Complex Phantoms for Dose Verification, Quality Assurance, and Treatment Planning System Commissioning in Radiotherapy

    SciTech Connect

    Kassaee, A; Ding, X; McDonough, J; Reiche, M; Witztum, A; Teo, B

    2014-06-15

    Purpose: To use 3D printers to design and construct complex geometrical phantoms for commissioning treatment planning systems, dose calculation algorithms, quality assurance (QA), dose delivery, and patient dose verifications. Methods: In radiotherapy, complex geometrical phantoms are often required for dose verification, dose delivery and calculation algorithm validation. Presently, fabrication of customized phantoms is limited due to time, expense and challenges in machining of complex shapes. In this work, we designed and utilized 3D printers to fabricate two phantoms for QA purposes. One phantom includes hills and valleys (HV) for verification of intensity modulated radiotherapy for photons, and protons (IMRT and IMPT). The other phantom includes cylindrical cavities (CC) of various sizes for dose verification of inhomogeneities. We evaluated the HV phantoms for an IMPT beam, and the CC phantom to study various inhomogeneity configurations using photon, electron, and proton beams. Gafcromic ™ films were used to quantify the dose distributions delivered to the phantoms. Results: The HV phantom has dimensions of 12 cm × 12 cm and consists of one row and one column of five peaks with heights ranging from 2 to 5 cm. The CC phantom has a size 10 cm × 14 cm and includes 6 cylindrical cavities with length of 7.2 cm and diameters ranging from 0.6 to 1.2 cm. The IMPT evaluation using the HV phantom shows good agreement as compared to the dose distribution calculated with treatment planning system. The CC phantom also shows reasonable agreements for using different algorithms for each beam modalities. Conclusion: 3D printers with submillimiter resolutions are capable of printing complex phantoms for dose verification and QA in radiotherapy. As printing costs decrease and the technology becomes widely available, phantom design and construction will be readily available to any clinic for testing geometries that were not previously feasible.

  20. Azide vs Alkyne Functionalization in Pt(II) Complexes for Post-treatment Click Modification: Solid-State Structure, Fluorescent Labeling, and Cellular Fate.

    PubMed

    Wirth, Regina; White, Jonathan D; Moghaddam, Alan D; Ginzburg, Aurora L; Zakharov, Lev N; Haley, Michael M; DeRose, Victoria J

    2015-12-01

    Tracking of Pt(II) complexes is of crucial importance toward understanding Pt interactions with cellular biomolecules. Post-treatment fluorescent labeling of functionalized Pt(II)-based agents using the bioorthogonal Cu(I)-catalyzed azide-alkyne cycloaddition (CuAAC) reaction has recently been reported as a promising approach. Here we describe an azide-functionalized Pt(II) complex, cis-[Pt(2-azidobutyl)amido-1,3-propanediamine)Cl2] (1), containing the cis geometry and difunctional reactivity of cisplatin, and present a comparative study with its previously described alkyne-functionalized congener. Single-crystal X-ray diffraction reveals a dramatic change in the solid-state arrangement with exchange of the alkyne for an azide moiety wherein 1 is dominated by a pseudo-chain of Pt-Pt dimers and antiparallel alignment of the azide substituents, in comparison with a circular arrangement supported by CH/?(C?C) interactions in the alkyne version. In vitro studies indicate similar DNA binding and click reactivity of both congeners observed by fluorescent labeling. Interestingly, complex 1 shows in vitro enhanced click reactivity in comparison to a previously reported azide-appended Pt(II) complex. Despite their similar behavior in vitro, preliminary in cellulo HeLa studies indicate a superior imaging potential of azide-functionalized 1. Post-treatment fluorescent labeling of 1 observed by confocal fluorescence microscopy shows nuclear and intense nucleolar localization. These results demonstrate the potential of 1 in different cell line localization studies and for future isolation and purification of Pt-bound targets. PMID:26512733

  1. Application of the upflow anaerobic sludge bed (UASB) process for treatment of complex wastewaters at low temperatures

    SciTech Connect

    Koster, I.W.; Lettinga, G.

    1985-10-01

    The feasibility of the upflow anaerobic sludge bed (UASB) process for the treatment of potato starch wastewater at low ambient temperatures was demonstrated by operating two 5.65 l reactors at 14 degrees C and 20 degrees C, respectively. The organic space loading rates achieved in these laboratory-scale reactors were 3 kg COD/cubic m/day at 14 degrees C and 4-5 kg COD/cubic m/day at 20 degrees C. The corresponding sludge loading rates were 0.12 kg COD/kg VSS/day at 14 degrees C and 0.16-0.18 kg COD/kg VSS/day at 20 degrees C. These findings are of considerable practical importance because application of anaerobic treatment at low ambient temperatures will lead to considerable savings in energy needed for operating the process. As compared with various other anaerobic wastewater treatment processes, a granular sludge upflow process represents one of the best options developed so far. Although the overall sludge yield under psychrophilic conditions is slightly higher than under optimal mesophilic conditions, this doesn't seriously hamper the operation of the process. The extra sludge yield, due to accumulation of slowly hydrolyzing substrate ingredients, was 4.75% of the COD input at 14 degrees C and 1.22% of the COD input at 20 degrees C. 26 references.

  2. [Usefulness of PK/PD parameters of antimicrobials in the treatment of complex and extremely-resistant infections].

    PubMed

    Horcajada, Juan Pablo

    2015-09-01

    Complex or difficult to treat infections should benefit from antimicrobial PK/PD data in each specific situation. In the case of multidrug resistant gram negative infections the optimized use of colistin needs the using of PK/PD indexes. Likewise, in infections of inaccessible sources, PK/PD concepts play a key role in choosing the best antimicrobial and dosage. An example would be the potential role of linezolid in CNS infections. Among fungal infections, symptomatic candiduria by fluconazole-resistant strains are a therapeutic challenge. In this context micafungin could be a good alternative, again based on PK/PD concepts. PMID:26365728

  3. A Case Report of Renal Sympathetic Denervation for the Treatment of Polymorphic Ventricular Premature Complexes: Expanding Horizons.

    PubMed

    Kiuchi, Márcio Galindo; Vitorio, Frederico Puppim; Silva, Gustavo Ramalho da; Paz, Luis Marcelo Rodrigues; Souto, Gladyston Luiz Lima

    2015-12-01

    Premature ventricular complexes are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Recently, Armaganijan et al reported the relevance of sympathetic activation in patients with ventricular arrhythmias and suggested a potential role for catheter-based renal sympathetic denervation in reducing the arrhythmic burden.In this report, we describe a 32-year-old hypertensive male patient presenting with a high incidence of polymorphic premature ventricular complexes on a 24?hour Holter monitor. Beginning 1 year prior, the patient experienced episodes of presyncope, syncope, and tachycardia palpitations. The patient was taking losartan 100?mg/day, which kept his blood pressure (BP) under control, and sotalol 160?mg twice daily. Bisoprolol 10?mg/day was used previously but was not successful for controlling the episodes. The 24?hour Holter performed after the onset of sotalol 160?mg twice daily showed a heart rate ranging between 48 (minimum)-78 (average)-119 (maximum) bpm; 14,286 polymorphic premature ventricular complexes; 3 episodes of nonsustained ventricular tachycardia, the largest composed of 4 beats at a rate of 197 bpm; and 14 isolated atrial ectopic beats. Cardiac magnetic resonance imaging with gadolinium perfusion performed at rest and under pharmacological stress with dipyridamole showed increased left atrial internal volume, preserved systolic global biventricular function, and an absence of infarcted or ischemic areas. The patient underwent bilateral renal sympathetic denervation.The only drug used postprocedure was losartan 25?mg/day. Three months after the patient underwent renal sympathetic denervation, the mean BP value dropped to 132/86?mmHg, the mean systolic/diastolic 24?hour ambulatory BP measurement was reduced to 128/83?mmHg, and the 24?hour Holter monitor showed a heart rate ranging between 51 (minimum)-67 (average)-108 (maximum) bpm, 854 polymorphic premature ventricular complexes, and no episodes of nonsustained ventricular tachycardia. PMID:26683960

  4. Materials and Fuels Complex Hazardous Waste Management Act/Resource Conservation and Recovery Act Storage and Treatment Permit Reapplication, Environmental Protection Agency Number ID4890008952

    SciTech Connect

    Holzemer, Michael J.; Hart, Edward

    2015-04-01

    Hazardous Waste Management Act/Resource Conservation and Recovery Act Storage and Treatment Permit Reapplication for the Idaho National Laboratory Materials and Fuels Complex Hazardous Waste Management Act/Resource Conservation and Recovery Act Partial Permit, PER-116. This Permit Reapplication is required by the PER-116 Permit Conditions I.G. and I.H., and must be submitted to the Idaho Department of Environmental Quality in accordance with IDAPA 58.01.05.012 [40 CFR §§ 270.10 and 270.13 through 270.29].

  5. Autologous adipose-tissue derived regenerative cells for the treatment of complex cryptoglandular fistula-in-ano: a report of three cases

    PubMed Central

    Borowski, David W; Gill, Talvinder S; Agarwal, Anil K; Bhaskar, Pudhupalayam

    2012-01-01

    The treatment of complex fistulae-in-ano is challenging and often includes a number of operations due to high rates of recurrence. We report the successful treatment of three consecutive patients with long-standing cryptoglandular fistula-in-ano with a novel combination of mucosal advancement flap and adipose-tissue derived regenerative cells (ADRCs) from the stromal vascular fraction (SVF) obtained from a simple lipoaspiration procedure, using Celution technology. There was no operative morbidity; one patient who had a colostomy for faecal diversion has since undergone restoration of bowel continuity. All thee fistulae remain healed at 2–3-year follow-up. Lipofilling of cryptoglandular fistulae-in-ano with ADRC-enhanced lipofilling appears feasible and safe, and may add to the range of procedures that can be used to treat this difficult problem. PMID:23144344

  6. Additive Complex Ayurvedic Treatment in Patients with Fibromyalgia Syndrome Compared to Conventional Standard Care Alone: A Nonrandomized Controlled Clinical Pilot Study (KAFA Trial)

    PubMed Central

    Kessler, Christian S.; Meier, Larissa; Stapelfeldt, Elmar; Schütte, Silvia; Duda, Joachim; Michalsen, Andreas

    2013-01-01

    Background. Fibromyalgia (FMS) is a challenging condition for health care systems worldwide. Only limited trial data is available for FMS for outcomes of complex treatment interventions of complementary and integrative (CIM) approaches. Methods. We conducted a controlled, nonrandomized feasibility study that compared outcomes in 21 patients treated with Ayurveda with those of 11 patients treated with a conventional approach at the end of a two-week inpatient hospital stay. Primary outcome was the impact of fibromyalgia on patients as assessed by the FIQ. Secondary outcomes included scores of pain intensity, pain perception, depression, anxiety, and quality of sleep. Follow-up assessments were done after 6 months. Results. At 2 weeks, there were comparable and significant improvements in the FIQ and for most of secondary outcomes in both groups with no significant in-between-group differences. The beneficial effects for both treatment groups were partly maintained for the main outcome and a number of secondary outcomes at the 6-month followup, again with no significant in-between-group differences. Discussion. The findings of this feasibility study suggest that Ayurvedic therapy is noninferior to conventional treatment in patients with severe FMS. Since Ayurveda was only used as add-on treatment, RCTs on Ayurveda alone are warranted to increase model validity. This trial is registered with NCT01389336. PMID:24073008

  7. Additive Complex Ayurvedic Treatment in Patients with Fibromyalgia Syndrome Compared to Conventional Standard Care Alone: A Nonrandomized Controlled Clinical Pilot Study (KAFA Trial).

    PubMed

    Kessler, Christian S; Ostermann, Thomas; Meier, Larissa; Stapelfeldt, Elmar; Schütte, Silvia; Duda, Joachim; Michalsen, Andreas

    2013-01-01

    Background. Fibromyalgia (FMS) is a challenging condition for health care systems worldwide. Only limited trial data is available for FMS for outcomes of complex treatment interventions of complementary and integrative (CIM) approaches. Methods. We conducted a controlled, nonrandomized feasibility study that compared outcomes in 21 patients treated with Ayurveda with those of 11 patients treated with a conventional approach at the end of a two-week inpatient hospital stay. Primary outcome was the impact of fibromyalgia on patients as assessed by the FIQ. Secondary outcomes included scores of pain intensity, pain perception, depression, anxiety, and quality of sleep. Follow-up assessments were done after 6 months. Results. At 2 weeks, there were comparable and significant improvements in the FIQ and for most of secondary outcomes in both groups with no significant in-between-group differences. The beneficial effects for both treatment groups were partly maintained for the main outcome and a number of secondary outcomes at the 6-month followup, again with no significant in-between-group differences. Discussion. The findings of this feasibility study suggest that Ayurvedic therapy is noninferior to conventional treatment in patients with severe FMS. Since Ayurveda was only used as add-on treatment, RCTs on Ayurveda alone are warranted to increase model validity. This trial is registered with NCT01389336. PMID:24073008

  8. [Value and place of tenolysis of the flexors of the fingers in the complex treatment of tenogenic contractures].

    PubMed

    Kolonta?, Iu Iu; Bely?, S I

    1989-07-01

    Having analysed their experience in the treatment of 102 patients with tendogenic contractures of the hand fingers the authors have proposed a test for prognosis of the recovery of the slipping function of the flexor tendons after suturing and tendoplasty. In cases of ineffective conservative therapy it is recommended to make tenolysis at the early stages of rehabilitation. Indications and contraindications, the operative technique including application of microsurgical technique and the authors' devices have been determined. The principles of postoperative management of this category of patients have been elucidated. It has been noted that tenolysis at the early stages allows to considerably reduce the terms of rehabilitation. PMID:2682432

  9. Vanadium and cancer treatment: antitumoral mechanisms of three oxidovanadium(IV) complexes on a human osteosarcoma cell line.

    PubMed

    León, I E; Butenko, N; Di Virgilio, A L; Muglia, C I; Baran, E J; Cavaco, I; Etcheverry, S B

    2014-05-01

    We report herein the antitumor actions of three oxidovanadium(IV) complexes on MG-63 human osteosarcoma cell line. The three complexes: VO(oda), VO(oda)bipy and VO(oda)phen (oda=oxodiacetate), caused a concentration dependent inhibition of cell viability. The antiproliferative action of VO(oda)phen could be observed in the whole range of concentrations (at 2.5 ?M), while VO(oda)bipy and VO(oda) showed a decrease of cell viability only at higher concentrations (at 50 and 75 ?M, respectively) (p<0.01). Moreover, VO(oda)phen caused a decrease of lysosomal and mitochondrial activities at 2.5 ?M, while VO(oda) and VO(oda)bipy affected neutral red uptake and mitochondrial metabolism at 50 ?M (p<0.01). On the other hand, no DNA damage studied by the Comet assay could be observed in MG-63 cells treated with VO(oda) at 2.5-10 ?M. Nevertheless, VO(oda)phen and VO(oda)bipy induced DNA damage at 2.5 and 10 ?M, respectively (p<0.01). The generation of reactive oxygen species increased at 10 ?M of VO(oda)phen and only at 100 ?M of VO(oda) and VO(oda)bipy (p<0.01). Besides, VO(oda)phen and VO(oda)bipy triggered apoptosis as determined by externalization of the phosphatidylserine. The determination of DNA cleavage by agarose gel electrophoresis showed that the ability of VO(oda)(bipy) is similar to that of VO(oda), while VO(oda)(phen) showed the highest nuclease activity in this series. Overall, our results showed a good relationship between the bioactivity of the complexes and their structures since VO(oda)phen presented the most potent antitumor action in human osteosarcoma cells followed by VO(oda)bipy and then by VO(oda) according to the number of intercalating heterocyclic moieties. PMID:24199985

  10. Prothrombin Complex Concentrate and Methylene Blue for Treatment of Coagulopathy and Vasoplegia in a Pediatric Heart Transplant Patient.

    PubMed

    Lee, Jennifer K; Ing, Caleb

    2016-03-01

    Ventricular assist devices (VADs) are associated with conditions that may complicate the perioperative course of pediatric heart transplants. A 7-year-old girl with dilated cardiomyopathy supported by a Toyobo-NCVC left VAD (Toyobo-National Cardiovascular Center, Osaka, Japan), a pulsatile extracorporeal device, and preoperatively anticoagulated with warfarin presented for orthotopic heart transplant. The course was complicated by persistent bleeding treated with prothrombin complex concentrate and refractory postbypass vasoplegia treated with methylene blue. Preoperative anticoagulation and the presence of a VAD are associated with postbypass coagulopathy and vasoplegia. We describe a case in which these conditions were successfully treated with no thrombotic complications and minimal need of vasopressors for hemodynamic stability. PMID:26599739

  11. HIV-1 Group O Origin, Evolution, Pathogenesis, and Treatment: Unraveling the Complexity of an Outlier 25 Years Later.

    PubMed

    Bush, Shannon; Tebit, Denis M

    2015-01-01

    Twenty-five years ago, an aberrant HIV-1 (now classified as HIV-1 group O) was described from a Cameroonian HIV patient living in Belgium. The epicenter of group O was later found to be in Central Africa, overlapping with the geographical location of the central chimpanzees (Pan troglodytes troglodytes) and western gorillas (Gorilla gorilla), the likely original hosts of group O. Although the prevalence of group O has remained low at 1-2% in Cameroon, some European countries (France, Spain, Belgium) with strong colonial ties to Central Africa have reported the highest prevalence out of Africa. The sequence diversity between HIV-1 group O and M strains is huge, reaching 50 and 30% in the envelope and pol, respectively. This diversity has hindered diagnosis, monitoring, and treatment of group O-infected patients. Due to the intrinsic presence of the C181 mutation in group O, more than 60% of the approximately 30,000 individuals that live with this virus are faced with the challenge of drug resistance to some currently used antiretroviral therapies, notably the non-nucleoside reverse transcriptase inhibitors. Despite its susceptibility to most antiretroviral therapies, some group Os show a high variable baseline susceptibility to enfuvirtide (T20) and maraviroc. Group O strains are the least fit among all HIV-1 and -2 and restrict tetherin using their Nef but not Vpu as reported for group M. Although limited follow-up studies indicate that the natural course of group O is similar to that of M, these viruses are dominantly CCR5 tropic even late in infection, suggesting slow disease progression. This review summarizes important findings that marked the discovery, origin, spread, evolution, pathogenesis, and treatment of group O within the last 25 years. PMID:26450803

  12. [Comparative estimation of efficacy of the immunecorrecting combined three- level cytokino- and ozonotherapy in complex treatment of extended peritonitis].

    PubMed

    Gadzhiev, N D; Sushkov, S V; Klimova, E M; Kordon, T I

    2013-05-01

    The results of surgical treatment of 211 patients, suffering extended peritonitis (EP) of various etiology, were analyzed. The peritonitis severity was graded in accordance to Mannheim's index of peritonitis (MIP). The patients were divided on two groups. In 60 patients (group of comparison) the basic treatment was conducted, without immunocorrection. The patients of the main group were divided on three subgroups. To the patients of the first subgroup (43) 400 ml of ozonated isotonic solution (OIS) of sodium chloride was infused intravenously additionally in the contents of basic therapy, as well as peritoneal-enteral detoxication using OIS was conducted. In a second subgroup a regional intraabdominal endolymphatic ozonotherapy (OTH) was conducted to 57 patients with OIS and peritoneal-enteral sanation using medical ozone. In the 3d subgroup in 51 patients additionally were applied intravenous infusion of OIS and peritoneal-enteral sanation with medical ozone. To these patients cytokinotherapy was conducted, when splenopid was applied intravenously, intraperitoneally and enterally simultaneously. The indices of the T- and B-immunity links, phagocytic activity of neutrophils, including phagocytic index, phagocytic number, the completeness of phagocytosis index, as well as the content of the tumor necrosis factor alpha (TNF-alpha), gamma-interferon (IFN-gamma) and interleukins (IL) - IL-1, IL-2, IL-4, IL-6, IL-10 were estimated in the blood serum in dynamics. The combined staged three-level (systemic, intraperitoneal and enteral) application of natural cytokins and medical ozone have promoted mutual potentiating of their action, significant efficacy of the immunemodulating therapy in comparison with such systemic and local OTH. PMID:23888800

  13. A comparison of novel organoiridium(III) complexes and their ligands as a potential treatment for prostate cancer.

    PubMed

    Hockey, Samantha C; Barbante, Gregory J; Francis, Paul S; Altimari, Jarrad M; Yoganantharajah, Prusothman; Gibert, Yann; Henderson, Luke C

    2016-02-15

    A range of 1,4-substituted 2-pyridyl-N-phenyl triazoles were synthesised and evaluated for their antiproliferative properties against lymph node cancer of the prostate (LNCaP) and bone metastasis of prostate cancer (PC-3) cells. Excellent-to-low IC50 values were determined (5.6-250 ?M), and a representative group of 4 ligands were then complexed to iridium(III) giving highly luminescent species. Re-evaluation of these compounds against both cell lines was then undertaken and improved potency (up to 72-fold) was observed, giving IC50 values of 0.36-11 ?M for LNCaP and 0.85-5.9 ?M for PC-3. Preliminary screens for in vivo toxicity were conducted using a zebrafish model showing a wide range of induced toxicity depending of the compound evaluated. Apoptosis and Caspase-3 levels were also determined and showed no statistical difference between some of the treated specimens and the controls. This study may identify novel therapeutic agents for advanced stage of prostate cancer in humans. PMID:26802546

  14. Complex Apical Intraradicular Infection and Extraradicular Mineralized Biofilms as the Cause of Wet Canals and Treatment Failure: Report of 2 Cases.

    PubMed

    Ricucci, Domenico; Candeiro, George T M; Bugea, Calogero; Siqueira, José F

    2016-03-01

    This article describes 2 cases that showed persistent intracanal exudation (wet canal) even after several visits of antimicrobial endodontic treatment. Histologic and histobacteriologic investigation was conducted for determination of the cause. The 2 cases involved teeth with apical periodontitis lesions, which presented persistent exudation refractory to treatment after several visits. In case 1, it was not possible to achieve a dry canal, and surgery had to be performed. In case 2, attempts to dry the canal succeeded and the canal was filled, but follow-up examination showed an enlarged apical periodontitis lesion and extraction was performed. Biopsy specimens consisting of the root apex and apical periodontitis lesion for case 1 and the whole root for case 2 were subjected to histologic and histobacteriologic analyses. Both cases showed complex bacterial infection in the apical root, affecting both the intraradicular space and the outer root surface. Case 1 showed bacterial biofilms in ramifications, on untouched walls, and extending to the external root surface to form a thick and partially mineralized structure with high bacterial density. Different bacterial morphotypes were evidenced. Case 2 had a ledge on the apical canal wall created during instrumentation, which was filled with necrotic debris, filling material, and bacteria. The walls of the apical portion of the canal were covered by a bacterial biofilm, which was continuous with a thick extraradicular biofilm covering the cementum and dentin in resorptive defects. The extraradicular biofilm showed areas of mineralization and was dominated by filamentous bacteria. The 2 cases with wet canals and treatment failure were associated with complex persistent infection in the apical part of the root canal system extending to form thick and partially mineralized biofilm structures (calculus) on the outer apical root surface. PMID:26831049

  15. Effect of solution properties, competing ligands, and complexing metal on sorption of tetracyclines on Al-based drinking water treatment residuals.

    PubMed

    Punamiya, Pravin; Sarkar, Dibyendu; Rakshit, Sudipta; Datta, Rupali

    2015-05-01

    In the current batch study, we investigated the effect of solution properties, competing ligands (phosphate (P(V)) and sulfate), and complexing metal (calcium (Ca(2+))) on tetracycline (TTC) and oxytetracycline (OTC) sorption by Al-based drinking water treatment residuals (Al-WTR). The sorption behavior for both TTC and OTC on Al-WTR was pH dependent. The sorption in absence of competing ligands and complexing metal increased with increasing pH up to circum-neutral pH and then decreased at higher pH. The presence of P(V) when added simultaneously had a significant negative effect (p??0.1). The presence of sulfate had a minimal/negligible effect on the sorption of TCs by Al-WTR. A significant negative effect (p?complex formation. Fourier transform infrared (FTIR) analysis indicated the possibility of inner-sphere-type bonding by the functional groups of OTC/TTC on Al-WTR surface. Results from the batch sorption study indicate high affinity of Al-WTR for TCs in the pH range 4-8 (majorly encountered pH in the environment) in the presence of competing ligands and complexing metal. PMID:25647490

  16. The Role of mTOR Inhibitors in the Treatment of Patients with Tuberous Sclerosis Complex: Evidence-based and Expert Opinions.

    PubMed

    Curatolo, Paolo; Bjørnvold, Marit; Dill, Patricia E; Ferreira, José Carlos; Feucht, Martha; Hertzberg, Christoph; Jansen, Anna; Jóźwiak, Sergiusz; Kingswood, J Christopher; Kotulska, Katarzyna; Macaya, Alfons; Moavero, Romina; Nabbout, Rima; Zonnenberg, Bernard A

    2016-04-01

    Tuberous sclerosis complex (TSC) is a genetic disorder arising from mutations in the TSC1 or TSC2 genes. The resulting over-activation of the mammalian target of rapamycin (mTOR) signalling pathway leaves patients with TSC susceptible to the growth of non-malignant tumours in multiple organs. Previously, surgery was the main therapeutic option for TSC. However, pharmacological therapy with mTOR inhibitors such as everolimus and sirolimus is now emerging as an alternate approach. Everolimus and sirolimus have already been shown to be effective in treating subependymal giant cell astrocytoma (SEGA) and renal angiomyolipoma (AML), and everolimus is currently being evaluated in treating TSC-related epilepsy. In November 2013 a group of European experts convened to discuss the current options and practical considerations for treating various manifestations of TSC. This article provides evidence-based recommendations for the treatment of SEGA, TSC-related epilepsy and renal AML, with a focus on where mTOR inhibitor therapy may be considered alongside other treatment options. Safety considerations regarding mTOR inhibitor therapy are also reviewed. With evidence of beneficial effects in neurological and non-neurological TSC manifestations, mTOR inhibitors may represent a systemic treatment for TSC. PMID:26927950

  17. New fly ash TiO2 composite for the sustainable treatment of wastewater with complex pollutants load

    NASA Astrophysics Data System (ADS)

    Visa, Maria; Isac, Luminita; Duta, Anca

    2015-06-01

    The goal of this paper was to develop a new composite obtained in mild hydrothermal conditions starting from fly ash (a waste raising significant environmental problems), and TiO2. The composite was characterized through XRD, SEM/EDX, AFM, and BET surface measurements. The composite was further used for the advanced treatment of wastewaters with multiple-pollutants load. The photocatalytic efficiency of the powder composite was tested on synthetic solutions containing a heavy metal cation (copper), a dye (methyl orange), and a surfactant (sodium dodecylbenzenesulfonate), under UV and simulated solar radiation. Comparative experiments were done in systems with and without H2O2 showing a significant increase in efficiency for methyl orange removal from mono-, bi-, and tri-pollutants solutions. The process parameters were optimized and the adsorption mechanisms are discussed, outlining that adsorption is the limiting step. Experiments also outlined that homogeneous photocatalysis (using H2O2) is less efficient then the heterogeneous process using the novel composite, both under UV and simulated solar radiation.

  18. Complex interactions among nutrients, chlorophyll-a, and microcystins in three stormwater wet detention basins with floating treatment wetlands.

    PubMed

    Hartshorn, Nicholas; Marimon, Zachary; Xuan, Zhemin; Cormier, Jessica; Chang, Ni-Bin; Wanielista, Martin

    2016-02-01

    Stormwater wet detention ponds hold a permanent pool of water and offer many beneficial uses including flood mitigation, pollution prevention, downstream erosion control, increased aesthetics, and recreational uses. Although the removal of nutrients is generally low for stormwater wet detention ponds in urban areas, floating treatment wetlands (FTWs) can be installed to offer an innovative solution toward naturally removing excess nutrients and aiding in stormwater management. To improve the stormwater reuse potential, this study assessed nutrient, microcystin, and chlorophyll-a interactions in three Florida stormwater wet detention ponds with recently implemented FTWs. Both episodic (storm events) and routine (non-storm events) sampling campaigns were carried out at the three ponds located in Ruskin, Gainesville, and Orlando. The results showed a salient negative correlation between total phosphorus and microcystin concentrations for both storm and non-storm events across all three ponds. The dominant nutrient species in correlation seemed to be total phosphorus, which correlated positively with chlorophyll-a concentrations at all ponds and sampling conditions, with the exception of Orlando non-storm events. These results showed a correlation conditional to the candidate pond and sampling conditions for microcystin and chlorophyll-a concentrations. PMID:26386430

  19. IRES complexity before IFN-alpha treatment and evolution of the viral load at the early stage of treatment in peripheral blood mononuclear cells from chronic hepatitis C patients.

    PubMed

    Thélu, M A; Leroy, V; Ramzan, M; Dufeu-Duchesne, T; Marche, P; Zarski, J P

    2007-03-01

    At the early stage of treatment, IFN alpha-2a induces inhibition of HCV replication. The viral load reflects mainly the degradation rate of the viruses. However, differences in the behavior of the viral population depend on changes, which occurred in the HCV-IRES genome. In this study, cloning and sequencing strategies permitted the generation of a large number of IRES sequences from the PBMCs of 18 patients (5 women, 13 men) with chronic hepatitis C. The HCV IRES appeared to be highly conserved structurally. However, some variability was found between the different isolates obtained: 467 substitutions with a median of 7 variants/patients. No relationship was observed between pre-treatment IRES complexity and the viral load at the beginning. However, on review of the evolution of viral load in the PBMCs during the first 3 days of IFN alpha-2a treatment, patients could be classified into two groups: Group 1, in which the viral population continued to replicate and Group 2, in which the viral load decreased significantly (P = 0.01727). Positioning of the mutations on the predicted IRES secondary structure showed that the distribution of the mutations and their apparition frequency were different between the two groups. At the early stage of treatment, IFN alpha-2a was efficient in reducing the viral replication in a significant number of patients; mechanisms of response might affect the virus directly. However, pre-treatment genomic variations observed in the 5'NCR of HCV were not a parameter of a later response to antiviral therapy in chronic hepatitis C patients. (244) PMID:17245718

  20. Relationship between rectal temperature at first treatment for bovine respiratory disease complex in feedlot calves and the probability of not finishing the production cycle.

    PubMed

    Theurer, Miles E; White, Brad J; Larson, Robert L; Holstein, Krista K; Amrine, David E

    2014-12-01

    OBJECTIVE-To determine the relationship between rectal temperature at first treatment for bovine respiratory disease complex (BRDC) in feedlot calves and the probability of not finishing the production cycle. DESIGN-Retrospective data analysis. ANIMALS-344,982 calves identified as having BRDC from 19 US feedlots from 2000 to 2009. PROCEDURES-For each calf, data for rectal temperature at initial treatment for BRDC and various performance and outcome variables were analyzed. A binary variable was created to identify calves that did not finish (DNF) the production cycle (died or culled prior to cohort slaughter). A mixed general linear model and receiver operating characteristic curve were created to evaluate associations of rectal temperature, number of days in the feedlot at time of BRDC diagnosis, body weight, quarter of year at feedlot arrival, sex, and all 2-way interactions with rectal temperature with the probability that calves DNF. RESULTS-27,495 of 344,982 (7.97%) calves DNF. Mean rectal temperature at first treatment for BRDC was 40.0°C (104°F). As rectal temperature increased, the probability that a calf DNF increased; however, that relationship was not linear and was influenced by quarter of year at feedlot arrival, sex, and number of days in the feedlot at time of BRDC diagnosis. Area under the receiver operating characteristic curve for correct identification of a calf that DNF was 0.646. CONCLUSIONS AND CLINICAL RELEVANCE-Rectal temperature of feedlot calves at first treatment for BRDC had limited value as a prognostic indicator of whether those calves would finish the production cycle. PMID:25406709

  1. The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan.

    PubMed

    Tilkeridis, Konstantinos; Chari, Basavraj; Cheema, Nusrat; Tryfonidis, Marios; Khaleel, Arshad

    2015-04-01

    We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation. PMID:25764152

  2. Irinotecan Lipid Complex Injection

    MedlinePLUS

    Irinotecan lipid complex is used in combination with other medications to treat pancreatic cancer that has spread to other ... worsened after treatment with other chemotherapy medications. Irinotecan lipid complex is in a class of antineoplastic medications ...

  3. Doxorubicin Lipid Complex Injection

    MedlinePLUS

    Doxorubicin lipid complex is used to treat ovarian cancer that has not improved or that has worsened after treatment with other medications. Doxorubicin lipid complex is also used to treat Kaposi's sarcoma ( ...

  4. Vincristine Lipid Complex Injection

    MedlinePLUS

    Vincristine lipid complex is used to treat a certain type of acute lymphoblastic leukemia (ALL; a type of cancer ... least two different treatments with other medications. Vincristine lipid complex is in a class of medications called ...

  5. Actinide immobilization in the subsurface environment by in-situ treatment with a hydrolytically unstable organophosphorus complexant: Uranyl uptake by calcium phytate

    SciTech Connect

    Nash, K.L.; Jensen, M.P.; Schmidt, M.A.

    1997-12-31

    In addition to naturally occurring uranium and thorium, actinide ions exist in the subsurface environment as a result of accidental releases and intentional disposal practices associated with nuclear weapons production. These species present a significant challenge to cost-effective remediation of contaminated environments. An attractive approach to decreasing the probability of actinide migration in the subsurface is to transform the ions into a less mobile form by remote treatment. We have under development a process which relies on a polyfunctional organophosphorus complexant to sequester the mobile metal ions by complexation/cation exchange in the near term, and to subsequently decompose, transforming the actinides into insoluble phosphate mineral forms in the long term. Studies to date include identification of a suitable organophosphorus reagent, profiling of its decomposition kinetics, verification of the formation of phosphate mineral phases upon decomposition of the reagent, and extensive comparison of the actinide uptake ability of the calcium salt of the reagent as compared with hydroxyapatite. In this report, we briefly describe the process with focus on the cation exchange behavior of the calcium salt of the organophosphorus sequestrant.

  6. Lenalidomide in the context of complex karyotype or interrupted treatment: case reviews of del(5q)MDS patients with unexpected responses

    PubMed Central

    Haase, Sabine; Heinsch, Michael; Göhring, Gudrun; Schlegelberger, Brigitte; Aul, Carlo

    2006-01-01

    Lenalidomide has particular activity in patients with transfusion-dependent del(5q) myelodysplastic syndromes (MDS), but mechanistic information is limited regarding the relationship between erythroid and cytogenetic responses. We reviewed medical records from three distinct subgroups of del(5q) MDS patients who had unexpected effects with lenalidomide treatment: 1. two patients with complex karyotypes who achieved both cytogenetic remissions and transfusion independence; 2. two patients with 5q- syndrome who took lenalidomide for less than 12 weeks but remained transfusion independent for 15+ months still displaying del(5q) metaphases after 6 and 12 months; and 3. one patient who was a non-responder on lenalidomide during treatment but became transfusion independent for 13+ months after discontinuation. All but the latter patient in this series had reduction of affected metaphases, suggesting that erythroid responses might be mediated by result from partial or complete suppression of the malignant clone, either directly or indirectly through modulation of the bone marrow microenvironment. These clinical observations illustrate the heterogeneity of del(5q)MDS pathogenesis and the diversity of lenalidomide responses within this patient subset. PMID:17111142

  7. Efficiency of liposomal albendazole for the treatment of the patients with complex alveolar echinococcosis: a comparative analysis of CEUS, CT, and PET/CT.

    PubMed

    Li, Haitao; Song, Tao; Qin, Yongde; Liu, Wenya; Li, Xiaohong; Shao, Yingmei; Wen, Hao

    2015-11-01

    We aim to investigate the efficiency of liposomal albendazole (L-ABZ) for the treatment of complex alveolar echinococcosis (CAE) using contrast-enhanced ultrasonography (CEUS), computed tomography (CT), and positron emission tomography (PET)/CT. Twelve patients with CAE admitted to our hospital between June 2000 and June 2011 were included in this retrospective study. CEUS, CT, and PET/CT were used to evaluate the clinical efficiency of L-ABZ for these patients. Effectiveness was defined as significant response after chemotherapy. Effectiveness with clinical significance was defined as complete response after chemotherapy, and non-effectiveness was defined as no response after chemotherapy. Patients were followed up for 3-11 years. Ten patients (83.3%) had a ratio of averaged gray scale in the enhanced band to that of hepatic tissues of ?1.1, and six patients (50.0%) had a ratio of ?0.9 as revealed by CEUS. CT scanning results indicated an effective rate of 91.6%. PET/CT indicated a maximal standard uptake (SUVmax) of <2.5 in nine patients (75.0%), which was considered to be effective. A high uptake of fluorodeoxyglucose was observed in three patients (25.0%) with SUVmax ?2.5, which was considered to be non-effective. Taken together, CEUS, CT, and PET/CT provide objective evaluation of the clinical efficiency of L-ABZ for the treatment of CAE. PMID:26239800

  8. Delta III reverse shoulder arthroplasty in the treatment of complex 3- and 4-part fractures of the proximal humerus: 6 to 42 months of follow up

    PubMed Central

    2013-01-01

    Background There is a growing tendency for complex proximal humerus fractures (PHF) in osteoporotic patients to be treated with reverse shoulder arthroplasty (RSA). It has been proposed that RSA has more benefits than other treatment options. The aim of our study was to investigate preoperative characteristics as well as clinical and radiological outcomes in patients with complex 3- or 4-part PHF who had undergone primary RSA. Methods Patients with a minimum follow-up of 6 months who had undergone a primary RSA after 3- or 4-part PHF in the period between 2008 and 2011 were eligible for the study. Clinical records, X-rays and CT-scans were investigated and a clinical examination was performed. Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant-Murley score (CMS) were calculated. Sixteen patients were examined as part of the study. The mean follow-up was 20 months (range 6-42 months). According to Codman-Hertel classification we encountered 15 Hertel “12” and 1 Hertel “8” type fractures. Results Thirty-two patients (27 female – 84.4%) with a mean age of 72 years underwent operations to treat complex 3- and 4-part fractures of the proximal humerus. Sixteen patients were reexamined. In 14 cases the dominant upper extremity was on the right, in 2 cases it was on the left, in 6 cases the right side was affected and in 10 cases the left side was affected. The mean CMS was 54.8 (range 18-95) and the mean DASH was 37.5 (range 2.9-81). A trend was established between the CMS and dominance of the affected shoulder. The CMS was better if the affected shoulder was on the non-dominant side (p-value 0.051). No statistical difference was noted between age and clinical outcome. Conclusions Our mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA. RSA can provide immediate relief and good shoulder function in elderly patients. Nevertheless, the question of longevity of these implants remains to be observed. PMID:23924060

  9. Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach

    PubMed Central

    Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

    2013-01-01

    Background Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. Objective The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. Methods We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. Results The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. Conclusions The descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports. PMID:23612478

  10. Pilot Quasi-Randomized Controlled Study of Herbal Medicine Hochuekkito as an Adjunct to Conventional Treatment for Progressed Pulmonary Mycobacterium avium Complex Disease

    PubMed Central

    Enomoto, Yasunori; Hagiwara, Eri; Komatsu, Shigeru; Nishihira, Ryuichi; Baba, Tomohisa; Kitamura, Hideya; Sekine, Akimasa; Nakazawa, Atsuhito; Ogura, Takashi

    2014-01-01

    Introduction Hochuekkito, a traditional herbal medicine, is occasionally prescribed in Japan to treat patients with a poor general condition. We aimed to examine whether this medicine was beneficial and tolerable for patients with progressed pulmonary Mycobacterium avium complex (MAC) disease. Methods This pilot open-label quasi-randomized controlled trial enrolled 18 patients with progressed pulmonary MAC disease who had initiated antimycobacterial treatment over one year ago but were persistently culture-positive or intolerant. All patients continued their baseline treatment regimens with (n?=?9) or without (n?=?9) oral Hochuekkito for 24 weeks. Results Baseline characteristics were generally similar between the groups. Most patients were elderly (median age 70 years), female, had a low body mass index (<20 kg/m2), and a long-term disease duration (median approximately 8 years). After the 24-week treatment period, no patient achieved sputum conversion. Although the number of colonies in sputum tended to increase in the control group, it generally remained stable in the Hochuekkito group. Radiological disease control was frequently observed in the Hochuekkito group than the control group (8/9 vs. 3/9; p?=?0.05). Patients in the Hochuekkito group tended to experience increase in body weight and serum albumin level compared with those in the control group (median body weight change: +0.4 kg vs. ?0.8 kg; median albumin change: +0.2 g/dl vs. ±0.0 g/dl). No severe adverse events occurred. Conclusions Hochuekkito could be an effective, feasible adjunct to conventional therapy for patients with progressed pulmonary MAC disease. Future study is needed to explore this possibility. Trial Registration UMIN Clinical Trials Registry UMIN000009920 PMID:25093868

  11. Complications of mammalian target of rapamycin inhibitor anticancer treatment among patients with tuberous sclerosis complex are common and occasionally life-threatening.

    PubMed

    Trelinska, Joanna; Dachowska, Iwona; Kotulska, Katarzyna; Fendler, Wojciech; Jozwiak, Sergiusz; Mlynarski, Wojciech

    2015-04-01

    The aim of this study was to evaluate the most common adverse events (AEs) linked to everolimus therapy, a mammalian target of rapamycin (mTOR) inhibitor, in children and adolescents with tuberous sclerosis complex (TSC) hospitalized in one medical center. The study group included 18 patients with a diagnosis of subependymal giant cell astrocytoma or renal angiomyolipoma related to TSC. The median duration of therapy was 15 months. All clinical symptoms and laboratory abnormalities including complete blood count, fasting lipid profile, glucose level, and liver and kidney function tests were analyzed as potential AEs. The most common AEs of everolimus therapy were laboratory abnormalities (100% of patients) and infection complications (83 episodes in 15 patients). Infectious episodes of pharyngitis (67%), diarrhea (44%), stomatitis (39%), and bronchitis (39%) were the most common infections. They were mostly mild or moderate in severity (grade 1-2). In two cases, life-threatening conditions related to mTOR inhibitor treatment were encountered. The first was classified as grade 4 pleuropneumonia and Streptococcus pneumoniae sepsis, whereas the second was classified as death related to AE (grade 5) Escherichia coli sepsis. The most common laboratory abnormalities were hypercholesterolemia (13/18 patients - 72%) and hypertriglyceridemia (12/18 patients - 66%). Neutropenia (12/18 patents - 66%) and anemia (8/18 patients - 44%) were the most common hematologic toxicities. Everolimus treatment in TSC patients may lead to life-threatening outcomes, including sepsis and death. Long-lasting effects of everolimus treatment in the context of high incidences of different laboratory abnormalities found in TSC patients are another subject that should be researched further. PMID:25719621

  12. The role of mycobacterial cell wall nucleic acid complex in the treatment of bacillus Calmette–Guérin failures for non-muscle-invasive bladder cancer

    PubMed Central

    Packiam, Vignesh T.; Pearce, Shane M.; Steinberg, Gary D.

    2016-01-01

    Introduction: The treatment of high-risk non-muscle-invasive bladder cancer (NMIBC) utilizes transurethral resection followed by adjuvant intravesical immunotherapy or chemotherapy. Intravesical bacillus Calmette–Guérin (BCG) is the mainstay of adjuvant immunotherapy, but there are limited nonsurgical options for patients that fail this treatment. Mycobacterial cell wall nucleic acid complex (MCNA) is an immunotherapeutic agent utilized primarily after failure of intravesical BCG. The purpose of this paper is to provide a comprehensive review of the published literature regarding MCNA. Methods: A literature review was performed and identified studies indexed in MEDLINE® related to utilization of MCNA for patients with NMIBC. Results: Two trials assessed the efficacy of MCNA in patients with NMIBC, comprising a total of 184 patients. Most patients had carcinoma in situ (CIS) with (26%) or without (52%) concomitant papillary tumors. A minority of patients had only papillary tumors (22%). Most patients (95%) previously received BCG or other intravesical therapy prior to receiving MCNA. In the largest available trial, 25% and 19% of patients had no evidence of residual cancer in 1 and 2 years following initiation of MCNA. A total of 2.3% of patients had adverse events (AEs) leading to delay or discontinuation of therapy and 66% of patients had mild drug-related AEs. Conclusion: Based on analysis of available published data, MCNA offers a durable response for a small proportion of patients that have failed prior intravesical therapy. There still exists a large unmet need for nonsurgical treatment options for patients with NMIBC who have failed adjuvant intravesical therapies. PMID:26834838

  13. 18F-FAZA PET imaging response tracks the reoxygenation of tumors in mice upon treatment with the mitochondrial complex I inhibitor BAY 87-2243

    PubMed Central

    Chang, Edwin; Liu, Hongguang; Unterschemmann, Kerstin; Ellinghaus, Peter; Liu, Shuanglong; Gekeler, Volker; Cheng, Zhen; Berndorff, Dietmar; Gambhir, Sanjiv S

    2014-01-01

    Purpose We describe a non-invasive PET imaging method that monitors early therapeutic efficacy of BAY 87-2243, a novel small molecule inhibitor of mitochondrial complex I as a function of hypoxia-inducible factor-1? (HIF-1?) activity Experimental Design Four PET tracers (18F-FDG, 18F-Fpp(RGD)2, 18F-FLT and 18F-FAZA) were assessed for uptake into tumor xenografts of drug-responsive (H460, PC3) or drug-resistant (786-0) carcinoma cells. Mice were treated with BAY 87-2243 or vehicle. At each point, RNA from treated and vehicle H460 tumor xenografts (n=3 each) was isolated and analyzed for target genes. Results Significant changes in uptake of 18F-FAZA, 18F-FLT and 18F-Fpp(RGD)2 (p<0.01) occurred with BAY 87-2243 treatment with 18F-FAZA being the most prominent. 18F-FDG uptake was unaffected. 18F-FAZA tumor uptake declined by 55–70% (1.21±0.10 %ID/g to 0.35±0.1 %ID/g, n=6, vehicle vs. treatment) in both H460 (p<0.001) and PC3 (p<0.05) xenografts 1–3 days post-drug. 18F-FAZA uptake in 786-0 xenografts was unaffected. Decline occurred before significant differences in tumor volume, thus that suggesting 18F-FAZA decrease reflected early changes in tumor metabolism. BAY 87-2243 reduced expression of hypoxia-regulated genes CA IX, ANGPTL4 and EGLN-3 by 99 %, 93% and 83%, respectively (p<0.001 for all), which corresponds with reduced 18F-FAZA uptake upon drug treatment. Heterogeneous expression of genes associated with glucose metabolism, vessel density and proliferation was observed. Conclusions Our studies suggest suitability of 18F-FAZA-PET as an early pharmacodynamic monitor on the efficacy of anti-cancer agents that target the mitochondrial complex I and intra-tumor oxygen levels (e.g. BAY 87-2243). PMID:25381339

  14. Connections and consequences in complex systems: insights from a case study of the emergence and local impact of crisis resolution and home treatment services.

    PubMed

    Hannigan, Ben

    2013-09-01

    In this article the broad contours of a complexity perspective are outlined. Complexity ideas are then drawn on to frame an empirical examination of the connections running between different levels of organisation in health and social care, and to underpin investigation into the intended and unintended local system consequences of service development. Data are used from a study conducted in the UK's mental health field. Here, macro-level policy has led to the supplementing of longstanding community mental health teams by newer, more specialised, services. An example includes teams providing crisis resolution and home treatment (CRHT) care as an alternative to hospital admission. Using an embedded case study design, where 'the case' examined was a new CRHT team set in its surrounding organisational environment, ethnographic data (with interviews predominating) were generated in a single site in Wales over 18 months from the middle of 2007. In a large-scale context favourable to local decision-making, and against a background of a partial and disputed evidence base, the move to establish the new standalone service was contested. Whilst users valued the work of the team, and local practitioners recognised the quality of its contribution, powerful effects were also triggered across the locality's horizontal interfaces. Participants described parts of the interconnected system being closed to release resources, staff gravitating to new crisis services leaving holes elsewhere, and the most needy service users being cared for by the least experienced workers. Some community mental health team staff described unexpected increases in workload, and disputes over eligibility for crisis care with implications for system-wide working relations. Detailed data extracts are used to illustrate these connections and consequences. Concluding lessons are drawn on the use of evidence to inform policy, on the significance of local contexts and system interfaces, and on anticipating the unexpected at times of change. PMID:22386638

  15. Fast and accurate Monte Carlo modeling of a kilovoltage X-ray therapy unit using a photon-source approximation for treatment planning in complex media.

    PubMed

    Zeinali-Rafsanjani, B; Mosleh-Shirazi, M A; Faghihi, R; Karbasi, S; Mosalaei, A

    2015-01-01

    To accurately recompute dose distributions in chest-wall radiotherapy with 120 kVp kilovoltage X-rays, an MCNP4C Monte Carlo model is presented using a fast method that obviates the need to fully model the tube components. To validate the model, half-value layer (HVL), percentage depth doses (PDDs) and beam profiles were measured. Dose measurements were performed for a more complex situation using thermoluminescence dosimeters (TLDs) placed within a Rando phantom. The measured and computed first and second HVLs were 3.8, 10.3 mm Al and 3.8, 10.6 mm Al, respectively. The differences between measured and calculated PDDs and beam profiles in water were within 2 mm/2% for all data points. In the Rando phantom, differences for majority of data points were within 2%. The proposed model offered an approximately 9500-fold reduced run time compared to the conventional full simulation. The acceptable agreement, based on international criteria, between the simulations and the measurements validates the accuracy of the model for its use in treatment planning and radiobiological modeling studies of superficial therapies including chest-wall irradiation using kilovoltage beam. PMID:26170553

  16. In vitro and in vivo anticancer properties of a Calcarea carbonica derivative complex (M8) treatment in a murine melanoma model

    PubMed Central

    2010-01-01

    Background Melanoma is the most aggressive form of skin cancer and the most rapidly expanding cancer in terms of worldwide incidence. Chemotherapeutic approaches to treat melanoma have had only marginal success. Previous studies in mice demonstrated that a high diluted complex derived from Calcarea carbonica (M8) stimulated the tumoricidal response of activated lymphocytes against B16F10 melanoma cells in vitro. Methods Here we describe the in vitro inhibition of invasion and the in vivo anti-metastatic potential after M8 treatment by inhalation in the B16F10 lung metastasis model. Results We found that M8 has at least two functions, acting as both an inhibitor of cancer cell adhesion and invasion and as a perlecan expression antagonist, which are strongly correlated with several metastatic, angiogenic and invasive factors in melanoma tumors. Conclusion The findings suggest that this medication is a promising non-toxic therapy candidate by improving the immune response against tumor cells or even induce direct dormancy in malignancies. PMID:20338038

  17. Increased Survivorship and Altered Cytokine Profile from Treatment of Influenza A H1N1-Infected Mice with Ekybion: A Drug Complex of Natural Extracts and Inorganic Compounds

    PubMed Central

    Lupfer, Christopher; Besnouin, Didier; Tepper, Samuel E.; Maselko, Maciej; Patton, Kristin M.; Pastey, Manoj

    2011-01-01

    Ekybion is a drug complex of 16 natural extracts and inorganic compounds designed to treat a variety of respiratory pathogens of bacterial and viral origin. It is licensed throughout Europe for the treatment of respiratory tract infections from equine parainfluenza type 3 and equine herpes virus type 1 in equine stables. The purpose of this paper was to test the efficacy of Ekybion on a well-developed animal model of influenza A infection and determine a mode of action. Experiments were performed with Balb/c mice infected with a lethal dose of influenza A/PR/8/34 H1N1 virus and treated with nebulized Ekybion every 8?h in a time-dependant or dose-dependant fashion. These experiments showed that mice treated prior to infection with Ekybion had a higher survival rates (~46%) compared with untreated animals (~0%). Paradoxically, these mice showed no significant difference in lung virus titer or weight loss. There was, however, a decrease in the level of GM-CSF, IL-6, and G-CSF cytokines in the lungs of Ekybion-treated, infected mice. It is possible that decreases in proinflammatory cytokines may have contributed to increased survivorship in Ekybion-treated influenza-infected mice. PMID:20981272

  18. Fast and accurate Monte Carlo modeling of a kilovoltage X-ray therapy unit using a photon-source approximation for treatment planning in complex media

    PubMed Central

    Zeinali-Rafsanjani, B.; Mosleh-Shirazi, M. A.; Faghihi, R.; Karbasi, S.; Mosalaei, A.

    2015-01-01

    To accurately recompute dose distributions in chest-wall radiotherapy with 120 kVp kilovoltage X-rays, an MCNP4C Monte Carlo model is presented using a fast method that obviates the need to fully model the tube components. To validate the model, half-value layer (HVL), percentage depth doses (PDDs) and beam profiles were measured. Dose measurements were performed for a more complex situation using thermoluminescence dosimeters (TLDs) placed within a Rando phantom. The measured and computed first and second HVLs were 3.8, 10.3 mm Al and 3.8, 10.6 mm Al, respectively. The differences between measured and calculated PDDs and beam profiles in water were within 2 mm/2% for all data points. In the Rando phantom, differences for majority of data points were within 2%. The proposed model offered an approximately 9500-fold reduced run time compared to the conventional full simulation. The acceptable agreement, based on international criteria, between the simulations and the measurements validates the accuracy of the model for its use in treatment planning and radiobiological modeling studies of superficial therapies including chest-wall irradiation using kilovoltage beam. PMID:26170553

  19. “Quantum Leap” in Photobiomodulation Therapy Ushers in a New Generation of Light-Based Treatments for Cancer and Other Complex Diseases: Perspective and Mini-Review

    PubMed Central

    Rodríguez-Santana, Elizabeth; Santana-Rodríguez, Karin E.; Reyes, Heberto

    2016-01-01

    Abstract Objective: Set within the context of the 2015 International Year of Light and Light-Based Technologies,and of a growing and aging world population with ever-rising healthcare needs, this perspective and mini-review focuses on photobiomodulation (PBM) therapy as an emerging, cost-effective, treatment option for cancer (i.e., solid tumors) and other complex diseases, particularly, of the eye (e.g., age-related macular degeneration, diabetic retinopathy, glaucoma, retinitis pigmentosa) and the central nervous system (e.g., Alzheimer's and Parkinson's disease). Background data: Over the last decades, primary and secondary mechanisms of PBM have been revealed. These include oxygen-dependent and oxygen-independent structural and functional action pathways. Signal and target characteristics determine biological outcome, which is optimal (or even positive) only within a given set of parameters. Methods: This study was a perspective and nonsystematic literature mini-review. Results: Studies support what we describe as a paradigm shift or “quantum leap” in the understanding and use of light and its interaction with water and other relevant photo-cceptors to restore physiologic function. Conclusions: Based on existing evidence, it is argued that PBM therapy can raise the standard of care and improve the quality of life of patients for a fraction of the cost of many current approaches. PBM therapy can, therefore,benefit large, vulnerable population groups, including the elderly and the poor, whilehaving a major impact on medical practice and public finances. PMID:26890728

  20. Galactose conjugated platinum(II) complex targeting the Warburg effect for treatment of non-small cell lung cancer and colon cancer.

    PubMed

    Wu, Meng; Li, Hong; Liu, Ran; Gao, Xiangqian; Zhang, Menghua; Liu, Pengxing; Fu, Zheng; Yang, Jinna; Zhang-Negrerie, Daisy; Gao, Qingzhi

    2016-03-01

    Malignant neoplasms exhibit a higher rate of glycolysis than normal cells; this is known as the Warburg effect. To target it, a galactose-conjugated (trans-R,R-cyclohexane-1,2-diamine)-2-chloromalonato-platinum(II) complex (Gal-Pt) was designed, synthesized, and evaluated in five human cancer cell lines and against two different xenograft tumour models. Gal-Pt exhibits much higher aqueous solubility (over 25 times) and improved cytotoxicity than oxaliplatin, especially in human colon (HT29) and lung (H460) cancer cell lines. The safety profile of Gal-Pt was investigated in vivo by exploring the maximum tolerated dose (MTD) and animal mortality rate. The ratios of the animal lethal dosage values to the cytotoxicity in HT29 (LD50/IC50) showed that Gal-Pt was associated with an increased therapeutic index by over 30-fold compared to cisplatin and oxaliplatin. We evaluated in vivo antitumor activity by single agent intravenous treatment comparison studies of Gal-Pt (50 mg/kg as 65% MTD) and cisplatin (3 mg/kg, as 80% MTD) in a H460 lung cancer xenograft model, and with oxaliplatin (7 mg/kg, as 90% MTD) in a HT29 colon cancer xenograft model. The results show that Gal-Pt was more efficacious against H460 than cisplatin, and had superior potency in HT29 cells compared to oxaliplatin under nontoxic dosage conditions. The dependency between cytotoxicity of Gal-Pt and glucose transporters (GLUTs) was investigated by using quercetin as an inhibitor of GLUTs in HT29 cells. The cytotoxic potency of Gal-Pt was highly reduced by the inhibitor, suggesting that the uptake of Gal-Pt was regulated by glucose transporters. The GLUT mediated transportability and cellular uptake of Gal-Pt was also demonstrated using a fluorescent glucose bioprobe in HT29 competition assay. PMID:26807543

  1. IL-2 / α-IL-2 Complex Treatment Cannot Be Substituted for the Adoptive Transfer of Regulatory T cells to Promote Bone Marrow Engraftment

    PubMed Central

    Mahr, Benedikt; Unger, Lukas; Hock, Karin; Pilat, Nina; Baranyi, Ulrike; Schwarz, Christoph; Maschke, Svenja; Farkas, Andreas Michael; Wekerle, Thomas

    2016-01-01

    Cell therapy with recipient Tregs achieves engraftment of allogeneic bone marrow (BM) without the need for cytoreductive conditioning (i.e., without irradiation or cytotoxic drugs). Thereby mixed chimerism and transplantation tolerance are established in recipients conditioned solely with costimulation blockade and rapamycin. However, clinical translation would be substantially facilitated if Treg-stimulating pharmaceutical agents could be used instead of individualized cell therapy. Recently, it was shown that interleukin-2 (IL-2) complexed with a monoclonal antibody (mAb) (clone JES6-1A12) against IL-2 (IL-2 complexes) potently expands and activates Tregs in vivo. Therefore, we investigated whether IL-2 complexes can replace Treg therapy in a costimulation blockade-based and irradiation-free BM transplantation (BMT) model. Unexpectedly, the administration of IL-2 complexes at the time of BMT (instead of Tregs) failed to induce BM engraftment in non-irradiated recipients (0/6 with IL-2 complexes vs. 3/4 with Tregs, p<0.05). Adding IL-2 complexes to an otherwise effective regimen involving recipient irradiation (1Gy) but no Treg transfer indeed actively triggered donor BM rejection at higher doses (0/8 with IL-2 complexes vs. 9/11 without, p<0.01) and had no detectable effect at two lower doses (3/5 vs. 9/11, p>0.05). CD8 T cells and NK cells of IL-2 complex-treated naïve mice showed an enhanced proliferative response towards donor antigens in vitro despite the marked expansion of Tregs. However, IL-2 complexes also expanded conventional CD4 T cells, CD8 T cells, NK cells, NKT cells and notably even B cells, albeit to a lesser extent. Notably, IL-2 complex expanded Tregs featured less potent suppressive functions than in vitro activated Tregs in terms of T cell suppression in vitro and BM engraftment in vivo. In conclusion, these data suggest that IL-2 complexes are less effective than recipient Tregs in promoting BM engraftment and in contrast actually trigger BM rejection, as their effect is not sufficiently restricted to Tregs but rather extends to several other lymphocyte populations. PMID:26731275

  2. IL-2 / ?-IL-2 Complex Treatment Cannot Be Substituted for the Adoptive Transfer of Regulatory T cells to Promote Bone Marrow Engraftment.

    PubMed

    Mahr, Benedikt; Unger, Lukas; Hock, Karin; Pilat, Nina; Baranyi, Ulrike; Schwarz, Christoph; Maschke, Svenja; Farkas, Andreas Michael; Wekerle, Thomas

    2016-01-01

    Cell therapy with recipient Tregs achieves engraftment of allogeneic bone marrow (BM) without the need for cytoreductive conditioning (i.e., without irradiation or cytotoxic drugs). Thereby mixed chimerism and transplantation tolerance are established in recipients conditioned solely with costimulation blockade and rapamycin. However, clinical translation would be substantially facilitated if Treg-stimulating pharmaceutical agents could be used instead of individualized cell therapy. Recently, it was shown that interleukin-2 (IL-2) complexed with a monoclonal antibody (mAb) (clone JES6-1A12) against IL-2 (IL-2 complexes) potently expands and activates Tregs in vivo. Therefore, we investigated whether IL-2 complexes can replace Treg therapy in a costimulation blockade-based and irradiation-free BM transplantation (BMT) model. Unexpectedly, the administration of IL-2 complexes at the time of BMT (instead of Tregs) failed to induce BM engraftment in non-irradiated recipients (0/6 with IL-2 complexes vs. 3/4 with Tregs, p<0.05). Adding IL-2 complexes to an otherwise effective regimen involving recipient irradiation (1Gy) but no Treg transfer indeed actively triggered donor BM rejection at higher doses (0/8 with IL-2 complexes vs. 9/11 without, p<0.01) and had no detectable effect at two lower doses (3/5 vs. 9/11, p>0.05). CD8 T cells and NK cells of IL-2 complex-treated naïve mice showed an enhanced proliferative response towards donor antigens in vitro despite the marked expansion of Tregs. However, IL-2 complexes also expanded conventional CD4 T cells, CD8 T cells, NK cells, NKT cells and notably even B cells, albeit to a lesser extent. Notably, IL-2 complex expanded Tregs featured less potent suppressive functions than in vitro activated Tregs in terms of T cell suppression in vitro and BM engraftment in vivo. In conclusion, these data suggest that IL-2 complexes are less effective than recipient Tregs in promoting BM engraftment and in contrast actually trigger BM rejection, as their effect is not sufficiently restricted to Tregs but rather extends to several other lymphocyte populations. PMID:26731275

  3. Synthesis, structural characterization and cytotoxic activity of ternary copper(II)-dipeptide-phenanthroline complexes. A step towards the development of new copper compounds for the treatment of cancer.

    PubMed

    Iglesias, Sebastián; Alvarez, Natalia; Torre, María H; Kremer, Eduardo; Ellena, Javier; Ribeiro, Ronny R; Barroso, Rafael P; Costa-Filho, Antonio J; Kramer, M Gabriela; Facchin, Gianella

    2014-10-01

    In the search for new compounds with antitumor activity, coordination complexes with different metals are being studied by our group. This work presents the synthesis and characterization of six copper complexes with general stoichiometry [Cu(L-dipeptide)(phen)]·nH2O (were phen=1,10-phenanthroline) and their cytotoxic activities against tumor cell lines. To characterize these systems, analytical and spectroscopic studies were performed in solid state (by UV-visible, IR, X-ray diffraction) including the crystal structure of four new complexes (of the six complexes studied): [Cu(Ala-Phe)(phen)]·4H2O, [Cu(Phe-Ala)(phen)]·4H2O, [Cu(Phe-Val)(phen)]·4.5H2O and [Cu(Phe-Phe)(phen)]·3H2O. In all of them, the copper ion is situated in a distorted squared pyramidal environment. The phen ligand is perpendicular to the dipeptide, therefore exposed and potentially available for interaction with biological molecules. In addition, for all the studied complexes, structural information in solution using EPR and UV-visible spectroscopies were obtained, showing that the coordination observed in solid state is maintained. The lipophilicity, DNA binding and albumin interaction were also studied. Biological experiments showed that all the complexes induce cell death in the cell lines: HeLa (human cervical adenocarcinoma), MCF-7 (human metastatic breast adenocarcinoma) and A549 (human lung epithelial carcinoma). Among the six complexes, [Cu(Ala-Phe)(phen)] presents the lowest IC50 values. Taken together all these data we hypothesize that [Cu(Ala-Phe)(phen)] may be a good candidate for further studies in vivo. PMID:25033418

  4. Use of Cone-beam Computed Tomography during Retreatment of a 2-rooted Maxillary Central Incisor: Case Report of a Complex Diagnosis and Treatment.

    PubMed

    Levin, Avi; Shemesh, Avi; Katzenell, Vered; Gottlieb, Ayelet; Ben Itzhak, Joe; Solomonov, Michael

    2015-12-01

    A double-rooted maxillary incisor is an extremely rare anatomic variation. Only a few case reports describe this abnormal anatomy. In recent decades, cone-beam computed tomographic (CBCT) imaging has become more common for endodontic purposes. This case report describes the retreatment of double-rooted maxillary central incisors using CBCT imaging. In 2012, a 20-year-old man was referred to our department because of asymptomatic periapical lesions in teeth #8, #9, and #10. During the evaluation of a periapical radiograph, a rare anatomic variation, in the form of an additional root of tooth #9, was detected, and it was impossible to decide about the source of the lesion between teeth #9 and #10. During retreatment, after gutta-percha removal, CBCT imaging was performed; this allowed proper treatment of the additional root and a final diagnosis of normal periapical tissue of tooth #10 with no treatment needed. The 18-month follow-up revealed a healing lesion in tooth #9 and normal periapical tissue in tooth #10. During the treatment of teeth with an anatomic variation, CBCT imaging can serve as an auxiliary tool for 3-dimensional evaluation that influences treatment steps and techniques. CBCT scanning can be very useful in assessing the actual location of a periapical lesion, which influences diagnosis and treatment planning. PMID:26478437

  5. Routine Depression Screening in an HIV Clinic Cohort Identifies Patients with Complex Psychiatric Co-morbidities Who Show Significant Response to Treatment

    PubMed Central

    McCullumsmith, Cheryl; Mugavero, Michael J.; Ingle-Pang, Paige E.; Raper, James L.; Willig, James H.; You, Zhiying; Batey, D. Scott; Crane, Heidi; Lawrence, Sarah T.; Wright, Charles; Treisman, Glenn; Saag, Michael S.

    2015-01-01

    This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders. PMID:23086427

  6. Synthesis and characterization of Cu(II), Co(II) and Ni(II) complexes of a number of sulfadrug azodyes and their application for wastewater treatment.

    PubMed

    El-Baradie, K; El-Sharkawy, R; El-Ghamry, H; Sakai, K

    2014-01-01

    The azodye ligand (HL(1)) was synthesized from the coupling of sulfaguanidine diazonium salt with 2,4-dihydroxy-benzaldehyde while the two ligands, HL(2) and HL(3), were prepared by the coupling of sulfadiazine diazonium salt with salicylaldehyde (HL(2)) and 2,4-dihydroxy-benzaldehyde (HL(3)). The prepared ligands were characterized by elemental analysis, IR, (1)H NMR and mass spectra. Cu(II), Co(II) and Ni(II) complexes of the prepared ligands have been synthesized and characterized by various spectroscopic techniques like IR, UV-Visible as well as magnetic and thermal (TG and DTA) measurements. It was found that all the ligands behave as a monobasic bidentate which coordinated to the metal center through the azo nitrogen and α-hydroxy oxygen atoms in the case of HL(1) and HL(3). HL(2) coordinated to the metal center through sulfonamide oxygen and pyrimidine nitrogen. The applications of the prepared complexes in the oxidative degradation of indigo carmine dye exhibited good catalytic activity in the presence of H2O2 as an oxidant. The reactions followed first-order kinetics and the rate constants were determined. The degradation reaction involved the catalytic action of the azo-dye complexes toward H2O2 decomposition, which can lead to the generation of HO radicals as a highly efficient oxidant attacking the target dye. The detailed kinetic studies and the mechanism of these catalytic reactions are under consideration in our group. PMID:24239761

  7. New ethanol and propylene glycol free gel formulations containing a minoxidil-methyl-β-cyclodextrin complex as promising tools for alopecia treatment.

    PubMed

    Lopedota, Angela; Cutrignelli, Annalisa; Denora, Nunzio; Laquintana, Valentino; Lopalco, Antonio; Selva, Stefano; Ragni, Lorella; Tongiani, Serena; Franco, Massimo

    2015-05-01

    New topical totally aqueous formulations that improve the low water solubility of minoxidil and realize an adequate permeability of drug in the skin are proposed. These formulations are lacking in propylene glycol and alcohol that are the principal irritant ingredients present in minoxidil commercial solutions. In order to enhance poor water solubility of minoxidil randomly methyl-β-cyclodextrin was used, and four hydrogels such as, calcium alginate, sodium alginate, carbopol 934 and hydroxyethylcellulose were utilized to ensure a prolonged time of contact with the scalp. The inclusion complex minoxidil/methyl-β-cyclodextrin with a molar ratio 1:1 was obtained by freeze drying and evaluated by NMR, FT-IR and DSC analysis. An apparent stability constant of formed inclusion complex was calculated by phase solubility diagram and its value was 400 M(-1). The solid inclusion complex was used to prepare gel formulations with similar dose to minoxidil commercial solution. The gels were evaluated for various technological parameters including rheological behavior, in vitro drug release and ex vivo permeation through pig skin. The best performance was observed for the calcium alginate formulation. PMID:24650036

  8. Direct nerve suture and knee immobilization in 90° flexion as a technique for treatment of common peroneal, tibial and sural nerve injuries in complex knee trauma

    PubMed Central

    Döring, Robert; Ciritsis, Bernhard; Giesen, Thomas; Simmen, Hans-Peter; Giovanoli, Pietro

    2012-01-01

    There are different ways to treat peripheral nerve injuries with concomitant defects in the lower extremity. One option is a direct nerve suture followed by immobilization of the knee in flexion as it is described for gunshot wounds that lead to lesions of the sciatic nerve and its terminal branches as well as isolated nerve lesions. We used this technique to treat a case of multiple nerve injuries of the lower extremity combined with a complex knee trauma including a lesion of both bones and the posterior capsule. To our knowledge, this technique has not yet been described for such a combined injury in literature. PMID:24968417

  9. [COMPLEX OF THE TREATMENT MEASURES IN A SYSTEM OF THE MEDICAL CARE DELIVERY TO WOUNDED PERSONS WITH THE GUN-SHOT AND MINE-EXPLOSIVE INJURIES OF THE FOOT].

    PubMed

    Korohl, S O

    2015-11-01

    Complex of the treatment measures, conducted in 302 wounded persons, suffering the gun-shot and mine-explosive injuries of the foot in 2014 - 2015 yrs, was analyzed. Primary surgical processing of the wound was conducted in all injured persons, secondary surgical processing--in 64.6%, the foot bones osteosynthesis--in 13.9%, primary immobilization, using improvised tire--in 77.8%, secondary immobilization, using the plaster splint--in 48.1%, llizarov's spokes--in 35.2%, Ilizarov's apparatus--in 18.5%, the rods apparatuses of external fixation--in 16.7%. For improvement of functioning of a modern system for the treatment-evacuation provision it is necessary, to reduce the quantity of levels of the medical help provision maximally. PMID:26939433

  10. A psychological intervention for smoking cessation delivered as treatment for smokers with chronic obstructive pulmonary disease: Multiple needs of a complex group and recommendations for novel service development.

    PubMed

    Yap, Su Yin; Lunn, Sarah; Pang, Elizabeth; Croft, Carla; Stern, Myra

    2015-08-01

    This pilot study investigated the benefits of adjunctive psychological intervention for smokers accessing standard smoking cessation interventions. Chronic obstructive pulmonary disease (COPD) smokers attending a smoking cessation service were offered up to 12 adjunctive clinical psychology sessions. Baseline data included demographics, smoking history, and disease severity. Outcomes included attendance and quit rate. In all, 59 patients with moderate COPD were referred. Of the 20 patients who attended training sessions, 7 (35%) were relapse prevention referrals and 13 (65%) were current smokers. Of the seven relapse prevention referrals, six (86%) maintained their quit, 2 of 13 (15%) of the current smoker group maintained a 28-day quit and 3 of 13 (23%) of current smokers reduced their tobacco intake. For COPD smokers with a heavy smoking history and multiple past quit attempts, there was insufficient evidence to show that additional psychological intervention leads to higher quit rates. Significant barriers to quitting and complex medical and psychosocial needs were identified in this group, suggesting that the current 'one-size-fits-all' approach to smoking cessation may not be sufficient to meet the needs of such a complex group. PMID:25990130

  11. [Carpal injuries associated with distal radius fractures. Diagnosis and therapy].

    PubMed

    Rappold, G; Leixnering, M; Pezzei, C

    2001-07-01

    The frequency of carpal injuries associated with distal radius fractures is often underestimated. Diagnosis of such lesions can be difficult. Important diagnostic steps include conventional X-rays, cinematography of the wrist, MRI, and arthroscopy. Different procedures such as wrist arthrography and CT are of secondary value. An early diagnosis of ligament injuries and instabilities can be obtained through cinematographic examination, whereas injuries to the TFCC are mainly diagnosed by MRI. Arthroscopy provides exact diagnosis as well as therapy, including arthroscopically controlled reposition of centrally depressed fragments of the articular surface of the radius and even treatment of TFCC lesions. PMID:11518981

  12. Comparison of the Degree of Exercise Tolerance in Children After Surgical Treatment of Complex Cardiac Defects, Assessed Using Ergospirometry and the Level of Brain Natriuretic Peptide

    PubMed Central

    Mazurek, Boguslaw; Szydlowski, Leslaw; Mazurek, Magdalena; Markiewicz-Loskot, Grazyna; Pajak, Jacek; Morka, Aleksandra

    2016-01-01

    Abstract Children who underwent surgery for complex congenital heart defects present worse exercise capacity than their healthy peers. In adults and adolescents, heart failure is assessed on the basis of clinical symptoms using the New York Heart Association (NYHA) score, while in an infant Ross scale; heart failure can also be evaluated by other parameters. The purpose of this study was to compare the degree of exercise tolerance in children after surgery for complex heart defects, assessed by the ratio of maximum oxygen uptake (VO2max) and the brain natriuretic peptide (N-terminal fragment of the prohormone brain-type natriuretic peptide [NT-proBNP]) concentration. The study group consisted of 42 children, ages 9 to 17 years (mean 14.00 ± 2.72). Among them there were 22 children with tetralogy of Fallot (ToF) after total correction, 18 children with transposition of the great arteries (d-TGA) after the arterial switch operation, and 2 children with single ventricle (SV) after the Fontan operation. All but 1 child were in NYHA class I. The control group consisted of 20 healthy children. Outcomes of interest were the ratio of VO2max, determined during ergospirometry, and the level of NT-proBNP. The statistical analysis was performed and the groups were considered significantly different for P < 0.05. There was no statistically significant correlation between NT-proBNP and maximum oxygen uptake (VO2) kg−1 min−1 in the study group compared with the control group. The VO2max in the test group had a mean value less (34.6 ± 8.0) than controls (38.4 ± 7.7), and the differences were statistically significant (P = 0.041). In contrast, the average concentration of NT-proBNP in the study group was higher than controls (117.9 ± 74.3 vs 18.0 ± 24.5), and these differences were statistically significant (P < 0.001). After operations for complex heart defects (ToF, TGA, and SV), children have worse heart function parameters and exercise capacity than the healthy population. To control this, we recommend postoperative ergospirometry and determination of NT-proBNP concentrations. PMID:26937900

  13. Comparison of the Degree of Exercise Tolerance in Children After Surgical Treatment of Complex Cardiac Defects, Assessed Using Ergospirometry and the Level of Brain Natriuretic Peptide.

    PubMed

    Mazurek, Boguslaw; Szydlowski, Leslaw; Mazurek, Magdalena; Markiewicz-Loskot, Grazyna; Pajak, Jacek; Morka, Aleksandra

    2016-02-01

    Children who underwent surgery for complex congenital heart defects present worse exercise capacity than their healthy peers. In adults and adolescents, heart failure is assessed on the basis of clinical symptoms using the New York Heart Association (NYHA) score, while in an infant Ross scale; heart failure can also be evaluated by other parameters. The purpose of this study was to compare the degree of exercise tolerance in children after surgery for complex heart defects, assessed by the ratio of maximum oxygen uptake (VO2max) and the brain natriuretic peptide (N-terminal fragment of the prohormone brain-type natriuretic peptide [NT-proBNP]) concentration.The study group consisted of 42 children, ages 9 to 17 years (mean 14.00 ± 2.72). Among them there were 22 children with tetralogy of Fallot (ToF) after total correction, 18 children with transposition of the great arteries (d-TGA) after the arterial switch operation, and 2 children with single ventricle (SV) after the Fontan operation. All but 1 child were in NYHA class I. The control group consisted of 20 healthy children. Outcomes of interest were the ratio of VO2max, determined during ergospirometry, and the level of NT-proBNP. The statistical analysis was performed and the groups were considered significantly different for P < 0.05.There was no statistically significant correlation between NT-proBNP and maximum oxygen uptake (VO2) kg min in the study group compared with the control group.The VO2max in the test group had a mean value less (34.6 ± 8.0) than controls (38.4 ± 7.7), and the differences were statistically significant (P = 0.041). In contrast, the average concentration of NT-proBNP in the study group was higher than controls (117.9 ± 74.3 vs 18.0 ± 24.5), and these differences were statistically significant (P < 0.001).After operations for complex heart defects (ToF, TGA, and SV), children have worse heart function parameters and exercise capacity than the healthy population. To control this, we recommend postoperative ergospirometry and determination of NT-proBNP concentrations. PMID:26937900

  14. Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report

    PubMed Central

    Lee, Jong-Hoo; Byun, Jeong-Hyun; Choe, Yu-Ri; Lim, Seung-Kyu; Lee, Ka-Young

    2015-01-01

    A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere. PMID:26361601

  15. Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report.

    PubMed

    Lee, Jong-Hoo; Byun, Jeong-Hyun; Choe, Yu-Ri; Lim, Seung-Kyu; Lee, Ka-Young; Choi, In-Sung

    2015-08-01

    A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere. PMID:26361601

  16. Effects of complex decongestive physiotherapy on the oedema and the quality of life of lower unilateral lymphoedema following treatment for gynecological cancer.

    PubMed

    Kim, S-J; Park, Y-D

    2008-09-01

    There is increasing interest in the health-related quality of life (QOL) of patients with chronic lymphoedema. The purpose of the present study was to ascertain whether or not complex decongestive physiotherapy (CDP) for 57 gynecological cancer patients with unilateral lymphedema results in a measurable change in the oedema and QOL, and % excess volume correlated with change in QOL. % excess volume was significantly (P<0.05) decreased after CDP. The QOL scores were significantly (P<0.05) higher than the scores at baseline, indicating an improvement in the QOL. The change in % excess volume was associated with a change in physical functioning, social functioning, role-physical, bodily pain and general health at baseline and 1 month (P<0.05). This study suggests that significant improvements are made in the QOL of gynecological cancer patients with unilateral lymphoedema after CDP, which is necessarily correlated with limb reduction. PMID:18637114

  17. Treatment of a complex posterior fossa aneurysm in a child using side-to-side posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass.

    PubMed

    Chandela, Sid; Alzate, Juan; Sen, Chandranath; Song, Joon; Nimi, Yasunari; Berenstein, Alejandro; Langer, David

    2008-01-01

    Endovascular and cerebral bypass therapies are rarely used in children. The authors describe the treatment of a partially coiled giant distal vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysm in a child. They performed a side-to-side PICA-PICA anastomosis followed by endovascular VA aneurysm deconstruction with PICA preservation. A healthy 11-year-old boy developed progressive holocephalic headaches over the course of 2 months. Magnetic resonance imaging and magnetic resonance angiography revealed a large right PICA aneurysm causing brainstem compression. In November 2005, 2 Neuroform stents and Guglielmi detachable coils and Matrix were placed in the aneurysm at an outside institution. In 2006, angiography demonstrated aneurysm enlargement from which the PICA originated, coil compaction, and increased mass effect. The patient underwent a PICA-PICA bypass with intraoperative flow measurements followed by endovascular embolization of the aneurysm and parent VA. An angiogram obtained after the procedure demonstrated filling of the right PICA medullary branch through the bypass and obliteration of the aneurysm. The patient remained neurologically intact. Giant aneurysms of the posterior circulation are rare but do occur in children. With the aid of combined surgical and endovascular strategies the authors were able to safely eliminate the aneurysm from circulation with good outcome. Cerebral bypass and endovascular deconstructive therapies can be used safely in children but should be reserved for cases in which direct treatment carries significant risk. Careful surgical and endovascular planning with intraoperative flow assessment is essential for good outcome. PMID:18352808

  18. Complexity Survey.

    ERIC Educational Resources Information Center

    Gordon, Sandra L.; Anderson, Beth C.

    To determine whether consensus existed among teachers about the complexity of common classroom materials, a survey was administered to 66 pre-service and in-service kindergarten and prekindergarten teachers. Participants were asked to rate 14 common classroom materials as simple, complex, or super-complex. Simple materials have one obvious part,…

  19. The complex differential diagnosis between thrombotic thrombocytopenic purpura and the atypical hemolytic uremic syndrome: Laboratory weapons and their impact on treatment choice and monitoring.

    PubMed

    Mannucci, P M; Cugno, M

    2015-11-01

    Thrombocytopenia and microangiopathic hemolytic anemia are the hallmark of the thrombotic microangiopathies (TMAs) thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). TTP, inherited or autoimmune, is mainly caused by the plasma deficiency of the von Willebrand factor cleaving protease ADAMTS13, owing to gene mutations or autoantibodies. Typical HUS is often caused by infections with Shiga-Toxin-producing Escherichia coli and thus is called STEC-HUS. The rarer atypical form of HUS is often associated with complement dysregulation, owing to the inherited deficiency or dysfunction of factor H or other complement proteins. In the past the distinction between these TMAs was almost exclusively based on clinical grounds, the term TTP being used for cases with predominant neurological involvement, STEC HUS for cases presenting with bloody diarrhea and atypical HUS identifying patients with severe renal damage. However the clinical presentation may not easily distinguish TTP from atypical HUS. A more accurate differential diagnosis has clinical implications, because plasma exchange (the treatment of choice in TTP) is much less effective in atypical HUS, which shows dramatic short- and long-term therapeutic benefits from eculizumab, a monoclonal antibody that inhibits complement activation. This article will point out that the measurement of ADAMTS13 is able to diagnose accurately the majority of TTP cases, and that very simple tests such as the platelet count and serum creatinine can predict the deficiency of the protease with a good degree of accuracy. In atypical HUS, new methods were recently developed that not only demonstrate the activation of the complement system, i.e., the main disease mechanism, but also help to tailor the short- and long-term treatment with eculizumab. PMID:26386489

  20. Ab initio treatment of the chemical reaction precursor complex Cl(2P)-HF. 1. Three-dimensional diabatic potential energy surfaces.

    PubMed

    Fishchuk, Anna V; Wormer, Paul E S; van der Avoird, Ad

    2006-04-27

    The three adiabatic potential surfaces of the Cl(2P)-HF complex that correlate with the 2P ground state of the Cl atom were calculated with the ab initio RCCSD(T) method (partially spin-restricted coupled cluster theory including single and double excitations and perturbative correction for the triples). With the aid of a geometry-dependent diabatic mixing angle, calculated by the complete active space self-consistent field (CASSCF) and multireference configuration-interaction (MRCI) methods, these adiabatic potential surfaces were converted to a set of four distinct diabatic potential surfaces required to define the full 3 x 3 matrix of diabatic potentials. Each of these diabatic potential surfaces was expanded in terms of the appropriate spherical harmonics in the angle theta between the HF bond axis r and the Cl-HF intermolecular axis R. The dependence of the expansion coefficients on the Cl-HF distance R and the HF bond length r(HF) was fit to an analytic form. The strongest binding occurs for the hydrogen-bonded linear Cl-HF geometry, with D(e) = 676.5 cm(-1) and R(e) = 6.217 a0 when r(HF) = r(e) = 1.7328 a0. This binding energy D(e) depends strongly on r(HF), with larger r(HF) causing stronger binding. An important contribution to the binding energy is provided by the interaction between the quadrupole moment of the Cl(2P) atom and the dipole of HF. In agreement with this electrostatic picture, the ground state of linear Cl-HF is a 2-fold degenerate electronic Pi state. For the linear Cl-FH geometry the states are in opposite order, i.e., the Sigma state is lower in energy than the Pi state. The following paper in this issue describes full three-dimensional computations of the bound states of the Cl-HF complex, based on the ab initio diabatic potentials of this paper. PMID:16623452

  1. Communication complexity and information complexity

    NASA Astrophysics Data System (ADS)

    Pankratov, Denis

    Information complexity enables the use of information-theoretic tools in communication complexity theory. Prior to the results presented in this thesis, information complexity was mainly used for proving lower bounds and direct-sum theorems in the setting of communication complexity. We present three results that demonstrate new connections between information complexity and communication complexity. In the first contribution we thoroughly study the information complexity of the smallest nontrivial two-party function: the AND function. While computing the communication complexity of AND is trivial, computing its exact information complexity presents a major technical challenge. In overcoming this challenge, we reveal that information complexity gives rise to rich geometrical structures. Our analysis of information complexity relies on new analytic techniques and new characterizations of communication protocols. We also uncover a connection of information complexity to the theory of elliptic partial differential equations. Once we compute the exact information complexity of AND, we can compute exact communication complexity of several related functions on n-bit inputs with some additional technical work. Previous combinatorial and algebraic techniques could only prove bounds of the form theta( n). Interestingly, this level of precision is typical in the area of information theory, so our result demonstrates that this meta-property of precise bounds carries over to information complexity and in certain cases even to communication complexity. Our result does not only strengthen the lower bound on communication complexity of disjointness by making it more exact, but it also shows that information complexity provides the exact upper bound on communication complexity. In fact, this result is more general and applies to a whole class of communication problems. In the second contribution, we use self-reduction methods to prove strong lower bounds on the information complexity of two of the most studied functions in the communication complexity literature: Gap Hamming Distance (GHD) and Inner Product mod 2 (IP). In our first result we affirm the conjecture that the information complexity of GHD is linear even under the uniform distribution. This strengthens the O(n) bound shown by Kerenidis et al. (2012) and answers an open problem by Chakrabarti et al. (2012). We also prove that the information complexity of IP is arbitrarily close to the trivial upper bound n as the permitted error tends to zero, again strengthening the O(n) lower bound proved by Braverman and Weinstein (2011). More importantly, our proofs demonstrate that self-reducibility makes the connection between information complexity and communication complexity lower bounds a two-way connection. Whereas numerous results in the past used information complexity techniques to derive new communication complexity lower bounds, we explore a generic way, in which communication complexity lower bounds imply information complexity lower bounds in a black-box manner. In the third contribution we consider the roles that private and public randomness play in the definition of information complexity. In communication complexity, private randomness can be trivially simulated by public randomness. Moreover, the communication cost of simulating public randomness with private randomness is well understood due to Newman's theorem (1991). In information complexity, the roles of public and private randomness are reversed: public randomness can be trivially simulated by private randomness. However, the information cost of simulating private randomness with public randomness is not understood. We show that protocols that use only public randomness admit a rather strong compression. In particular, efficient simulation of private randomness by public randomness would imply a version of a direct sum theorem in the setting of communication complexity. This establishes a yet another connection between the two areas. (Abstract shortened by UMI.).

  2. Hyaluronic acid co-functionalized gold nanoparticle complex for the targeted delivery of metformin in the treatment of liver cancer (HepG2 cells).

    PubMed

    Kumar, C Senthil; Raja, M D; Sundar, D Sathish; Gover Antoniraj, M; Ruckmani, K

    2015-09-01

    In this study, green synthesis of gold nanoparticles (AuNPs) was achieved using the extract of eggplant as a reducing agent. Hyaluronic acid (HA) serves as a capping and targeting agent. Metformin (MET) was successfully loaded on HA capped AuNPs (H-AuNPs) and this formulation binds easily on the surface of the liver cancer cells. The synthesized nanoparticles were characterized by UV-Vis spectrophotometer, HR-TEM, particle size analyser and zeta potential measurement. Toxicity studies of H-AuNPs in zebra fish confirmed the in vivo safety of the AuNPs. The in vitro cytotoxicity results showed that the amount of MET-H-AuNPs enough to achieve 50% inhibition (IC50) was much lower than free MET. Flow cytometry analysis showed the significant reduction in G2/M phase after treatment with MET-H-AuNPs, and molecular level apoptosis were studied using western blotting. The novelty of this study is the successful synthesis of AuNPs with a higher MET loading and this formulation exhibited better targeted delivery as well as increased regression activity than free MET in HepG2 cells. PMID:26005140

  3. MR Arthrography of the Wrist: Controversies and Concepts

    PubMed Central

    Brown, Jacqueline A.; Clement, Jason J.; Grebenyuk, Julia; Fenton, David M.; Smith, Donna E.; Jacobson, Jon A.

    2008-01-01

    Magnetic resonance arthrography (MRA) has become the preferred modality for imaging patients with internal derangement of the wrist. However, several aspects of MRA use need to be clarified before a standardized approach to the imaging of internal derangement of the wrist can be developed. The objective of the study is to evaluate the efficiency of different magnetic resonance (MR) sequences in the detection of lesions of the triangular fibrocartilage complex (TFCC) and scapholunate and lunotriquetral ligaments on direct MRA. Thirty-one consecutive direct magnetic resonance arthrographic examinations of the wrist using a wrist surface coil were performed for the assessment of the TFCC and intrinsic ligaments on a 1.5-T MR imaging system (Signa; 16 channel, Excite, GE Healthcare, Milwaukee, WI, USA). All patients had wrist pain, and in six cases, there was associated clinical carpal instability. The presence, location, and extent of TFCC, scapholunate ligament (SLL), and lunotriquetral ligament (LTL) lesions on T1 fat-saturated, multiplanar gradient recalled (MPGR) and short tau inversion recovery (STIR) images were identified, compared, and analyzed. Forty-one lesions of the TFCC, SLL, and LTL were visualized on contrast-sensitive (T1 fat-saturated) images in 23/31 (74.2%) patients. Twenty-one lesions of the TFCC and intrinsic ligaments were visualized on noncontrast-sensitive (MPGR and STIR) images (15 tears of the TFCC and six tears of the SLL and LTL). All of these lesions were seen on T1 fat-saturated images; 48.8% (20/41) lesions seen on T1 fat-saturated images (eight tears of TFCC and 12 tears of SLL and LTT) were not seen on MPGR and/or STIR images. Superior contrast resolution, joint distention, and the flow of contrast facilitate the diagnosis of lesions of the TFCC and intrinsic ligaments on contrast-sensitive sequences making MRA the preferred modality for imaging internal derangements of the wrist. Little agreement exists regarding the value and location of perforations of the intrinsic ligaments given that both traumatic and degenerative perforations may be symptomatic. Noncommunicating defects of the ulnar attachments of the triangular fibrocartilage (TFC), tears of the dorsal segment of the SLL, and defects at the lunate attachment of the SLL have a higher likelihood of being symptomatic and caused by trauma rather than by degenerative perforation. Although no consensus exists, it would appear that most arthrographies should be started with a radiocarpal injection. Injection into the distal radioulnar joint should be added if no communicational defects are visualized following radiocarpal injection in patients with ulnar-sided wrist pain. PMID:19048349

  4. Anti-N-methyl-d-aspartate receptor encephalitis in a patient with a 7-year history of being diagnosed as schizophrenia: complexities in diagnosis and treatment

    PubMed Central

    Huang, Chaohua; Kang, Yukun; Zhang, Bo; Li, Bin; Qiu, Changjian; Liu, Shanming; Ren, Hongyan; Yang, Yanchun; Liu, Xiehe; Li, Tao; Guo, Wanjun

    2015-01-01

    Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune encephalitis associated with antibodies against the NR1 subunits of NMDARs. Although new-onset acute prominent psychotic syndromes in patients with NMDAR encephalitis have been well documented, there is a lack of case studies on differential diagnosis and treatment of anti-NMDAR encephalitis after a long-term diagnostic history of functional psychotic disorders. The present study reports an unusual case of anti-NMDAR encephalitis. The patient had been diagnosed with schizophrenia 7 years earlier, and was currently hospitalized for acute-onset psychiatric symptoms. The diagnosis became unclear when the initial psychosis was confounded with considerations of other neurotoxicities (such as neuroleptic malignant syndrome). Finally, identification of specific immunoglobulin G NR1 autoantibodies in the cerebrospinal fluid and greater effectiveness of immunotherapy over antipsychotics alone (which has been well documented in anti-NMDAR encephalitis) indicated the diagnosis of anti-NMDAR encephalitis in this case. Based on the available evidence, however, the relationship between the newly diagnosed anti-NMDAR encephalitis and the seemingly clear, long-term history of schizophrenia in the preceding 7 years is uncertain. This case report illustrates that psychiatrists should consider anti-NMDAR encephalitis and order tests for specific immunoglobulin G NR1 autoantibodies in patients presenting with disorientation, disturbance of consciousness, cognitive deficit, dyskinesia, autonomic disturbance, or rapid deterioration, even with a seemingly clear history of a psychiatric disorder and no specific findings on routine neuroimaging, electroencephalography, or cerebrospinal fluid tests in the early stage of the illness. PMID:26089673

  5. Fourier-transform spectroscopy and coupled-channels deperturbation treatment of the A {sup 1{Sigma}+}-b {sup 3{Pi}} complex of KCs

    SciTech Connect

    Kruzins, A.; Klincare, I.; Nikolayeva, O.; Tamanis, M.; Ferber, R.; Pazyuk, E. A.; Stolyarov, A. V.

    2010-04-15

    The laser-induced fluorescence (LIF) A {sup 1{Sigma}+}-b {sup 3{Pi}{yields}}X {sup 1{Sigma}+} spectra of the KCs molecule were recorded in a near infrared region by a Fourier-transform spectrometer with a resolution of 0.03 cm{sup -1}. Overall more than 200 collisionally enhanced LIF spectra were rotationally assigned to {sup 39}K{sup 133}Cs and {sup 41}K{sup 133}Cs isotopomers yielding more than 3400 rovibronic term values of the strongly mixed singlet A {sup 1{Sigma}+} and triplet b {sup 3{Pi}} states with the uncertainty of 0.003-0.01 cm{sup -1}. Experimental data massive starts from the lowest vibrational level v{sub A}=0 of the singlet and nonuniformly covers the energy range E is an element of [10 040,13 250] cm{sup -1} with rotational quantum numbers J{sup '} is an element of [7,225]. Besides the dominating regular A {sup 1{Sigma}+}-b {sup 3{Pi}}{sub {Omega}=0} interactions, the weak local heterogeneous A {sup 1{Sigma}+}-b {sup 3{Pi}}{sub {Omega}=1} perturbations have been discovered and analyzed. Coupled-channels deperturbation analysis of the experimental {sup 39}K{sup 133}Cs e-parity term values of the A {sup 1{Sigma}+}-b {sup 3{Pi}}{sub {Omega}=0,1,2} complex was accomplished in the framework of the phenomenological 4x4 Hamiltonian accounting implicitly for regular interactions with the remote {sup 1{Pi}} and {sup 3{Sigma}+} states. The diabatic potential energy curves of the A {sup 1{Sigma}+} and b {sup 3{Pi}} states, as well as relevant spin-orbit coupling matrix elements, were defined analytically with the expanded Morse oscillators model. The obtained parameters reproduce 95% of experimental data field of the {sup 39}K{sup 133}Cs isotopomer with a standard deviation of 0.004 cm{sup -1}, which is consistent with the uncertainty of the experiment. Reliability of the derived parameters was confirmed by a good agreement between the predicted and experimental term values of the {sup 41}K{sup 133}Cs isotopomer. The calculated relative intensity distributions in A-b{yields}X LIF progressions are also consistent with their experimental counterparts. The deperturbation model was applied for simulation of a pump-dump optical cycle a {sup 3{Sigma}+{yields}}A {sup 1{Sigma}+}-b {sup 3{Pi}{yields}}X {sup 1{Sigma}+} proposed for transformation of ultracold KCs molecules to their absolute ground state v{sub X}=0;J{sub X}=0.

  6. Has the emergence of endovascular treatment for aneurysmal and occlusive aortic disease increased the complexity and difficulty of open aortic operations?

    PubMed

    Patel, Ajay P; Langan, Eugene M; Taylor, Spence M; Snyder, Bruce A; Cull, David L; Carsten, Christopher G; Youkey, Jerry R; Gray, Bruce H; Sullivan, Timothy M

    2004-03-01

    With the emergence of endovascular surgery, there is a perception that open aortic procedures for aneurysmal and occlusive disease have become more difficult. To test this hypothesis, two consecutive groups of patients undergoing open aortic surgery for aneurysmal (AAA) and occlusive (AIOD) disease before and after the establishment of an endovascular program (EP) were analyzed. The pre-EP patient group (January 1996 through December 1997) consisted of 112 patients (52 with AAA, 60 with AIOD) and the post-EP patient group (January 2000 through December 2001) consisted of 142 patients (72 with AAA, 70 with AIOD). The pre-EP AAA group was compared with the post-EP AAA group and the pre-EP AIOD group was compared with the post-EP AIOD group. Factors analyzed included patient demographics, comorbidities, and operative outcomes. Statistical comparisons were carried out using Fisher's exact test for proportions and the Wilcoxon rank-sum test for medians. There were no statistical differences in patient demographics between the pre-EP and post-EP groups, regardless of procedure. When considering AAA repair, there was a higher rate of hypertension and hypercholesterolemia in the pre-EP group and a higher number of total comorbidities per patient in the post-EP group. There was also an increased incidence of perioperative blood transfusion in the post-EP group. When considering open procedures for AIOD, there was an increased rate of hypertension and history of previous abdominal operation in the post-EP group. There also was an increased incidence of perioperative blood transfusion. Other than these factors, there were no statistically significant differences between the pre- and post-EP groups with regard to mortality, complication rate, length of procedure, blood loss, length of ICU stay, or length of hospital stay for either the aneurysmal patients or the occlusive disease patients. With only minor exception, endovascular surgery has not appreciably increased the complexity of open aortic operations performed for either AAA or AIOD. PMID:15253258

  7. [Complex decongestive physiotherapy (CDP)].

    PubMed

    Sato, Kayoko

    2005-01-01

    Complex decongestive physiotherapy (CDP) is a representative conservative treatment for lymph edema symptoms conducted by combination of various physical therapies. In the mid-twentieth century, Dr. Michael Foeldi structured CDP. Regular treatments by CDP will relieve lymph edema symptoms as well as mental and physical distress, leading to enhancement of ADL and QOL. In Europe, CDP is served by close tie-up of physiotherapists and massotherapists under supervision of medical doctors. For effective CDP, early start of the treatment and full guidance of life style are recommended. PMID:15675334

  8. A Phase I Trial of Samarium-153-Lexidronam Complex for Treatment of Clinically Nonmetastatic High-Risk Prostate Cancer: First Report of a Completed Study

    SciTech Connect

    Valicenti, Richard K.; Trabulsi, Edouard; Intenzo, Charles; Lavarino, Jorosali; Xu Yihuan; Chervoneva, Inna

    2011-03-01

    Purpose: We completed a Phase I trial to determine the maximum tolerated dose of samarium-153 EDTMP ({sup 153}Sm) with hormonal therapy (HT) and radiation therapy (RT) in high-risk clinically nonmetastatic prostate cancer. Methods and Materials: High-risk M0 prostate cancer patients (prostate-specific antigen >20 ng/mL, Gleason score >7, or >T3) were eligible for this prospective trial of dose-escalated radioactive {sup 153}Sm-EDTMP (.25-2.0 mCi/kg) as primary or postoperative therapy. After 1 month of HT, we administered {sup 153}Sm-EDTMP followed by 4 more months of HT, 46.8 Gy to the pelvic region and 23.4 Gy to the prostate target (TD = 70.2 Gy). The primary endpoint was Grade III toxicity or higher by the National Cancer Institute Common Toxicity Criteria. Results: Twenty-nine patients enrolled (median prostate-specific antigen = 8.2 ng/mL, 27/29 (93%) T stage {>=}T2b, 24/29 (83%) had Gleason >7) and received {sup 153}Sm-EDTMP (.25 mCi/kg, 4 patients; 0.5 mCi/kg, 4 patients; 0.75 mCi/kg, 6 patients; 1.0 mCi/kg, 6 patients; 1.5 mCi/kg, 5 patients; 2.0mCi/kg, 4 patients). Twenty-eight patients underwent all planned therapy without delays (1 patient required surgery before the start of RT). With a median follow-up time of 23 months, there were 2 patients (7 %) experiencing Grade III hematologic toxicity. There were no other Grade III or IV side effects. Conclusions: Our trial demonstrates that 2 mCi/kg {sup 153}Sm -EDTMP with HT and RT was safe and feasible in men with high-risk M0 prostate cancer. A Phase II study to test this treatment is currently underway by the Radiation Therapy Oncology Group.

  9. Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations

    PubMed Central

    Woitzik, Erin; deGraauw, Chris; Easter, Brock

    2014-01-01

    Ulnar sided wrist pain is a common site for upper extremity disability. Ulnar impaction syndrome results in a spectrum of triangular fibrocartilage complex (TFCC) injuries and associated lunate, triquetrum, and ligamentous damage. Patients commonly present with insidious ulnar sided wrist pain and clicking, and a history of trauma or repetitive axial loading and rotation. In this case series, three patients presented to a sports chiropractor for evaluation and were subsequently diagnosed with ulnar impaction syndrome. Treatment strategies consist of conservative management, arthroscopic debridement or repair, arthroscopic wafer procedure, or ulnar shortening osteotomy. For the athlete, intervention should be individualized and sport-specific, considering athletic priorities, healing potential, return to play, and long-term health concerns. PMID:25550665

  10. [Clinical guidelines as part of total quality management. Analysis of heterogenous treatment concepts of sepsis in various clinics with computer assisted generation, logical testing and complexity assessment of clinical algorithms].

    PubMed

    Sitter, H; Dietz, W; Stinner, B; Geks, J; Bauhofer, A; Celik, I; Prünte, H; Lorenz, W

    1999-01-01

    Generation, local tailoring, implementation and evaluation of clinical guidelines is an integral part of quality management. Clinical guidelines are intimately related to the independency of physicians' decisions. By this the physicians should be responsible for guideline development and guarantee the use of adequate methods of total quality management and outcome assessment. Formal consensus finding and transparency of evidence are necessary to guarantee the use of guidelines. Clinical algorithms are highly formalized and they are well suited for generation and analysis by the software ALGO. Determination of complexity and comparison of the clinical contents of algorithms is done by the scores CASA (Clinical Algorithm Structural Analysis) and CAPA (Clinical Algorithm Patient Abstraction). In a study of 22 clinical departments on treatment management concepts in sepsis following anastomotic insufFiciency in colorectal carcinoma a considerable heterogeneity was shown using this program. PMID:10355087

  11. Designing Complexity

    ERIC Educational Resources Information Center

    Glanville, Ranulph

    2007-01-01

    This article considers the nature of complexity and design, as well as relationships between the two, and suggests that design may have much potential as an approach to improving human performance in situations seen as complex. It is developed against two backgrounds. The first is a world view that derives from second order cybernetics and radical…

  12. Designing Complexity

    ERIC Educational Resources Information Center

    Glanville, Ranulph

    2007-01-01

    This article considers the nature of complexity and design, as well as relationships between the two, and suggests that design may have much potential as an approach to improving human performance in situations seen as complex. It is developed against two backgrounds. The first is a world view that derives from second order cybernetics and radical…

  13. Complex derivatives

    NASA Astrophysics Data System (ADS)

    Battiston, Stefano; Caldarelli, Guido; Georg, Co-Pierre; May, Robert; Stiglitz, Joseph

    2013-03-01

    The intrinsic complexity of the financial derivatives market has emerged as both an incentive to engage in it, and a key source of its inherent instability. Regulators now faced with the challenge of taming this beast may find inspiration in the budding science of complex systems.

  14. Sarcoglycan Complex

    PubMed Central

    Groh, Séverine; Zong, Haihong; Goddeeris, Matthew M.; Lebakken, Connie S.; Venzke, David; Pessin, Jeffrey E.; Campbell, Kevin P.

    2009-01-01

    The sarcoglycans are known as an integral subcomplex of the dystrophin glycoprotein complex, the function of which is best characterized in skeletal muscle in relation to muscular dystrophies. Here we demonstrate that the white adipocytes, which share a common precursor with the myocytes, express a cell-specific sarcoglycan complex containing ?-, ?-, and ?-sarcoglycan. In addition, the adipose sarcoglycan complex associates with sarcospan and laminin binding dystroglycan. Using multiple sarcoglycan null mouse models, we show that loss of ?-sarcoglycan has no consequence on the expression of the adipocyte sarcoglycan complex. However, loss of ?- or ?-sarcoglycan leads to a concomitant loss of the sarcoglycan complex as well as sarcospan and a dramatic reduction in dystroglycan in adipocytes. We further demonstrate that ?-sarcoglycan null mice, which lack the sarcoglycan complex in adipose tissue and skeletal muscle, are glucose-intolerant and exhibit whole body insulin resistance specifically due to impaired insulin-stimulated glucose uptake in skeletal muscles. Thus, our data demonstrate a novel function of the sarcoglycan complex in whole body glucose homeostasis and skeletal muscle metabolism, suggesting that the impairment of the skeletal muscle metabolism influences the pathogenesis of muscular dystrophy. PMID:19494113

  15. Softball Complex

    ERIC Educational Resources Information Center

    Ellis, Jim

    1977-01-01

    The Parks and Recreation Department of Montgomery, Alabama, has developed a five-field softball complex as part of a growing community park with facilities for camping, golf, aquatics, tennis, and picnicking. (MJB)

  16. Tuberous sclerosis complex.

    PubMed

    DiMario, Francis J; Sahin, Mustafa; Ebrahimi-Fakhari, Darius

    2015-06-01

    Tuberous sclerosis complex is an autosomal-dominant, neurocutaneous, multisystem disorder characterized by cellular hyperplasia and tissue dysplasia. The genetic cause is mutations in the TSC1 gene, found on chromosome 9q34, and TSC2 gene, found on chromosome 16p13. The clinical phenotypes resulting from mutations in either of the 2 genes are variable in each individual. Herein, advances in the understanding of molecular mechanisms in tuberous sclerosis complex are reviewed, and current guidelines for diagnosis, treatment, follow-up, and management are summarized. PMID:26022167

  17. TREATMENT AND DISPOSAL OF COMPLEX INDUSTRIAL WASTES

    EPA Science Inventory

    The waste effluent from operation of the Tuscaloosa, Alabama, plant of Reichhold Chemicals, Inc., results from both batch and continuous operations, contains both organic and inorganic wastes and varies both in composition and concentration. This report describes development of a...

  18. Psoriasis: evolving treatment for a complex disease.

    PubMed

    Villaseñor-Park, Jennifer; Wheeler, David; Grandinetti, Lisa

    2012-06-01

    The cutaneous manifestations of psoriasis can vary in morphology and severity, and therapy should be tailored accordingly. Biologic agents are important new options for treating patients with the most severe forms of the disease. All physicians should be aware that severe psoriasis may increase cardiovascular morbidity and the risk of death, and preventive strategies for patients with severe disease should be considered. PMID:22660873

  19. Narrow QRS complex tachycardias.

    PubMed

    Jacobson, Carol

    2007-01-01

    Narrow QRS complex tachycardias are either atrioventricular (AV) nodal passive or AV nodal active. AV nodal passive tachycardias do not require the participation of the AV node in maintenance of the tachycardia. Examples are atrial tachycardia, atrial flutter, and atrial fibrillation. Treatment is directed at ventricular rate control with calcium channel blockers or beta-blockers. AV nodal active tachycardias require active participation of the AV node in maintaining the tachycardia. Examples include AV nodal reentry tachycardia and circus movement tachycardia using an accessory pathway. Treatment with a vagal maneuver or adenosine usually terminates the tachycardia. Recognition of these tachycardias is reviewed. PMID:18019517

  20. Controlling complexity

    NASA Astrophysics Data System (ADS)

    Zelinka, Ivan; Skanderova, Lenka; Davendra, Donald D.; Senkerik, Roman; Oplatkova, Zuzana

    2012-09-01

    Complex systems and dynamics are present in many parts of daily life and branches of science. This participation is continuation of our previous research, that introduced a novelty method of visualization and possible control of complex networks, that are used to visualize dynamics of evolutionary algorithms. Selected evolutionary algorithms are used as an example in order to show how its behavior can be understood as complex network and controlled via conversion into CML system - a model based on mutually joined nonlinear n equations. The main aim of this investigation was to show that dynamics of evolutionary algorithms can be converted to CML system and then controlled. Selected results of evolutionary controlled CML system are discussed here.

  1. Land Treatment Digital Library

    USGS Publications Warehouse

    Pilliod, David S.; Welty, Justin L.

    2013-01-01

    The Land Treatment Digital Library (LTDL) was created by the U.S. Geological Survey to catalog legacy land treatment information on Bureau of Land Management lands in the western United States. The LTDL can be used by federal managers and scientists for compiling information for data-calls, producing maps, generating reports, and conducting analyses at varying spatial and temporal scales. The LTDL currently houses thousands of treatments from BLM lands across 10 states. Users can browse a map to find information on individual treatments, perform more complex queries to identify a set of treatments, and view graphs of treatment summary statistics.

  2. Holographic complexity

    NASA Astrophysics Data System (ADS)

    Alishahiha, Mohsen

    2015-12-01

    For a field theory with a gravitational dual, following Susskind's proposal we define holographic complexity for a subsystem. The holographic complexity is proportional to the volume of a codimension one time slice in the bulk geometry enclosed by the extremal codimension two hypersurface appearing in the computation of the holographic entanglement entropy. The proportionally constant, up to a numerical order of 1 factor is G R where G is the Newton constant and R is the curvature of the space-time. We study this quantity in certain holographic models. We also explore a possible relation between the defined quantity and fidelity appearing in quantum information literature.

  3. About Alzheimer's Disease: Treatment

    MedlinePLUS

    ... National Alzheimer's Project Act (NAPA) About ADEAR About Alzheimer's Disease: Treatment How is Alzheimer's disease treated? What drugs ... being researched? What are clinical trials? How is Alzheimer's disease treated? Alzheimer's disease is complex, and it is ...

  4. Packaged Waste Treatment

    NASA Technical Reports Server (NTRS)

    1977-01-01

    This Jacksonville, Florida, apartment complex has a wastewater treatment system which clears the water, removes harmful microorganisms and reduces solid residue to ash. It is a spinoff from spacecraft waste management and environmental control technology.

  5. Amorphic complexity

    NASA Astrophysics Data System (ADS)

    Fuhrmann, G.; Gröger, M.; Jäger, T.

    2016-02-01

    We introduce amorphic complexity as a new topological invariant that measures the complexity of dynamical systems in the regime of zero entropy. Its main purpose is to detect the very onset of disorder in the asymptotic behaviour. For instance, it gives positive value to Denjoy examples on the circle and Sturmian subshifts, while being zero for all isometries and Morse–Smale systems. After discussing basic properties and examples, we show that amorphic complexity and the underlying asymptotic separation numbers can be used to distinguish almost automorphic minimal systems from equicontinuous ones. For symbolic systems, amorphic complexity equals the box dimension of the associated Besicovitch space. In this context, we concentrate on regular Toeplitz flows and give a detailed description of the relation to the scaling behaviour of the densities of the p-skeletons. Finally, we take a look at strange non-chaotic attractors appearing in so-called pinched skew product systems. Continuous-time systems, more general group actions and the application to cut and project quasicrystals will be treated in subsequent work.

  6. Researching Complexity.

    ERIC Educational Resources Information Center

    Sumara, Dennis J.

    2000-01-01

    Discusses what Complexity Theory (presented as a rubric that collects theoretical understandings from a number of domains such as ecology, biology, neurology, and education) suggests about mind, selfhood, intelligence, and practices of reading, and the import of these reconceptualizations to reader-response researchers. Concludes that developing…

  7. Managing Complexity

    SciTech Connect

    Chassin, David P.; Posse, Christian; Malard, Joel M.

    2004-08-01

    Physical analogs have shown considerable promise for understanding the behavior of complex adaptive systems, including macroeconomics, biological systems, social networks, and electric power markets. Many of today’s most challenging technical and policy questions can be reduced to a distributed economic control problem. Indeed, economically-based control of large-scale systems is founded on the conjecture that the price-based regulation (e.g., auctions, markets) results in an optimal allocation of resources and emergent optimal system control. This paper explores the state of the art in the use physical analogs for understanding the behavior of some econophysical systems and to deriving stable and robust control strategies for them. In particular we review and discussion applications of some analytic methods based on the thermodynamic metaphor according to which the interplay between system entropy and conservation laws gives rise to intuitive and governing global properties of complex systems that cannot be otherwise understood.

  8. Time complexity and gate complexity

    SciTech Connect

    Koike, Tatsuhiko; Okudaira, Yosuke

    2010-10-15

    We formulate and investigate the simplest version of time-optimal quantum computation theory (TO-QCT), where the computation time is defined by the physical one and the Hamiltonian contains only one- and two-qubit interactions. This version of TO-QCT is also considered as optimality by sub-Riemannian geodesic length. The work has two aims: One is to develop a TO-QCT itself based on a physically natural concept of time, and the other is to pursue the possibility of using TO-QCT as a tool to estimate the complexity in conventional gate-optimal quantum computation theory (GO-QCT). In particular, we investigate to what extent is true the following statement: Time complexity is polynomial in the number of qubits if and only if gate complexity is also. In the analysis, we relate TO-QCT and optimal control theory (OCT) through fidelity-optimal computation theory (FO-QCT); FO-QCT is equivalent to TO-QCT in the limit of unit optimal fidelity, while it is formally similar to OCT. We then develop an efficient numerical scheme for FO-QCT by modifying Krotov's method in OCT, which has a monotonic convergence property. We implemented the scheme and obtained solutions of FO-QCT and of TO-QCT for the quantum Fourier transform and a unitary operator that does not have an apparent symmetry. The former has a polynomial gate complexity and the latter is expected to have an exponential one which is based on the fact that a series of generic unitary operators has an exponential gate complexity. The time complexity for the former is found to be linear in the number of qubits, which is understood naturally by the existence of an upper bound. The time complexity for the latter is exponential in the number of qubits. Thus, both the targets seem to be examples satisfyng the preceding statement. The typical characteristics of the optimal Hamiltonians are symmetry under time reversal and constancy of one-qubit operation, which are mathematically shown to hold in fairly general situations.

  9. Cosmic Complexity

    NASA Technical Reports Server (NTRS)

    Mather, John C.

    2012-01-01

    What explains the extraordinary complexity of the observed universe, on all scales from quarks to the accelerating universe? My favorite explanation (which I certainty did not invent) ls that the fundamental laws of physics produce natural instability, energy flows, and chaos. Some call the result the Life Force, some note that the Earth is a living system itself (Gaia, a "tough bitch" according to Margulis), and some conclude that the observed complexity requires a supernatural explanation (of which we have many). But my dad was a statistician (of dairy cows) and he told me about cells and genes and evolution and chance when I was very small. So a scientist must look for me explanation of how nature's laws and statistics brought us into conscious existence. And how is that seemll"!gly Improbable events are actually happening a!1 the time? Well, the physicists have countless examples of natural instability, in which energy is released to power change from simplicity to complexity. One of the most common to see is that cooling water vapor below the freezing point produces snowflakes, no two alike, and all complex and beautiful. We see it often so we are not amazed. But physlc!sts have observed so many kinds of these changes from one structure to another (we call them phase transitions) that the Nobel Prize in 1992 could be awarded for understanding the mathematics of their common features. Now for a few examples of how the laws of nature produce the instabilities that lead to our own existence. First, the Big Bang (what an insufficient name!) apparently came from an instability, in which the "false vacuum" eventually decayed into the ordinary vacuum we have today, plus the most fundamental particles we know, the quarks and leptons. So the universe as a whole started with an instability. Then, a great expansion and cooling happened, and the loose quarks, finding themselves unstable too, bound themselves together into today's less elementary particles like protons and neutrons, liberating a little energy and creating complexity. Then, the expanding universe cooled some more, and neutrons and protons, no longer kept apart by immense temperatures, found themselves unstable and formed helium nuclei. Then, a little more cooling, and atomic nuclei and electrons were no longer kept apart, and the universe became transparent. Then a little more cooling, and the next instability began: gravitation pulled matter together across cosmic distances to form stars and galaxies. This instability is described as a "negative heat capadty" in which extracting energy from a gravitating system makes it hotter -- clearly the 2nd law of thermodynamics does not apply here! (This is the physicist's part of the answer to e e cummings' question: what is the wonder that's keeping the stars apart?) Then, the next instability is that hydrogen and helium nuclei can fuse together to release energy and make stars burn for billions of years. And then at the end of the fuel source, stars become unstable and explode and liberate the chemical elements back into space. And because of that, on planets like Earth, sustained energy flows support the development of additional instabilities and all kinds of complex patterns. Gravitational instability pulls the densest materials into the core of the Earth, leaving a thin skin of water and air, and makes the interior churn incessantly as heat flows outwards. And the heat from the sun, received mostly near the equator and flowing towards the poles, supports the complex atmospheric and oceanic circulations. And because or that, the physical Earth is full of natural chemical laboratories, concentrating elements here, mixing them there, raising and lowering temperatures, ceaselessly experimenting with uncountable events where new instabilities can arise. At least one of them was the new experiment called life. Now that we know that there are at least as many planets as there are stars, it is hard to imagine that nature's ceasess experimentation would not be able to produce life elsewhere

  10. Cosmic Complexity

    NASA Technical Reports Server (NTRS)

    Mather, John C.

    2012-01-01

    What explains the extraordinary complexity of the observed universe, on all scales from quarks to the accelerating universe? My favorite explanation (which I certainty did not invent) ls that the fundamental laws of physics produce natural instability, energy flows, and chaos. Some call the result the Life Force, some note that the Earth is a living system itself (Gaia, a "tough bitch" according to Margulis), and some conclude that the observed complexity requires a supernatural explanation (of which we have many). But my dad was a statistician (of dairy cows) and he told me about cells and genes and evolution and chance when I was very small. So a scientist must look for me explanation of how nature's laws and statistics brought us into conscious existence. And how is that seemll"!gly Improbable events are actually happening a!1 the time? Well, the physicists have countless examples of natural instability, in which energy is released to power change from simplicity to complexity. One of the most common to see is that cooling water vapor below the freezing point produces snowflakes, no two alike, and all complex and beautiful. We see it often so we are not amazed. But physlc!sts have observed so many kinds of these changes from one structure to another (we call them phase transitions) that the Nobel Prize in 1992 could be awarded for understanding the mathematics of their common features. Now for a few examples of how the laws of nature produce the instabilities that lead to our own existence. First, the Big Bang (what an insufficient name!) apparently came from an instability, in which the "false vacuum" eventually decayed into the ordinary vacuum we have today, plus the most fundamental particles we know, the quarks and leptons. So the universe as a whole started with an instability. Then, a great expansion and cooling happened, and the loose quarks, finding themselves unstable too, bound themselves together into today's less elementary particles like protons and neutrons, liberating a little energy and creating complexity. Then, the expanding universe cooled some more, and neutrons and protons, no longer kept apart by immense temperatures, found themselves unstable and formed helium nuclei. Then, a little more cooling, and atomic nuclei and electrons were no longer kept apart, and the universe became transparent. Then a little more cooling, and the next instability began: gravitation pulled matter together across cosmic distances to form stars and galaxies. This instability is described as a "negative heat capadty" in which extracting energy from a gravitating system makes it hotter -- clearly the 2nd law of thermodynamics does not apply here! (This is the physicist's part of the answer to e e cummings' question: what is the wonder that's keeping the stars apart?) Then, the next instability is that hydrogen and helium nuclei can fuse together to release energy and make stars burn for billions of years. And then at the end of the fuel source, stars become unstable and explode and liberate the chemical elements back into space. And because of that, on planets like Earth, sustained energy flows support the development of additional instabilities and all kinds of complex patterns. Gravitational instability pulls the densest materials into the core of the Earth, leaving a thin skin of water and air, and makes the interior churn incessantly as heat flows outwards. And the heat from the sun, received mostly near the equator and flowing towards the poles, supports the complex atmospheric and oceanic circulations. And because or that, the physical Earth is full of natural chemical laboratories, concentrating elements here, mixing them there, raising and lowering temperatures, ceaselessly experimenting with uncountable events where new instabilities can arise. At least one of them was the new experiment called life. Now that we know that there are at least as many planets as there are stars, it is hard to imagine that nature's ceasess experimentation would not be able to produce life elsewhere -- but we don't know for sure. And life went on to cause new Instabilities, constantly evolving, with living things in an extraordinary range of environments, changing the global environment, with boom-and-bust cycles. with predators for every kInd of prey, with criminals for every possible crime, with governments to prevent them, and instabilities of the governments themselves. One of the instabilities Is that humans demand new weapons and new products of all sort, leading to serious investments in science and technology. So the natural/human world of competition and combat is structured to lead to advanced weaponry and cell phones. So here we are In 2012, with people writing essays and wondering whether their descendents will be artificial life forms travelling back into space. And, pondering what are the origins of those forces of nature that give rise to everything. Verllnde has argued that gravitation, the one force that has so far resisted our efforts at a Quantum description, is not even a fundamental force, but is itself it a statistical force, like osmosis. What an amazing turn of events! But after all I've just said, I should not be surprised a bit.

  11. Carney complex: an update.

    PubMed

    Correa, Ricardo; Salpea, Paraskevi; Stratakis, Constantine A

    2015-10-01

    Carney complex (CNC) is a rare autosomal dominant syndrome, characterized by pigmented lesions of the skin and mucosa, cardiac, cutaneous and other myxomas and multiple endocrine tumors. The disease is caused by inactivating mutations or large deletions of the PRKAR1A gene located at 17q22-24 coding for the regulatory subunit type I alpha of protein kinase A (PKA) gene. Most recently, components of the complex have been associated with defects of other PKA subunits, such as the catalytic subunits PRKACA (adrenal hyperplasia) and PRKACB (pigmented spots, myxomas, pituitary adenomas). In this report, we review CNC, its clinical features, diagnosis, treatment and molecular etiology, including PRKAR1A mutations and the newest on PRKACA and PRKACB defects especially as they pertain to adrenal tumors and Cushing's syndrome. PMID:26130139

  12. Symmetry and complexity

    NASA Astrophysics Data System (ADS)

    Mainzer, Klaus

    Symmetry and complexity in early culture and philosophy -- Symmetry and complexity in mathematics -- Symmetry and complexity in physical sciences -- Symmetry and complexity in chemical sciences -- Symmetry and complexity in life sciences -- Symmetry and complexity in economic and social sciences -- Symmetry and complexity in computer science -- Symmetry and complexity in philosophy and arts.

  13. Complex regional pain syndrome

    PubMed Central

    Sebastin, Sandeep J

    2011-01-01

    Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. CRPS is not uncommon after hand surgery and may complicate post-operative care. There is no specific diagnostic test for CRPS and the diagnosis is based on history, clinical examination, and supportive laboratory findings. Recent modifications to diagnostic criteria have enabled clinicians to diagnose this disease more consistently. This review gives a synopsis of CRPS and discusses the diagnosis, pathophysiology, and treatment options based on the limited evidence in the literature. PMID:22022040

  14. Hyperbaric treatment

    NASA Technical Reports Server (NTRS)

    Amoroso, Michael T.

    1990-01-01

    Viewgraphs on hyperbaric treatment are presented. Topics covered include: hyperbaric treatment - purpose; decompression sickness; sources of decompression sickness; physical description; forms of decompression sickness; hyperbaric treatment of decompression sickness; and duration of treatment.

  15. [Complex decongestive therapy].

    PubMed

    Heinig, B; Wollina, U

    2015-11-01

    The amount of physical pressure plays an important role in complex decongestive therapy (CDT). As a function of pressure, microcirculation takes place between blood vessels and tissue. As part of the total lymphatic system, lymphatic vessels transport the lymphatic load from the interstitial space to the blood stream. The lymphatic vessel system, characterized by specific anatomical conditions like initial lymphatic vessels, precollectors, collectors, and lymphatic strains, is the therapeutic target of complex decongestive therapy. Components of CDT include manual lymphatic drainage, compression therapy, decongestive kinesitherapy, and good skin care, which increase the transport capacity of the lymphatic vessel system. Currently, CDT is acknowledged as the main conservative treatment of lymphedema of primary and secondary genesis, lipolymphedema, and phlebolymphedema. In clinical practice, we are increasingly confronted with edema of multifactorial genesis requiring a critical discussion and stocktaking of comprehensive clinical findings in terms of the indication for CDT. Therapeutic success depends on a joint application of all CDT components and patient compliance. To an increasing extent, medical research tries to combine successfully CDT with adjunct treatment options. PMID:26315101

  16. Complexed iron removal from groundwater

    SciTech Connect

    Munter, R.; Ojaste, H.; Sutt, J.

    2005-07-01

    The paper demonstrates an intensive work carried out and results obtained on the pilot plant of the City of Kogalym Water Treatment Station (Tjumen, Siberia, Russian Federation) to elaborate on a contemporary nonreagent treatment technology for the local iron-rich groundwater. Several filter materials (Birm, Pyrolox, hydroanthracite, Everzit, granulated activated carbon) and chemical oxidants (ozone, chlorine, hydrogen peroxide, oxygen, and potassium permanganate) were tested to solve the problem with complexed iron removal from groundwater. The final elaborated technology consists of raw water intensive aeration in the gas-degas treatment unit followed by sequential filtration through hydroanthracite and the special anthracite Everzit.

  17. [Complex injuries associated with somnambulism].

    PubMed

    Sillesen, Nanna Hylleholt; Nielsen, Lisa Toft; Bonde, Christian

    2010-12-13

    Up to 3% of adults walk in their sleep and some perform complex behaviours. Treatment recommendations for sleepwalking are inconsistent. This case report describes a 64-year-old man who climbed out of a 2nd floor toilet window during somnambulism. He fell 6-8 meters and fractured the tibia, fibula, cervical columna, lumbal columna, calcaneus, costae and suffered a pneumothorax. Evidence to support sleepwalking treatment is lacking and besides benzodiazepines, prevention is the preferred treatment choice according to the literature. PMID:21156113

  18. Complex sleep apnea syndrome

    PubMed Central

    Wang, Juan; Wang, Yan; Feng, Jing; Chen, Bao-yuan; Cao, Jie

    2013-01-01

    Complex sleep apnea syndrome (CompSAS) is a distinct form of sleep-disordered breathing characterized as central sleep apnea (CSA), and presents in obstructive sleep apnea (OSA) patients during initial treatment with a continuous positive airway pressure (CPAP) device. The mechanisms of why CompSAS occurs are not well understood, though we have a high loop gain theory that may help to explain it. It is still controversial regarding the prevalence and the clinical significance of CompSAS. Patients with CompSAS have clinical features similar to OSA, but they do exhibit breathing patterns like CSA. In most CompSAS cases, CSA events during initial CPAP titration are transient and they may disappear after continued CPAP use for 4~8 weeks or even longer. However, the poor initial experience of CompSAS patients with CPAP may not be avoided, and nonadherence with continued therapy may often result. Treatment options like adaptive servo-ventilation are available now that may rapidly resolve the disorder and relieve the symptoms of this disease with the potential of increasing early adherence to therapy. But these approaches are associated with more expensive and complicated devices. In this review, the definition, potential plausible mechanisms, clinical characteristics, and treatment approaches of CompSAS will be summarized. PMID:23861580

  19. Enhanced Analgesic Properties and Reduced Ulcerogenic Effect of a Mononuclear Copper(II) Complex with Fenoprofen in Comparison to the Parent Drug: Promising Insights in the Treatment of Chronic Inflammatory Diseases

    PubMed Central

    Gumilar, Fernanda; Boeris, Mónica; Toso, Ricardo; Minetti, Alejandra

    2014-01-01

    Analgesic and ulcerogenic properties have been studied for the copper(II) coordination complex of the nonsteroidal anti-inflammatory drug Fenoprofen and imidazole [Cu(fen)2(im)2] (Cu: copper(II) ion; fen: fenoprofenate anion from Fenoprofen, im: imidazole). A therapeutic dose of 28?mg/kg was tested for [Cu(fen)2(im)2] and 21?mg/kg was employed for Fenoprofen calcium, administered by oral gavage in female mice to compare the therapeutic properties of the new entity. The acetic acid induced writhing test was employed to study visceral pain. The percentage of inhibition in writhing and stretching was 78.9% and 46.2% for the [Cu(fen)2(im)2] and Fenoprofen calcium, respectively. This result indicates that the complex could be more effective in diminishing visceral pain. The formalin test was evaluated to study the impact of the drugs over nociceptive and inflammatory pain. The complex is a more potent analgesic on inflammatory pain than the parent drug. Ulcerogenic effects were evaluated using a model of gastric lesions induced by hypothermic-restraint stress. Fenoprofen calcium salt caused an ulcer index of about 79?mm2 while the one caused by [Cu(fen)2(im)2] was 22?mm2. The complex diminished the development of gastric mucosal ulcers in comparison to the uncomplexed drug. Possible mechanisms of action related to both therapeutic properties have been discussed. PMID:25050353

  20. ICD Complex Operations and Maintenance Plan

    SciTech Connect

    Gibson, P. L.

    2007-06-25

    This Operations and Maintenance (O&M) Plan describes how the Idaho National Laboratory (INL) conducts operations, winterization, and startup of the Idaho CERCLA Disposal Facility (ICDF) Complex. The ICDF Complex is the centralized INL facility responsible for the receipt, storage, treatment (as necessary), and disposal of INL Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation waste.

  1. SCFA lead lab technical assistance at Oak Ridge Y-12 nationalsecurity complex: Evaluation of treatment and characterizationalternatives of mixed waste soil and debris at disposal area remedialaction DARA solids storage facility (SSF)

    SciTech Connect

    Hazen, Terry

    2002-08-26

    On July 17-18, 2002, a technical assistance team from the U.S. Department of Energy (DOE) Subsurface Contaminants Focus Area (SCFA) met with the Bechtel Jacobs Company Disposal Area Remedial Action (DARA) environmental project leader to review treatment and characterization options for the baseline for the DARA Solids Storage Facility (SSF). The technical assistance request sought suggestions from SCFA's team of technical experts with experience and expertise in soil treatment and characterization to identify and evaluate (1) alternative treatment technologies for DARA soils and debris, and (2) options for analysis of organic constituents in soil with matrix interference. Based on the recommendations, the site may also require assistance in identifying and evaluating appropriate commercial vendors.

  2. Complex regional pain syndrome

    PubMed Central

    Palmer, Greta

    2015-01-01

    SUMMARY Complex regional pain syndrome is an uncommon chronic pain condition. It develops spontaneously or following an injury. The features are limb pain, allodynia, hypersensitivity, hyperalgesia, abnormalities of the vasomotor, sudomotor and motor systems, and trophic changes, with reduced use of the affected limb. The diagnosis is clinical and one of exclusion. The emphasis of therapy is graded rehabilitation and movement of the limb with physiotherapy and occupational therapy. Psychological therapies should be offered if a patient is making no or slow progress in the acute phase, and to all patients in the chronic phase as depression can occur. The goal of pharmacotherapy is to assist functional improvement. The early phase may be managed with simple analgesia. Antineuropathic drugs including tricyclic antidepressants and antiepileptic drugs may be added. Other treatments with some evidence of effectiveness include corticosteroids, calcitonin and bisphosphonates. Vitamin C has been used for primary prevention after wrist fracture and upper and lower limb surgery. There is no evidence that it is effective for treating established complex regional pain syndrome. PMID:26648626

  3. Complex regional pain syndrome.

    PubMed

    Palmer, Greta

    2015-06-01

    Complex regional pain syndrome is an uncommon chronic pain condition. It develops spontaneously or following an injury. The features are limb pain, allodynia, hypersensitivity, hyperalgesia, abnormalities of the vasomotor, sudomotor and motor systems, and trophic changes, with reduced use of the affected limb. The diagnosis is clinical and one of exclusion. The emphasis of therapy is graded rehabilitation and movement of the limb with physiotherapy and occupational therapy. Psychological therapies should be offered if a patient is making no or slow progress in the acute phase, and to all patients in the chronic phase as depression can occur. The goal of pharmacotherapy is to assist functional improvement. The early phase may be managed with simple analgesia. Antineuropathic drugs including tricyclic antidepressants and antiepileptic drugs may be added. Other treatments with some evidence of effectiveness include corticosteroids, calcitonin and bisphosphonates. Vitamin C has been used for primary prevention after wrist fracture and upper and lower limb surgery. There is no evidence that it is effective for treating established complex regional pain syndrome. PMID:26648626

  4. On State Complexes and Special Cube Complexes

    ERIC Educational Resources Information Center

    Peterson, Valerie J.

    2009-01-01

    This thesis presents the first steps toward a classification of non-positively curved cube complexes called state complexes. A "state complex" is a configuration space for a "reconfigurable system," i.e., an abstract system in which local movements occur in some discrete manner. Reconfigurable systems can be used to describe, for example,…

  5. On State Complexes and Special Cube Complexes

    ERIC Educational Resources Information Center

    Peterson, Valerie J.

    2009-01-01

    This thesis presents the first steps toward a classification of non-positively curved cube complexes called state complexes. A "state complex" is a configuration space for a "reconfigurable system," i.e., an abstract system in which local movements occur in some discrete manner. Reconfigurable systems can be used to describe, for example,…

  6. Spin-orbit treatment of UV-vis absorption spectra and photophysics of rhenium(I) carbonyl-bipyridine complexes: MS-CASPT2 and TD-DFT analysis.

    PubMed

    Heydová, Radka; Gindensperger, Etienne; Romano, Roberta; Sýkora, Jan; Vl?ek, Antonín; Záliš, Stanislav; Daniel, Chantal

    2012-11-26

    The lowest-lying spectral transitions in [ReX(CO)(3)(bpy)] (X = Cl, Br, I; bpy = 2,2'-bipyridine) complexes were calculated by means of spin-orbit time-dependent density functional theory (SO-TD-DFT) and spin-orbit multistate complete active space second-order perturbation theory (SO-MS-CASPT2). Computational results are compared with absorption spectra measured in different solvents and used to qualitatively explain the temperature dependence of the phosphorescence decay parameters that were measured for the whole series of complexes. Spin-orbit excited-state calculations interpret their electronic absorption spectra as arising from a bunch of spin mixed states with a singlet component of only 50-90% (depending on the halide), and attribute the phosphorescence decay to thermal population of spin-mixed states with a substantial singlet character. PMID:22817529

  7. Complex soundproofing of industrial rooms

    NASA Technical Reports Server (NTRS)

    Pocsa, V.; Veres, A.; Biborosch, L.

    1974-01-01

    Some structures treated for sound absorption are described that are used to soundproof industrial rooms with a very high noise level. Soundproofing treatments for the walls and coilings or only for the ceilings are considered. In the case of relatively small rooms having a noise source with a high level, complex treatments involve, in addition to soundproofing of the walls and ceiling, suspended panels specially oriented with respect to the noise source. The efficiency of the adopted solutions is compared with calculated damping values.

  8. Treatment of Mitochondrial Disorders

    PubMed Central

    Avula, Sreenivas; Parikh, Sumit; Demarest, Scott; Kurz, Jonathan; Gropman, Andrea

    2014-01-01

    Opinion statement While numerous treatments for mitochondrial disorders have been suggested, relatively few have undergone controlled clinical trials. Treatment of these disorders is challenging, as only symptomatic therapy is available. In this review we will focus on newer drugs and treatment trials in mitochondrial diseases, with a special focus on medications to avoid in treating epilepsy and ICU patient with mitochondrial disease, which has not been included in such a review. Readers are also referred to the opinion statement in A Modern Approach to the Treatment of Mitochondrial Disease published in Current Treatment Options in Neurology 2009. Many of the supplements used for treatment were reviewed in the previous abstract, and dosing guidelines were provided. The focus of this review is on items not previously covered in depth, and our discussion includes more recently studied compounds as well as any relevant updates on older compounds. We review a variety of vitamins and xenobiotics, including dichloroacetate (DCA), arginine, coenzyme Q10, idebenone, EPI-743, and exercise training. Treatment of epilepsy, which is a common feature in many mitochondrial phenotypes, warrants special consideration due to the added toxicity of certain medications, and we provide a discussion of these unique treatment challenges. Interesting, however, with only a few exceptions, the treatment strategies for epilepsy in mitochondrial cytopathies are the same as for epilepsy without mitochondrial dysfunction. We also discuss intensive care management, building upon similar reviews, adding new dimensions, and demonstrating the complexity of overall care of these patients. PMID:24700433

  9. The Mycobacterium avium complex.

    PubMed Central

    Inderlied, C B; Kemper, C A; Bermudez, L E

    1993-01-01

    Mycobacterium avium complex (MAC) disease emerged early in the epidemic of AIDS as one of the common opportunistic infections afflicting human immunodeficiency virus-infected patients. However, only over the past few years has a consensus developed about its significance to the morbidity and mortality of AIDS. M. avium was well known to mycobacteriologists decades before AIDS, and the MAC was known to cause disease, albeit uncommon, in humans and animals. The early interest in the MAC provided a basis for an explosion of studies over the past 10 years largely in response to the role of the MAC in AIDS opportunistic infection. Molecular techniques have been applied to the epidemiology of MAC disease as well as to a better understanding of the genetics of antimicrobial resistance. The interaction of the MAC with the immune system is complex, and putative MAC virulence factors appear to have a direct effect on the components of cellular immunity, including the regulation of cytokine expression and function. There now is compelling evidence that disseminated MAC disease in humans contributes to both a decrease in the quality of life and survival. Disseminated disease most commonly develops late in the course of AIDS as the CD4 cells are depleted below a critical threshold, but new therapies for prophylaxis and treatment offer considerable promise. These new therapeutic modalities are likely to be useful in the treatment of other forms of MAC disease in patients without AIDS. The laboratory diagnosis of MAC disease has focused on the detection of mycobacteria in the blood and tissues, and although the existing methods are largely adequate, there is need for improvement. Indeed, the successful treatment of MAC disease clearly will require an early and rapid detection of the MAC in clinical specimens long before the establishment of the characteristic overwhelming infection of bone marrow, liver, spleen, and other tissue. Also, a standard method of susceptibility testing is of increasing interest and importance as new effective antimicrobial agents are identified and evaluated. Antimicrobial resistance has already emerged as an important problem, and methods for circumventing resistance that use combination therapies are now being studied. Images PMID:8358707

  10. Complex Regional Pain Syndrome

    MedlinePLUS

    ... Diversity Find People About NINDS NINDS Complex Regional Pain Syndrome Information Page Synonym(s): Reflex Sympathetic Dystrophy Syndrome, ... Additional resources from MedlinePlus What is Complex Regional Pain Syndrome? Complex regional pain syndrome (CRPS) is a ...

  11. Complex carbohydrates (image)

    MedlinePLUS

    Complex carbohydrates are made up of sugar molecules that are strung together in long, complex chains. Complex carbohydrates are found in foods such as peas, beans, whole grains, and vegetables. Both ...

  12. [Enduring pain II. Treatment].

    PubMed

    Baldessarini, Ross; Selle, Valerio; Vigo, Daniel V

    2013-01-01

    Pain disorders present highly challenging therapeutic problems, owing in part to complex co-morbidities associated with pain disorders, notably including psychiatric disorders characterized by depressed mood or anxiety. Many treatments are employed to treat pain-disorder patients, and most are unsatisfactory. Virtually all analgesic medicines in long-term use provide only partial efficacy and present substantial risks of adverse effects, loss of benefit over time, or dependency and risk of abuse. Commonly employed drugs with analgesic properties include non-opioids (mainly nonsteroidal anti-inflammatory agents [NSAIDs] or acetaminophen), many natural or synthetic opioids (including opiates and phenylpiperidines), some antidepressants (especially those with noradrenergic activity), a few anticonvulsants, skeletal muscle relaxants or topical remedies, and a growing variety of experimental treatments. The major overlap between pain and psychiatric disorders, as well as the currently unsatisfactory state of treatments available for chronic pain syndromes, encourage a comprehensive approach to assessment and clinical management of patients with chronic pain. Many current treatment programs for pain disorder patients offer narrowly specialized and incomplete treatment options. Ideally however, such care should be provided by multi-disciplinary teams with expertise in neurology, general medicine, pain management, physical medicine and rehabilitation, as well as psychiatry. Psychiatrists as well as pain specialists can serve an essential role in leading comprehensive assessment and general management of such complex and challenging patients who are typically only partially responsive to available treatments. PMID:24312919

  13. [Treatment of limbs lymphedema].

    PubMed

    Vaillant, Loïc; Müller, Christine; Goussé, Pascal

    2010-12-01

    The treatment of lymphedema aims to reduce the volume and prevent infectious and joints mobility complications. This treatment rarely cure and is usually symptomatic; thus it should be continued throughout the life. The erysipelas and lymphangitis are common complications of lymphedema. Erysipela is always of streptococcal origin and requires systemic antibiotics. The risk of recurrent erysipelas on lymphedema is high. In case of large swelling associated with significant dermal sclerosis, it may lead to decrease joint mobility and functional impairment. The skin cares, manual lymph drainage, compression therapy with bandages and exercises are the four pillars of the complex decongestive therapy of limb lymphedema. Compression is the most important treatment. Lymphedema can be improved by only bandages, but a sustained improvement of lymphedema cannot be seen without bandages. The effectiveness of treatment must be evaluated by objective methods, measuring the perimeters of members or volumes. The management of lymphedema includes three phases: attack or initial treatment that aims to reduce volume of the lymphedema and maintenance phase to maintain the result and finally withdrawal phase. In the attack phase, we use complex decongestive therapy, mainly multilayer inelastic bandaging and manual lymphatic drainage (MLD). In the maintenance phase, we use elastic compression (stockings or sleeves) possibly associated with MLD. At all stages skin care and exercises are used. Adjuvant treatments may be useful (intermittent pneumatic compression, drug treatment). Surgery is rarely used except for genital lymphedema. The therapeutic management of lymphedema is difficult but has a variety of techniques. The complex decongestive therapy is very effective to restore a better quality of life even though it does not provide a cure for lymphedema. PMID:20850261

  14. Turkey osteomyelitis complex.

    PubMed

    Huff, G R; Huff, W E; Rath, N C; Balog, J M

    2000-07-01

    Turkey osteomyelitis complex (TOC) is defined by the US Food Safety Inspection Service (FSIS) to include normal-appearing processed turkey carcasses that contain lesions including green discoloration of the liver, arthritis/synovitis, soft-tissue abscesses, and osteomyelitis of the proximal tibia. The lesions are associated with many different opportunistic organisms, mainly Staphylococcus aureus and Escherichia coli, suggesting that TOC incidence may be influenced more by deficiencies in the host immune response rather than by the virulence of any one organism. This syndrome is primarily a disease of adolescent male turkeys, and birds with TOC lesions have decreased indices of cell-mediated immunity, leading to the hypothesis that defects in the immune response of individuals within flocks of male turkeys may be responsible for the occurrence of these opportunistic infections. We have developed an experimental model for this disease in which treatment with dexamethasone (DEX), either with or without air sac inoculation with Escherichia coli, produces all of the lesions associated with TOC. These studies suggest that TOC is a result of stress-induced immunosuppression in a subpopulation of male turkeys that respond to the stressors in modern poultry production in a detrimental manner. Supplemental vitamin D3 treatment protected male turkeys from the immunosuppression induced by multiple treatments with DEX and resulted in decreased incidence of mortality, TOC, green liver, and isolation of bacteria from tissues, lower air sacculitis scores, and lower heterophil to lymphocyte ratios than nonsupplemented controls. Vitamin D3 also protected BW; relative weights of the liver, heart, spleen, and bursa; and clinical chemistry values from the effects of DEX treatment. The ability of vitamin D3 supplementation to protect turkeys from the immunosuppressive effects of severe stress emphasizes its role as a prohormone that affects health and disease resistance in turkeys and suggests that variation in the vitamin D receptor genotype may be involved in this disease process. This model has potential value in the identification of other nutritional and physiological immunomodulators that can decrease TOC incidence and will provide a means for the divergent selection of birds more resistant to the stressors of turkey production. In addition, this model will provide justification for management options designed to minimize stress. PMID:10901209

  15. 1. VIEW OF SEWAGE TREATMENT PLANT (BLDG. 769) SOUTH OF ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. VIEW OF SEWAGE TREATMENT PLANT (BLDG. 769) SOUTH OF STORAGE SHED (BLDG 773). SECURITY FENCE EAST OF SEWAGE TREATMENT PLANT. - Vandenberg Air Force Base, Space Launch Complex 3, Sewage Treatment Plant, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

  16. [Lymphedema--treatment].

    PubMed

    Strössenreuther, R H K; Dax, I; Emde, C

    2004-01-22

    Treatment of lymphedema utilizes complex physical (or decongestive) therapy (CDT), so-called. This covers a number of measures including compression, lymph drainage, skin care and individualized exercises. CDT is divided into two phases--an intensive phase during which daily treatment is applied over a period of two to four weeks, and a maintenance phase in which especially compression therapy is continued in order to secure the positive effects achieved during the first phase. Treatment should be initiated in an early stage of the condition, and the aim is to return the patient to the symptom-free latency stage. Neither isolated manual lymph drainage nor equipment-based decongestion is considered for the treatment of lymphedema. To date, the efficacy of various drugs, including selenium, has not been confirmed. PMID:15035445

  17. Psychological Treatment

    MedlinePLUS

    ... and Holidays Personal Stories IBS Awareness Month The Art of IBS Who We Are Contact Us Donate Psychological Treatments Jump to Topic Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation Techniques for IBS The cause ...

  18. Stroke Treatments

    MedlinePLUS

    ... type of stroke. Ischemic Stroke Treatment tPA, the Gold Standard The only FDA approved treatment for ischemic ... guided to the aneurysm or AVM ; it then deposits a mechanical agent, such as a coil, to ...

  19. The effects of infrared laser therapy and weightbath traction hydrotherapy as components of complex physical treatment in disorders of the lumbar spine: a controlled pilot study with follow-up

    NASA Astrophysics Data System (ADS)

    Oláh, Csaba; Oláh, Mihály; Demeter, Béla; Jancsó, Zoltán; Páll, Valéria; Bender, Tamás

    2010-02-01

    Introduction: The therapeutic modalities available for the conservative management of chronic lumbar pain included infrared laser therapy and underwater traction, which usefulness is not universally acknowledged. This study was intended to ascertain any beneficial impact of infrared laser therapy and weightbath treatment on the clinical parameters and quality of life of patients with lumbar discopathy. Material and methods: The study population comprised 54 randomised subjects. I. group of 18 patents received only infrared laser therapy to lumbar region and painful Valley points. II. group of 18 subjects each received underwater traction therapy of lumbar spine with add-on McKenzie exercise and iontophoresis. The remaining III. group treated with exercise and iontophoresis, served as control. VAS, Oswestry index, SF36 scores, range of motion, neurological findings and thermography were monitored to appraise therapeutic afficacy in lumbar discopathy. A CT or MRI scan was done at baseline and after 3 months follow-up. Result:Infrared laser therapy and underwater traction for discopathy achieved significant improvement of all study parameters, which was evident 3 months later. Among the controls, significant improvement of only a single parameter was seen in patients with lumbar discopathy. Conclusions: Infrared laser therapy and underwater traction treatment effectively mitigate pain, muscle spasms, enhance joint flexibility, and improve the quality of life of patients with lumbar discopathy.

  20. Complexity analysis of angiogenesis vasculature

    NASA Astrophysics Data System (ADS)

    Mahadevan, Vijay; Tyrell, James A.; Tong, Ricky T.; Brown, Edward B.; Jain, Rakesh K.; Roysam, Badrinath

    2005-04-01

    Tumor vasculature has a high degree of irregularity as compared to normal vasculature. The quantification of the morphometric complexity in tumor images can be useful in diagnosis. Also, it is desirable in several other medical applications to have an automated complexity analysis to aid in diagnosis and prognosis under treatment. e.g. in diabetic retinopathy and in arteriosclerosis. In addition, prior efforts at segmentation of the tumor vasculature using matched filtering, template matching and splines have been hampered by the irregularity of these vessels. We try to solve both problems by introducing a novel technique for vessel detection, followed by a tracing-independent complexity analysis based on a combination of ideas. First, the vessel cross-sectional profile is modeled using a continuous and everywhere differentiable family of super-Gaussian curves. This family generates rectangular profiles that can accurately localize the vessel boundaries in microvasculature images. Second, a robust non-linear regression algorithm based on M-estimators is used to estimate the parameters that optimally characterize the vessel"s shape. A framework for the quantitative analysis of the complexity of the vasculature based on the vessel detection is presented. A set of measures that quantify the complexity are proposed viz. Squared Error, Entropy-based and Minimum Description Length-based Shape Complexities. They are completely automatic and can deal with complexities of the entire vessel unlike existing tortuousity measures which deal only with vessel centerlines. The results are validated using carefully constructed phantom and real image data with ground truth information from an expert observer.

  1. National Emphysema Treatment Trial

    PubMed Central

    Criner, Gerard J.; Sternberg, Alice L.

    2008-01-01

    The National Emphysema Treatment Trial (NETT) has published many articles reporting the various outcomes of lung volume reduction surgery versus medical treatment for patients with severe emphysema. However, long and complex clinical trials like NETT that involve both medical and surgical issues generate multiple manuscripts over a period of years and report an array of various outcomes. As a result, the essential findings of the trial may appear to be fragmented to the clinician or clinical researcher or be lost among the many medical reports published each year. In this review, we summarize in one publication the major medical and surgical outcomes of NETT. PMID:18453345

  2. Therapeutic Doll Making in Art Psychotherapy for Complex Trauma

    ERIC Educational Resources Information Center

    Stace, Sonia M.

    2014-01-01

    Therapeutic doll making can hold diverse functions for clients in therapy, particularly for those clients who are working through complex trauma histories. Recent literature pertaining to the treatment of complex trauma suggests that talking treatments have their limits; supplementary therapeutic approaches that focus on sensory, physical,…

  3. Therapeutic Doll Making in Art Psychotherapy for Complex Trauma

    ERIC Educational Resources Information Center

    Stace, Sonia M.

    2014-01-01

    Therapeutic doll making can hold diverse functions for clients in therapy, particularly for those clients who are working through complex trauma histories. Recent literature pertaining to the treatment of complex trauma suggests that talking treatments have their limits; supplementary therapeutic approaches that focus on sensory, physical,…

  4. Protein Complexes in Bacteria

    PubMed Central

    Caufield, J. Harry; Abreu, Marco; Wimble, Christopher; Uetz, Peter

    2015-01-01

    Large-scale analyses of protein complexes have recently become available for Escherichia coli and Mycoplasma pneumoniae, yielding 443 and 116 heteromultimeric soluble protein complexes, respectively. We have coupled the results of these mass spectrometry-characterized protein complexes with the 285 “gold standard” protein complexes identified by EcoCyc. A comparison with databases of gene orthology, conservation, and essentiality identified proteins conserved or lost in complexes of other species. For instance, of 285 “gold standard” protein complexes in E. coli, less than 10% are fully conserved among a set of 7 distantly-related bacterial “model” species. Complex conservation follows one of three models: well-conserved complexes, complexes with a conserved core, and complexes with partial conservation but no conserved core. Expanding the comparison to 894 distinct bacterial genomes illustrates fractional conservation and the limits of co-conservation among components of protein complexes: just 14 out of 285 model protein complexes are perfectly conserved across 95% of the genomes used, yet we predict more than 180 may be partially conserved across at least half of the genomes. No clear relationship between gene essentiality and protein complex conservation is observed, as even poorly conserved complexes contain a significant number of essential proteins. Finally, we identify 183 complexes containing well-conserved components and uncharacterized proteins which will be interesting targets for future experimental studies. PMID:25723151

  5. Treatment of Thoracolumbar Fracture

    PubMed Central

    Kim, Byung-Guk; Shin, Dong-Eun

    2015-01-01

    The most common fractures of the spine are associated with the thoracolumbar junction. The goals of treatment of thoracolumbar fracture are leading to early mobilization and rehabilitation by restoring mechanical stability of fracture and inducing neurologic recovery, thereby enabling patients to return to the workplace. However, it is still debatable about the treatment methods. Neurologic injury should be identified by thorough physical examination for motor and sensory nerve system in order to determine the appropriate treatment. The mechanical stability of fracture also should be evaluated by plain radiographs and computed tomography. In some cases, magnetic resonance imaging is required to evaluate soft tissue injury involving neurologic structure or posterior ligament complex. Based on these physical examinations and imaging studies, fracture stability is evaluated and it is determined whether to use the conservative or operative treatment. The development of instruments have led to more interests on the operative treatment which saves mobile segments without fusion and on instrumentation through minimal invasive approach in recent years. It is still controversial for the use of these treatments because there have not been verified evidences yet. However, the morbidity of patients can be decreased and good clinical and radiologic outcomes can be achieved if the recent operative treatments are used carefully considering the fracture pattern and the injury severity. PMID:25705347

  6. Complex emergencies in Indonesia.

    PubMed

    Bradt, D A; Drummond, C M; Richman, M

    2001-01-01

    Recently, Indonesia has experienced six major provincial, civil, armed conflicts. Underlying causes include the transmigration policy, sectarian disputes, the Asian economic crisis, fall of authoritarian rule, and a backlash against civil and military abuses. The public health impact involves the displacement nationwide of > 1.2 million persons. Violence in the Malukus, Timor, and Kalimantan has sparked the greatest population movements such that five provinces in Indonesia each now harbor > 100,000 internally displaced persons. With a background of government instability, hyperinflation, macroeconomic collapse, and elusive political solutions, these civil armed conflicts are ripe for persistence as complex emergencies. Indonesia has made substantial progress in domestic disaster management with the establishment of central administrative authority, strategic planning, and training programs. Nevertheless, the Indonesian experience reveals recurrent issues in international humanitarian health assistance. Clinical care remains complicated by absences of treatment protocols, inappropriate drug use, high procedural complication rates, and variable referral practices. Epidemiological surveillance remains complicated by unsettled clinical case definitions, non-standardized case management of diseases with epidemic potential, variable outbreak management protocols, and inadequate epidemiological analytic capacity. International donor support has been semi-selective, insufficient, and late. The militia murders of three UN staff in West Timor prompted the withdrawal of UN international staff from West Timor for nearly a year to date. Re-establishing rules of engagement for humanitarian health workers must address security, public health, and clinical threats. PMID:12090212

  7. Complex networks analysis of language complexity

    NASA Astrophysics Data System (ADS)

    Amancio, Diego R.; Aluisio, Sandra M.; Oliveira, Osvaldo N., Jr.; Costa, Luciano da F.

    2012-12-01

    Methods from statistical physics, such as those involving complex networks, have been increasingly used in the quantitative analysis of linguistic phenomena. In this paper, we represented pieces of text with different levels of simplification in co-occurrence networks and found that topological regularity correlated negatively with textual complexity. Furthermore, in less complex texts the distance between concepts, represented as nodes, tended to decrease. The complex networks metrics were treated with multivariate pattern recognition techniques, which allowed us to distinguish between original texts and their simplified versions. For each original text, two simplified versions were generated manually with increasing number of simplification operations. As expected, distinction was easier for the strongly simplified versions, where the most relevant metrics were node strength, shortest paths and diversity. Also, the discrimination of complex texts was improved with higher hierarchical network metrics, thus pointing to the usefulness of considering wider contexts around the concepts. Though the accuracy rate in the distinction was not as high as in methods using deep linguistic knowledge, the complex network approach is still useful for a rapid screening of texts whenever assessing complexity is essential to guarantee accessibility to readers with limited reading ability.

  8. Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

    PubMed Central

    Wu, Yong-De; Cai, Xian-Hua; Liu, Xi-Ming; Zhang, Hong-Xi

    2013-01-01

    OBJECTIVE: The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area. METHODS: A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1) group A, the normal pelvis and (2) group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations. RESULTS: As the load was added, the displacements were A

  9. Cyanobacterial NADPH dehydrogenase complexes

    SciTech Connect

    Ogawa, Teruo; Mi, Hualing

    2007-07-01

    Cyanobacteria possess functionally distinct multiple NADPH dehydrogenase (NDH-1) complexes that are essential to CO2 uptake, photosystem-1 cyclic electron transport and respiration. The unique nature of cyanobacterial NDH-1 complexes is the presence of subunits involved in CO2 uptake. Other than CO2 uptake, chloroplastic NDH-1 complex has similar role as cyanobacterial NDH-1 complexes in photosystem-1 cyclic electron transport and respiration (chlororespiration). In this mini-review we focus on the structure and function of cyanobacterial NDH-1 complexes and their phylogeny. The function of chloroplastic NDH-1 complex and characteristics of plants defective in NDH-1 are also described forcomparison.

  10. Evolution of biological complexity

    PubMed Central

    Adami, Christoph; Ofria, Charles; Collier, Travis C.

    2000-01-01

    To make a case for or against a trend in the evolution of complexity in biological evolution, complexity needs to be both rigorously defined and measurable. A recent information-theoretic (but intuitively evident) definition identifies genomic complexity with the amount of information a sequence stores about its environment. We investigate the evolution of genomic complexity in populations of digital organisms and monitor in detail the evolutionary transitions that increase complexity. We show that, because natural selection forces genomes to behave as a natural “Maxwell Demon,” within a fixed environment, genomic complexity is forced to increase. PMID:10781045

  11. Evolution of biological complexity.

    PubMed

    Adami, C; Ofria, C; Collier, T C

    2000-04-25

    To make a case for or against a trend in the evolution of complexity in biological evolution, complexity needs to be both rigorously defined and measurable. A recent information-theoretic (but intuitively evident) definition identifies genomic complexity with the amount of information a sequence stores about its environment. We investigate the evolution of genomic complexity in populations of digital organisms and monitor in detail the evolutionary transitions that increase complexity. We show that, because natural selection forces genomes to behave as a natural "Maxwell Demon," within a fixed environment, genomic complexity is forced to increase. PMID:10781045

  12. Mycobacterium abscessus Complex Infections in Humans

    PubMed Central

    Lee, Meng-Rui; Sheng, Wang-Huei; Hung, Chien-Ching; Yu, Chong-Jen; Lee, Li-Na

    2015-01-01

    Mycobacterium abscessus complex comprises a group of rapidly growing, multidrug-resistant, nontuberculous mycobacteria that are responsible for a wide spectrum of skin and soft tissue diseases, central nervous system infections, bacteremia, and ocular and other infections. M. abscessus complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. The 2 major subspecies, M. abscessus subsp. abscessus and M. abscessus subsp. massiliense, have different erm(41) gene patterns. This gene provides intrinsic resistance to macrolides, so the different patterns lead to different treatment outcomes. M. abscessus complex outbreaks associated with cosmetic procedures and nosocomial transmissions are not uncommon. Clarithromycin, amikacin, and cefoxitin are the current antimicrobial drugs of choice for treatment. However, new treatment regimens are urgently needed, as are rapid and inexpensive identification methods and measures to contain nosocomial transmission and outbreaks. PMID:26295364

  13. Scabies: Treatment

    MedlinePLUS

    ... INFO Scabies General Information Scabies FAQs Workplace FAQs Epidemiology & Risk Factors Biology Disease Diagnosis Treatment Prevention & Control Resources for Health Professionals Medications Institutional Settings Prevention ...

  14. Daunorubicin Lipid Complex Injection

    MedlinePLUS

    Daunorubicin lipid complex is used to treat advanced Kaposi's sarcoma (a type of cancer that causes abnormal tissue to ... body) related to acquired immunodeficiency syndrome (AIDS). Daunorubicin lipid complex is in a class of medications called ...

  15. Chiral lutetium benzamidinate complexes.

    PubMed

    Benndorf, Paul; Jenter, Jelena; Zielke, Larissa; Roesky, Peter W

    2011-03-01

    Enantiomerically pure lutetium complexes were synthesized as the first rare earth metal complexes containing a chiral amidinate ligand. The catalytic activity and the enantioselectivity in hydroamination reactions were studied. PMID:21173978

  16. Oligocyclopentadienyl transition metal complexes

    SciTech Connect

    de Azevedo, Cristina G.; Vollhardt, K. Peter C.

    2002-01-18

    Synthesis, characterization, and reactivity studies of oligocyclopentadienyl transition metal complexes, namely those of fulvalene, tercyclopentadienyl, quatercyclopentadienyl, and pentacyclopentadienyl(cyclopentadienyl) are the subject of this account. Thermal-, photo-, and redox chemistries of homo- and heteropolynuclear complexes are described.

  17. Complex-I-ty in aging

    PubMed Central

    Stork, Devon A.

    2016-01-01

    The role of mitochondrial complex I in aging has been studied in both C. elegans and Drosophila, where RNAi knock down of specific complex I subunits has been shown to extend lifespan. More recently, studies in Drosophila have shown that an increase in mitochondrial activity, including complex I-like activity, can also slow aging. In this review, we discuss this apparent paradox. Improved maintenance of mitochondrial activity, mitochondrial homeostasis, may be responsible for lifespan extension in both cases. Decreased electron transport chain activity caused by reducing complex I subunit expression prompts an increase in stress response signaling that leads to enhanced mitochondrial homeostasis during aging. Increased complex I activity, as well as mitochondrial biogenesis, is expected to both directly counteract the decline in mitochondrial health that occurs during aging and may also increase cellular NAD+ levels, which have been linked to mitochondrial homeostatic mechanisms through activation of sirtuins. We suggest that manipulations that increase or decrease complex I activity both converge on improved mitochondrial homeostasis during aging, resulting in prolonged lifespan. PMID:24961226

  18. Frequency of Natural Resistance within NS5a Replication Complex Domain in Hepatitis C Genotypes 1a, 1b: Possible Implication of Subtype-Specific Resistance Selection in Multiple Direct Acting Antivirals Drugs Combination Treatment.

    PubMed

    Bagaglio, Sabrina; Andolina, Andrea; Merli, Marco; Uberti-Foppa, Caterina; Morsica, Giulia

    2016-01-01

    Different HCV subtypes may naturally harbor different resistance selection to anti-NS5a inhibitors. 2761 sequences retrieved from the Los Alamos HCV database were analyzed in the NS5a domain 1, the target of NS5a inhibitors. The NS5a resistance-associated polymorphisms (RAPs) were more frequently detected in HCV G1b compared to G1a. The prevalence of polymorphisms associated with cross-resistance to compounds in clinical use (daclatasvir, DCV, ledipasvir, LDV, ombitasvir, and OMV) or scheduled to come into clinical use in the near future (IDX719, elbasvir, and ELV) was higher in G1b compared to G1a (37/1552 (2.4%) in 1b sequences and 15/1209 (1.2%) in 1a isolates, p = 0.040). Interestingly, on the basis of the genotype-specific resistance pattern, 95 (6.1%) G1b sequences had L31M RAP to DCV/IDX719, while 6 sequences of G1a (0.5%) harbored L31M RAP, conferring resistance to DCV/LDV/IDX719/ELV (p < 0.0001). Finally, 28 (2.3%) G1a and none of G1b isolates harbored M28V RAP to OMV (p < 0.0001). In conclusion, the pattern of subtype-specific resistance selection in the naturally occurring strains may guide the treatment option in association with direct acting antivirals (DAAs) targeting different regions, particularly in patients that are difficult to cure, such as those with advanced liver disease or individuals who have failed previous DAAs. PMID:27023593

  19. Complexity and Fisher information

    NASA Astrophysics Data System (ADS)

    Binder, P.-M.

    2000-04-01

    The connection between an observer-based theory of measurement and a hierarchical classification of complex systems in terms of topological exponents is discussed. This leads to generalized definitions of complexity that capture different aspects of the structure of the trajectory space of complex systems.

  20. Lyme borreliosis treatment.

    PubMed

    Vanousová, Daniela; Hercogová, Jana

    2008-01-01

    Lyme borreliosis is the most common human tick-borne illness in the Northern Hemisphere. The causative agent is the spirochete Borrelia burgdorferi species complex, and the hard-shell ticks of the genus Ixodes is responsible for pathogen transmission from animals to humans. The incidence of the disease is increasing year by year and although lyme disease is not fatal, it can affect the skin, heart, nervous, and musculoskeletal system with an impairment of quality of life. The appropriate diagnosis of lyme disease should be promptly treated by antibiotics to prevent late stage of the disease. The choice of antibiotics depends on many factors such as the stage of the disease, the drug efficacy, adverse effects, type of delivery, duration of treatment, and cost. Treatment failure occurs as a result of many reasons, re-infection is possible. The recommended treatment schedule in the Czech Republic is presented. PMID:18394084

  1. Crystallization of macromolecular complexes: combinatorial complex crystallization

    NASA Astrophysics Data System (ADS)

    Stura, Enrico A.; Graille, Marc; Charbonnier, Jean-Baptiste

    2001-11-01

    The usefulness of antibody complexation, as a way of increasing the chances of crystallization needs to be re-evaluated after many antibody complexes have been crystallized and their structure determined. It is somewhat striking that among these, only a small number is a complex with a large protein antigen. The problem is that the effort of raising, cleaving and purifying an Fab is rewarded only by an extra chance of getting crystals; depending on the relative likelihood of crystallization of the complexed and uncomplexed protein. The example of the complex between HIV gp120, CD4 and an Fab fragment from a neutralizing antibody suggests that further complexation of an antigen-antibody complex with a third protein could, by increasing the number of possible combinations, improve the likelihood of crystallization. We propose the use of Ig-binding proteins as a way of extending the method from HIV gp120 to all proteins for which there are monoclonal antibodies. We discuss this technique, combinatorial complex crystallization (CCC), as part of a multi-component system for the enhancement of crystallization of macromolecular complexes. The method makes use of single Ig-binding domains from Staphylococcus aureus protein A (SpA), Peptostreptococcus magnus protein L (PpL) and the streptococcal protein G (SpG). The generality of the method depends on the ability of these domains to interact with a large repertoire of antibodies without affecting antigen binding. There is strong evidence to suggest that these Ig-binding domains bind outside the antigen-combining site of the antibody without perturbing antigen binding. It is clear from the crystal structure of the single SpG domain complexed with an Fab that the interaction involves mainly the immunoglobulin CH1 domain, a region not involved in antigen recognition. We have recently determined the structure of the complex between a human Fab and the domain D from SpA and found that steric hindrance is unlikely even for large antigens. We find that such binding involves only the well conserved framework region of the variable domain of the antibody heavy chain (VH) and does not affect the conformation of the hypervariable loops that define the antigen recognition site. Thus this domain could be used to complex to Fab or Fv fragments derived from a wide variety of antibodies. While protein A complexes with the VH domain, protein L recognizes the VL region of immunoglobulins. Our recent study of the interaction between an Fab and a domain of protein L shows that the situation is very similar. Indeed this domain binds to the VL framework region outside the antigen binding site. Since individual domains from each of these three multi-domain proteins bind to well separated and independent locations on immunoglobulins, they can be combined to search for a suitable crystalline lattice. This allows us to propose a combinatorial method as a rational way to exploit antibody complexation for the crystallographic structure determination of proteins that are otherwise difficult to crystallize. The overall method has strong parallels with other combinatorial methods used elsewhere in biology and chemistry, and we propose that together with stoichiometry variation screening (SVS), it may further enhance the probability of crystallization.

  2. Family Therapy in Complex Temporomandibular Joint Dysfunction

    PubMed Central

    Boll, Pamela G.; Mercuri, Louis G.

    1988-01-01

    The purpose of this paper is to offer the oral and maxillofacial surgeon a collaborative approach to the treatment of complex temporomandibular joint (TMJ) dysfunction. Through a positive relationship with a family therapist, the oral and maxillofacial surgeon in this case reports family therapy intervention as an additive solution to resolving apparent recurrent surgical failures. After three surgical procedures, the oral and maxillofacial surgeon noted continued muscle hyperactivity brought on by family environmental stress and arranged for family therapy treatment before a fourth surgical procedure. This paper presents a complicated TMJ case history, documentation for including the family in treatment of pain problems, collaborative efforts necessary for acceptance of referral for psychological intervention, and a family therapy approach to treatment in complex TMJ dysfunction. PMID:3166348

  3. [Tuberculosis treatment].

    PubMed

    Ben Amar, J; Dhahri, B; Aouina, H; Azzabi, S; Baccar, M A; El Gharbi, L; Bouacha, H

    2015-01-01

    The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis. Most patients follow TB standard treatment recommended by WHO that depend on category of patient. It is a combination of four essential tuberculosis drugs of the first group: isoniazid, rifampicin, pyrazinamid and ethambutol; in some cases streptomycin can replace ethambutol. This initial phase of intensive treatment is followed by a consolidation phase. Drugs should be administered in the morning on an empty stomach one hour before meals. Treatment of latent tuberculosis (TB) infection is an important component of TB control programs. Preventive treatment can reduce the risk of developing active TB. PMID:25434510

  4. [A complex forearm injury caused by skateboarding].

    PubMed

    Bauer, G; Kiefer, H

    1991-12-01

    Conservative treatment of forearm fractures in children is preferred. However, in a few cases an open reduction and internal fixation are required. The case of a 15-year-old boy with a complex forearm injury following a skateboard accident is reported. The surgical treatment of these injuries is presented and the indications for open reduction and internal fixation of forearm fractures in children are discussed. PMID:1796349

  5. Heuristic dynamic complexity coding

    NASA Astrophysics Data System (ADS)

    Škorupa, Jozef; Slowack, Jürgen; Mys, Stefaan; Lambert, Peter; Van de Walle, Rik

    2008-04-01

    Distributed video coding is a new video coding paradigm that shifts the computational intensive motion estimation from encoder to decoder. This results in a lightweight encoder and a complex decoder, as opposed to the predictive video coding scheme (e.g., MPEG-X and H.26X) with a complex encoder and a lightweight decoder. Both schemas, however, do not have the ability to adapt to varying complexity constraints imposed by encoder and decoder, which is an essential ability for applications targeting a wide range of devices with different complexity constraints or applications with temporary variable complexity constraints. Moreover, the effect of complexity adaptation on the overall compression performance is of great importance and has not yet been investigated. To address this need, we have developed a video coding system with the possibility to adapt itself to complexity constraints by dynamically sharing the motion estimation computations between both components. On this system we have studied the effect of the complexity distribution on the compression performance. This paper describes how motion estimation can be shared using heuristic dynamic complexity and how distribution of complexity affects the overall compression performance of the system. The results show that the complexity can indeed be shared between encoder and decoder in an efficient way at acceptable rate-distortion performance.

  6. Sewage Treatment

    NASA Technical Reports Server (NTRS)

    1976-01-01

    A million gallon-a-day sewage treatment plant in Huntington Beach, CA converts solid sewage to activated carbon which then treats incoming waste water. The plant is scaled up 100 times from a mobile unit NASA installed a year ago; another 100-fold scale-up will be required if technique is employed for widespread urban sewage treatment. This unique sewage-plant employed a serendipitous outgrowth of a need to manufacture activated carbon for rocket engine insulation. The process already exceeds new Environmental Protection Agency Standards Capital costs by 25% compared with conventional secondary treatment plants.

  7. Wastewater Treatment.

    ERIC Educational Resources Information Center

    Zoltek, J., Jr.; Melear, E. L.

    1978-01-01

    Presents the 1978 literature review of wastewater treatment. This review covers: (1) process application; (2) coagulation and solids separation; (3) adsorption; (4) ion exchange; (5) membrane processes; and (6) oxidation processes. A list of 123 references is also presented. (HM)

  8. Norovirus Treatment

    MedlinePLUS

    ... Norovirus Infection, National Institutes of Health NoroCORE Food Virology Treatment Language: English Español (Spanish) Recommend on Facebook ... Norovirus Infection, National Institutes of Health NoroCORE Food Virology Language: English Español (Spanish) File Formats Help: How ...

  9. Rotavirus Treatment

    MedlinePLUS

    ... Search The CDC Cancel Submit Search The CDC Rotavirus Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Rotavirus Home About Rotavirus Symptoms Transmission Prevention Treatment Photos ...

  10. Treatment & Coping

    MedlinePLUS

    ... Patient gender Curve worsening Associated symptoms such as back pain or shortness of breath What are treatment options ... problems in addition to your scoliosis (such as back pain), your doctor may prescribe physical therapy to address ...

  11. Update on multiple sclerosis treatments.

    PubMed

    Bridel, Claire; Lalive, Patrice H

    2014-01-01

    Relapsing-remitting multiple sclerosis (RRMS) management has dramatically changed over the past decade. New drugs have arrived on the market, allowing for more individualised treatment selection. However, this diversity has increased the complexity of RRMS patient follow-up. In this review, we provide summarised information about treatment efficacy, potential side-effects, follow-up recommendations, vaccinations, and pregnancy safety issues for all currently available disease modifying therapies and those awaiting approval. PMID:25247669

  12. Taurid meteor complex

    NASA Astrophysics Data System (ADS)

    Bu?ek, M.; Porub?an, V.

    2014-07-01

    Structure of the autumnal part of the Taurid meteor complex based on photographic, radio and video meteor orbits is investigated and presented. Potential filaments or sub-streams to be associated with the complex were searched for utilizing the Southworth-Hawkins D-criterion. Altogether fourteen filaments or sub-streams associated with the complex were separated, with the length of the complex exceeding 100 degrees. Central part of the complex is formed by four the most dense filaments, the Northern and Southern Taurids, Southern Piscids and Omicron Orionids. The most probable bodies genetically related to the complex besides 2P/Encke are 2005 UY6, 2005 TF50 and 2007 RU17.

  13. Artistic forms and complexity.

    PubMed

    Boon, J-P; Casti, J; Taylor, R P

    2011-04-01

    We discuss the inter-relationship between various concepts of complexity by introducing a complexity 'triangle' featuring objective complexity, subjective complexity and social complexity. Their connections are explored using visual and musical compositions of art. As examples, we quantify the complexity embedded within the paintings of the Jackson Pollock and the musical works of Johann Sebastian Bach. We discuss the challenges inherent in comparisons of the spatial patterns created by Pollock and the sonic patterns created by Bach, including the differing roles that time plays in these investigations. Our results draw attention to some common intriguing characteristics suggesting 'universality' and conjecturing that the fractal nature of art might have an intrinsic value of more general significance. PMID:21382264

  14. Complex nursing systems.

    PubMed

    Clancy, Thomas R; Delaney, Connie-White

    2005-05-01

    The specific aim of this paper is to identify the causes underlying the growth in health care system complexity, discuss challenges nurse administrators face as a result of it and suggest strategies for better decision-making in complex system environments. This paper further discusses the merits of computational modelling and simulation which can assist nurse administrators predict the results of their decisions through a virtual complex system environment. PMID:15819831

  15. School Phobia: Understanding a Complex Behavioural Response

    ERIC Educational Resources Information Center

    Chitiyo, Morgan; Wheeler, John J.

    2006-01-01

    School phobia affects about 5% of the school-age population. If left untreated, school phobia can have devastating long-term consequences in children challenged by this condition. Various treatment approaches have been used to explore this complex behavioural response, major among them being the psychoanalytic, psychodynamic, pharmacological and…

  16. School Phobia: Understanding a Complex Behavioural Response

    ERIC Educational Resources Information Center

    Chitiyo, Morgan; Wheeler, John J.

    2006-01-01

    School phobia affects about 5% of the school-age population. If left untreated, school phobia can have devastating long-term consequences in children challenged by this condition. Various treatment approaches have been used to explore this complex behavioural response, major among them being the psychoanalytic, psychodynamic, pharmacological and…

  17. Complexity and schizophrenia.

    PubMed

    Fernández, Alberto; Gómez, Carlos; Hornero, Roberto; López-Ibor, Juan José

    2013-08-01

    Complexity estimators have been broadly utilized in schizophrenia investigation. Early studies reported increased complexity in schizophrenia patients, associated with a higher variability or "irregularity" of their brain signals. However, further investigations showed reduced complexities, thus introducing a clear divergence. Nowadays, both increased and reduced complexity values are reported. The explanation of such divergence is a critical issue to understand the role of complexity measures in schizophrenia research. Considering previous arguments a complementary hypothesis is advanced: if the increased irregularity of schizophrenia patients' neurophysiological activity is assumed, a "natural" tendency to increased complexity in EEG and MEG scans should be expected, probably reflecting an abnormal neuronal firing pattern in some critical regions such as the frontal lobes. This "natural" tendency to increased complexity might be modulated by the interaction of three main factors: medication effects, symptomatology, and age effects. Therefore, young, medication-naïve, and highly symptomatic (positive symptoms) patients are expected to exhibit increased complexities. More importantly, the investigation of these interacting factors by means of complexity estimators might help to elucidate some of the neuropathological processes involved in schizophrenia. PMID:22507763

  18. Child health in complex emergencies.

    PubMed Central

    Moss, William J.; Ramakrishnan, Meenakshi; Storms, Dory; Henderson Siegle, Anne; Weiss, William M.; Lejnev, Ivan; Muhe, Lulu

    2006-01-01

    Coordinated and effective interventions are critical for relief efforts to be successful in addressing the health needs of children in situations of armed conflict, population displacement, and/or food insecurity. We reviewed published literature and surveyed international relief organizations engaged in child health activities in complex emergencies. Our aim was to identify research needs and improve guidelines for the care of children. Much of the literature details the burden of disease and the causes of morbidity and mortality; few interventional studies have been published. Surveys of international relief organizations showed that most use World Health Organization (WHO), United Nations Children's Fund (UNICEF), and ministry of health guidelines designed for use in stable situations. Organizations were least likely to have formal guidelines on the management of asphyxia, prematurity, and infection in neonates; diagnosis and management of children with human immunodeficiency virus (HIV) infection; active case-finding and treatment of tuberculosis; paediatric trauma; and the diagnosis and management of mental-health problems in children. Guidelines often are not adapted to the different types of health-care workers who provide care in complex emergencies. Evidence-based, locally adapted guidelines for the care of children in complex emergencies should be adopted by ministries of health, supported by WHO and UNICEF, and disseminated to international relief organizations to ensure appropriate, effective, and uniform care. PMID:16501716

  19. Tuberous Sclerosis Complex Diagnostic Criteria Update: Recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference

    PubMed Central

    Northrup, Hope; Krueger, Darcy A.

    2014-01-01

    BACKGROUND Tuberous sclerosis complex is highly variable in clinical presentation and findings. Disease manifestations continue to develop over the lifetime of an affected individual. Accurate diagnosis is fundamental to implementation of appropriate medical surveillance and treatment. Although significant advances have been made in the past 15 years in the understanding and treatment of tuberous sclerosis complex, current clinical diagnostic criteria have not been critically evaluated or updated since the last clinical consensus conference in 1998. METHODS The 2012 International Tuberous Sclerosis Complex Consensus Group, comprising 79 specialists from 14 countries, was organized into 12 subcommittees, each led by a clinician with advanced expertise in tuberous sclerosis complex and the relevant medical subspecialty. Each subcommittee focused on a specific disease area with important diagnostic implications and was charged with reviewing prevalence and specificity of disease-associated clinical findings and their impact on suspecting and confirming the diagnosis of tuberous sclerosis complex. RESULTS Clinical features of tuberous sclerosis complex continue to be a principal means of diagnosis. Key changes compared with 1998 criteria are the new inclusion of genetic testing results and reducing diagnostic classes from three (possible, probable, and definite) to two (possible, definite). Additional minor changes to specific criterion were made for additional clarification and simplification. CONCLUSIONS The 2012 International Tuberous Sclerosis Complex Diagnostic Criteria provide current, updated means using best available evidence to establish diagnosis of tuberous sclerosis complex in affected individuals. PMID:24053982

  20. Treatment of subepidermal immunobullous diseases

    PubMed Central

    Culton, Donna A.; Diaz, Luis A.

    2013-01-01

    The subepidermal immunobullous diseases are a group of autoimmune blistering disorders of the skin and mucous membranes that share the common features of autoantibody deposition and blister formation at the dermal-epidermal junction or basement membrane. This group includes bullous pemphigoid, linear IgA disease, dermatitis herpetiformis, and epidermolysis bullosa acquisita, among others. Although these disorders share some common features, each disease is unique in its clinical presentation, histopathology, and immunofluorescence patterns, which allows for accurate diagnosis and disease-specific treatment strategy. Treatment of these disorders is complex and requires expert knowledge of disease pathogenesis. We review common treatment approaches for each of these disorders. PMID:22137232

  1. Performance Improvement Assuming Complexity

    ERIC Educational Resources Information Center

    Rowland, Gordon

    2007-01-01

    Individual performers, work teams, and organizations may be considered complex adaptive systems, while most current human performance technologies appear to assume simple determinism. This article explores the apparent mismatch and speculates on future efforts to enhance performance if complexity rather than simplicity is assumed. Included are…

  2. Beyond the Hox complex

    PubMed Central

    Patel, Nipam H; Prince, Victoria E

    2000-01-01

    The Hox complex is an example of a gene cluster created by tandem duplications. Recent findings suggest the Hox complex may be just part of a larger chromosomal assemblage of homeobox-containing genes that existed in the ancestor to all vertebrates. PMID:11178261

  3. U1A Complex

    ScienceCinema

    None

    2015-01-09

    Some of the most sophisticated experiments in the stockpile stewardship program are conducted in an environmentally safe manner, nearly 1000 feet below the ground at the site. The U1a complex a sprawling underground laboratory and tunnel complex is home to a number of unique capabilities.

  4. Complexity in Picture Books

    ERIC Educational Resources Information Center

    Sierschynski, Jarek; Louie, Belinda; Pughe, Bronwyn

    2015-01-01

    One of the key requirements of Common Core State Standards (CCSS) in English Language Arts is that students are able to read and access complex texts across all grade levels. The CCSS authors emphasize both the limitations and lack of accuracy in the current CCSS model of text complexity, calling for the development of new frameworks. In response…

  5. Complex vague relation

    NASA Astrophysics Data System (ADS)

    Al-Husban, Rima; Salleh, Abdul Razak

    2015-12-01

    The present paper, introduces a complex vague relation (CVR) as a generalization of a vague relation by extending the range of truth-membership and false-membership functions from the closed unit interval [0, 1] to the unit circle in the complex plane. Then we introduce the basic operations on CVRs, namely complement, union and intersection. Some examples are given.

  6. Bacterial formate hydrogenlyase complex

    PubMed Central

    McDowall, Jennifer S.; Murphy, Bonnie J.; Haumann, Michael; Palmer, Tracy; Armstrong, Fraser A.; Sargent, Frank

    2014-01-01

    Under anaerobic conditions, Escherichia coli can carry out a mixed-acid fermentation that ultimately produces molecular hydrogen. The enzyme directly responsible for hydrogen production is the membrane-bound formate hydrogenlyase (FHL) complex, which links formate oxidation to proton reduction and has evolutionary links to Complex I, the NADH:quinone oxidoreductase. Although the genetics, maturation, and some biochemistry of FHL are understood, the protein complex has never been isolated in an intact form to allow biochemical analysis. In this work, genetic tools are reported that allow the facile isolation of FHL in a single chromatographic step. The core complex is shown to comprise HycE (a [NiFe] hydrogenase component termed Hyd-3), FdhF (the molybdenum-dependent formate dehydrogenase-H), and three iron-sulfur proteins: HycB, HycF, and HycG. A proportion of this core complex remains associated with HycC and HycD, which are polytopic integral membrane proteins believed to anchor the core complex to the cytoplasmic side of the membrane. As isolated, the FHL complex retains formate hydrogenlyase activity in vitro. Protein film electrochemistry experiments on Hyd-3 demonstrate that it has a unique ability among [NiFe] hydrogenases to catalyze production of H2 even at high partial pressures of H2. Understanding and harnessing the activity of the FHL complex is critical to advancing future biohydrogen research efforts. PMID:25157147

  7. Tuberculosis in complex emergencies.

    PubMed

    Coninx, Rudi

    2007-08-01

    This paper describes the key factors and remaining challenges for tuberculosis (TB) control programmes in complex emergencies. A complex emergency is "a humanitarian crisis in a country, region or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single agency and/or the ongoing United Nations country programme." Some 200 million people are believed to live in countries affected by complex emergencies; almost all of these are developing countries that also bear the main burden of TB. The effects of complex emergencies impact on TB control programmes, interfering with the goals of identifying and curing TB patients and possibly leading to the emergence of MDR-TB. There are many detailed descriptions of aid interventions during complex emergencies; yet TB control programmes are absent from most of these reports. If TB is neglected, it may quickly result in increased morbidity and mortality, as was demonstrated in Bosnia and Herzegovina and in Somalia. TB is a major disease in complex emergencies and requires an appropriate public health response. While there is no manual to cover complex emergencies, the interagency manual for TB control in refugee and displaced populations provides valuable guidance. These programmes contribute to the body of evidence needed to compile such a manual, and should ensure that the experiences of TB control in complex emergencies lead to the establishment of evidence-based programmes. PMID:17768523

  8. Complexity and Relations

    ERIC Educational Resources Information Center

    Lancaster, Jeanette Elizabeth

    2013-01-01

    A central feature of complexity is that it is based on non-linear, recursive relations. However, in most current accounts of complexity such relations, while non-linear, are based on the reductive relations of a Newtonian onto-epistemological framework. This means that the systems that are emergent from the workings of such relations are a…

  9. Performance Improvement Assuming Complexity

    ERIC Educational Resources Information Center

    Rowland, Gordon

    2007-01-01

    Individual performers, work teams, and organizations may be considered complex adaptive systems, while most current human performance technologies appear to assume simple determinism. This article explores the apparent mismatch and speculates on future efforts to enhance performance if complexity rather than simplicity is assumed. Included are…

  10. Visual Complexity: A Review

    ERIC Educational Resources Information Center

    Donderi, Don C.

    2006-01-01

    The idea of visual complexity, the history of its measurement, and its implications for behavior are reviewed, starting with structuralism and Gestalt psychology at the beginning of the 20th century and ending with visual complexity theory, perceptual learning theory, and neural circuit theory at the beginning of the 21st. Evidence is drawn from…

  11. Schools and Complexity

    ERIC Educational Resources Information Center

    Trombly, Christopher E.

    2014-01-01

    As schools, districts, and the overall education system are complex entities, both the approaches taken to improve them and the methods used to study them must be similarly complex. Simple solutions imposed with no regard for schools' or districts' unique contexts hold little promise, while seemingly insignificant differences between those…

  12. U1A Complex

    SciTech Connect

    2014-10-28

    Some of the most sophisticated experiments in the stockpile stewardship program are conducted in an environmentally safe manner, nearly 1000 feet below the ground at the site. The U1a complex a sprawling underground laboratory and tunnel complex is home to a number of unique capabilities.

  13. Complexity in Picture Books

    ERIC Educational Resources Information Center

    Sierschynski, Jarek; Louie, Belinda; Pughe, Bronwyn

    2015-01-01

    One of the key requirements of Common Core State Standards (CCSS) in English Language Arts is that students are able to read and access complex texts across all grade levels. The CCSS authors emphasize both the limitations and lack of accuracy in the current CCSS model of text complexity, calling for the development of new frameworks. In response…

  14. Freestanding Complex Optical Scanners.

    ERIC Educational Resources Information Center

    Frisbie, David A.

    A complex freestanding optical mark recognition (OMR) scanner is one which is not on-line to an external processor; it has intelligence stemming from an internal processor located within the unit or system. The advantages and disadvantages of a complex OMR can best be assessed after identifying the scanning needs and constraints of the potential…

  15. COMPLEXITY IN ECOLOGICAL SYSTEMS

    EPA Science Inventory

    The enormous complexity of ecosystems is generally obvious under even the most cursory examination. In the modern world, this complexity is further augmented by the linkage of ecosystems to economic and social systems through the human use of the environment for technological pu...

  16. Gold trifluoromethyl complexes.

    PubMed

    Gil-Rubio, Juan; Vicente, José

    2015-12-01

    This article reviews the synthesis, reactivity and applications of gold trifluoromethyl complexes, which are the only isolated perfluoroalkyl complexes of gold. The most reported examples are neutral Au(i) complexes of the type [Au(CF3)L], whereas only two Au(ii) trifluoromethyl complexes have been reported, both being diamagnetic and containing a strong Au-Au bond. A number of Au(iii) trifluoromethyl complexes have been prepared by oxidative addition of halogens or iodotrifluoromethane to Au(i) complexes or, in a few cases, by transmetallation reactions. Owing to the limitations of the available synthetic methods, a lower number of examples is known, particularly for the oxidation states (ii) and (iii). Gold trifluoromethyl complexes present singular characteristics, such as thermal stability, strong Au-C bonds and, in some cases, reactive α-C-F bonds. Some of the Au(iii) complexes reported, show unusually easy reductive elimination reactions of trifluoromethylated products which could be applied in the development of gold-catalyzed processes for the trifluoromethylation of organic compounds. PMID:26169553

  17. Root resorption following treatment with aligners.

    PubMed

    Brezniak, Naphtali; Wasserstein, Atalia

    2008-11-01

    Can orthodontically induced inflammatory root resorption (OIIRR) be the result of Invisalign treatment? Since OIIRR was first described in the literature, orthodontists have been looking for a treatment procedure where no root shortening will occur. In the past decade, Invisalign orthodontic treatment has become very popular, and there is no description of OIIRR after this treatment. Therefore, it might be incorrectly concluded that the body is immune to this type of orthodontic treatment modality and no OIIRR appears as a result of this treatment. The following case report demonstrates an aspect of the complexity of OIIRR. PMID:18947291

  18. Antitumor effects of electrochemical treatment

    PubMed Central

    González, Maraelys Morales; Zamora, Lisset Ortíz; Cabrales, Luis Enrique Bergues; Sierra González, Gustavo Victoriano; de Oliveira, Luciana Oliveira; Zanella, Rodrigo; Buzaid, Antonio Carlos; Parise, Orlando; Brito, Luciana Macedo; Teixeira, Cesar Augusto Antunes; Gomes, Marina das Neves; Moreno, Gleyce; Feo da Veiga, Venicio; Telló, Marcos; Holandino, Carla

    2013-01-01

    Electrochemical treatment is an alternative modality for tumor treatment based on the application of a low intensity direct electric current to the tumor tissue through two or more platinum electrodes placed within the tumor zone or in the surrounding areas. This treatment is noted for its great effectiveness, minimal invasiveness and local effect. Several studies have been conducted worldwide to evaluate the antitumoral effect of this therapy. In all these studies a variety of biochemical and physiological responses of tumors to the applied treatment have been obtained. By this reason, researchers have suggested various mechanisms to explain how direct electric current destroys tumor cells. Although, it is generally accepted this treatment induces electrolysis, electroosmosis and electroporation in tumoral tissues. However, action mechanism of this alternative modality on the tumor tissue is not well understood. Although the principle of Electrochemical treatment is simple, a standardized method is not yet available. The mechanism by which Electrochemical treatment affects tumor growth and survival may represent more complex process. The present work analyzes the latest and most important research done on the electrochemical treatment of tumors. We conclude with our point of view about the destruction mechanism features of this alternative therapy. Also, we suggest some mechanisms and strategies from the thermodynamic point of view for this therapy. In the area of Electrochemical treatment of cancer this tool has been exploited very little and much work remains to be done. Electrochemical treatment constitutes a good therapeutic option for patients that have failed the conventional oncology methods. PMID:23592904

  19. Integrated nonthermal treatment system study

    SciTech Connect

    Biagi, C.; Bahar, D.; Teheranian, B.; Vetromile, J.; Quapp, W.J.; Bechtold, T.; Brown, B.; Schwinkendorf, W.; Swartz, G.

    1997-01-01

    This report presents the results of a study of nonthermal treatment technologies. The study consisted of a systematic assessment of five nonthermal treatment alternatives. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The alternatives considered were innovative nonthermal treatments for organic liquids and sludges, process residue, soil and debris. Vacuum desorption or various washing approaches are considered for treatment of soil, residue and debris. Organic destruction methods include mediated electrochemical oxidation, catalytic wet oxidation, and acid digestion. Other methods studied included stabilization technologies and mercury separation of treatment residues. This study is a companion to the integrated thermal treatment study which examined 19 alternatives for thermal treatment of MLLW waste. The quantities and physical and chemical compositions of the input waste are based on the inventory database developed by the US Department of Energy. The Integrated Nonthermal Treatment Systems (INTS) systems were evaluated using the same waste input (2,927 pounds per hour) as the Integrated Thermal Treatment Systems (ITTS). 48 refs., 68 figs., 37 tabs.

  20. Sewage Treatment

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Stennis Space Center's aquaculture research program has led to an attractive wastewater treatment for private homes. The system consists of a septic tank or tanks for initial sewage processing and a natural secondary treatment facility for further processing of septic tanks' effluent, consisting of a narrow trench, which contains marsh plants and rocks, providing a place for microorganisms. Plants and microorganisms absorb and digest, thus cleansing partially processed wastewater. No odors are evident and cleaned effluent may be discharged into streams or drainage canals. The system is useful in rural areas, costs about $1,900, and requires less maintenance than mechanical systems.

  1. [Complexity: an introduction].

    PubMed

    Gómez, Carlos Alberto Palacio; Jaramillo, Francisco Luis Ochoa

    2011-01-01

    Complexity appears in the twentieth century as a way to understand many phenomena that are perceived as chaotic and complex from classical thought, which still persist in our way of explaining the world. Its purpose is to study the complex and adaptive systems that are sensitive to initial conditions. Some of the characteristics of complex thought are systemic perspective, autopoiesis, self-organization, emergent properties, unpredictability of the systems, analogic thought, and the complementarity of the phenomena, among others. Living systems respond to a complex logic, and in that sense, our vision of human populations and patients, and how we try to solve problems and human diseases, should be open to the possibilities that arise from this form of understand the world. PMID:21503430

  2. BIOLOGICAL TREATMENT OF HIGH STRENGTH PETROCHEMICAL WASTEWATER

    EPA Science Inventory

    The biological treatment of a complex petrochemical wastewater containing high concentrations of organic chlorides, nitrates, and amines was initially studied using a sequence of anaerobic methanogenesis and oxygen activated sludge. Bench-scale and pilot-plant treatability studie...

  3. Acute Heart Failure Treatment

    PubMed Central

    Bellou, Abdel

    2013-01-01

    Dyspnea is the predominant symptom for patients with acute heart failure and initial treatment is largely directed towards the alleviation of this. Contrary to conventional belief, not all patients present with fluid overload and the approach to management is rapidly evolving from a solitary focus on diuresis to one that more accurately reflects the complex interplay of underlying cardiac dysfunction and acute precipitant. Effective treatment thus requires an understanding of divergent patient profiles and an appreciation of various therapeutic options for targeted patient stabilization. The key principle within this paradigm is directed management that aims to diminish the work of breathing through situation appropriate ventillatory support, volume reduction and hemodynamic improvement. With such an approach, clinicians can more efficiently address respiratory discomfort while reducing the likelihood of avoidable harm. PMID:24223323

  4. Complex Spectra in Fusion Plasmas

    NASA Astrophysics Data System (ADS)

    von Hellermann, M. G.; Bertschinger, G.; Biel, W.; Giroud, C.; Jaspers, R.; Jupen, C.; Marchuk, O.; O'Mullane, M.; Summers, H. P.; Whiteford, A.; Zastrow, K.-D.

    2005-01-01

    The need for quantitative evaluation of complex line emission spectra as observed in hot fusion plasmas initiated a challenging development of sophisticated interpretation tools based on integrating advanced atomic modelling with detailed treatment of the plasma environment. The successful merging of the two worlds has led to routine diagnostic procedures which have contributed enormously to the understanding of underlying plasma processes and also to a wide acceptance of spectroscopy as a reliable diagnostic method. In this paper three characteristic types of spectra of current and continuing interest are presented. The first is that of medium/heavy species with many ionisation stages revealed in survey VUV and XUV spectra. Such species occur as control gases, as wall materials, as ablated heavy species and possible as layered wall dopants for monitoring erosion. The spectra are complex with line-like and quasi-continuum regions and are amenable to advanced `pattern recognition' methods. The second type is of few electron, highly ionised systems observed as line-of-sight integrated passive emission spectra in the soft x-ray region. They are analysed successfully in terms of plasma parameters through matching of observation with predicted synthetic spectra. Examples used here include highly resolved helium-like emission spectra of argon, iron and titanium observed on the tokamaks TEXTOR and Tore Supra. The third type, and the emphasis of this work, comprises spectra linked to active beam spectroscopy, that is, charge exchange recombination spectroscopy (CXRS) and beam emission spectroscopy (BES). In this case, a complex spectrum is again composed of a (usually) dominating active spectrum and an underlying passive emission spectrum. Its analysis requires modelling of both active and passive features. Examples used here are from the CXRS diagnostic at JET and TEXTOR. They display characteristic features of the main light impurity ions (C+6, He+2, N+7, Ne+10 and Ar+18), as well as that of the bulk plasma ions, H+, D+ and T+. A main conclusion is that spectral complexity is not necessarily negative, but that `complex structures' can provide a rich source of information on the plasma and its parameters—provided it is matched with integrated analysis—and that the methods can have universal applicability. In the present preparatory phase of the next generation fusion experiment ITER (International Thermonuclear Experimental Reactor) the concepts and expectations of complex spectra and integrated data analysis play an important role in the design and optimisation procedure of the ITER diagnostic assembly.

  5. Glenohumeral instability associated with Buford complex.

    PubMed

    del Rey, Fernando Canillas; Vázquez, Diego García-Germán; López, Daniel Nieto

    2009-12-01

    Buford complex is described as a normal anatomical variant of the anterosuperior part of the glenoid consisting of the absence of the anterosuperior labrum with the presence of a cord-like middle glenohumeral ligament. Traditionally, reattachment to the glenoid has been discouraged. We present a case of a Buford complex associated with glenohumeral instability. The patient was operated for recurrent instability without a preoperative diagnosis of Buford complex. The diagnosis was made during shoulder arthroscopy and reattachment to the glenoid was performed with a satisfactory outcome. Here, we discuss the relationship of the Buford complex with intraarticular pathology and the surgical treatment in cases when this variant is associated with instability. PMID:19629434

  6. Labile sulfide and sulfite in phytochelatin complexes

    SciTech Connect

    Eannetta, N.T.; Steffens, J.C. )

    1989-04-01

    Heavy metals such as cadmium induce tomato cell cultures to synthesize the metal binding polypeptides ({gamma}-Glu-Cys){sub 3} and ({gamma}-Glu-Cys){sub 4}-Gly (phytochelatins). Tomato cells selected for growth on normally lethal concentrations of CdCl{sub 2} synthesize higher quantities of these polypeptides. Cd{sup r} cells are not cross-resistant to other heavy metals, and recent work suggests that metal detoxification by these peptides may be Cd-specific. The occurrence of labile sulfur as a component of the metal complex raises questions concerning possible functions of phytochelatins besides that of Cd binding. The presence of acid-labile sulfide ion in phytochelatin complexes has been reported by several groups. We report the additional finding that labile sulfite is also present in these complexes and in higher amounts than sulfide. Sulfide and sulfite are both released from the metal binding complex by acidification or by treatment with EDTA.

  7. The Evolution of Privatization at Hanford Tank Waste Treatment Complex

    SciTech Connect

    BROWN, N.R.

    2001-02-01

    Privatization acquisition strategies embody substantial contract reform principles-private financing and ownership, competition, fixed prices, and payment only upon delivery of services-which in time became the recipe for privatization of Department of Energy (DOE) Environmental Management (EM) cleanup projects. Privatization changes the federal government's approach from traditional cost-plus contracting, where the federal government pays the contractor as the project progresses, to a strategy where the federal government pays for products or services as they are delivered. To be successful, the privatization requires additional risk taking by the contractor. This paper focuses on why the Tank Waste Remediation System (TWRS) pursued privatization, how the TWRS Privatization Project matured, and why the privatization project moved to an alternate path. The paper is organized as follows: a description of the TWRS-Privatization framework, how the project changed from the original request for proposal through the decision not to proceed to Part B-2, and the lessons learned during evolution of the effort, including what worked as well as what went wrong and how such negative outcomes might be prevented in the future.

  8. B Plant complex treatment, storage, and disposal units inspection plan

    SciTech Connect

    Beam, T.G.

    1994-10-01

    Owners or operators of facilities that treat, store, and/or dispose of dangerous waste and/or mixed waste as defined by WAC 173-303, {open_quotes}Dangerous Waste Regulations,{close_quotes} must inspect their facilities to prevent malfunctions and deteriorations, operator errors, and discharges that may cause or lead to the release of hazardous waste constituents to the environment and/or cause a threat to human health. The WAC regulations require a written inspection schedule be developed, implemented, and kept at the facility.

  9. Surface Treatment

    NASA Technical Reports Server (NTRS)

    Park, Cheol (Inventor); Lowther, Sharon E. (Inventor); St.Clair, Terry L. (Inventor)

    2003-01-01

    A simple surface treatment process is provided which offers a high performance surface for a variety of applications at low cost. This novel surface treatment, which is particularly useful for Ti-6Al-4V alloys, is achieved by forming oxides on the surface with a two-step chemical process and without mechanical abrasion. First, after solvent degreasing, sulfuric acid is used to generate a fresh titanium surface. Next, an alkaline perborate solution is used to form an oxide on the surface. This acid-followed-by-base treatment is cost effective and relatively safe to use in commercial applications. In addition, it is chromium-free, and has been successfully used with a sol-gel coating to afford a strong adhesive bond that exhibits excellent durability after the bonded specimens have been subjected to a harsh 72 hour water boil immersion. Phenylethynyl containing adhesives were used to evaluate this surface treatment with a novel coupling agent containing both trialkoxysilane and phenylethynyl groups. 8 Claims, 16 Drawing Sheets

  10. WATER TREATMENT

    DOEpatents

    Pitman, R.W.; Conley, W.R. Jr.

    1962-12-01

    An automated system for adding clarifying chemicals to water in a water treatment plant is described. To a sample of the floc suspension polyacrylamide or similar filter aid chemicals are added, and the sample is then put through a fast filter. The resulting filtrate has the requisite properties for monitoring in an optical turbidimeter to control the automated system. (AEC)

  11. Scabies Treatment

    MedlinePLUS

    ... Issues Listen Español Text Size Email Print Share Scabies Treatment Page Content Article Body Scabies is caused by a microscopic mite that burrows ... deposits its eggs. The rash that results from scabies is actually a reaction to the mite’s body, ...

  12. PARACOCCIDIOIDOMYCOSIS TREATMENT

    PubMed Central

    SHIKANAI-YASUDA, Maria Aparecida

    2015-01-01

    SUMMARY Considered to be an emerging endemic mycosis in Latin America, paracoccidioidomycosis is characterized by a chronic course and involvement of multiple organs in immunocompromised hosts. Infection sequelae are mainly related to pulmonary and adrenal insufficiency. The host-parasite interaction results in different expressions of the immune response depending on parasite pathogenicity, fungal load and genetic characteristics of the host. A few controlled and case series reports have shown that azoles and fast-acting sulfa derivatives are useful treatment alternatives in milder forms of the disease. For moderate/severe cases, more prolonged treatments or even parenteral routes are required especially when there is involvement of the digestive tract mucosa, resulting in poor drug absorption. Although comparative studies have reported that shorter treatment regimens with itraconazole are able to induce cure in chronically-infected patients, there are still treatment challenges such as the need for more controlled studies involving acute cases, the search for new drugs and combinations, and the search for compounds capable of modulating the immune response in severe cases as well as the paradoxical reactions. PMID:26465367

  13. PARACOCCIDIOIDOMYCOSIS TREATMENT.

    PubMed

    Shikanai-Yasuda, Maria Aparecida

    2015-09-01

    Considered to be an emerging endemic mycosis in Latin America, paracoccidioidomycosis is characterized by a chronic course and involvement of multiple organs in immunocompromised hosts. Infection sequelae are mainly related to pulmonary and adrenal insufficiency. The host-parasite interaction results in different expressions of the immune response depending on parasite pathogenicity, fungal load and genetic characteristics of the host. A few controlled and case series reports have shown that azoles and fast-acting sulfa derivatives are useful treatment alternatives in milder forms of the disease. For moderate/severe cases, more prolonged treatments or even parenteral routes are required especially when there is involvement of the digestive tract mucosa, resulting in poor drug absorption. Although comparative studies have reported that shorter treatment regimens with itraconazole are able to induce cure in chronically-infected patients, there are still treatment challenges such as the need for more controlled studies involving acute cases, the search for new drugs and combinations, and the search for compounds capable of modulating the immune response in severe cases as well as the paradoxical reactions. PMID:26465367

  14. [Avalanche accidents and treatment of avalanche victims].

    PubMed

    Skaiaa, Sven Christjar; Thomassen, Øyvind

    2016-03-01

    Avalanches may be provoked spontaneously or as a result of human activity, and they trigger the need for considerable rescue resources. Avalanche search and rescue operations are complex and characterised by physical and mental stress. The guidelines for resuscitation of avalanche victims may be perceived as complex and abstruse, which can lead to suboptimal treatment and an increased strain on rescue teams. The purpose of this article is to summarise the principles for medical treatment of avalanche victims. PMID:26983147

  15. CELL-PERMEABLE PROTEIN THERAPY FOR COMPLEX I DYSFUNCTION

    PubMed Central

    Pepe, Salvatore; Mentzer, Robert M.; Gottlieb, Roberta A.

    2015-01-01

    Complex I deficiency is difficult to treat because of the size and complexity of the multi-subunit enzyme complex. Mutations or deletions in the mitochondrial genome are not amenable to gene therapy. However, animal studies have shown that yeast-derived internal NADH quinone oxidoreductase (Ndi1) can be delivered as a cell-permeable recombinant protein (Tat-Ndi1) that can functionally replace complex I damaged by ischemia/reperfusion. Current and future treatment of disorders affecting complex I are discussed, including the use of Tat-Ndi1. PMID:25005682

  16. Selenophene transition metal complexes

    SciTech Connect

    White, C.J.

    1994-07-27

    This research shows that selenophene transition metal complexes have a chemistry that is similar to their thiophene analogs. Selenophene coordination has been demonstrated and confirmed by molecular structure in both the {eta}{sup 5}- and the {eta}{sup 1}(Se)-coordination modes. The reaction chemistry of selenophene complexes closely resembles that of the analogous thiophene complexes. One major difference, however, is that selenophene is a better donor ligand than thiophene making the selenophene complexes more stable than the corresponding thiophene complexes. The {sup 77}Se NMR chemical shift values for selenophene complexes fall within distinct regions primarily depending on the coordination mode of the selenophene ligand. In the final paper, the C-H bond activation of {eta}{sup 1}(S)-bound thiophenes, {eta}{sup 1}(S)-benzothiophene and {eta}{sup 1}(Se)-bound selenophenes has been demonstrated. The deprotonation and rearrangement of the {eta}{sup 1}(E)-bound ligand to the carbon bound L-yl complex readily occurs in the presence of base. Reprotonation with a strong acid gives a carbene complex that is unreactive towards nucleophilic attack at the carbene carbon and is stable towards exposure to air. The molecular structure of [Cp(NO)(PPh{sub 3})Re(2-benzothioenylcarbene)]O{sub 3}SCF{sub 3} was determined and contains a Re-C bond with substantial double bond character. Methyl substitution for the thienylcarbene or selenylcarbene gives a carbene that rearranges thermally to give back the {eta}{sup 1}(E)-bound complex. Based on these model reactions, a new mechanism for the H/D exchange of thiophene over the hydrodesulfurization catalyst has been proposed.

  17. Audits for advanced treatment dosimetry

    NASA Astrophysics Data System (ADS)

    Ibbott, G. S.; Thwaites, D. I.

    2015-01-01

    Radiation therapy has advanced rapidly over the last few decades, progressing from 3D conformal treatment to image-guided intensity modulated therapy of several different flavors, both 3D and 4D and to adaptive radiotherapy. The use of intensity modulation has increased the complexity of quality assurance and essentially eliminated the physicist's ability to judge the validity of a treatment plan, even approximately, on the basis of appearance and experience. Instead, complex QA devices and procedures are required at the institutional level. Similarly, the assessment of treatment quality through remote and on-site audits also requires greater sophistication. The introduction of 3D and 4D dosimetry into external audit systems must follow, to enable quality assurance systems to perform meaningful and thorough audits.

  18. Controllability of Complex Systems

    NASA Astrophysics Data System (ADS)

    Slotine, Jean-Jacques

    2013-03-01

    We review recent work on controllability of complex systems. We also discuss the interplay of our results with questions of synchronization, and point out key directions of future research. Work done in collaboration with Yang-Yu Liu, Center for Complex Network Research and Departments of Physics, Computer Science and Biology, Northeastern University and Center for Cancer Systems Biology, Dana-Farber Cancer Institute; and Albert-László Barabási, Center for Complex Network Research and Departments of Physics, Computer Science and Biology, Northeastern University; Center for Cancer Systems Biology, Dana-Farber Cancer Institute; and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School.

  19. Trimethoxybenzene complexes of pentafluorophenylchlorocarbene.

    PubMed

    Wang, Lei; Moss, Robert A; Krogh-Jespersen, Karsten

    2011-07-21

    Pentafluorophenylchlorocarbene, generated by laser flash photolysis (LFP) of pentafluorophenylchlorodiazirine, formed ?-type complexes with 1,3,5-trimethoxybenzene in pentane. The carbene and carbene complexes were in equilibrium with K = 3.21 × 10(5) M(-1) at 294 K. From the temperature dependence of K, ?H° = -10.2 kcal/mol, ?S° = -9.5 eu, and ?G° = -7.4 kcal/mol at 298 K. The carbene complexes were characterized by UV-vis spectroscopy and computational analysis. PMID:21696161

  20. Complexity and forensic pathology.

    PubMed

    Jones, Richard Martin

    2015-12-01

    It has become increasingly apparent that nonlinearity and complexity are the norm in human physiological systems, the relevance of which is informing an enhanced understanding of basic pathological processes such as inflammation, the host response to severe trauma, and critical illness. This article will explore how an understanding of nonlinear systems and complexity might inform the study of the pathophysiology of deaths of medicolegal interest, and how 'complexity thinking' might usefully be incorporated into modern forensic medicine and forensic pathology research, education and practice. PMID:26372537

  1. Afterglow Complex Plasma

    SciTech Connect

    Samarian, A. A.; Boufendi, L.; Mikikian, M.

    2008-09-07

    The review of the first detailed experimental and theoretical studies of complex plasma in RF discharge afterglow is presented. The studies have been done in a frame of FAST collaborative research project between Complex Plasma Laboratory of the University of Sydney and the GREMI laboratory of Universite d'Orleans. We examined the existing models of plasma decay, presents experimental observations of dust dynamics under different afterglow complex plasma conditions, presents the experimental data obtained (in particular the presence of positively charged particles in discharge afterglow), discusses the use of dust particles as a probe to study the diffusion losses in afterglow plasmas.

  2. Complexity and robustness

    PubMed Central

    Carlson, J. M.; Doyle, John

    2002-01-01

    Highly optimized tolerance (HOT) was recently introduced as a conceptual framework to study fundamental aspects of complexity. HOT is motivated primarily by systems from biology and engineering and emphasizes, (i) highly structured, nongeneric, self-dissimilar internal configurations, and (ii) robust yet fragile external behavior. HOT claims these are the most important features of complexity and not accidents of evolution or artifices of engineering design but are inevitably intertwined and mutually reinforcing. In the spirit of this collection, our paper contrasts HOT with alternative perspectives on complexity, drawing on real-world examples and also model systems, particularly those from self-organized criticality. PMID:11875207

  3. Complex Flow Workshop Report

    SciTech Connect

    none,

    2012-05-01

    This report documents findings from a workshop on the impacts of complex wind flows in and out of wind turbine environments, the research needs, and the challenges of meteorological and engineering modeling at regional, wind plant, and wind turbine scales.

  4. Complex and unpredictable Cardano

    NASA Astrophysics Data System (ADS)

    Ekert, Artur

    2008-08-01

    This purely recreational paper is about one of the most colorful characters of the Italian Renaissance, Girolamo Cardano, and the discovery of two basic ingredients of quantum theory, probability and complex numbers.

  5. Bitter Sweetness of Complexity

    NASA Astrophysics Data System (ADS)

    Horst, A. K.; Wagener, C.

    Glycosylation of proteins, lipids and mucins has gained increasing complexity in the course of evolution. Metazoans and mammals exhibit extensively exploited pathways of N-glycan biosynthesis, with unique features that are not found in plants or protozoans.

  6. Complexity at mesoscopic lengthscale.

    PubMed

    Egami, T

    2015-09-01

    Modern materials are often complex in the structure at mesoscale. The method of pair-density function (PDF) is a powerful tool to characterize mesoscopic structure, bridging short- and long-range structures. PMID:26306189

  7. Reconstruction Using Witness Complexes.

    PubMed

    Guibas, Leonidas J; Oudot, Steve Y

    2008-10-01

    We present a novel reconstruction algorithm that, given an input point set sampled from an object S, builds a one-parameter family of complexes that approximate S at different scales. At a high level, our method is very similar in spirit to Chew's surface meshing algorithm, with one notable difference though: the restricted Delaunay triangulation is replaced by the witness complex, which makes our algorithm applicable in any metric space. To prove its correctness on curves and surfaces, we highlight the relationship between the witness complex and the restricted Delaunay triangulation in 2d and in 3d. Specifically, we prove that both complexes are equal in 2d and closely related in 3d, under some mild sampling assumptions. PMID:21643440

  8. Complex Regional Pain Syndrome

    MedlinePLUS

    Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

  9. A complex legacy

    NASA Astrophysics Data System (ADS)

    Moore, Cristopher

    2011-11-01

    In his tragically short life, Alan Turing helped define what computing machines are capable of, and where they reach inherent limits. His legacy is still felt every day, in areas ranging from computational complexity theory to cryptography and quantum computing.

  10. Microsolvation in molecular complexes

    NASA Astrophysics Data System (ADS)

    Pasquini, M.; Schiccheri, N.; Piani, G.; Pietraperzia, G.; Becucci, M.; Castellucci, E.

    2008-11-01

    In this paper, we report the results of our study of the microsolvation process involving the anisole molecule. We are able to study bimolecular complexes of different compositions. Changing the second partner molecule bound to anisole, we observed complexes of different geometries, because of the large variety of interactions possible for the anisole. High-resolution electronic spectroscopy is the best tool to reveal the correct vibrationally (zero-point) averaged geometry of the complex. That is done by analysing the rovibronic structure of the electronic spectra, which are related to the equilibrium geometry of the complex as well as dynamical processes, both in the ground and in the excited state. The interpretation of the experimental results is supported by high-level quantum calculations.

  11. Ideas, Complexity, and Innovation.

    ERIC Educational Resources Information Center

    Blau, Judith R.; McKinley, William

    1979-01-01

    This study focuses on the ideas that are articulated within architectural firms and how these ideas affect basic dimensions of organization: task and structural complexity and successful innovation, as measured by the firm's success in winning design awards. (Author)

  12. Antimicrobials Treatment

    NASA Astrophysics Data System (ADS)

    Drosinos, Eleftherios H.; Skandamis, Panagiotis N.; Mataragas, Marios

    The use of antimicrobials is a common practice for preservation of foods. Incorporation, in a food recipe, of chemical antimicrobials towards inhibition of spoilage and pathogenic micro-organisms results in the compositional modification of food. This treatment is nowadays undesirable for the consumer, who likes natural products. Scientific community reflecting consumers demand for natural antimicrobials has made efforts to investigate the possibility to use natural antimicrobials such us bacteriocins and essential oils of plant origin to inhibit microbial growth.

  13. Complex/Symplectic Mirrors

    SciTech Connect

    Chuang, Wu-yen; Kachru, Shamit; Tomasiello, Alessandro; /Stanford U., ITP

    2005-10-28

    We construct a class of symplectic non-Kaehler and complex non-Kaehler string theory vacua, extending and providing evidence for an earlier suggestion by Polchinski and Strominger. The class admits a mirror pairing by construction. Comparing hints from a variety of sources, including ten-dimensional supergravity and KK reduction on SU(3)-structure manifolds, suggests a picture in which string theory extends Reid's fantasy to connect classes of both complex non-Kaehler and symplectic non-Kaehler manifolds.

  14. Proteins and Complexity

    NASA Astrophysics Data System (ADS)

    Murray, Joelle; Gibbon, Dana; Runyon, Alissa; Bajracharya, Arun

    2015-03-01

    A protein's tertiary structure determines its function in living organisms. The different functions proteins serve necessitate variety in native structures. How is variation in tertiary structure created from a common set of amino acids and molecular forces? In other words, what generates complexity in structures across all types of native proteins? To explore this question, a simple HP model of protein folding was explored for evidence of self-organized criticality, a potential generator of complexity.

  15. On complex Riemannian foliations

    NASA Astrophysics Data System (ADS)

    Ida, Cristian

    2016-01-01

    In this paper we make some general considerations about the geometry of complex Riemannian foliations, we introduce a leafwise characteristic connection and we write Einstein equations with respect to it. Next, using an one-to-one correspondence between leafwise holomorphic Riemannian metrics and leafwise anti-Kählerian metrics, we focus on the Einstein condition for a leafwise holomorphic Riemannian metric and the associated real leafwise anti-Kählerian metric on a manifold endowed with a complex foliation.

  16. Congenital complex penile curvature.

    PubMed Central

    Okeke, Linus I.; Aisuodionoe-Shadrach, Oseremen I.; Adekanye, Adedeji O.

    2005-01-01

    Congenital complex penile curvature is a rare deformity that arises from asymmetry of the corpora cavernosa. The deformity is generally not severe enough to interfere with sexual intercourse but can be a source of great concern to the patient and may cause him to avoid sexual contact altogether. We report a case of congenital complex penile curvature in a 21-year-old man who was satisfactorily corrected using the modified Nesbit procedure. Images Figure 1 Figure 2 PMID:16334506

  17. Trauma-focused CBT for youth with complex trauma

    PubMed Central

    Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2013-01-01

    Objectives Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with complex trauma. Methods TF-CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include a) dedicating proportionally more of the model to the TF-CBT coping skills phase; b) implementing the TF-CBT Safety component early and often as needed throughout treatment; c) titrating gradual exposure more slowly as needed by individual youth; d) incorporating unifying trauma themes throughout treatment; and e) when indicated, extending the TF-CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Results Recent data from youth with complex trauma support the use of the above TF-CBT strategies to successfully treat these youth. Conclusions The above practical strategies can be incorporated into TF-CBT to effectively treat youth with complex trauma. Practice implications Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF-CBT for youth with complex trauma. PMID:22749612

  18. Complex Regional Pain Syndrome

    MedlinePLUS

    ... works, it may be repeated. Physical therapy and psychological counseling are also helpful. However, a treatment that ... my pain? If my injury has healed, why am I still in pain? Do I need any tests? What is the best treatment option for me? ...

  19. ICDF Complex Remedial Action Report

    SciTech Connect

    W. M. Heileson

    2007-09-26

    This Idaho CERCLA Disposal Facility (ICDF) Remedial Action Report has been prepared in accordance with the requirements of Section 6.2 of the INEEL CERCLA Disposal Facility Remedial Action Work Plan. The agency prefinal inspection of the ICDF Staging, Storage, Sizing, and Treatment Facility (SSSTF) was completed in June of 2005. Accordingly, this report has been developed to describe the construction activities completed at the ICDF along with a description of any modifications to the design originally approved for the facility. In addition, this report provides a summary of the major documents prepared for the design and construction of the ICDF, a discussion of relevant requirements and remedial action objectives, the total costs associated with the development and operation of the facility to date, and identification of necessary changes to the Agency-approved INEEL CERCLA Disposal Facility Remedial Action Work Plan and the ICDF Complex Operations and Maintenance Plan.

  20. Finding the missing heritability of complex diseases

    PubMed Central

    Manolio, Teri A.; Collins, Francis S.; Cox, Nancy J.; Goldstein, David B.; Hindorff, Lucia A.; Hunter, David J.; McCarthy, Mark I.; Ramos, Erin M.; Cardon, Lon R.; Chakravarti, Aravinda; Cho, Judy H.; Guttmacher, Alan E.; Kong, Augustine; Kruglyak, Leonid; Mardis, Elaine; Rotimi, Charles N.; Slatkin, Montgomery; Valle, David; Whittemore, Alice S.; Boehnke, Michael; Clark, Andrew G.; Eichler, Evan E.; Gibson, Greg; Haines, Jonathan L.; Mackay, Trudy F. C.; McCarroll, Steven A.; Visscher, Peter M.

    2010-01-01

    Genome-wide association studies have identified hundreds of genetic variants associated with complex human diseases and traits, and have provided valuable insights into their genetic architecture. Most variants identified so far confer relatively small increments in risk, and explain only a small proportion of familial clustering, leading many to question how the remaining, ‘missing’ heritability can be explained. Here we examine potential sources of missing heritability and propose research strategies, including and extending beyond current genome-wide association approaches, to illuminate the genetics of complex diseases and enhance its potential to enable effective disease prevention or treatment. PMID:19812666

  1. Nipple areola complex sparing mastectomy

    PubMed Central

    Mingozzi, Matteo; Curcio, Annalisa; Buggi, Federico; Folli, Secondo

    2015-01-01

    Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes. PMID:26645007

  2. Nipple areola complex sparing mastectomy.

    PubMed

    Rossi, Camilla; Mingozzi, Matteo; Curcio, Annalisa; Buggi, Federico; Folli, Secondo

    2015-12-01

    Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes. PMID:26645007

  3. Cell complexes through time

    NASA Astrophysics Data System (ADS)

    Klette, Reinhard

    2000-10-01

    The history of cell complexes is closely related to the birth and development of topology in general. Johann Benedict Listing (1802 - 1882) introduced the term 'topology' into mathematics in a paper published in 1847, and he also defined cell complexes for the first time in a paper published in 1862. Carl Friedrich Gauss (1777 - 1855) is often cited as the one who initiated these ideas, but he did not publish either on topology or on cell complexes. The pioneering work of Leonhard Euler (1707 - 1783) on graphs is also often cited as the birth of topology, and Euler's work was cited by Listing in 1862 as a stimulus for his research on cell complexes. There are different branches in topology which have little in common: point set topology, algebraic topology, differential topology etc. Confusion may arise if just 'topology' is specified, without clarifying the used concept. Topological subjects in mathematics are often related to continuous models, and therefore quite irrelevant to computer based solutions in image analysis. Compared to this, only a minority of topology publications in mathematics addresses discrete spaces which are appropriate for computer-based image analysis. In these cases, often the notion of a cell complex plays a crucial role. This paper briefly reports on a few of these publications. This paper is not intended to cover the very lively progress in cell complex studies within the context of image analysis during the last two decades. Basically it stops its historic review at the time when this subject in image analysis research gained speed in 1980 - 1990. As a general point of view, the paper indicates that image analysis contributes to a fusion of topological concepts, the geometric and the abstract cell structure approach and point set topology, which may lead towards new problems for the study of topologies defined on geometric or abstract cell complexes.

  4. Sewage Treatment

    NASA Technical Reports Server (NTRS)

    1984-01-01

    In the early 1970's, National Space Technology Laboratories discovered that water hyacinths literally thrive on sewage; they absorb and digest nutrients and minerals from wastewater, converting sewage effluents to clean water. They offer a means of purifying water at a fraction of the cost of a conventional sewage treatment plant, and provide a bonus value in byproducts. Hyacinths must be harvested at intervals; the harvested plants are used as fertilizers, high-protein animal feed and a source of energy. Already serving a number of small towns, the "aquaculture" technique has significantly advanced with its adoption by a major U.S. city.

  5. Exponential random simplicial complexes

    NASA Astrophysics Data System (ADS)

    Zuev, Konstantin; Eisenberg, Or; Krioukov, Dmitri

    2015-11-01

    Exponential random graph models have attracted significant research attention over the past decades. These models are maximum-entropy ensembles subject to the constraints that the expected values of a set of graph observables are equal to given values. Here we extend these maximum-entropy ensembles to random simplicial complexes, which are more adequate and versatile constructions to model complex systems in many applications. We show that many random simplicial complex models considered in the literature can be casted as maximum-entropy ensembles under certain constraints. We introduce and analyze the most general random simplicial complex ensemble {\\boldsymbol{? }} with statistically independent simplices. Our analysis is simplified by the observation that any distribution {{P}}(O) on any collection of objects {O}=\\{O\\}, including graphs and simplicial complexes, is maximum-entropy subject to the constraint that the expected value of -{ln}{{P}}(O) is equal to the entropy of the distribution. With the help of this observation, we prove that ensemble {\\boldsymbol{? }} is maximum-entropy subject to the two types of constraints which fix the expected numbers of simplices and their boundaries.

  6. Complexes and imagination.

    PubMed

    Kast, Verena

    2014-11-01

    Fantasies as imaginative activities are seen by Jung as expressions of psychic energy. In the various descriptions of active imagination the observation of the inner image and the dialogue with inner figures, if possible, are important. The model of symbol formation, as Jung describes it, can be experienced in doing active imagination. There is a correspondence between Jung's understanding of complexes and our imaginations: complexes develop a fantasy life. Complex episodes are narratives of difficult dysfunctional relationship episodes that have occurred repeatedly and are internalized with episodic memory. This means that the whole complex episode (the image for the child and the image for the aggressor, connected with emotions) is internalized and can get constellated in everyday relationship. Therefore inner dialogues do not necessarily qualify as active imaginations, often they are the expression of complex-episodes, very similar to fruitless soliloquies. If imaginations of this kind are repeated, new symbols and new possibilities of behaviour are not found. On the contrary, old patterns of behaviour and fantasies are perpetuated and become cemented. Imaginations of this kind need an intervention by the analyst. In clinical examples different kinds of imaginations are discussed. PMID:25331506

  7. Quantum Complexity in Graphene

    NASA Astrophysics Data System (ADS)

    Baskaran, G.

    Carbon has a unique position among elements in the periodic table. It produces an allotrope, graphene, a mechanically robust two dimensional semimetal. The multifarious properties that graphene exhibits has few parallels among elemental metals. From simplicity, namely carbon atoms connected by pure sp2 bonds, a wealth of novel quantum properties emerge. In classical complex systems such as a spin glass or a finance market, several competing agents or elements are responsible for unanticipated and difficult to predict emergent properties. The complex (sic) structure of quantum mechanics is responsbile for an unanticipated set of emergent properties in graphene. We call this quantum complexity. In fact, most quantum systems, phenomena and modern quantum field theory could be viewed as examples of quantum complexity. After giving a brief introduction to the quantum complexity we focus on our own work, which indicates the breadth in the type of quantum phenomena that graphene could support. We review our theoretical suggestions of, (i) spin-1 collective mode in netural graphene, (ii) relativistic type of phenomena in crossed electric and magnetic fields, (iii) room temperature superconductivity in doped graphene and (iv) composite Fermi sea in neutral graphene in uniform magnetic field and (v) two-channel Kondo effect. Except for the relativistic type of phenomena, the rest depend in a fundamental way on a weak electron correlation that exists in the broad two-dimensional band of graphene.

  8. Hydridomethyl iridium complex

    DOEpatents

    Bergman, Robert G.; Buchanan, J. Michael; Stryker, Jeffrey M.; Wax, Michael J.

    1989-01-01

    A process for functionalizing methane comprising: (a) reacting methane with a hydridoalkyl metal complex of the formula: CpIr[P(R.sub.1).sub.3 ]H(R.sub.2) wherein Cp represents a cyclopentadienyl or alkylcyclopentadienyl radical having from 1 to 5 carbon atoms; Ir represents an iridium atom; P represents a phosphorus atom; R.sub.1 represents an alkyl group; R.sub.2 represents an alkyl group having at least two carbon atoms; and H represents a hydrogen atom, in the presence of a liquid alkane R.sub.3 H having at least three carbon atoms to form a hydridomethyl complex of the formula: CpIr[P(R.sub.1).sub.3 ]HMe where Me represents a methyl radical. (b) reacting said hydridomethyl complex with an organic halogenating agent such as a tetrahalomethane or a haloform of the formulas: CX'X"X'"X"" or CHX'X"X'"; wherein X', X", X"', and X"" represent halogens selected from bromine, iodine and chlorine, to halomethyl complex of step (a) having the formula: CpIr[P(R.sub.1).sub.3 ]MeX: (c) reacting said halomethyl complex with a mercuric halide of the formula HgX.sub.2 to form a methyl mercuric halide of the formula HgMeX; and (d) reacting said methyl mercuric halide with a molecular halogen of the formula X.sub.2 to form methyl halide.

  9. Catalytic organometallic anticancer complexes

    PubMed Central

    Dougan, Sarah J.; Habtemariam, Abraha; McHale, Sarah E.; Parsons, Simon; Sadler, Peter J.

    2008-01-01

    Organometallic complexes offer chemistry that is not accessible to purely organic molecules and, hence, potentially new mechanisms of drug action. We show here that the presence of both an iodido ligand and a ?-donor/?-acceptor phenylazopyridine ligand confers remarkable inertness toward ligand substitution on the half-sandwich “piano-stool” ruthenium arene complexes [(?6-arene)Ru(azpy)I]+ (where arene = p-cymene or biphenyl, and azpy = N,N-dimethylphenyl- or hydroxyphenyl-azopyridine) in aqueous solution. Surprisingly, despite this inertness, these complexes are highly cytotoxic to human ovarian A2780 and human lung A549 cancer cells. Fluorescence-trapping experiments in A549 cells suggest that the cytotoxicity arises from an increase in reactive oxygen species. Redox activity of these azopyridine RuII complexes was confirmed by electrochemical measurements. The first one-electron reduction step (half-wave potential ?0.2 to ?0.4 V) is assignable to reduction of the azo group of the ligand. In contrast, the unbound azopyridine ligands are not readily reduced. Intriguingly the ruthenium complex acted as a catalyst in reactions with the tripeptide glutathione (?-l-Glu-l-Cys-Gly), a strong reducing agent present in cells at millimolar concentrations; millimolar amounts of glutathione were oxidized to glutathione disulfide in the presence of micromolar ruthenium concentrations. A redox cycle involving glutathione attack on the azo bond of coordinated azopyridine is proposed. Such ligand-based redox reactions provide new concepts for the design of catalytic drugs. PMID:18687892

  10. Tuberous Sclerosis Complex: Perioperative Considerations

    PubMed Central

    Rabito, Matthew J.; Kaye, Alan David

    2014-01-01

    Background Tuberous sclerosis complex (TSC), also known as Bourneville disease, is an inherited, progressive neurocutaneous disorder characterized by the potential for hamartoma formation throughout the body. TSC is an autosomal dominant genetic disorder, but more than two-thirds of cases are sporadic. Methods Clinical manifestations and treatment options are discussed. Both surgical and anesthetic perioperative considerations are described in this review. Results Routine monitoring is appropriate for minor surgical procedures for patients with TSC who have mild disease manifestations. More extensive monitoring is indicated for major procedures that have the potential for significant blood loss and for patients with more severe pathology. Postoperatively, TSC patients should be admitted for monitoring and treatment after more extensive procedures or if significant organ dysfunction occurs. Postoperative complications, which may be related to either the surgery or the TSC pathology itself, may have origins in many different organs and may include seizures, severe hypertension, and bradyarrhythmias. Conclusion TSC is a rare disease with a highly variable clinical presentation and provides a multitude of challenges for the patient, the family, and the healthcare team. PMID:24940133

  11. The complex regional pain syndrome.

    PubMed

    Oaklander, Anne Louise; Horowitz, Steven H

    2015-01-01

    Complex regional pain syndrome (CRPS) is the current consensus-derived name for a syndrome usually triggered by limb trauma. Required elements include prolonged, disproportionate distal-limb pain and microvascular dysregulation (e.g., edema or color changes) or altered sweating. CRPS-II (formerly "causalgia") describes patients with identified nerve injuries. CRPS-I (formerly "reflex sympathetic dystrophy") describes most patients who lack evidence of specific nerve injuries. Diagnosis is clinical and the pathophysiology involves combinations of small-fiber axonopathy, microvasculopathy, inflammation, and brain plasticity/sensitization. Females have much higher risk and workplace accidents are a well-recognized cause. Inflammation and dysimmunity, perhaps facilitated by injury to the blood-nerve barrier, may contribute. Most patients, particularly the young, recover gradually, but treatment can speed healing. Evidence of efficacy is strongest for rehabilitation therapies (e.g., graded-motor imagery), neuropathic pain medications, and electric stimulation of the spinal cord, injured nerve, or motor cortex. Investigational treatments include ketamine, botulinum toxin, immunoglobulins, and transcranial neuromodulation. Nonrecovering patients should be re-evaluated for neurosurgically treatable causal lesions (nerve entrapment, impingement, infections, or tumors) and treatable potentiating medical conditions, including polyneuropathy and circulatory insufficiency. Earlier impressions that CRPS represents malingering or psychosomatic illness have been replaced by evidence that CRPS is a rare complication of limb injury in biologically susceptible individuals. PMID:26563805

  12. Liposuction in Lymphedema Treatment.

    PubMed

    Brorson, Håkan

    2016-01-01

    Background?Lymphedema leads to early deposition of adipose tissue. This may explain why conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT), as well as various forms of microsurgical reconstructions, cannot completely remove the excess volume in patients with a large chronic nonpitting lymphedema. Liposuction is therefore a logical and tempting treatment to reduce the adipose tissue volume excess. This article outlines the benefits of using liposuction and presents evidence to support its use. Methods?The mechanism between adipose tissue depositions is described as well as the surgical technique, postoperative care, volume measurements, effects on the lymph transport, and follow-up. Results?Fifteen years' follow-up shows complete reduction of the excess volume without recurrence following liposuction in patients with postmastectomy arm lymphedema. The same promising results can also be seen in patients with leg lymphedema. Conclusion?Various types of treatment of lymphedema are under discussion and there has been some controversy regarding liposuction for lymphedema. Improvements in techniques, patient preparation, and patient follow-up have led to a greater and wider acceptance of liposuction as a treatment for lymphedema in patients with large chronic nonpitting extremity lymphedemas. PMID:25893630

  13. Multiple myeloma: treatment evolution.

    PubMed

    San Miguel, Jesus F; Mateos, Maria Victoria; Ocio, Enrique; Garcia-Sanz, Ramón

    2012-04-01

    Melphalan-prednisone (MP) was introduced for the treatment of MM in late 1960s. In the subsequent 30 years, the treatment improvements remained stagnant, since more complex chemotherapy combinations, such as vincristine, doxorubicin, and dexamethasone (VAD), or with the addition of BCNU (VBAD) or melphalan and cyclophosphamide (VCMP), only led to small increases in the overall response rate but without differences in survival, as assessed in a large meta-analysis that included over 6000 patients. The next step forward was the use of high-dose melphalan followed by stem cell support (autologous stem cell transplant - ASCT) for young myeloma patients, which resulted in a significant improvement in disease free survival and overall survival. However, for elderly patients MP remained as the standard of care. From year 2000, a revolution in the treatment armamentarium of MM has emerged with the availability of new agents with singular mechanism of action such as thalidomide and lenalidomide (Revlimid®), both immunomodulatory drugs and the proteasome inhibitor bortezomib (Velcade®). PMID:22507766

  14. Activation of coagulation during treatment with haemodialysis.

    PubMed

    Bartels, P C; Schoorl, M; Schoorl, M; Wiering, J G; Nubé, M J

    2000-07-01

    Generation of factor XII, thrombin antithrombin complexes, prothrombin fragment 1+2 and thrombus precursor protein has been monitored in 16 subjects during haemodialysis. Immediately after starting treatment, contact of blood with the negatively charged surfaces of the polyacrylnitril membrane AN-69 resulted in a 9-45% decrease in factor XII activity. Peak concentrations for thrombin antithrombin complexes (50 to 120 microg/L) were observed 30 min after the start of haemodialysis. Establishment of thrombus precursor protein concentrations yielded steadily increasing results without any tendency to decrease during treatment. Determination of thrombin antithrombin complexes is considered to establish the most sensitive short-term reacting parameter indicating activation of coagulation. A steady generation of fibrin and fibrinogen-fibrin complexes during treatment with haemodialysis is indicated by increasing results for thrombus precursor protein. In order to prevent clotting during haemodialysis, an additional supplementation of anticoagulant is needed. PMID:10943598

  15. Pyrophosphate-bridged complexes with picomolar toxicity.

    PubMed

    Ikotun, Oluwatayo F; Higbee, Elizabeth M; Ouellette, Wayne; Doyle, Robert P

    2009-09-01

    Recently, we have observed the emergence of a new series of pyrophosphate-bridged coordination complexes. Such complexes have been prepared by overcoming the ready hydrolysis of the pyrophosphate moiety. To date, no exploration has been conducted on the cytotoxicity of such complexes. Three pyrophosphate-bridged complexes, namely {[Ni(phen)(2)](2)(mu-P(2)O(7))}.27H(2)O, {[Cu(phen)(H(2)O)](2)(mu-P(2)O(7))}.8H(2)O and {[Co(phen)(2)](2)(mu-P(2)O(7))}.6MeOH, (where phen is 1,10'-phenanthroline) were chosen for their comparative structural similarities and suitable aqueous solubility. Cytotoxicity studies in the adriamycin-resistant ovarian cancer cell line A2780/AD demonstrated highly significant efficacy, with values as low as 160pM for the cobalt complex at 72h. The underlying mechanism for such exceptional toxicity is investigated focusing on DNA interactions, topoisomerase I enzyme inhibition and oxidative stress (followed by intracellular glutathione levels). The role of hydrolysis in uptake and toxicity is also explored (followed by electronic absorption spectroscopy, (31)P NMR, and confocal microscopy) and the complexes are compared to cisplatin controls. Overall a clear picture of the extraordinary toxicity emerged. The results demonstrate a new class of prodrugs with significant potential for future development for the treatment of drug-resistant cancer cell lines. PMID:19666193

  16. Mycobacterium Avium Complex (MAC)

    MedlinePLUS

    ... two drugs are used: usually azithromycin or clarithromycin plus up to three other drugs. MAC treatment must ... will probably be treated with azithromycin or clarithromycin plus one to three other antibiotics. You will have ...

  17. Controllability of complex networks.

    PubMed

    Liu, Yang-Yu; Slotine, Jean-Jacques; Barabási, Albert-László

    2011-05-12

    The ultimate proof of our understanding of natural or technological systems is reflected in our ability to control them. Although control theory offers mathematical tools for steering engineered and natural systems towards a desired state, a framework to control complex self-organized systems is lacking. Here we develop analytical tools to study the controllability of an arbitrary complex directed network, identifying the set of driver nodes with time-dependent control that can guide the system's entire dynamics. We apply these tools to several real networks, finding that the number of driver nodes is determined mainly by the network's degree distribution. We show that sparse inhomogeneous networks, which emerge in many real complex systems, are the most difficult to control, but that dense and homogeneous networks can be controlled using a few driver nodes. Counterintuitively, we find that in both model and real systems the driver nodes tend to avoid the high-degree nodes. PMID:21562557

  18. Synchronization in complex networks

    SciTech Connect

    Arenas, A.; Diaz-Guilera, A.; Moreno, Y.; Zhou, C.; Kurths, J.

    2007-12-12

    Synchronization processes in populations of locally interacting elements are in the focus of intense research in physical, biological, chemical, technological and social systems. The many efforts devoted to understand synchronization phenomena in natural systems take now advantage of the recent theory of complex networks. In this review, we report the advances in the comprehension of synchronization phenomena when oscillating elements are constrained to interact in a complex network topology. We also overview the new emergent features coming out from the interplay between the structure and the function of the underlying pattern of connections. Extensive numerical work as well as analytical approaches to the problem are presented. Finally, we review several applications of synchronization in complex networks to different disciplines: biological systems and neuroscience, engineering and computer science, and economy and social sciences.

  19. Multiple sclerosis - New treatment modalities.

    PubMed

    Totaro, Rocco; Di Carmine, Caterina; Marini, Carmine; Carolei, Antonio

    2015-12-01

    Ever since the introduction of the first disease modifying therapies, the concept of multiple sclerosis treatment algorithms developed ceaselessly. The increasing number of available drugs is paralleled by impelling issue of ensuring the most appropriate treatment to the right patient at the right time. The purpose of this review is to describe novel agents recently approved for multiple sclerosis treatment, namely teriflunomide, alemtuzumab and dimethylfumarate, focusing on mechanism of action, efficacy data in experimental setting, safety and tolerability. The place in therapy of newer treatment implies careful balancing of risk-benefit profile as well as accurate patient selection. Hence the widening of therapeutic arsenal provides greater opportunity for personalized therapy but also entails a complex trade-off between efficacy, tolerability, safety and eventually patient preference. PMID:26831413

  20. Multiple sclerosis - New treatment modalities

    PubMed Central

    Totaro, Rocco; Di Carmine, Caterina; Marini, Carmine; Carolei, Antonio

    2015-01-01

    Ever since the introduction of the first disease modifying therapies, the concept of multiple sclerosis treatment algorithms developed ceaselessly. The increasing number of available drugs is paralleled by impelling issue of ensuring the most appropriate treatment to the right patient at the right time. The purpose of this review is to describe novel agents recently approved for multiple sclerosis treatment, namely teriflunomide, alemtuzumab and dimethylfumarate, focusing on mechanism of action, efficacy data in experimental setting, safety and tolerability. The place in therapy of newer treatment implies careful balancing of risk-benefit profile as well as accurate patient selection. Hence the widening of therapeutic arsenal provides greater opportunity for personalized therapy but also entails a complex trade-off between efficacy, tolerability, safety and eventually patient preference. PMID:26831413

  1. Nonsurgical treatment of recurrent glioblastoma

    PubMed Central

    Gallego, O.

    2015-01-01

    Standard treatment for glioblastoma multiforme is surgery followed by radiotherapy and chemotherapy, generally with temozolomide. However, disease recurs in almost all patients. Diagnosis of progression is complex given the possibility of pseudoprogression. The Response Assessment in Neuro-Oncology criteria increase the sensitivity for detecting progression. Most patients will not be candidates for new surgery or re-irradiation, and anticancer drugs are the most common approach for second-line treatment, if the patient’s condition allows. Antiangiogenics, inhibitors of the epidermal growth factor receptor, nitrosoureas, and re-treatment with temozolomide have been studied in the second line, but a standard therapy has not yet been established. This review considers currently available medical treatment options for patients with glioblastoma recurrence. PMID:26300678

  2. [Patient adherence in antihypertensive treatment].

    PubMed

    Simonyi, Gábor

    2013-10-01

    Hypertension is one of the most frequent chronic diseases as well as most important cardiovascular risk factors in developed countries. Blood pressure control to target levels can significantly decrease the risk for development of coronary artery disease, stroke, chronic renal disease and mortality. Adequately maintained blood pressure is very important in high risk patients. In the treatment of hypertension, life style therapy and drug treatment have essential roles. Further, patient adherence plays a significant part of the treatment, too. Importantly, about half of the patients only become adherent to antihypertensive therapy by the end of the first year treatment. Hence, non-adherence of patients is an important cause for resistant hypertension. Adherence is influenced by the complexity of drug regimen and characteristic of drug class, as well as age and gender of patients. PMID:24077162

  3. Planning Complex Projects Automatically

    NASA Technical Reports Server (NTRS)

    Henke, Andrea L.; Stottler, Richard H.; Maher, Timothy P.

    1995-01-01

    Automated Manifest Planner (AMP) computer program applies combination of artificial-intelligence techniques to assist both expert and novice planners, reducing planning time by orders of magnitude. Gives planners flexibility to modify plans and constraints easily, without need for programming expertise. Developed specifically for planning space shuttle missions 5 to 10 years ahead, with modifications, applicable in general to planning other complex projects requiring scheduling of activities depending on other activities and/or timely allocation of resources. Adaptable to variety of complex scheduling problems in manufacturing, transportation, business, architecture, and construction.

  4. Complex matrix model duality

    SciTech Connect

    Brown, T. W.

    2011-04-15

    The same complex matrix model calculates both tachyon scattering for the c=1 noncritical string at the self-dual radius and certain correlation functions of operators which preserve half the supersymmetry in N=4 super-Yang-Mills theory. It is dual to another complex matrix model where the couplings of the first model are encoded in the Kontsevich-like variables of the second. The duality between the theories is mirrored by the duality of their Feynman diagrams. Analogously to the Hermitian Kontsevich-Penner model, the correlation functions of the second model can be written as sums over discrete points in subspaces of the moduli space of punctured Riemann surfaces.

  5. Luminescent macrocyclic lanthanide complexes

    DOEpatents

    Raymond, Kenneth N. (Berkeley, CA); Corneillie, Todd M. (Campbell, CA); Xu, Jide (Berkeley, CA)

    2012-05-08

    The present invention provides a novel class of macrocyclic compounds as well as complexes formed between a metal (e.g., lanthanide) ion and the compounds of the invention. Preferred complexes exhibit high stability as well as high quantum yields of lanthanide ion luminescence in aqueous media without the need for secondary activating agents. Preferred compounds incorporate hydroxy-isophthalamide moieties within their macrocyclic structure and are characterized by surprisingly low, non-specific binding to a variety of polypeptides such as antibodies and proteins as well as high kinetic stability. These characteristics distinguish them from known, open-structured ligands.

  6. Luminescent macrocyclic lanthanide complexes

    DOEpatents

    Raymond, Kenneth N; Corneillie, Todd M; Xu, Jide

    2014-05-20

    The present invention provides a novel class of macrocyclic compounds as well as complexes formed between a metal (e.g., lanthanide) ion and the compounds of the invention. Preferred complexes exhibit high stability as well as high quantum yields of lanthanide ion luminescence in aqueous media without the need for secondary activating agents. Preferred compounds incorporate hydroxy-isophthalamide moieties within their macrocyclic structure and are characterized by surprisingly low, non-specific binding to a variety of polypeptides such as antibodies and proteins as well as high kinetic stability. These characteristics distinguish them from known, open-structured ligands.

  7. The ESCRT Complexes

    PubMed Central

    Hurley, James H.

    2010-01-01

    The ESCRT machinery consists of the peripheral membrane protein complexes, ESCRT-0, -I, -II, -III, and Vps4-Vta1, and the ALIX homodimer. The ESCRT system is required for degradation of unneeded or dangerous plasma membrane proteins; biogenesis of the lysosome and the yeast vacuole; the budding of most membrane enveloped viruses; the membrane abscission step in cytokinesis; macroautophagy; and several other processes. From their initial discovery in 2001-2002, the literature on ESCRTs has grown exponentially. This review will describe the structure and function of the six complexes noted above and summarizes current knowledge of their mechanistic roles in cellular pathways and in disease. PMID:20653365

  8. Six Questions on Complex Systems

    NASA Astrophysics Data System (ADS)

    Symons, John F.; Sanayei, Ali

    2011-09-01

    This paper includes an interview with John F. Symons regarding some important questions in "complex systems" and "complexity". In addition, he has stated some important open problems concerning complex systems in his research area from a philosophical point of view.

  9. Graphical Representation of Complex Functions.

    ERIC Educational Resources Information Center

    Renka, Robert J.

    1988-01-01

    Describes methods and software for graphing representation of a complex function of a complex variable. Includes an application of a graphical interpretation of the complex zeros of the cubic and their properties. (PK)

  10. Treatment of Cachexia in Oncology

    PubMed Central

    Tazi, EM; Errihani, H

    2010-01-01

    Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology. The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research. Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine). To date, despite several years of coordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful. PMID:21218002

  11. [Prophylaxis and treatment of periimpalntitis].

    PubMed

    Mandzhavidze, N; Vadachkoriia, N; Gumberidze, N

    2013-09-01

    Ultrasonic Vector System (Dürr Dental, Germany) is the best means for complex treatment of peri-implantitis. The therapeutic effect of the system proved anti-inflammatory and regenerative impact of calcium hydroxyapatite on the soft tissue around the implant. The effectiveness of the result provided full, persistent and safe removal of bacteria, dental plaque, infected granulation tissue; the possibility of regular monitoring, prevention of re-infection of pathological pockets, without damaging the hard and soft tissues around the implant, the implant itself and artificial fragile crown, securing superb cleaning and polishing of the implant surface, which is an important condition for the further reduction and inactivation of pathogenic bacteria population. Healing peri-implantitis pockets at the expense of using conventional oral hygiene is not possible. Tools of carbon fiber in combination with a suspension Vector Fluid Polish and the Vector machine successfully accomplish the function of disinfection and polishing. The aim of the research was to present the results of peri-implantitis treatment with a new ultrasonic device Ultrasonic Vector System. Surgical treatment (21% of patients) was atraumatic. The risk of infection was decreased and necessary conditions were created for a significant acceleration of the tissue healing process. Relying on the successful results we recommend Vector- therapy before surgical procedures. Complex treatment was repeated depending on the clinical manifestations of inflammation around the implant. To prevent peri-implantitis, and get timely diagnosis of unwanted changes, and to maintain implants and the soft tissues around them in a healthy condition, the patients were strongly recommended to visit the dentist 3-4 times a year. They were offered professional oral hygiene and accessible parts of the implants with the help of a Vector machine. Relying on the results of the research we conducted during the treatment of peri-implantitis, we have seen the "magic" efficiency and the need to apply the «Vector» system into the complex treatment of this disease. PMID:24099810

  12. Cancer treatments.

    PubMed

    Maramaldi, Peter; Dungan, Sheryn; Poorvu, Nancy Levitan

    2008-01-01

    Cancer is of particular importance to gerontology due to the changing nature of the disease. Survival rates are at all time highs as a result of technological advances in early detection and treatment of cancer. Some less aggressive or invasive forms of cancer are now seen as chronic illnesses rather than acute, terminal diseases. As a result, demand is increasing for evidence-based psychosocial interventions designed to improve the health and well-being of people living with cancer. This article reviews evidence-based psychosocial interventions designed to address the needs of persons with cancer and their family members. Traditional and technology enhance interventions are discussed as are complementary and alternative therapies designed to augment traditional interventions. PMID:18924387

  13. Anaerobic treatment

    SciTech Connect

    Witt, E.R.; Humphrey, W.J.; Cave, J.P.

    1982-12-28

    This invention provides for the anaerobic treatment of acidic petrochemical wastes in an anaerobic filter at high loadings and high recycle rates. The effluent from the top of the filter passes into a gas-disengaging/solids-settling zone containing a quiescent body of the effluent liquid. The settled solids are withdrawn and recycled to the base of the filter together with fresh acidic waste and an inorganic alkaline material (preferably magnesium oxide or carbonate) to maintain a neutral pH. The liquid portion of the effluent is sent to an aerobic digester to remove the rest of the organic material, which is used to support the growth of bacteria and fed back to the anaerobic system.

  14. Mesothelioma treatment.

    PubMed

    Parente, Bárbara

    2008-07-01

    Malignant mesothelioma (MM) is a locally aggressive advanced tumour, with bad prognosis and many times fatal, who have been growing in the last two decades with possibilities to be continue in all the world until 2020, showing use of pic asbestos to the years 1960/1970. Next 35 years the previsions of the deaths is more than 250 000. In Portugal (ROR) incidence is 1,2/1 000 000/year for total of the patients. Until now any new therapy showed advantage in the median survival and time to progression. The more important change whose the news than the antifolatos, particularly pemetrexed in combination with cisplatinum were actives in MM. Chemoterapy as soon as possible and second lines treatment it is very important thinking in the survival this fatal tumor. Rev Port Pneumol 2008; XIV (Sup.2): S35-S44. PMID:25967566

  15. Treatment of slowly growing mycobacteria.

    PubMed

    Philley, Julie V; Griffith, David E

    2015-03-01

    The most common nontuberculous mycobacterial (NTM) lung pathogen, Mycobacterium avium complex (MAC), requires antibiotic treatment regimens that are long and often arduous. M kansasii is the slowly growing NTM pathogen with the most predictably successful treatment outcomes, whereas other slowly growing NTM pathogens such as M xeonpi, M szulgai, and M malmoense are less predictably responsive to antibiotic regimens. M simiae is the most difficult of the common slowly growing NTM pathogens to eradicate. Surgical intervention for slowly growing mycobacterial lung infection has proved beneficial for some patients, but the optimal candidates and timing for surgical intervention remain unknown. PMID:25676521

  16. Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment

    PubMed Central

    Torres, Patrick A.; Helmstetter, John A.; Kaye, Adam M.; Kaye, Alan David

    2015-01-01

    Background Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. Methods This review focuses on the epidemiology, pathophysiology, causes, presentation, diagnosis, complications, management, and anesthetic considerations related to rhabdomyolysis. Results Any form of muscle damage––and by extension any entity that causes muscle damage––can initiate rhabdomyolysis. One of the most important treatment goals when rhabdomyolysis is suspected is avoiding acute kidney injury. Conclusion All clinicians should be aware of common causes, diagnosis, and treatment options. PMID:25829882

  17. Coordination Complexes of Cobalt.

    ERIC Educational Resources Information Center

    Williams, Gregory M.; And Others

    1989-01-01

    Described is an experiment involving the synthesis and spectral studies of cobalt complexes that not only give general chemistry students an introduction to inorganic synthesis but allows them to conduct a systematic study on the effect of different ligands on absorption spectra. Background information, procedures, and experimental results are…

  18. METAL COMPLEXING SILOXANE POLYMERS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Novel silicone polymers containing pendant phosphonate groups have been synthesized. A new silicone monomer, (CH3O)2CH3Si(CH2)3P=O(OCH2CH3)2 has been copolymerized with dimethyldimethoxysilane to form polymers capable of binding metal salts. The viscous liquids can complex a variety of metals, inc...

  19. Complex Digital Visual Systems

    ERIC Educational Resources Information Center

    Sweeny, Robert W.

    2013-01-01

    This article identifies possibilities for data visualization as art educational research practice. The author presents an analysis of the relationship between works of art and digital visual culture, employing aspects of network analysis drawn from the work of Barabási, Newman, and Watts (2006) and Castells (1994). Describing complex network…

  20. Launching Complex Tasks

    ERIC Educational Resources Information Center

    Jackson, Kara J.; Shahan, Emily C.; Gibbons, Lynsey K.; Cobb, Paul A.

    2012-01-01

    Mathematics lessons can take a variety of formats. In this article, the authors discuss lessons organized around complex mathematical tasks. These lessons usually unfold in three phases. First, the task is introduced to students. Second, students work on solving the task. Third, the teacher "orchestrates" a concluding whole-class discussion in…

  1. Lanthanide porphyrin complexes

    NASA Astrophysics Data System (ADS)

    Mironov, A. F.

    2013-01-01

    The review summarizes literature data and results of the author's research on the synthesis, properties and possible fields of practical application of lanthanide porphyrin complexes. Emphasis is given to the application of luminescence properties of lanthanide derivatives in medicine. The bibliography includes 108 references

  2. Simplifying complexity in metabolomics.

    PubMed

    Eick, Katharina; Pohnert, Georg

    2015-05-21

    Metabolomics analysis to unravel secondary metabolite dynamics in microorganisms faces the challenge of immense data sets and complex experimental setups. In this issue, Goodwin et al. present a multiple stimuli approach combined with self-organizing map-based analysis to elucidate variations in the metabolome of Streptomyces coelicolor caused by biotic and environmental perturbations. PMID:26000745

  3. Surface complexation modeling

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adsorption-desorption reactions are important processes that affect the transport of contaminants in the environment. Surface complexation models are chemical models that can account for the effects of variable chemical conditions, such as pH, on adsorption reactions. These models define specific ...

  4. Complex Event Recognition Architecture

    NASA Technical Reports Server (NTRS)

    Fitzgerald, William A.; Firby, R. James

    2009-01-01

    Complex Event Recognition Architecture (CERA) is the name of a computational architecture, and software that implements the architecture, for recognizing complex event patterns that may be spread across multiple streams of input data. One of the main components of CERA is an intuitive event pattern language that simplifies what would otherwise be the complex, difficult tasks of creating logical descriptions of combinations of temporal events and defining rules for combining information from different sources over time. In this language, recognition patterns are defined in simple, declarative statements that combine point events from given input streams with those from other streams, using conjunction, disjunction, and negation. Patterns can be built on one another recursively to describe very rich, temporally extended combinations of events. Thereafter, a run-time matching algorithm in CERA efficiently matches these patterns against input data and signals when patterns are recognized. CERA can be used to monitor complex systems and to signal operators or initiate corrective actions when anomalous conditions are recognized. CERA can be run as a stand-alone monitoring system, or it can be integrated into a larger system to automatically trigger responses to changing environments or problematic situations.

  5. Analyzing Complex Survey Data.

    ERIC Educational Resources Information Center

    Rodgers-Farmer, Antoinette Y.; Davis, Diane

    2001-01-01

    Uses data from the 1994 AIDS Knowledge and Attitudes Supplement to the National Health Interview Survey (NHIS) to illustrate that biased point estimates, inappropriate standard errors, and misleading tests of significance can result from using traditional software packages, such as SPSS or SAS, for complex survey analysis. (BF)

  6. Managing Complex Dynamical Systems

    ERIC Educational Resources Information Center

    Cox, John C.; Webster, Robert L.; Curry, Jeanie A.; Hammond, Kevin L.

    2011-01-01

    Management commonly engages in a variety of research designed to provide insight into the motivation and relationships of individuals, departments, organizations, etc. This paper demonstrates how the application of concepts associated with the analysis of complex systems applied to such data sets can yield enhanced insights for managerial action.

  7. The Complexity of Care

    ERIC Educational Resources Information Center

    Collins, Steve; Ting, Hermia

    2014-01-01

    The profession of teaching is unique because of the extent to which a teacher becomes involved in the lives of their "clients". The level of care required to support students well can be intense, confusing, and overwhelming. Relationships co-evolve within an ever-changing process and care is considered an essential aspect of complex relationships…

  8. Complex Characters Made Simple

    ERIC Educational Resources Information Center

    Kettle, Sidney F. A.

    2009-01-01

    The physical significance of complex characters is explored with particular reference to the C[subscript 4] point group. While a diagrammatic representation of these characters in this group is possible, the extension to higher groups C[subscript n], n greater than 4 is left as a problem for discussion. (Contains 3 tables, 8 figures, and 1 note.)

  9. Carotenoid-protein complexes.

    PubMed

    Lakshman, M R; Okoh, C

    1993-01-01

    This chapter provides an updated report of carotenoprotein-related research. Very few carotenoproteins have been purified; however, their presence in aqueous extracts may be indicated by spectroscopic evidence. Carotenoproteins have been isolated, purified, and characterized from the ectoderm, exoskeleton, eggs, and ovaries of marine invertebrates, especially crustaceans. Water-soluble and detergent-soluble carotenoid-protein complexes have also been isolated from the cytoplasmic membrane of some cyanobacteria, Mangifera indica, and carrots. Recently, we have been able to partially purify a beta-carotene-protein complex from fresh livers of rats fed beta-carotene. Studies are currently in progress to purify and characterize the protein. This is the first successful isolation of a vertebrate carotenoprotein. The isolation of carotenoproteins is generally by standard techniques of protein chemistry. Purification, crystallization of the complex, and reconstitution of apoprotein and carotenoid components have been achieved for some crustacean carotenoproteins. The complex is very sensitive to bright light and to temperatures above that of refrigeration. However, it is best preserved in solutions of high ionic strength or as a precipitate in strong ammonium sulfate solutions. PMID:8469154

  10. Complex medium education

    NASA Astrophysics Data System (ADS)

    Kalluri, Dikshitulu K.

    2001-07-01

    A simple electromagnetic medium is described by the constitutive relations D = ? E,B = ? H,J = ? E, where all the electromagnetic parameters, the permittivity ?, the permeability ? , and the conductivity ? are scalar constants. All other electromagnetic mediums are complex mediums. A sub-class of complex mediums are layered mediums which are piece-wise simple mediums. Each layer is a simple medium with scalar electromagnetic parameters. Availability of commercial software for electromagnetic simulation justifies reduction of time spent in teaching the mathematics of special functions in electromagnetic core course at the graduate level. However to make effective use of these packages, the ability to relate the dominant effect of each kind of a geometrical feature and the dominant effect of each kind of complexity in the medium properties could be important in interpreting the results and also to find out when the package did not give correct results. The course outline of a departmental core course in 'Electromagnetic Waves and Materials' at our university, which includes dispersive medium, anisotropic medium, chiral medium, periodic medium, superconducting medium and their applications in the areas of microwaves and optics will be presented. Extension of the system theory to the systems where the basic elements are complex mediums of various kinds is a challenging research area.

  11. Cytarabine Lipid Complex Injection

    MedlinePLUS

    ... used to treat lymphomatous meningitis (a type of cancer in the covering of the spinal cord and brain). Cytarabine lipid complex is in a class of medications called antimetabolites. It works by slowing or stopping the growth of cancer cells in your body.

  12. COMPLEX TERRAIN DISPERSION MODEL

    EPA Science Inventory

    The paper describes the current state of EPA's Complex Terrain Disperson Model (CTDM), which has been under development during the past five years. The CTDM employs the concept of a dividing streamline height (a function of wind and temperature profiles), below which plume segmen...

  13. E Complex groundbreaking

    NASA Technical Reports Server (NTRS)

    2009-01-01

    Representatives from NASA, Orbital Sciences Corp. and Aerojet participate in a ribbon-cutting ceremony for construction of a flame deflector trench at Stennis Space Center's E Test Complex. Participants included Orbital CEO J.R. Thompson (center, left) and Stennis Space Center Director Gene Goldman (center, right).

  14. Unifying Complexity and Information

    NASA Astrophysics Data System (ADS)

    Ke, Da-Guan

    2013-04-01

    Complex systems, arising in many contexts in the computer, life, social, and physical sciences, have not shared a generally-accepted complexity measure playing a fundamental role as the Shannon entropy H in statistical mechanics. Superficially-conflicting criteria of complexity measurement, i.e. complexity-randomness (C-R) relations, have given rise to a special measure intrinsically adaptable to more than one criterion. However, deep causes of the conflict and the adaptability are not much clear. Here I trace the root of each representative or adaptable measure to its particular universal data-generating or -regenerating model (UDGM or UDRM). A representative measure for deterministic dynamical systems is found as a counterpart of the H for random process, clearly redefining the boundary of different criteria. And a specific UDRM achieving the intrinsic adaptability enables a general information measure that ultimately solves all major disputes. This work encourages a single framework coving deterministic systems, statistical mechanics and real-world living organisms.

  15. Complex Digital Visual Systems

    ERIC Educational Resources Information Center

    Sweeny, Robert W.

    2013-01-01

    This article identifies possibilities for data visualization as art educational research practice. The author presents an analysis of the relationship between works of art and digital visual culture, employing aspects of network analysis drawn from the work of Barabási, Newman, and Watts (2006) and Castells (1994). Describing complex network…

  16. Photoacoustic Spectral Study of Lanthanide Complexes Doped in Silica Matrix

    NASA Astrophysics Data System (ADS)

    Yang, Y. T.; Gao, B.; Zhang, S. Y.; Liu, X. J.

    2015-06-01

    Lanthanide phenanthroline (phen) complexes and were incorporated into a silica matrix by an ultrasonic assisted sol-gel method. In the region of ligand absorption, the photoacoustic (PA) intensity for a lanthanide complex is the same as in wet gels. Upon heat treatment at 120C, however, the PA intensity of a O-doped sample is much larger than that of a O-doped sample. The characteristic emissions of complex-doped samples were used to interpret the stability of the complex in silica matrices. The luminescence spectra are consistent with the PA results. The study indicates that phen can only coordinate with lanthanide ions in a silica matrix after a suitable heat treatment. Moreover, the covalency parameters and PA bands of f-f transionts of have been used to study the formation of the complex in a silica matrix.

  17. INTRODUCTION: Complex substrate morphologies

    NASA Astrophysics Data System (ADS)

    Herminghaus, S.

    2005-03-01

    In most situations of practical relevance, the morphology of the substrate is much more complex than what was discussed in the previous section. The behaviour of wet granular materials, the phreatic rise, or the dynamics of tertiary oil recovery from porous rock are all concerned with formidably complex interface topologies, and transformations among them. The next four papers lead us gradually into this vast universe of phenomena. The first three papers (Gillies et al, Xu et al, Fournier et al) all consider the wetting of spherical particles, but with strongly different focuses, and with increasing system complexity. Gillies et al introduce us to the subject by considering wetting and adhesion to single small spheres, and show that this rather simple system already poses enough interesting questions to necessitate the novel method of measurement the authors put forward. The next two papers discuss the wetting and other physical properties of large ensembles of such spheres. Xu et al show that spherical particles may not only behave similarly to surfactants (as in Pickering emulsions), but that these systems may be used to generate a variety of completely novel micro- and nano\\/structures by simple self-assembly processes. Fournier et al discuss the physical properties of a model wet granulate, consisting of a dense pile of many spherical particles and some liquid. They demonstrate that despite the enormous complexity of this system, many of its physical properties may be understood on the basis of rather perspicuous concepts. Finally, Mecke and Arns display the full power of Minkowski functionals, which have been exemplarily applied to dewetting morphologies in the first section (Seemann et al). It is shown that not only wetting, but also mechanical properties of structures as complex as samples of natural soil, may be successfully predicted. Finally, direct relations between Minkowski functionals and thermodynamic potentials are established.

  18. Treatment of bioresorbable scaffold failure.

    PubMed

    Felix, Cordula; Everaert, Bert; Jepson, Nigel; Tamburino, Corrado; van Geuns, Robert-Jan

    2015-01-01

    Bioresorbable scaffolds (BRS) are a promising new interventional treatment strategy for coronary artery disease (CAD). They are intended to overcome some of the shortcomings of metal drug-eluting stents (DES), mainly late reinterventions which occur at a consistent rate after one year and have not been reduced by the use of local drug elution. Initial experience in non-complex lesions established efficacy in opening the vessel and the concept of bioresorption. However, with the use of BRS in more complex lesions, the incidence of BRS failure, including both scaffold restenosis and thrombosis, has also increased. Therefore, understanding of both the pathophysiology and of the available treatment options of scaffold failure remains an important issue in ensuring procedural and long-term clinical success. PMID:25983160

  19. Pharmacogenetics of antidepressive treatment.

    PubMed

    Zobel, Astrid; Maier, Wolfgang

    2010-08-01

    The search of the genetic predictors of response to antidepressants is a rapidly expanding field. A large number of clinical studies are reporting partly inconsistent results. Emerging new results focus on new candidate single nucleotide polymorphisms--particularly in the 5HT2a-receptor gene and the gene coding for the co-chaperone FKBP5. The impact of the 5HTTLPR polymorphism on therapeutic outcome and side effects under treatment with SSRIs has to be viewed in a more complex manner than previously proposed. All replicable genetic associations display only a very modest effect. Despite of enormous research efforts, currently pharmacogenetics of therapeutic effects and of side effects of antidepressants are unable to guide decisions on the selection of the most beneficial drug for an individual patient. PMID:20047055

  20. Interminable treatment: an autobiographical study.

    PubMed

    Schwartz, Scott C

    2011-01-01

    While the notion of interminable therapy often is seen to revolve around a patient's unfulfilled needs and inability to individuate, there may exist a strong countertransferential need on the part of the psychoanalyst to continue treatment. This countertransferential need deserves to be regarded through the prism of the power inherent in the analyst's role. This article presents aspects of the author's complex personal analysis marked by the analyst's refusal to allow for termination and, notably, the consequent impact on the patient. PMID:21434755