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Treatment of injury of the triangular fibrocartilage complex (TFCC).  


Background. The triangular fibrocartilage complex (TFCC) supplies stability and cushioning for proper wrist function. TFCC lesions, a common cause of ulnar-sided wrist pain, can be traumatic (Palmer I) or degenerative (Palmer II) in nature. Clinical assessment is basic for making the diagnosis, but imaging may be helpful. Conservative treatment is the best choice for most acute cases. If the symptoms persist, however, operative treatment has a better prognosis for pain relief. Wrist arthroscopy has a major role to play in the diagnosis and treatment of TFCC lesions. Material and methods. 29 patients were operated in the Hand Surgery Department in Pozna? due to TFCC lesions. 16 patients were qualified as Palmer type I (9 sport injuries, 7 sprains). while 13 patients had Palmer type II secondary to distal radial fractures. All patients suffered ulnar wrist pain and were positive on provocation tests. The indication for surgery was a lack of response to conservative treatment. Different operative procedures were used, depending on the type of lesion: arthroscopic debridement, open or arthroscopic restabilization of the TFCC, ulnar shortening, or partial resection of the ulnar head (Wafer). Rehabilitation was introduced following a period of immobilization. Results. Wrist pain was significantly diminished or disappeared after surgical treatment and rehabilitation. Conclusions. Good functional result and pain relief can be expected following surgical treatment of TFCC injuries. PMID:17592403

Lubiatowski, Przemys?aw; Romanowski, Leszek; Sp?awski, Robert; Manikowski, W?adys?aw; Ogrodowicz, Piotr



[TFCC (Triangular Fibrocartilage Complex) lesions. Diagnosis and therapy].  


Lesions of the TFCC may have degenerative or post-traumatic causes. Distal radioulnar joint as well as the ulnocarpal joint can be affected. Patients present with ulnar-sided wrist pain especially in forearm rotation. Therapy depends on the degree of lesions and additional pathology. Wrist arthroscopy offers a certain diagnostic tool. In addition, adequate therapy can be realized. After failed arthroscopic therapy, ulnar shortening osteotomy reduces ulnar load significantly. PMID:10550439

Beyermann, K; Krimmer, H; Lanz, U



Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability.  


PURPOSE: To report the 10-years' experience of a novel arthroscopic assisted anatomical TFCC reconstruction in treatment of chronic DRUJ instability resulting from irreparable TFCC injuries. MATERIALS AND METHODS: 15 patients (7 males, 8 females) with mean age of 37 (17-49) suffering from irreparable TFCC injuries received arthroscopic assisted reconstruction using palmaris longus graft. Three skin incisions were made with creation of one radial and one ulna tunnel for passage of graft following the path of dorsal and palmar radio-ulnar ligaments under fluoroscopic and arthroscopic guidance. The joint capsule was kept intact. Early mid-range forearm rotation was started since 4th week postoperatively. RESULTS: The mean follow-up was 85.53months (32-138). Mayo wrist score improved from 62.5 to 88(p<0.05). Comparing contralateral side, total prono-supination range increased from 76.6% to 92.1% and grip strength increased from 56.1% to 76.9%. Twelve patients resumed previous jobs. No evidence of DRUJ arthritis was noticed. Complications included 2 late graft ruptures and one unexplained dystonia. CONCLUSIONS: Our arthroscopic assisted approach on TFCC reconstruction is safe, produces comparable results as the standard technique and may achieve better range of motion with less soft tissue dissection and earlier mobilization. PMID:23337702

Tse, Wing-Lim; Lau, Sun-Wing; Wong, Wing Yee; Cheng, Hi-Shan; Chow, Ching-Shan; Ho, Pak-Cheong; Hung, Leung-Kim



[Primary arthroscopic treatment of TFCC tears in fractures of the distal radius].  


The primary simultaneous diagnosis and therapy of TFCC tears in distal radius fractures is still the exception. We present our results of arthroscopic treatment of these injuries. From January 1998 until September 1999, we treated 21 patients with a type C fracture (AO classification) of the distal radius and one patient with a scaphoid fracture and TFCC tears. The Palmer 1A (n = 5) and 1 C (n = 4) tears have been arthroscopically shaved as well as the meniscal tear (n = 1). The Palmer 1B tears were refixed either in an outside-inside technique (n = 6) or in a new all-inside technique (n = 6). Palmer 1D tears were refixed in the Fellinger technique (n = 5). In the clinical follow-up examination six to fifteen months later, we saw symptoms of ulnar-sided wrist pain only in one case of a Palmer 1B tear treated in an outside-inside technique. Especially the patients treated by the new all-inside technique were free from symptoms of TFCC instability. We conclude, that arthroscopic treatment of TFCC tears in acute radius fractures is possible with good results. The new technique of all-inside repair is minimally invasive and shows good results. PMID:11518985

Böhringer, G; Schädel-Höpfner, M; Junge, A; Gotzen, L



TILT Following a TFCC Tear: A Case Report.  


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

Wollstein, Ronit; Unadkat, Jignesh; Grand, Aaron



TILT Following a TFCC Tear: A Case Report  

PubMed Central

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.

Wollstein, Ronit; Unadkat, Jignesh; Grand, Aaron



Triangular fibrocartilage complex tears: a review.  


Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar sided wrist pain. Originally described by Palmer, in 1981, as a complex of several structures, our understanding of the anatomy and the function of the TFCC has been refined by histologic studies. The TFCC plays an important role in load bearing across the wrist as well as in distal radioulnar joint (DRUJ) stabilization. A thorough knowledge of the anatomy as well as the Palmer classification system helps to guide treatment options. PMID:17155920

Ahn, Anthony K; Chang, David; Plate, Ann-Marie



[Therapy of triangular fibrocartilage complex lesions].  


The triangular fibrocartilage complex (TFCC) represents an important anatomical structure interposed between the ulnar carpus and the distal ulnar. Injuries and degenerative changes of the TFCC are of high clinical relevance and there are numerous treatment options available based on different concepts and which are being used to varying extents. The aim of this systematic review was to evaluate the effectiveness of different therapies for lesions of the TFCC. Studies on TFCC lesions were systematically reviewed, classified into evidence levels and selected according to predefined criteria. A total of 259 publications were identified as being potentially relevant and finally 35 studies could be included in the review. In addition, a survey was performed among German hand surgeons in order to identify commonly used procedures for TFCC lesions in Germany. The classification of Palmer is mostly used both in the literature and in Germany and therapeutic decisions are predominantly based on this classification. The systematic review revealed some common treatment strategies for traumatic and degenerative lesions. Generally, the level of evidence was poor for all identified publications. For this reason, evidence-based recommendations for the treatment of TFCC lesions could not be derived from the literature. There was broad consent between the results of the literature review and the survey. PMID:22706650

Schädel-Höpfner, M; Müller, K; Gehrmann, S; Lögters, T T; Windolf, J



Arthroscopic and open repair of the TFCC.  


Injury to the triangular fibrocartilage complex is the most common cause of ulnar-sided wrist pain. This functionally related complex of anatomic structures can be a source of pain secondary to acute injury or chronic degeneration. Strategies for the treatment of these injuries involve determining the anatomic location of the tear, the presence of associated distal radioulnar joint instability, and the presence of associated degenerative changes. Surgical management with open and arthroscopic techniques have been described, both with successful results. PMID:20951898

Kovachevich, Rudy; Elhassan, Bassem T



The innervation of the triangular fibrocartilage complex: nitric acid maceration rediscovered.  


Injury to the triangular fibrocartilage complex (TFCC) is frequently implicated in the etiology of ulnar-sided wrist pain. This study examines the nervous anatomy of the TFCC using a nitric acid maceration technique and attempts to correlate this information with known tear patterns. Ten fresh frozen cadaveric specimens were studied in detail. Gross dissection of each upper-extremity specimen included removal of all flexor and extensor tendons. After identification and labeling with permanent color of the ulnar nerve, dorsal sensory branch of the ulnar nerve, posterior interosseous nerve, anterior interosseous nerve, and median nerve, an en bloc excision of the distal radioulnar region was performed. Digestion of the soft tissue was performed with nitric acid at sequential concentrations of 50% and 33% for 9 of 10 specimens. The digestion was halted by immersing the specimen in a mixture of 10% formaldehyde and 1% glycerine. After removal of bone, the specimens were fixed in paraffin, sectioned, and stained with hematoxylin and eosin. Nine of the 10 specimens were studied microscopically to determine the contribution of the grossly identified nerves to each zone of the triangular fibrocartilage complex as defined by Palmer's classification of acute TFCC tears. The anterior interosseous, median, and superficial radial nerves did not contribute to the innervation of the TFCC. The intraarticular course of the peripheral nerves could not be defined in the one specimen that was not digested with nitric acid. Nitric acid maceration is a rediscovered technique for identifying the nervous anatomy of soft tissues. The study showed that the triangular fibrocartilage complex is innervated by branches of the posterior interosseous, ulnar, and dorsal sensory ulnar nerves in a fairly consistent manner. Improved treatment of TFCC tears may result from an enhanced understanding of the supporting structures' innervation and mechanical function. PMID:11176611

Gupta, R; Nelson, S D; Baker, J; Jones, N F; Meals, R A



Arthroscopic repairs of triangular fibrocartilage complex tears.  


Technical advancements in arthroscopic wrist procedures have improved our knowledge of normal and abnormal intraarticular wrist function. Triangular fibrocartilage complex (TFCC) tears from trauma injuries are a common source of ulnar-sided wrist pain. Fortunately, the TFCC is a structure that can be evaluated and treated arthroscopically with results that are comparable to open surgical procedures. Successful arthroscopic repairs of TFCC tears depend on a coordinated team effort between perioperative nurses, orthopedic surgeons, nurse practitioners, and occupational hand therapists, as well as cooperation from patients and family members. This article reviews the anatomy and physiology of the TFCC, the biomechanics of the wrist and mechanisms of injury, and arthroscopic repairs of TFCC tears. PMID:9220068

Baehser-Griffith, P; Bednar, J M; Osterman, A L; Culp, R



Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist  

PubMed Central

The aim of this study was to assess the value of direct magnetic resonance (MR) arthrography of the wrist for detecting full-thickness tears of the triangular fibrocartilage complex (TFCC). Twenty-four consecutive patients who had ulnar-sided wrist pain and clinical suspicion of TFCC tear were included in the study. All patients underwent direct MR arthrography and then wrist arthroscopy, and the results of MR arthrography were compared with the arthroscopic findings. The positive predictive value of MR arthrography in detecting TFCC full-thickness tear was 0.95, and the negative predictive value was 0.50. The sensitivity of MR arthrography in detecting a TFCC full-thickness tear was 74% (15/19), and specificity was 80% (4/5). The overall accuracy of MR arthrography in detecting a full-thickness tear of the TFCC in our study was 79% (19/24). We believe that diagnosis of tears in the TFCC by direct MR arthrography is not entirely satisfactory, although MR arthrography has a high positive predictive value for detecting TFCC tears. Negative results of MR arthrography in patients with clinical suspicion of TFCC tear should be interpreted with caution.

Lee, Kenneth; Deshmukh, Subodh C.



Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist.  


The aim of this study was to assess the value of direct magnetic resonance (MR) arthrography of the wrist for detecting full-thickness tears of the triangular fibrocartilage complex (TFCC). Twenty-four consecutive patients who had ulnar-sided wrist pain and clinical suspicion of TFCC tear were included in the study. All patients underwent direct MR arthrography and then wrist arthroscopy, and the results of MR arthrography were compared with the arthroscopic findings. The positive predictive value of MR arthrography in detecting TFCC full-thickness tear was 0.95, and the negative predictive value was 0.50. The sensitivity of MR arthrography in detecting a TFCC full-thickness tear was 74% (15/19), and specificity was 80% (4/5). The overall accuracy of MR arthrography in detecting a full-thickness tear of the TFCC in our study was 79% (19/24). We believe that diagnosis of tears in the TFCC by direct MR arthrography is not entirely satisfactory, although MR arthrography has a high positive predictive value for detecting TFCC tears. Negative results of MR arthrography in patients with clinical suspicion of TFCC tear should be interpreted with caution. PMID:17216523

Joshy, Suraj; Ghosh, Subhajit; Lee, Kenneth; Deshmukh, Subodh C



Thermal energy for the arthroscopic treatment of tears of the triangular fibrocartilage of the wrist.  


We evaluated the clinical and occupational outcomes of arthroscopic treatment with electrothermal shrinkage for triangular fibrocartilage complex (TFCC) tears. We retrospectively reviewed 162 patients. All patients had ulnar-sided wrist pain that limited their occupational and sporting activities. The surgical technique consisted of electrothermal collagen shrinkage of the TFCC. Pain relief, range of motion, complications, reoperation rate, time to return to work and workers' compensation claims were evaluated. Exclusion criteria were distal radioulnar joint instability and association of other wrist lesions. Complete pain relief was noted in 80.3% of the patients, incomplete pain relief in 14.8%, and only 4.9% required reoperation because of pain-persistence. The average range of motion was over 90% compared to the opposite hand. Worker's compensation claims were introduced by 20 patients, of which 6 did not return to their previous occupation. Electrodiathermy may be a useful option for arthroscopic treatment of TFCC tears in cases without distal radioulnar joint instability. PMID:23409566

Garcia-Lopez, Ignacio; Delgado, Pedro J; Abad, Jose M; Garcia De Lucas, Fernando



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

PubMed Central

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.

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



Ulnar-sided wrist pain due to isolated disk tear of triangular fibrocartilage complex within the distal radioulnar joint: two case reports.  


Wrist arthroscopy has been successfully used with many modifications and improvements. However, distal radioulnar joint (DRUJ) arthroscopy is still uncommon. We experienced 2 cases of ulnar-sided wrist pain due to isolated triangular fibrocartilage complex (TFCC) disk tear within the DRUJ. DRUJ arthroscopy in these cases showed horizontal tear and fibrillation of TFCC disk without TFCC tear at the radiocarpal joint. Foveal attachment was intact in both cases. These were treated with debridement, which relieved pain after surgery and achieved good functional recovery. Although DRUJ arthroscopy is technically difficult, it is mandatory for making a diagnosis and treating ulnar-sided wrist pain. PMID:21548155

Abe, Yukio; Tominaga, Yasuhiro




Microsoft Academic Search

Complex trauma occurs repeatedly and escalates over its duration. In families, it is exemplified by domestic violence and child abuse and in other situations by war, prisoner of war or refugee status, and human trafficking. Complex trauma also refers to situations such as acute\\/chronic illness that requires intensive medical intervention or a single traumatic event that is calamitous. Complex trauma

Christine A. Courtois



Complex Trauma, Complex Reactions: Assessment and Treatment  

Microsoft Academic Search

Complex trauma occurs repeatedly and escalates over its duration. In families, it is exemplified by domestic violence and child abuse and in other situations by war, prisoner of war or refugee status, and human trafficking. Complex trauma also refers to situations such as acute\\/chronic illness that requires intensive medical intervention or a single traumatic event that is calamitous. Complex trauma

Christine A. Courtois



The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears  

PubMed Central

Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings. Methods: The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females) who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA) and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93%) and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39), and specificity was 80% (16/20). The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34). Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

Al-Hiari, Asem A.



Treatment of the Complex Idiopathic Clubfoot  

Microsoft Academic Search

Treatment with the Ponseti method corrects congenital idio- pathic clubfeet in the majority of patients. However, some feet do not respond to the standard treatment protocol. We describe the characteristics and treatment results of these complex idiopathic clubfeet. We identified 50 patients (75 clubfeet) from 762 consecutive patients treated at five insti- tutions. Clinically, complex clubfeet were defined as having

Ignacio V. Ponseti; Miroslav Zhivkov; Naomi Davis; Marc Sinclair; Matthew B. Dobbs; Jose A. Morcuende



Complexity in the Treatment of Naming Deficits  

ERIC Educational Resources Information Center

Purpose: This article discusses a novel approach for treatment of lexical retrieval deficits in aphasia in which treatment begins with complex, rather than simple, lexical stimuli. This treatment considers the semantic complexity of items within semantic categories, with a focus on their featural detail. Method and Results: Previous work on…

Kiran, Swathi



A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome  

PubMed Central

Background This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. Methods The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. Results The modified Mayo wrist score in groups A, B, and C was 74.5 ± 8.9, 73.9 ± 11.6, and 61.3 ± 10.2, respectively (p < 0.05). The DASH score in groups A, B, and C was 15.6 ± 11.8, 19.3 ± 11.9, and 33.2 ± 8.5, respectively (p < 0.05). The average Chun and Palmer grading score in groups A and B was 85.7 ± 8.9 and 84.7 ± 6.7, respectively. The difference in the Mayo wrist score, DASH score and Chun and Palmer grading score between group A and B was not significant (p > 0.05). Conclusions Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable.

Song, Hyun Seok



Complexity in Language Learning and Treatment  

ERIC Educational Resources Information Center

Purpose: To introduce a Clinical Forum focused on the Complexity Account of Treatment Efficacy (C. K. Thompson, L. P. Shapiro, S. Kiran, & J. Sobecks, 2003), a counterintuitive but effective approach for treating language disorders. This approach espouses training "complex" structures to promote generalized improvement of simpler, linguistically…

Thompson, Cynthia K.



Complexity in Treatment of Syntactic Deficits  

PubMed Central

Purpose This article addresses complexity in the context of treatment for sentence structural impairments in agrammatic aphasia, with emphasis on noncanonical sentences involving linguistic movement and their related counterparts. Extensions of the complexity effect to recovery of canonical sentences also are discussed, stressing the linguistic properties of verbs as well as grammatical morphology in building complexity hierarchies. Method A number of variables to consider in developing complexity hierarchies in the syntactic domain are addressed, and a series of studies using single-subject controlled experimental analysis are discussed. Results Findings across studies show that training complex sentences results in improvement of simpler structures when, and only when, the underlying linguistic properties are shared by both. The opposite approach, training simple structures first and building to more complex ones, does not provide the full benefit of treatment, in that little or no generalization occurs across structures. Conclusion Using complex language material as a starting point for treatment of sentence structural deficits in aphasia results in cascading generalization to simpler, linguistically related material and expands spontaneous language production in many language-disordered adults with aphasia. Clinicians are, therefore, urged to adopt this approach in clinical practice, even though it is counterintuitive and departs significantly from conventional treatment methods.

Thompson, Cynthia K.; Shapiro, Lewis P.



Arthroscopic treatment of triangular fibrocartilage tears.  


Lesions of the TFCC are more frequently implicated as a cause of ulnar-sided wrist pain. Accurate diagnosis of TFCC pathology must be based on a thorough history and physical examination. Imaging modalities of particular use include plain radiographs, triple compartment arthrography, and MR imaging. The most sensitive and accurate diagnosis of the extent as well as the clinical significance of intra-articular pathology on the ulnar side of the wrist is by means of the arthroscope. With the advent of smaller and more elaborate arthroscopic instrumentation, the ability to perform arthroscopic surgery on the TFCC has dramatically increased over the past decade. The present arthroscopic treatment of traumatic central and radial lesions consists of debridement of unstable flaps, whereas dorsal and ulnar-sided lesions can be directly repaired. Centrally located degenerative perforations can be debrided in conjunction with an arthroscopic wafer procedure on the distal ulna. PMID:7566916

Gan, B S; Richards, R S; Roth, J H



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


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

Watanabe, Atsuya; Souza, Felipe; Vezeridis, Peter S; Blazar, Philip; Yoshioka, Hiroshi



All-arthroscopic repair of peripheral triangular fibrocartilage complex tears using FasT-Fix.  


Injury to the triangular fibrocartilage complex (TFCC) is a major source of ulnar-sided wrist pain that results in disability with common activities of daily living involving forearm rotation, for which operative management is indicated if conservative management fails. Past results with open repairs have been successful, but recent surgical advances have allowed the development of arthroscopic management. This article describes and reviews an all-arthroscopic technique of repair of Palmer type IB TFCC injuries with FasT-Fix suture technology (Smith and Nephew, Andover, MA, USA), which is advantageous both biomechanically and in terms of decreasing risk of morbidity. PMID:21871346

Yao, Jeffrey



Innervation of the triangular fibrocartilage complex of the human wrist: quantitative immunohistochemical study.  


The distribution of neural elements in the triangular fibrocartilage complex (TFCC) of the human wrists was studied via immunohistochemical staining of protein gene product (PGP) 9.5 and calcitonin gene-related peptide (CGRP). Articular branches projecting to the TFCC arose from the dorsal branch of the ulnar nerve in all wrists examined. The TFCC is subdivided into the following six regions: the articular disc proper (ADP), meniscus homolog (MH), radio-ulnar ligament (RUL), loose part of ulnar collateral ligament (lUCL), dense part of ulnar collateral ligament (dUCL), and internal portion (IP). The IP consists of a mixture of dense and loose connective tissues enclosed by the ADP, MH, RUL, and UCL, and resides deep in the prestyloid recess, which is a pit in the MH. The densities of PGP 9.5-positive neural elements, including free nerve endings, single nerve fibers, nerve fascicles, and perivascular neural nets, were significantly higher in the IP than in other regions. Some of the neural elements except for the perivascular neural nets were positive for CGRP. The high density of neural elements in the IP suggests that sensory nerves projecting to the TFCC enter into the IP and from there distribute to adjacent regions such as the MH and RUL. Free nerve endings are responsible for pain transmission. The high density of free nerve endings in the IP suggests that the IP is a source of ulnar side wrist pain. PMID:17867338

Shigemitsu, Toshio; Tobe, Masahiro; Mizutani, Kazuhiro; Murakami, Kunio; Ishikawa, Youichi; Sato, Fumi



Advanced QPC complex salt bath heat treatment  

Microsoft Academic Search

Salt bath surface treatment has been used widely for various industrial applications for many years. However, the technology is able to be applied in mass scale production only in limited countries, such as USA, Japan, Britain and France, due to the specific salt being obtainable only from one single company in Germany. This article reveals that a new salt, developed

C. F. Yeung; K. H. Lau; H. Y. Li; D. F. Luo




Microsoft Academic Search

\\u000a Many water streams, both wastewater effluents and drinking8 water sources, contain pollutants that cannot be removed or destroyed\\u000a by conventional physical or biological treatment processes. In such cases it is necessary to seek alternatives. One approach\\u000a is to destroy the pollutant by application of a strong oxidizing agent. Chlorine is one candidate reagent, but it can produce\\u000a undesirable reaction products,



[Fecal incontinence--operative treatment of a complex problem].  


Anal continence is maintained by the controlled synergism of all parts of the complex anal sphincter system and the normal functioning of the preposed gut. Operative treatment may improve the function of a single part of the system. In case of malfunction of more than one element of the anal sphincter, an operation may result in partial improvement. In these cases, additional conservative treatment is recommended. In a few cases, additional operations are needed. The indications for and results of the established operations for the treatment of anal incontinence will be discussed here. PMID:15038581

Raulf, Franz



Clearing the complexity: immune complexes and their treatment in lupus nephritis  

PubMed Central

Systemic lupus erythematosus (SLE) is a classic antibody-mediated systemic autoimmune disease characterised by the development of autoantibodies to ubiquitous self-antigens (such as antinuclear antibodies and antidouble-stranded DNA antibodies) and widespread deposition of immune complexes in affected tissues. Deposition of immune complexes in the kidney results in glomerular damage and occurs in all forms of lupus nephritis. The development of nephritis carries a poor prognosis and high risk of developing end-stage renal failure despite recent therapeutic advances. Here we review the role of DNA-anti-DNA immune complexes in the pathogenesis of lupus nephritis and possible new treatment strategies aimed at their control.

Toong, Catherine; Adelstein, Stephen; Phan, Tri Giang



Treatment for ADHD: Is More Complex Treatment Cost-Effective for More Complex Cases?  

PubMed Central

Objective To determine the cost-effectiveness of three alternative high-quality treatments for attention deficit hyperactivity disorder (ADHD) relative to community care (CC) and to determine whether cost-effectiveness varies with the presence of comorbid disorders. Data Sources/Collection The study included 579 children ages 7–9.9 with diagnosed ADHD at six sites. Data for the study were distilled from administrative data and from interviews with parents, including estimates of the child's functional impairment. These analyses focus on changes in functional impairment over 14 months. Study Design The study involved a large clinical trial that randomized participants to one of four arms: routine CC, intensive medication management (MedMgt), multicomponent behavioral treatment, and a combination of behavioral treatment and medication. Principal Findings We assessed the cost-effectiveness of the alternatives using costs measured from a payer perspective. The preferred cost-effective treatment varies as a function of the child's comorbidity and of the policy maker's willingness to pay. For pure (no comorbidity) ADHD, high-quality MedMgt appears likely to be cost-effective at all levels of willingness to pay. In contrast, for some comorbid conditions, willingness to pay is critical: the policy maker with low willingness to pay likely will judge MedMgt most cost-effective. On the other hand, a policy maker willing to pay more now in expectation of future costs savings (involving, for example, juvenile justice), will recognize that the most cost-effective choice for comorbid conditions likely involves behavior therapy, with or without medication. Conclusions Analyses of costs and effectiveness of treatment for ADHD must consider the role of comorbidities.

Foster, E Michael; Jensen, Peter S; Schlander, Michael; Pelham, William E; Hechtman, Lily; Arnold, L Eugene; Swanson, James M; Wigal, Timothy



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

Microsoft Academic Search

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

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



Modification of Tencel with Treatment of Ferric Sodium Tartrate Complex Solution I. Effect of Treatment Condition  

Microsoft Academic Search

Partial dissolution of cellulose by ferric sodium tartrate complex (FeTNa) solution was examined as refining treatment of the organic-solvent spun cellulose fiber (Tencel). The treatment conditions were discussed in terms of solvent strength, temperature, duration of the treatment, and free NaOH concentration by measuring the weight loss, crystallinity, and tenacity of the resultant yarns. For improving fibrillation resistance, the optimized

Katsuji Kasahara; Hiroaki Sasaki; Nobuo Donkai; Tohru Yoshihara; Tohru Takagishi



Understanding treatment decision making: Contexts, commonalities, complexities, and challenges  

Microsoft Academic Search

Background: The diagnosis of cancer sets off a cascade of complex decisions at a time when patients feel vulnerable and distressed.\\u000a Although clinical decisions used to follow one standard, many guidelines now outline several options and include explicit\\u000a recognition of the need to incorporate patients’ preferences to determine the most appropriate treatment.Purpose: The purpose of this article is to provide

Thomas Blank; Kristi Graves; Karen Sepucha; Hilary Llewellyn-Thomas



[Complex treatment of patients with chronic cerebrovascular insufficiency].  


Chronic cerebrovascular insufficiency is the most common manifestation of chronic diseases of the nervous system. Its main causes are hypertension and atherosclerosis. Diseases debut mainly on 5-6th decade of life. The condition prohreiyentnyy, but the degree of progression can be varied--from slow to galloping. Therefore, when studying the effectiveness of treatment programs, in our opinion, it is important to include the medical complex of different methods of reflexology. PMID:23350145

Parnikoza, T P; Iavors'ky?, V V



Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex.  


Over a 4-year period, 160 wrist arthroscopies were performed at 1 institution. Ninety-seven patients had central or nondetached ulnar peripheral tears of the triangular fibrocartilage complex (TFCC). All these patients underwent debridement with an arthroscopic shaver. Thirteen of the 97 had persistent pain in the TFCC region for more than 3 months after surgery. At an average of 8 months after failed arthroscopic debridement of the TFCC, all 13 patients underwent a 2-mm-long ulna-shortening osteotomy with fixation by a 3.5-mm 6-hole dynamic compression plate. At follow-up examination (an average of 2.3 years later), 12 of the 13 had complete relief of pain at the ulnar side of the wrist. One patient continued to complain of pain with moderate to heavy activity use of her hand. Four of the 13 had postoperative complications: 1 had traumatic pull-out of the screws requiring reinsertion and distal radius bone graft, 1 had nonunion at 4 months after surgery that required iliac crest bone graft, and 2 had pain necessitation hardware removal. All 4 of these patients had no further problems at final follow-up evaluation. There was no statistically significant difference between the arthroscopic debridement alone cohort and the arthroscopy/ulna-shortening subgroup relative to ulnar variance or incidence of associated lunotriquetral ligament tears. On the basis of these findings the authors recommend a 2-mm-long ulna-shortening osteotomy for patients whose previous arthroscopic debridement for central or nondetached peripheral TFCC was unsuccessful in eliminating ulnar-sided wrist pain. PMID:9260628

Hulsizer, D; Weiss, A P; Akelman, E



Four treatment strategies for complex regional pain syndrome type 1.  


Complex regional pain syndrome (CRPS) poses a dilemma for many clinicians due to its unknown etiology and largely unsuccessful treatment modalities. The purpose of this study was to compare the clinical results of 4 treatment modalities for CRPS type 1. A total of 59 patients were divided into 4 groups based on treatment modality: group A, an oral nonsteroidal anti-inflammatory drug (NSAID) (n=10); group B, oral gabapentin (n=12); group C, intravenous (IV) 10% mannitol and steroid (n=11); group D, a combination of IV 20% mannitol and steroid with oral gabapentin (n=26). The patients remained under medical supervision after discharge and were evaluated either once a month or once every 2 months until final follow-up at a mean of 8 months. Patients in group A showed improvement in pain level, finger range of motion, swelling, and grip strength, without statistical significance (P=.076, P=.062, P=.312, and P=.804, respectively). Patients in group B showed significant improvement in pain level (P<.001), and patients in group C showed improvement in pain, finger range of motion, and swelling (P=.127), which rendered functional impairment unchanged. In comparison, patients in group D showed recovery of grip strength and improvement in pain level, finger range of motion, and (P<.001, P=.016, P=.031, and P=.047, respectively). Based on these results, a protocol including a combination of IV 20% mannitol and steroid with oral gabapentin is an acceptable and effective treatment for CRPS type 1. PMID:22691654

Lee, Sang Ki; Yang, Dae Suk; Lee, Jae Won; Choy, Won Sik



Ulnar shortening after failed arthroscopic treatment of triangular fibrocartilage complex tears.  


Ulnar shortening osteotomy was performed in 11 wrists with ulnar abutment syndrome, after failed arthroscopic surgery on the TFCC (ten debridements, one repair). A delayed union was present in three, a non-union occurred in two, of whom one needed a revision and grafting procedure. According to the Mayo wrist score, only four had an acceptable outcome. Patient's satisfaction was higher: seven were satisfied, four were not. The postoperative wrist pain score was good in ten patients. Overall outcome was not very successful. Problems related to the procedure could be avoided by adapting the technique (oblique osteotomy, palmar placement of the plate, and compression devices). The key statement remains however to us; ulnar sided wrist pain thought to be caused by an ulnar abutment is not necessarily resolved by decompressing the ulnocarpal joint. PMID:11723772

Van Sanden, S; De Smet, L



Surimi wash water treatment for protein recovery: effect of chitosan–alginate complex concentration and treatment time on protein adsorption  

Microsoft Academic Search

Chitosan (Chi), a protein recovery agent for the treatment of aqueous food processing streams, appears to work by mechanical entrapment and electrostatic interaction of chitosan amino groups with anionic groups on proteins. Chitosan effectiveness for recovering soluble proteins from surimi wash water (SWW) is increased by complexation with alginate (Alg) and by adjusting complex concentration and treatment time. Flocculation at

Singgih Wibowo; Gonzalo Velazquez; Vivek Savant; J. Antonio Torres



[Arthroscopic treatment of the ulnar impaction syndrome].  


The ulnar impaction syndrome is due to hyperpressure in the ulnocarpal joint. It occurs most frequently following distal radial fractures with shortening, but can also be secondary to a primitive length discrepancy between a short radius and a long ulna (positive ulnar variance). Symptoms and clinical findings, even though characteristic, are not specific. Standard X rays show a positive ulnar variance, and sometimes a hyperpressure cyst in the lunate. CT arthroscan and MRI studies demonstrate indirect signs of hyperpressure. If medical treatment fails to improve the condition, the choice surgical technique is arthroscopic, allowing debridement of the TFCC central tear, and shortening of the horizontal aspect of the ulnar head. PMID:17361891

Leclercq, C



[Arthroscopic treatment of the ulnar impaction syndrome.  


The ulnar impaction syndrome is due to hyperpressure in the ulnocarpal joint. It occurs most frequently following distal radial fractures with shortening, but can also be secondary to a primitive length discrepancy between a short radius and a long ulna (positive ulnar variance). Symptoms and clinical findings, even though characteristic, are not specific. Standard X rays show a positive ulnar variance, and sometimes a hyperpressure cyst in the lunate. CT arthroscan and MRI studies demonstrate indirect signs of hyperpressure. If medical treatment fails to improve the condition, the choice surgical technique is arthroscopic, allowing debridement of the TFCC central tear, and shortening of the horizontal aspect of the ulnar head. PMID:17349396

Leclercq, C



A complex approach to the treatment of Fournier's gangrene.  


Fournier's gangrene is a necrotizing, life-threatening fasciitis of the perineal, genital and perianal region which can spread to the abdominal wall, causing soft-tissue necrosis and sepsis. It is usually a polymicrobial infection. The prevalence of the disease is low, but the mortality rate remains high. Several urogenital and anorectal diseases, as well as diabetes mellitus and conditions associated with the immunosuppressive reaction, may predispose an individual to the development of Fournier's gangrene. A diagnosis of Fournier's gangrene is clinical, but radiological examinations may be helpful in establishing the extent of the necrotic process. The treatment consists mainly of aggressive surgical debridement, broad-spectrum antibiotic combinations and hyperbaric oxygen therapy. The Fournier's gangrene severity index (FGSI) score can be used to evaluate patients. Because of its heterogeneity and aggressiveness, Fournier's gangrene is a very serious and complex medical condition that should be under the care of an interdisciplinary team with access not only to the best surgical and critical care but also to a hyperbaric chamber. PMID:23468272

Sroczy?ski, Maciej; Sebastian, Maciej; Rudnicki, Jerzy; Sebastian, Agata; Agrawal, Anil K


Treatment of Complex Cyanide Compounds for Reuse or Disposal.  

National Technical Information Service (NTIS)

Complex cyanides (ferro-and ferricyanide) in industrial waste water effluents impose a direct threat upon the environment. Methods to recover or destroy these compounds were evaluated in laboratory studies. The techniques tested include electrolysis, ozon...

T. N. Hendrickson L. G. Daignault



Pediatric distal radius fractures and triangular fibrocartilage complex injuries.  


Management of distal radius fractures is guided by the pattern and location of injury, degree of deformity, and expectations of bony remodeling based on the amount of remaining skeletal growth.Indications for surgical treatment include unstable or irreducible fractures, open fractures, floating elbow injuries, and neurovascular or soft-tissue compromise precluding cast immobilization. Patients and families should be counseled regarding the potential for post-traumatic distal radial growth arrest following physeal fractures. In these cases, epiphysiodeses, ulnar shortening osteotomies, or corrective radial osteotomies may be performed, depending on the pattern of arrest,degree of deformity, and remaining skeletal growth.TFCC tears may be the source of ulnar-sided wrist pain in children and adolescents, though symptoms and physical examination findings maybe subtle. Patients who have persistent pain and functional limitations despite activity modification and therapy are candidates for surgical treatment. Appropriate repair of peripheral TFCC tears with correction of concomitant wrist pathology restores normal wrist anatomy, alleviates pain, and allows for return to functional activities. PMID:16504777

Bae, Donald S; Waters, Peter M



Treatment of complex regional pain syndrome type I  

Microsoft Academic Search

Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome type I (CRPS I), is a disabling neuropathic pain syndrome. Controversy exists about the effectiveness of therapeutic interventions for the management of RSD\\/CRPS I. In order to ascertain appropriate therapies we conducted a review of existing randomized controlled trials of therapies for this disabling disease. Eligible trials were identified

Tymour Forouzanfar; Albere J. A. Köke; Maarten van Kleef; Wilhelm E. J. Weber



[Antioxidant therapy in the complex treatment of late pregnancy toxemia].  


Lipid oxidation blood levels, activity of serum antioxidative system and erythrocytic membranes were investigated in the time-course of treatment of 145 pregnant females with nephropathies of various severity. More pronounced improvement of the parameters studied and elimination of late gestosis symptoms were revealed in the treatment with antioxidative preparations, lipostabil and solcoseryl. Regardless of treatment pattern in pregnancies complicated by severe nephropathy there were improvements noted, as a rule, in presence of pharmacological management but after its withdrawal the signs of the diseases relapsed (2-6 days after). Continuation of pregnancy up to the terms when the fetus was expected to be born viable was considered as the main target of the aforementioned treatment. PMID:2742065

Shalina, R I; Kushch, I B; Oreshkina, V P; Azizova, O A; Kozlov, A V



[Treatment of experimental immune complex nephritis with indomethacin].  


Functional, histological and immune-histological examination were performed in altogether 64 Wistar-rats, in order to control the effect of a therapy with 2 mg/kg per body weight indomethazine lasting 2 months at the model of an experimental immune complex nephritis. In 44 rats after presensibilisation an immune complex nephritis was performed by intraperitoneal injections with human serum albumin which were repeated three times a week. 24 glomerulonephritis animals and other 20 animals without glomerulonephritis were daily administered indomethazin through a tube probe, the remaining 20 animals with glomerulonephritis served as untreated control groups. The excretion function of the kidney was tested before the beginning of the experiment, 2 weeks after the beginning of the therapy and the regular serum injections, respectively, and before the end of the experiment by determination of the biological half-life period of 131J-hippuran. In every case one day before this the proteinuria during 24 hours was determined. At the end of the experiment the kidneys were examined histologically and immune-histologically. The results showed that indomethazin does not lead to a clear influence on the proteinuria in the immune complex nephritis of the rat. The excretion of 131J-hippuran was significantly restricted, whereas the histological and immune-histological preparations in the animals with foreign serum injections showed clear changes of the glomeruli in the sense of an early stage of the immune complex nephritis, however, they did not show any essential influence by indomethazin. That is, indomethazin had altogether no favourable effect on the immune complex nephritis of the rat. PMID:154798

Hagemann, I; Schneider, W; Philipp, H; Strangfeld, D; Siewert, H; Tietze, G; Pietsch, R



Complexity analysis of spontaneous brain activity: effects of depression and antidepressant treatment.  


Magnetoencephalography (MEG) allows the real-time recording of neural activity and oscillatory activity in distributed neural networks. We applied a non-linear complexity analysis to resting-state neural activity as measured using whole-head MEG. Recordings were obtained from 20 unmedicated patients with major depressive disorder and 19 matched healthy controls. Subsequently, after 6 months of pharmacological treatment with the antidepressant mirtazapine 30 mg/day, patients received a second MEG scan. A measure of the complexity of neural signals, the Lempel-Ziv Complexity (LZC), was derived from the MEG time series. We found that depressed patients showed higher pre-treatment complexity values compared with controls, and that complexity values decreased after 6 months of effective pharmacological treatment, although this effect was statistically significant only in younger patients. The main treatment effect was to recover the tendency observed in controls of a positive correlation between age and complexity values. Importantly, the reduction of complexity with treatment correlated with the degree of clinical symptom remission. We suggest that LZC, a formal measure of neural activity complexity, is sensitive to the dynamic physiological changes observed in depression and may potentially offer an objective marker of depression and its remission after treatment. PMID:21708836

Méndez, María Andreina; Zuluaga, Pilar; Hornero, Roberto; Gómez, Carlos; Escudero, Javier; Rodríguez-Palancas, Alfonso; Ortiz, Tomás; Fernández, Alberto



[Use of decamethoxine in the complex treatment of chronic bronchitis].  


Seventy-two patients with chronic bronchitis were examined and divided into 3 groups. Group I consisted of patients with chronic catarrhal bronchitis (CCB) group II of those with chronic purulent bronchitis (CPB), group III of subjects with bronchitis associated with purulent destructive pulmonary diseases. All the patients received combined treatment with decamethoxin as an antibacterial modality. It was found that decamethoxin promotes elimination of the infection of the bronchial secretion in 60% of chronic bronchitis suffers, the incidence of microorganisms resistent to several antibiotics reduced 2-fold. Local use of decamethoxin as an antibacterial and antiinflammatory drug in multimodality treatment of chronic purulent bronchitis proved highly effective. PMID:2335954

Iukhimets, V A; Pilipchuk, V N



[The complex recovery treatment of chronic obstructive pulmonary disease patients using haloaerosoltherapy and blastomunil (remote results)].  


The expediency of complex recovery treatment of chronic obstructive pulmonary disease patients with the usage of artificial rock salt aerosol medium (haloaerosoltherapy) and immunomodulator "Blastomunil" intake was grounded on the base of the treatment's remote results study. It was revealed that additional prescription of blastomunil resulted in the lowering the frequency of ambulant and, especially, hospital treatment, decrease of average quantity of disability days during one year after treatment and promoted the remission lengthening by 1,9-2,1 months. PMID:23951920


Former and modern taxonomic treatment of the apomictic Rubus complex  

Microsoft Academic Search

The development of the taxonomy of the European bramble flora is discussed. Previous taxonomic concepts were mainly (1) description\\u000a of each different bramble bush as a species of its own, (2) treatment of bramble taxa with hybrid formulas, (3) arranging\\u000a of bramble taxa as infraspecific taxa within an artificial system, (4) creation of special taxonomic units like “agamospecies”.\\u000a In modern

Heinrich E. Weber



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...


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...


Sodium hydroxide treatment of field water in a biopolymer complex  

SciTech Connect

A method is described for making an aqueous gel formed into a polysaccharide. The gel is used as a fluid medium in a subterranean formation for the production of hydrocarbonaceous fluids. The improvement comprises: mixing a substantially small amount of an alkali or alkaline earth metal hydroxide sufficient to cause gelation with a water soluble scleroglucan polysaccharide 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 which solution also contains a water thickening amount of the water soluble scleroglucan polysaccharide; and then complexing the polysaccharide with an amount of a water-soluble compound of a polyvalent metal ion.

Phelps, C.H.; Sampath, K.



Sodium hydroxide treatment of field water in a biopolymer complex  

SciTech Connect

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.

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



Complex endodontic treatment of an immature type III dens invaginatus. A case report  

Microsoft Academic Search

Fregnani ER, Spinola LFB, Sonego JRO, Bueno CES, De Martin AS. Complex endodontic treatment of an immature type III dens invaginatus. A case report. International Endodontic Journal, 41, 913-919, 2008. Aim To report the endodontic treatment of an immature maxillary central incisor with dens invaginatus. Summary Dens invaginatus is a rare malformation of teeth, probably resulting from an infolding of

E. R. Fregnani; L. F. B. Spinola; J. R. O. Sônego; C. E. S. Bueno; A. S. De Martin



Complexity and Continuity of Treatments Among Privately Insured Youth Diagnosed with Bipolar Disorder  

PubMed Central

Objectives: To examine longitudinal patterns of complexity, continuity, and initiation of treatment for youth diagnosed with bipolar disorder. Additionally, we explore bipolar diagnosis stability and its relationship to observed treatment patterns. Methods: A cohort of 426 privately insured youth (ages 6–18) diagnosed with bipolar disorder was identified from the 2000–2001 Thomson/Medstat-MarketScan® database. Medication complexity was defined as number of different psychotropic medication classes dispensed during a 6-month period following a new treatment episode of bipolar disorder. Treatment continuity was examined over a 6-month follow-up period, specifically focusing on mood stabilizing medications and antidepressant monotherapy. Predictors of complexity and continuity were investigated. Results: Fifty-five percent of youth received more than one and 25% received three or more different types of psychotropic medication classes during follow-up. This was contrasted with several youth having no prescription fills (21%) and 31% discontinuing mood stabilizing medication. Youth with a stable bipolar diagnosis were more likely to have continuity of mood stabilizing prescriptions (OR: 4.05), but also greater psychotropic medication complexity. Age, health status/comorbidity, and being in a managed care plan were also related to complexity and continuity of psychotropic medication class regimens. Conclusions: More evidence is needed on the causal patterns leading to increased psychotropic medication complexity and continuity and how diagnosis of bipolar disorder may drive treatment patterns.

Evans-Lacko, Sara; Riley, Anne W.; dosReis, Susan



Helical tomotherapy in patients with breast cancer and complex treatment volumes  

Microsoft Academic Search

Purpose  To describe early clinical results of tomotherapy treatment in patients with breast cancer and complex treatment volumes.\\u000a \\u000a \\u000a \\u000a Methods and materials  Ten patients were treated with tomotherapy between January 2009 and March 2010. Treatment planning objectives were to cover\\u000a at least 95% of the planning target volume with the 95% isodose; to have a minimum dose of 90% and a maximum dose

Ricardo Cendales; Luis Schiappacasse; Franco Schnitman; Graciela García; Hugo Marsiglia



Photodynamic Antimicrobial Chemotherapy (PACT) in combination with antibiotics for treatment of Burkholderia cepacia complex infection.  


This study aimed to determine if Photodynamic Antimicrobial Chemotherapy (PACT) was effective in the treatment of Burkholderia cepacia complex infection and whether a synergistic effect was evident if PACT was used in combination with antibiotics. The susceptibility of both planktonic and biofilm cultures of B. cepacia complex strains to methylene blue (MB) and meso-tetra(n-methyl-4-pyridyl)porphine tetra-tosylate (TMP)-mediated PACT was determined alone and in combination with antibiotics used in the treatment of Cystic Fibrosis pulmonary infection caused by these bacteria. When B. cepacia complex strains were grown planktonically, high levels of kill of were achieved with both TMP and MB-mediated PACT with strain and photosensitizer specific differences apparent. When strains were grown in biofilm, antibiotic treatment alone was bactericidal in 17/36 (47%) strain/antibiotic combinations tested. When antibiotic treatment was combined with PACT, bactericidal activity was apparent for 33/36 (92%) strain/antibiotic combinations. No antagonism was detected between PACT and antibiotic treatment with the combination synergistic for 6/36 (17%) and indifferent for 30/36 (83%) strain/antibiotic combinations. PACT could be a viable treatment option, either alone or in combination with antibiotics for treatment of B. cepacia complex pulmonary infection. PMID:22079165

Cassidy, Corona M; Donnelly, Ryan F; Elborn, J Stuart; Magee, Nicholas D; Tunney, Michael M



Declining incidence of AIDS dementia complex after introduction of zidovudine treatment.  

PubMed Central

OBJECTIVE--To assess the incidence of the AIDS dementia complex and the presence of HIV I p24 antigen in cerebrospinal fluid in relation to zidovudine treatment. DESIGN--Retrospective study of a consecutive series of patients with AIDS from 1982 to 1988. SETTING--An academic centre for AIDS. PATIENTS--196 Patients with AIDS and neurological symptoms examined from 1982 to 1988. INTERVENTIONS--Zidovudine treatment, which was introduced to The Netherlands on 1 May 1987 for patients with severe symptoms of HIV infection (Centers for Disease Control groups IVA, B, C, and D). MAIN OUTCOME MEASURES--Diagnosis of AIDS dementia complex and presence of HIV I p24 antigen in cerebrospinal fluid. RESULTS--The AIDS dementia complex was diagnosed in 40 of the 196 (20%) patients with AIDS. Thirty eight of 107 patients with AIDS (36%) not taking zidovudine developed the AIDS dementia complex compared with two of the 89 (2%) taking the drug (p less than 0.00001). The incidence of the AIDS dementia complex increased to 53% in the first half of 1987, after the introduction of zidovudine in May 1987, decreasing to 10% in the second half of 1987 and to 3% in 1988. Dementia was diagnosed before definition of the AIDS dementia complex (1986) according to DSM-III criteria and there was good agreement between diagnosis before and after 1986. Sixteen of 61 samples of cerebrospinal fluid (26%) from patients with AIDS (10 with the AIDS dementia complex) not taking zidovudine were positive for HIV I p24 antigen, whereas none of 37 cerebrospinal fluid samples from patients with AIDS (two with the AIDS dementia complex) taking zidovudine were positive. CONCLUSIONS--The incidence of AIDS dementia complex in patients with AIDS declined after the introduction of systematic treatment with zidovudine; the AIDS dementia complex might be prevented by inhibiting viral replication in the central nervous system.

Portegies, P.; de Gans, J.; Lange, J. M.; Derix, M. M.; Speelman, H.; Bakker, M.; Danner, S. A.; Goudsmit, J.



[The efficiency of complex recovery treatment of chronic obstructive pulmonary disease patients using subalin].  


The expediency of complex recovery treatment of chronic obstructive pulmonary disease (COPD) patients on the base of artificial rock salt aerosol medium (haloaerosoltherapy) and probiotic drug subalin intake was grounded. It was revealed that additional prescription of subalin results in the more expressed lipoperoxidation's inhibition, especially in patients with COPD II st. and more considerable decrease of endogenic intoxication at COPD III st. It was shown that complex treatment with subalin usage promoted the relief of desease's clinical duration in remoted period. PMID:23356139

Lemko, O I; Habor, M L; Safronova, L A; Lemko, I S; Kopynets'


Effect of penicillamine treatment on immune complexes in two cases of seropositive juvenile rheumatoid arthritis  

PubMed Central

Bresnihan, F. P., and Ansell, B. M. (1976).Annals of the Rheumatic Diseases,35, 463-465. Effect of penicillamine treatment on immune complexes in two cases of seropositive juvenile rheumatoid arthritis. A correlation has previously been observed between the presence of enhancing complexes and cutaneous vasculitis in rheumatoid arthritis. Two patients with seropositive juvenile rheumatoid arthritis are described in whom enhancing complexes were detected before the appearance of cutaneous vasculitis. Their contrasting response to penicillamine is discussed in relation to the role of rheumatoid factor and antinuclear antibodies.

Bresnihan, F. P.; Ansell, Barbara M.



The use of imagery in phase 1 treatment of clients with complex dissociative disorders  

PubMed Central

The “standard of care” for clients with complex dissociative disorders and other complex trauma-related disorders is phase-oriented treatment. Within this frame, therapeutic progress can be enhanced by the use of imagery-based therapeutic techniques. In this article, the emphasis is on their application in phase 1 treatment, stabilization, symptom reduction, and skills training, but attention is also paid to applications in phase 2 and phase 3 treatment. Many of the existing imagery techniques are geared toward clients becoming more able to function in a more adaptive way in daily life, which, however, requires the involvement of various dissociative parts of the personality. Such collaborative involvement is also essential in the later treatment phases. Therefore, understanding the dissociative nature of these disorders is helpful in the judicious application of these techniques.

van der Hart, Onno



[Acute inpatient conservative multimodal treatment of complex and multifactorial orthopedic diseases in the ANOA concept].  


In Germany there is a clear deficit in the non-operative treatment of chronic and complex diseases and pain disorders in acute care hospitals. Only about 20?% of the treatments are carried out in orthopedic hospitals. Hospitals specialized in manual medicine have therefore formed a working group on non-operative orthopedic manual medicine acute care clinics (ANOA). The ANOA has developed a multimodal assessment procedure called the OPS 8-977 which describes the structure and process quality of multimodal and interdisciplinary diagnosis and treatment of the musculoskeletal system. Patients are treated according to clinical pathways oriented on the clinical findings. The increased duration of treatment in the German diagnosis-related groups (DRG) system is compensated for with a supplemental remuneration. Thus, complex and multifactorial orthopedic diseases and pain disorders are conservatively and appropriately treated as inpatient departments of acute care hospitals. PMID:24052170

Psczolla, M



Stability of poly(L-lysine)-complexed plasmid DNA during mechanical stress and DNase I treatment.  


The aim of this study was to investigate the formation and stability of complexes between plasmid DNA (pDNA) and poly(L-lysine) (PLL). Formation of pDNA/PLL complexes with various ratios was determined by a fluorescence spectrophotometric method using fluorescamine. The effects of sonication, vortexing, and exposure to DNase I on the stability of free pDNA and pDNA/PLL complexes are discussed. A linear correlation between PLL added and PLL bound was obtained with overall reaction efficiency of 84.2-92.6%. Sonication degraded both free and PLL-complexed pDNA within 15 sec of vortexing. However, vortexing did not alter the stability of free and complexed pDNA. Dramatic increase in the protection of pDNA in pDNA/PLL complexes was observed in the DNase I digestion experiment; 68.1-89.0% of total pDNA in the pDNA/PLL complexes was protected from DNase I digestion compared to only 19.2% of total pDNA that remained undegraded after DNase I treatment of free pDNA. An increase in the PLL/pDNA ratio led to an increase in the protection of supercoiled pDNA; 15.5-38.2% of supercoiled pDNA pin PLL/pDNA complexes was protected after DNase I treatment. The results show that complexation of pDNA with PLL can stabilize the supercoiled structure of pDNA for the development of biodegradable microspheres as a delivery system for pDNA. Stability of pDNA/PLL complex can be monitored by PicoGreen dye and fluorescence densitometric assay methods. PMID:10578502

Capan, Y; Woo, B H; Gebrekidan, S; Ahmed, S; DeLuca, P P



Combined electron-beam and biological treatment of dyeing complex wastewater. Pilot plant experiments  

Microsoft Academic Search

Pilot plant (output 1000m3day?1) with ELV electron accelerator (energy 1MeV, beam power 40kW) is in operation from October 1998. Combined electron-beam and biological treatment was used for purification of dyeing complex wastewater under continuous flow conditions. The main results of pilot-scale experiments consisted in the fact that decrease in total content of pollutants after biological treatment was substantially influenced by

Bumsoo Han; Jaein Ko; Jinkyu Kim; Yuri Kim; Wooho Chung; I. E. Makarov; A. V. Ponomarev; A. K. Pikaev



Vasculitis complicating treatment with intravenous anisoylated plasminogen streptokinase activator complex in acute myocardial infarction.  

PubMed Central

Vasculitis developed in six of 253 patients treated with intravenous anisoylated plasminogen streptokinase activator complex (APSAC) after acute myocardial infarction. All patients recovered spontaneously with no evidence of renal impairment and no long term sequelae. Although leucocytoclastic vasculitis and serum sickness have been reported after streptokinase treatment, such allergic reactions have not been described as a complication of other thrombolytic agents. Images Figure

Bucknall, C; Darley, C; Flax, J; Vincent, R; Chamberlain, D



Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy  

Microsoft Academic Search

Objective: To evaluate the safety and efficacy of intravenous iron sucrose complex (ISC) as compared with oral ferrous sulfate in the treatment of iron deficiency anemia during pregnancy. Study design: prospective, open, controlled study in which pregnant women with iron deficiency anemia were sequentially selected from the antenatal clinic and assigned either to ISC (study group) or to ferrous sulfate

Abdul-Kareem Al-Momen; Abdulaziz Al-Meshari; Lulu Al-Nuaim; Abdulaziz Saddique; Zainab Abotalib; Tariq Khashogji; Munir Abbas



Complex treatment of trophic affections with vascular patients using monochromatic red light and hyperbaric oxygenation  

NASA Astrophysics Data System (ADS)

Monochromatic red light irradiation therapy of trophic skin affections with vascular patients permits to receive positive results with small wounds. A combination of monochromatic red light and hyperbaric oxygenation is most perspective when conducting a complex therapy of trophic wounds not more than 40 mm2 and allows to diminish time of treatment almost two times.

Babkina, Zinaida M.; Vasilyev, Mikhail V.; Zakharov, Vyacheslav P.; Nikolayev, Viktor V.; Babkin, Vasily I.; Samoday, Valery G.; Zon, Boris A.; Pakhomov, Gennady V.; Naskidashvili, Vasily I.; Kumin, Anatoly A.



Hyaluronic acid-gold nanoparticle/interferon ? complex for targeted treatment of hepatitis C virus infection.  


Gold nanoparticles (AuNPs) have been extensively investigated as an emerging delivery carrier of various biopharmaceuticals. Instead of nonspecific polyethylene glycol (PEG) conjugated interferon ? (IFN?) for the clinical treatment of hepatitis C virus (HCV) infection, in this work, a target-specific long-acting delivery system of IFN? was successfully developed using the hybrid materials of AuNP and hyaluronic acid (HA). The HA-AuNP/IFN? complex was prepared by chemical binding of thiolated HA and physical binding of IFN? to AuNP. According to antiproliferation tests in Daudi cells, the HA-AuNP/IFN? complex showed a comparable biological activity to PEG-Intron with a highly enhanced stability in human serum. Even 7 days postinjection, HA-AuNP/IFN? complex was target-specifically delivered and remained in the murine liver tissue, whereas IFN? and PEG-Intron were not detected in the liver. Accordingly, HA-AuNP/IFN? complex significantly enhanced the expression of 2',5'-oligoadenylate synthetase 1 (OAS1) for innate immune responses to viral infection in the liver tissue, which was much higher than those by IFN?, PEG-Intron, and AuNP/IFN? complex. Taken together, the target-specific HA-AuNP/IFN? complex was thought to be successfully applied to the systemic treatment of HCV infection. PMID:23092111

Lee, Min-Young; Yang, Jeong-A; Jung, Ho Sang; Beack, Songeun; Choi, Jung Eun; Hur, Wonhee; Koo, Heebeom; Kim, Kwangmeyung; Yoon, Seung Kew; Hahn, Sei Kwang



The assertive community treatment team as a complex dynamic system of care.  


This paper presents a dynamic systems view of assertive community treatment (ACT), a recognized evidence-based treatment for adults with severe and persistent mental illness (SPMI). It is argued that because an ACT team operates as a complex adaptive system (CAS), it engages in the organizational processes of "sensemaking" and self-organization, which help to bring order to the actions of team members and sustainability of the intervention itself. Consequently, successful implementation of ACT requires that management technologies such as meaning-creation and design are used in conjunction with traditional "command and control" technologies of policies, procedures, processes, and structures. PMID:15844845

Allred, Charlene A; Burns, Barbara J; Phillips, Susan D



Private sector treatment centres are treating less complex patients than the NHS  

PubMed Central

Summary Objectives In England, patients can choose to have their NHS elective care delivered by private (or ‘independent sector’) providers or by the NHS. Providers are paid a fixed tariff for each type of procedure. Our objectives were to compare NHS providers with private treatment centres in terms of (a) the quality of data coding and (b) patient complexity. Design We compared elective patients aged 18 years and over treated in the NHS and private sectors using the Hospital Episode Statistics (HES) data for 2007–2008. The absence of diagnostic information was used as a measure of data quality. We analysed differences in complexity for each of the 30 Healthcare Resource Groups (HRGs) that together account for 78% of coded private treatment centre activity. Statistical significance was assessed at the 1% level. Setting Hospitals and treatment centres. Main outcome measures Patient complexity was assessed by four characteristics: age; number of diagnoses; number of procedures; and income deprivation of residential area. Results NHS providers treated almost 7 million adult elective patients in 2007–2008. Fewer than 100,000 patients were treated by private providers (1.3% of elective activity). Less than 1% of NHS patients lacked diagnostic information compared to 36% of patients treated by private providers. For the top 30 HRGs, NHS patients had significantly (p<0.01) higher levels of co-morbidity, underwent more procedures and were more likely to come from deprived areas compared with patients treated by private providers. Although patients treated in private settings tended to be younger, the difference was not statistically significant. Conclusions Some private companies provide poor quality data. In general, the NHS is treating more complex patients than private providers. If complexity drives costs, then a fair reimbursement system would require higher payments for NHS providers.

Mason, Anne; Street, Andrew; Verzulli, Rossella



Current Concepts: Simple and Complex Elbow Dislocations – Acute and Definitive Treatment  

Microsoft Academic Search

Dislocations of the elbow account for 20% of all dislocations. Thus, after the shoulder, the elbow joint is the joint most\\u000a frequently afflicted by dislocations. A distinction is made between simple elbowdislocations without associated fractures\\u000a and fracture-dislocations of the elbow, which are frequently referred to as complex elbow dislocations. Treatment principles\\u000a are reduction of the joint, stabilization of associated fractures,

Pascal Jungbluth; Mohssen Hakimi; Wolfgang Linhart; Joachim Windolf



Development of polyion complex membranes based on cellulose acetate modified by oxygen plasma treatment for pervaporation  

Microsoft Academic Search

Cellulose acetate (CA) membrane was modified with ultra-thin polyion complex (PIC) layers, and the pervaporation performance for water–ethanol mixture was investigated. Introduction of oxygen-containing anionic groups onto the surface of the CA membrane was attempted by the oxygen plasma treatment, and was confirmed by the electron spectroscopy for chemical analysis (ESCA). The formation of an ultra-thin PIC layer on the

Samuel P Kusumocahyo; Toshiyuki Kanamori; Takashi Iwatsubo; Kimio Sumaru; Toshio Shinbo



Treatment Complexities of a Young Woman Suffering Psychosis and Pituitary Adenoma  

PubMed Central

This paper is a clinical description of the presentation, therapy, and pharmacological management of a 28-year-old woman who had nine admissions to a psychiatry ward, the last four within one year. It became clear that the treatments, which the patient had received concurrently for ten years for a pituitary adenoma and for psychotic symptoms, were counteractive. The case highlights the importance of the role of prolactin in psychosis and of an interdisciplinary team approach when patients present with complex symptoms.

Sigman, Maxine; Drury, Kate



The influence of thermomechanical treatment on the complex modulus of Mg alloy AZ31  

Microsoft Academic Search

Dynamic modulus analyses were performed on Mg alloy AZ31 following thermomechanical treatments to enable investigation of\\u000a the influence of microstructural features created by plastic deformation on the elastic and the anelastic behavior of this\\u000a alloy as quantified by variations in the complex elastic modulus (E* = E? + iE?) with temperature. The real component or storage modulus (E?) determined for

A. Munitz; R. E. Ricker; D. J. Pitchure; G. Kimmel



Complex pediatric orbital fractures combined with traumatic brain injury: treatment and follow-up.  


The treatment of orbital fractures aims at the restoration of orbital anatomy and prevention of posttraumatic sequels. The treatment of facial fractures in patients with traumatic brain injury may necessitate a postponement of fracture surgery to allow for brain recovery. However, such delay of reconstruction in complex orbital fractures may lead to inferior results. Fourteen pediatric patients with complex orbital fractures were retrospectively reviewed. Eleven patients (79%) had brain injury, with a mean Glasgow Coma Scale score of 8.6 at initial evaluation. Fracture patterns were highly complex with many bilateral and multiple orbital wall fractures. Six patients (43%) had injuries to the medial canthal tendon, as part of a naso-orbito-ethmoid fracture. Mean follow-up time was 4.7 years (range, 1.2-13.1 years). Eleven patients (79%) had reconstructive surgery early (within 3 weeks), and 3 (29%) patients had the surgery postponed. Four patients had secondary surgeries for enophthalmos and medial canthal dislocation. Eighty-two percent of patients with brain injury had a good overall neurologic outcome (Glasgow Outcome Scale score of 1 or 2). Sixty-seven percent of patients had a good aesthetic outcome without any need for revisional surgery. Medial canthal injury and late surgery both correlated with an inferior aesthetic result. In conclusion, good results with respect to mental outcome and aesthetics can be achieved in highly complex orbital fractures combined with brain injury. Delayed surgery and medial canthal tendon injury predispose for posttraumatic sequels and secondary surgery. PMID:20613557

Nowinski, Daniel; Di Rocco, Frederico; Roujeau, Thomas; Meyer, Philippe; Renier, Dominique; Arnaud, Eric



Treatment of plutonium-bearing solutions: A brief survey of the DOE complex  

SciTech Connect

With the abrupt shutdown of some DOE facilities, a significant volume of in-process material was left in place and still requires treatment for interim storage. Because the systems containing these process streams have deteriorated since shutdown, a portable system for treating the solutions may be useful. A brief survey was made of the DOE complex on the need for a portable treatment system to treat plutonium-bearing solutions. A survey was completed to determine (1) the compositions and volumes of solutions and heels present, (2) the methods that have been used to treat these solutions and heels in the past, and (3) the potential problems that exist in removing and treating these solutions. Based on the surveys and on the Defense Nuclear Facilities Safety Board Recommendation 94-1, design criteria for a portable treatment system were generated.

Conner, C.; Chamberlain, D.B.; Chen, L.; Vandegrift, G.F.



Treatment of refractory Mycobacterium avium complex lung disease with a moxifloxacin-containing regimen.  


Moxifloxacin (MXF) has in vitro and in vivo activity against Mycobacterium avium complex (MAC) in experimental models. However, no data are available concerning its treatment effect in patients with MAC lung disease. The aim of this study was to evaluate the clinical efficacy of an MXF-containing regimen for the treatment of refractory MAC lung disease. Patients with MAC lung disease who were diagnosed between January 2002 and December 2011 were identified from our hospital database. We identified 41 patients who received MXF for ? 4 weeks for the treatment of refractory MAC lung disease. A total of 41 patients were treated with an MXF-containing regimen because of a persistent positive culture after at least 6 months of clarithromycin-based standardized antibiotic therapy. The median duration of antibiotic therapy before MXF administration was 410 days (interquartile range [IQR], 324 to 683 days). All patients had culture-positive sputum when MXF treatment was initiated. The median duration of MXF administration was 332 days (IQR, 146 to 547 days). The overall treatment success rate was 29% (12/41), and the median time to sputum conversion was 91 days (IQR, 45 to 190 days). A positive sputum acid-fast-bacillus smear at the start of treatment with MXF-containing regimens was an independent predictor of an unfavorable microbiological response. Our results indicate that MXF may improve treatment outcomes in about one-third of patients with persistently culture-positive MAC lung disease who fail to respond to clarithromycin-based standardized antibiotic treatment. Prospective studies are required to assess the clinical efficacy of MXF treatment for refractory MAC lung disease. PMID:23478956

Koh, Won-Jung; Hong, Goohyeon; Kim, Su-Young; Jeong, Byeong-Ho; Park, Hye Yun; Jeon, Kyeongman; Kwon, O Jung; Lee, Seung-Heon; Kim, Chang Ki; Shin, Sung Jae



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

PubMed Central

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".



Treatment of complex regional pain syndrome type 1 in a pediatric patient using the lidocaine patch 5%: a case report  

Microsoft Academic Search

BackgroundSuccessful treatment of complex regional pain syndrome type 1 (CRPS-1) requires a coordinated, multidisciplinary approach. Physical rehabilitation is an important component of long-term treatment. Unfortunately, patients with significant allodynia or hyperalgesia characteristic of CRPS-1 often have difficulty progressing through a physical therapy (PT) regimen. In most adults with CRPS-1, the treatment of choice is PO opioids.

Steven G Frost



[Expert assessment of operations' complexity and its interrelationship with lethal outcomes and duration of treatment].  


The aim of the work was to carry out expert assessment of complexity of operations and to study interrelationship of the average score of complexity of the interventions with lethal outcome and duration of treatment in the Intensive Care Unit (exemplified by comparison with the outcomes of operations on cardiac valves performed in 2009 in the setting of artificial circulation in adult patients). Complexity was assessed by a total of 13 cardiovascular surgeons specialized in operations aimed at correcting valve defects (4 of them were from the A. N. Bakulev Scientific Centre for Cardiovascular Surgery), with none of the participants being aware of the therapeutic outcomes of each type of the operation performed. An average expert-defined score was assigned for each of the 33 names of the operations. The Kendall coefficient of concordance for all operations amounted to 0.29 (p<0.001); consensus in the complexity-score (from 69 to 85%) was achieved for 48.5% of the operations thus considered. The values of the mean scores of complexity of operations, defined by the specialists form the SCCS (2.02±0.54) were significantly lower (Wilcoxon's test; p<0.001) as compared with the average score assigned by specialists from other facilities (2.28±0.43). The duration of the stay at the ICU of the patients subdivided into groups depending on the expert score was found to differ significantly (p=0.007). The area under the ROC curve using the EuroSCORE (0.59) is suggestive of its lower accuracy in assessing the lethal outcome as compared to the expert score (0.68). The obtained findings strongly suggest advisability of using expert score of operations' complexity for solving complicated non-formalized tasks on allied problems of cardiovascular surgery and organization of public health care (accrediting of medical facilities, formation of the government order, and planning of the budget of medical facilities). PMID:21389961

Bokeriia, L A; Samorodskaia, I V; Skopin, I I; Mironenko, V A; Kambarov, S Iu; Myrzakulov, E S



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

SciTech Connect

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.

Pruden, K.G.; Beaudoin, S.P. [Department of Chemical and Materials Engineering, Arizona State University, Tempe, Arizona 85287-6006 (United States); Department of Chemical and Materials Engineering, Arizona State University, Tempe, Arizona 85287-6006 and School of Chemical Engineering, Purdue University, Forney Hall of Chemical Engineering, 480 Stadium Mall Drive, West Lafayette, Indiana 47907-2100 (United States)



Treatment complexities of a young woman suffering psychosis and pituitary adenoma.  


This paper is a clinical description of the presentation, therapy, and pharmacological management of a 28-year-old woman who had nine admissions to a psychiatry ward, the last four within one year. It became clear that the treatments, which the patient had received concurrently for ten years for a pituitary adenoma and for psychotic symptoms, were counteractive. The case highlights the importance of the role of prolactin in psychosis and of an interdisciplinary team approach when patients present with complex symptoms. PMID:22937400

Sigman, Maxine; Drury, Kate



Treatment of gastric ulceration in 10 standardbred racehorses with a pectin-lecithin complex.  


The severity of the erosive and ulcerative lesions of the squamous gastric mucosa in 10 standardbred racehorses in training was classified according to a standard scoring system. Each horse was then treated orally for 30 days with 50 g/100 kg bodyweight daily of a pectin-lecithin complex mixed into the feed. At the end of the period of treatment, the gastric lesions were re-evaluated gastroscopically and the scores were compared with those assigned at the previous evaluation. In three of the horses the gastric ulcerations had healed completely, and in six others the lesions had improved significantly. PMID:12803394

Ferrucci, F; Zucca, E; Croci, C; Di Fabio, V; Ferro, E



Modeling the Complexity of Post-Treatment Drinking: It's a Rocky Road to Relapse  

PubMed Central

The most widely cited road block to successful treatment outcomes for psychological and substance use disorders has been described as the return to the previous behavior, or “relapse.” The operational definition of “relapse” varies from study to study and between clinicians, but in general the term is used to indicate the return to previous levels of symptomatic behavior. One explanation for the variation in the operationalization of relapse is the wide variety of behaviors for which the term is applied, including (but not limited to): depression, substance abuse, schizophrenia, mania, sexual offending, risky sexual behavior, dieting, and the anxiety disorders. A second explanation for the multitude of definitions for relapse is the inherent complexity in the process of behavior change. In this paper we present the most recent treatment outcome research evaluating relapse rates, with a special focus on the substance use disorders. Following this review of the literature we present an argument for the operationalization of relapse as a dynamic process, which can be empirically characterized using dynamical systems theory. We support this argument by presenting results from the analysis of alcohol treatment outcomes using catastrophe modeling techniques. These results demonstrate the utility of catastrophe theory in modeling the alcohol relapse process. The implications of these analyses for the treatment of alcohol use disorders, as well as a discussion of future research incorporating nonlinear dynamical systems theory is provided.

Witkiewitz, Katie; Marlatt, G. Alan



Limb salvage treatment for Gollop-Wolfgang complex (femoral bifurcation, complete tibial hemimelia, and hand ectrodactyly).  


We reported the findings from three patients with Gollop-Wolfgang complex and demonstrated the results of five limb salvage treatments for this condition. All three femoral bifurcations were accompanied by ipsilateral complete tibial hemimelia. Two patients showed contralateral complete or partial tibial hemimelia, and one patient had hand ectrodactyly. The five limb salvage treatments included resection of the anteromedial bifurcated femur in three limbs, foot centralization in five limbs, tibiofibular fusion in one limb with partial tibial hemimelia, fibular transfer (Brown's procedure) in three limbs with complete tibial hemimelia, and callus distraction lengthening in one limb. The duration from the first operation to the final follow-up ranged from 3.5 to 5.4 years. None of the three knees treated by fibular transfer achieved a successful functional result, but all of the knees were ultimately able to withstand weight bearing. Early knee disarticulation and resection of the protruded bifurcated femur, followed by fitting of a modern prosthesis is likely to be the best treatment for patients with Gollop-Wolfgang syndrome. We note that limb salvage treatment is an alternative in patients who opt to retain their feet and refuse amputation. PMID:23660549

Wada, Akifusa; Nakamura, Tomoyuki; Fujii, Toshio; Urano, Noriko; Yanagida, Haruhisa; Takamura, Kazuyuki; Taketa, Mayuki; Oketani, Yutaka; Kubota, Hideaki



"Sandwich technique" in the surgical treatment of primary complex fractures of the femur and humerus  

PubMed Central

In this prospective study, our aim was to determine the clinical and radiographic outcomes of the surgical treatment of primary complex problem femoral and humeral shaft fractures treated by a new technique called “sandwich technique.” A total of 45 patients with comminuted, complex and/or osteopoenic fractures of the femur or humerus (30 femoral and 15 humeral fractures) were treated using this technique. The patients were followed up for a mean of 25 months. In 24 (85.7%) of 28 patients with femoral fractures and in 14 (93.3%) of 15 patients with humeral fractures, union was achieved within 3–6 months of the operation (mean: 4.5 months). The total union rate was 88.4%. The pseudoarthrosis rate was 12%. There was no infection or implant failure seen during the follow-up period. The cortical allograft struts can be used to provide collateral support to weakened osteopoenic/osteoporotic bone. This technique provides a union rate of about 88% in osteoporotic and/or complex primary humerus or femur fractures.

Gogus, A.; Tezer, M.; Camurdan, K.; Hamzaoglu, A.



Predicting Stabilizing Treatment Outcomes for Complex Posttraumatic Stress Disorder and Dissociative Identity Disorder: An Expertise-Based Prognostic Model  

Microsoft Academic Search

The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex PTSD therapists), and in the second round we surveyed a subset of 22

Erik W. Baars; Onno van der Hart; Ellert R. S. Nijenhuis; James A. Chu; Gerrit Glas; Nel Draijer



Treatment of complex chemical wastewater in a sequencing batch reactor (SBR) with an aerobic suspended growth configuration  

Microsoft Academic Search

A sequencing batch reactor (SBR) has certain advantages over conventional activated sludge processes (ASP) for the treatment of complex wastewater. The performance of a sequencing batch reactor in treating complex chemical effluents was investigated with a suspended biomass configuration and operating under aerobic conditions. A total sequence of 24h (15min: filling phase; 23h: reaction phase (aeration with recirculation); 30min: setting;

S. Venkata Mohan; N. Chandrashekara Rao; K. Krishna Prasad; B. T. V. Madhavi; P. N. Sharma



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

ERIC Educational Resources Information Center

|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…

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



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

|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…

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



Pipeline™ embolization device for the treatment of complex intracranial aneurysms: a NICE Medical Technology Guidance.  


As part of its Medical Technologies Evaluation Programme, the National Institute of Health and Clinical Excellence (NICE) invited the manufacturer, Covidien, to provide clinical and economic evidence for the evaluation of the Pipeline™ embolization device (PED) for the treatment of complex intracranial aneurysms. Cedar; a consortium between Cardiff and Vale University Health Board and Cardiff University, was commissioned to act as an External Assessment Centre (EAC) for NICE to independently critique the manufacturers' submissions. This article gives an overview of the evidence provided, the findings of the EAC and the final guidance published by NICE. The scope issued by NICE considered PED as the intervention in a patient population with complex unruptured intracranial aneurysms (IAs), specifically large/giant, wide-necked and fusiform aneurysms. The comparator treatments identified were stent-assisted coiling, parent vessel occlusion, neurosurgical techniques and conservative management. The manufacturer claimed that PED fulfils a currently unmet clinical need in the treatment of large or giant, wide-necked or fusiform IAs. Thirteen studies were identified by the manufacturer as being relevant to the decision problem, with two of these included for data extraction. The EAC identified 16 studies as relevant, three of which had been published after the manufacturer's search. Data extraction was carried out on these studies as, although many were low level research comprising of case reports and case series, they provided useful, pertinent safety and outcome data. No relevant economic studies of the device were identified; therefore, a new economic model was designed by the manufacturer. The base-case scenario provided recognized the costs of PED to be higher than the costs for endovascular parent vessel occlusion, neurosurgical parent vessel occlusion, neurosurgical clipping and conservative management. However, PED was found to be cost saving compared with stent-assisted coiling, with a saving of £13,110 per patient. Analysis of the clinical data suggested that treatment with PED has high rates of clinical success with high rates of aneurysm occlusion and acceptable adverse events for the patient population. Economic evidence suggested that the costs in the base-case for PED may have been underestimated, meaning that PED would only become cost saving in patients who would otherwise require treatment with 32 coils or more. NICE Medical Technologies Guidance MTG10, issued in May 2012, recommends the adoption of PED in selected patients within the UK National Health Service (NHS). PMID:23341264

Withers, Kathleen; Carolan-Rees, Grace; Dale, Megan



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


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

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



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


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

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



A Controlled Pilot-Outcome Study of Sensory Integration (SI) in the Treatment of Complex Adaptation to Traumatic Stress  

Microsoft Academic Search

This study tested whether sensory integration (SI) treatment combined with psychotherapy would improve symptom outcome over psychotherapy alone in the treatment of complex posttraumatic stress, as measured by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) clinical construct in a group of 10 adult patients with histories of childhood abuse. DESNOS symptoms were assessed at three time periods (T1,

Erika M. Kaiser; Craig S. Gillette; Joseph Spinazzola



Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis  

Microsoft Academic Search

Objective: The treatment of complex aortic pathologies of the thoracic aorta remains a challenging issue in aortic surgery. The most recent development of the classic elephant trunk technique, the ‘frozen elephant trunk’ technique, represents the combination of an endovascular approach with a conventional surgical treatment for a hybrid approach. Methods: Between January 2007 and July 2008, 34 patients were operated

Roberto Di Bartolomeo; Luca Di Marco; Alessandro Armaro; Daniele Marsilli; Alessandro Leone; Emanuele Pilato; Davide Pacini



Treatment of complex proximal interphalangeal joint fractures using a new dynamic external fixator: 15 cases.  


The management of proximal interphalangeal joint fractures of the fingers is difficult. Dynamic traction splinting systems are cumbersome and the Suzuki fixator does not prevent secondary fracture displacement. Fifteen cases were treated with a new dynamic external fixator with distraction, the Ligamentotaxor. In two cases, additional fixation was required with a screw. After 10 months, grip strength scored 85.7% compared with the contralateral hand, flexion achieved 76.3 degrees and the extension deficit was 19.6 degrees . The visual analogical scale pain level (VAS) was 1.9 and the Quick DASH score totalled 16.9. Revision treatment was needed for sepsis for one patient. A case of secondary fracture displacement was corrected in the outpatient clinic. Consolidation was achieved in all cases. In conclusion, despite imperfect outcomes for these complex fractures, we believe that the Ligamentotaxor technique is useful. PMID:19362033

Körting, O; Facca, S; Diaconu, M; Liverneaux, P



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

NASA Astrophysics Data System (ADS)

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.

Sokolova, Irina; Erina, Stanislava



[Clinical results with a complex conservative treatment method in infiltrative ophthalmopathy (preliminary report)].  


The present methods for the treatment of infiltrative ophthalmopathy are still unsatisfactory, some of them associated with considerable and lasting side effects. Clinical results are present in the communication, from the application of an original therapeutic complex, consisting in the parallel administration of ACTH, intravenous infusions, moderate doses cortison, diuretics and sanation via antibiotics and eventual surgical intervention of the existing focal infectious agents. The complex is applied in the course of 4 weeks. Regression of the clinical symptomatics is observed and assessed by a particular method, it reaches an average of about 50 per cent of the initial manifestations. In 45 per cent of the patients the result was assessed as very good and excellent. The subjective complaints, congestion, chemosis and edema are best and most rapidly influenced, whereas exophthalmos and the eventual ophthalmoplegic phenomena showed no essential changes. The correlations between the results obtained, accompanying the disease (Basedow disease, focal infections) and the severity of ophthalmopathy were discussed. The method was admitted to be perspective, harmless and could ensure good and lasting therapeutic results of properly and persistently applied. PMID:6275612

Bozadzhieva, E; V?rbanov, V; Denev, V; Ovcharova, N; Pe?cheva, E



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

NASA Astrophysics Data System (ADS)

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.

Visa, Maria



Treatment of complex regional pain syndrome type I with oral phenoxybenzamine: rationale and case reports.  


The nonselective alpha-adrenergic antagonist, phenoxybenzamine, has been used in the treatment of neuropathic pain syndromes, specifically, complex regional pain syndrome (CRPS) types I and II. This agent has also previously been used in intravenous regional peripheral blocks for treatment of CRPS I; however, an intravenous preparation of phenoxybenzamine is not currently available in the U.S.A. In this case series, systemic administration was more appropriate for three of the four patients, as their syndromes had spread beyond the initial area of surgery or trauma. We report an apparent clinical benefit in three of the four patients following oral administration. We postulate that this may be due to the noncompetitive (irreversible) blockade of alpha(1)- and alpha(2)-adrenergic receptors. We further hypothesize that this blockade could reduce stimulation of an increased population of adrenergic receptors in hyperalgesic skin, blunt the stimulation by norepinephrine of alpha(2)-adrenergic receptors on macrophages, and ultimately reduce the release of proinflammatory cytokines from cellular elements. PMID:18194348

Inchiosa, Mario A; Kizelshteyn, Grigory



Decisions on multiple sclerosis immunotherapy: new treatment complexities urge patient engagement.  


For patients with multiple sclerosis (MS) involvement in treatment decisions becomes ever more imperative. Recently new therapeutic options have become available for the treatment of MS and more will be licensed in the near future. Although more efficacious and easier to administer, the new drugs pose increased risks of severe side effects. Also, new diagnostic criteria lead to more and earlier MS diagnoses. Facing increasingly complex decisions, patients need up-to-date evidence-based information and decision support systems in order to make informed decision together with physicians based on their autonomy preferences. This article summarizes recently terminated and ongoing trials on MS patient education and decision aids conducted by the authors' study groups. Programs on relapse management, immunotherapy, and for patients with suspected and early MS have been developed and evaluated in randomized controlled clinical trials. It could be shown that the programs successfully increase knowledge and allow patients to make informed decisions based on their preferences. For the near future, we aim to develop a modular program for all relevant decisions in MS to increase patients' self-management and empower patients to develop their individual approach with the disease. Faced by a disease with many uncertainties, this should enhance patients' sense of control. Still, it remains a challenge to adequately assess decision quality. Therefore, a study in six European and one Australian centers will start soon aiming to establish adequate tools to assess decision-making quality. PMID:20920815

Heesen, Christoph; Solari, Alessandra; Giordano, Andrea; Kasper, Jürgen; Köpke, Sascha



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

PubMed Central

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.

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



Medial reconstruction technique in the treatment of complex fractures of humeral proximal epiphysis with SMR prosthetic modular system  

Microsoft Academic Search

Prosthetic treatment of complex fractures of humeral proximal meta-epiphysis is a very complex surgery that often does not\\u000a lead to satisfactory results. Indeed, although in the last 35 years since Neer’s studies some progress has been made in the\\u000a knowledge of the anatomy of humeral meta-epiphysis proximal portion, surgical technique and prosthetic design, in the literature\\u000a we find non-homogeneous experiences

Raffele Russo; Luigi Vernaglia Lombardi; Fabio Cautiero; Gerardo Giudice; Michele Ciccarelli



Autologous chondrocyte implantation (ACI) for the treatment of large and complex cartilage lesions of the knee  

PubMed Central

Background Complex cartilage lesions of the knee including large cartilage defects, kissing lesions, and osteoarthritis (OA) represent a common problem in orthopaedic surgery and a challenging task for the orthopaedic surgeon. As there is only limited data, we performed a prospective clinical study to investigate the benefit of autologous chondrocyte implantation (ACI) for this demanding patient population. Methods Fifty-one patients displaying at least one of the criteria were included in the present retrospective study: (1.) defect size larger than 10 cm2; (2.) multiple lesions; (3.) kissing lesions, cartilage lesions Outerbridge grade III-IV, and/or (4.) mild/moderate osteoarthritis (OA). For outcome measurements, the International Cartilage Society's International Knee Documentation Committee's (IKDC) questionnaire, as well as the Cincinnati, Tegner, Lysholm and Noyes scores were used. Radiographic evaluation for OA was done using the Kellgren score. Results and Discussion Patient's age was 36 years (13-61), defects size 7.25 (3-17.5) cm2, previous surgical procedures 1.94 (0-8), and follow-up 30 (12-63) months. Instruments for outcome measurement indicated significant improvement in activity, working ability, and sports. Mean ICRS grade improved from 3.8 preoperatively to grade 3 postoperatively, Tegner grade 1.4 enhanced to grade 3.39. The Cincinnati score enhanced from 25.65 to 66.33, the Lysholm score from 33.26 to 64.68, the Larson score from 43.59 to 79.31, and Noyes score from 12.5 to 46.67, representing an improvement from Cincinnati grade 3.65 to grade 2.1. Lysholm grade 4 improved to grade 3.33, and Larson grade 3.96 to 2.78 (Table 1), (p < 0.001). Patients with kissing cartilage lesions had similar results as patients with single cartilage lesions. Table 1 Mean scores and grades at surgery (Tx) and at follow-up Tx Follow-up Score Grade Score Grade ICRS 4 3 Tegner 1 3 Noyes 13 47 Cincinnati 26 4 66 2 Lysholm 33 4 65 3 Larson 44 4 79 3 Conclusion Our results suggest that ACI provides mid-term results in patients with complex cartilage lesions of the knee. If long term results will confirm our findings, ACI may be a considered as a valuable tool for the treatment of complex cartilage lesions of the knee.



Spinal cord stimulation in the treatment of complex regional pain syndrome (CRPS) of the lower extremity: a case report.  


Complex regional pain syndrome (CRPS) is a condition that is often associated with the extremities. This chronic pain syndrome, when localized to the lower extremity, includes peripheral changes such as edema, temperature alterations, limited range of motion, loss of or excessive perspiration, pain out of proportion to any stimulus, and trophic alterations of the skin, hair, and nails. In this report, we describe the case of a patient who developed complex regional pain syndrome following an ankle injury and surgery. This case report highlights treatment options that are available to patients experiencing complex regional pain, including the use of a spinal cord stimulator. Level of Clinical Evidence: 4. PMID:19110160

Saranita, Julie; Childs, Douglas; Saranita, Anthony D


Serial CT Findings of Nodular Bronchiectatic Mycobacterium avium Complex Pulmonary Disease With Antibiotic Treatment.  


OBJECTIVE. The objective of our study was to analyze the serial CT findings of patients with the nodular bronchiectatic form of Mycobacterium avium complex (MAC) pulmonary disease treated with antibiotic therapy. MATERIALS AND METHODS. Between January 2005 and December 2009, MAC lung disease was diagnosed in 475 patients at a single tertiary referral hospital. Of the 475 patients, 339 had a CT pattern of disease consistent with the nodular bronchiectatic form. Among these 339 patients, 110 patients treated with a combination of antibiotics for 1 year were selected for this study. Two independent chest radiologists reviewed retrospectively the chest CT scans of 101 patients (M. avium disease [n = 57] and M. intracellulare disease [n = 44]) in whom serial CT scans had been obtained at the beginning of and at 12 months after standardized therapy. Each CT study was assessed for the presence and extent of lung parenchymal abnormalities (maximum score, 30). RESULTS. After 12 months of antibiotic therapy, 84 patients (83%) had a decrease in the overall CT score, three (3%) had an increase, and 14 (14%) had no change in disease extent. The decrease in total CT score was statistically significant (overall score difference, 2.54; p < 0.0001). Cellular bronchiolitis showed the largest decrease in extent (difference in mean pre and posttreatment scores, -1.02, -1.07, and -0.94 for MAC, M. avium, and M. intracellulare diseases, respectively). Before treatment, patients with M. intracellulare disease showed more extensive disease than patients with M. avium disease (total CT score, 13.31 vs 11.10; p = 0.025). CONCLUSION. In the nodular bronchiectatic form of MAC pulmonary disease, lung parenchymal abnormalities show a significant decrease in extent on CT after antibiotic treatment and the decrease is mainly related to the improvement of cellular bronchiolitis. PMID:24059365

Lee, Geewon; Kim, Hyun Su; Lee, Kyung Soo; Koh, Won-Jung; Jeon, Kyeongman; Jeong, Byeong-Ho; Ahn, Joonghyun



Heart Failure with a Normal Ejection Fraction: Treatments for a Complex Syndrome?  

PubMed Central

Opinion statement Heart failure with a normal ejection fraction (HFNEF) now comprises more than 50% of all patients with heart failure. As the population ages, HFNEF will continue to be a growing public health problem. Recent studies highlight the heterogeneity of this syndrome with regards to underlying pathophysiologic mechanisms. It has been recognized that multiple physiologic domains of cardiovascular function are abnormal in afflicted subjects resulting in a reduced reserve capacity which contributes in an integrated fashion to produce the observed phenotype. Additionally, the realization that differing aspects of this syndrome (e.g. exercise limitations, pulmonary edema and labile blood pressure) likely each have distinct physiologic causes further adds to the complexity. As a result of the heterogeneous nature of the pathophysiologic processes and comorbid illnesses in this population, there is a wide range of clinical outcomes. Accordingly, appreciation of the global nature of HFNEF will ideally better inform optimal design for future diagnostic and therapeutic strategies. Completed clinical trials have not resulted in any evidence-based treatments available for improving survival. Given the disappointing results of these investigations, there has been renewed interest in developing interventions that target underlying comorbidities and peripheral mechanisms. Additionally, non-pharmacologic interventions such as diet and exercise have shown promise in early, small clinical investigations. Finally, methods to more rationally subgroup patients in order to identify cohorts who could respond to targeted intervention are essential. Recognizing the success achieved in the treatment of systolic heart failure, or heart failure with a reduced ejection fraction (HFREF) by addressing neurohormonal and renal mechanisms, new therapies for HFNEF may be achieved by a similar shift in attention away from the heart.

Bernard, Samuel; Maurer, Mathew S.



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

PubMed Central

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.

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



Successful treatment of complex traumatic and surgical wounds with a foetal bovine dermal matrix.  


A foetal bovine dermal repair scaffold (PriMatrix, TEI Biosciences) was used to treat complex surgical or traumatic wounds where the clinical need was to avoid skin flaps and to build new tissue in the wound that could be reepithelialised from the wound margins or closed with a subsequent application of a split-thickness skin graft (STSG). Forty-three consecutive cases were reviewed having an average size of 79·3?cm(2) , 50% of which had exposed tendon and/or bone. In a subset of wounds (44·7%), the implantation of the foetal dermal collagen scaffold was also augmented with negative pressure wound therapy (NPWT). Complete wound healing was documented in over 80% of the wounds treated, whether the wound was treated with the foetal bovine dermal scaffold alone (95·2%) or when supplemented with NPWT (82·4%). The scaffold successfully incorporated into wounds with exposed tendon and/or bone to build vascularised, dermal-like tissue. The new tissue in the wound supported STSGs however, in the majority of the cases (88·3%); wound closure was achieved through reepithelialisation of the incorporated dermal scaffold by endogenous wound keratinocytes. The foetal bovine dermal repair scaffold was found to offer an effective alternative treatment strategy for definitive closure of challenging traumatic or surgical wounds on patients who were not suitable candidates for tissue flaps. PMID:23452161

Hayn, Ernesto



Successive multisite peripheral nerve catheters for treatment of complex regional pain syndrome type I.  


Complex regional pain syndrome (CRPS) type I is a painful and disabling syndrome that is accompanied by physical changes in the affected extremity. It generally occurs after trauma, manifesting as pain that is out of proportion to the inciting event. Treatment of the disorder is difficult, with many patients being refractory to multiple pharmacologic regimens. Regional anesthetic techniques, including neuraxial blockade, sympathetic blockade, Bier block, or peripheral nerve catheters, have been used with varying degrees of success. We describe, for the first time, the use of multiple peripheral nerve catheters to treat CRPS type I in a 10-year-old girl when multimodal pharmacologic regimens failed. At separate times, a peripheral nerve catheter was placed to treat CRPS of the distal left lower extremity as well as the right upper extremity. The goal of this therapy was to relieve pain and thereby allow the reinitiation of intensive physical therapy. A continuous infusion of 0.1% ropivacaine was infused via the catheters for ~60 hours. The patient was subsequently able to participate in physical therapy as well as activities of daily living with improved eating, sleeping, and mood. Although many therapeutic modalities have been tried in CRPS type I, given the debilitating nature of the disorder and the variable response to therapy, new and alternative therapeutic interventions, such as continuous peripheral nerve catheters, are needed. PMID:23230070

Martin, David P; Bhalla, Tarun; Rehman, Saif; Tobias, Joseph D



Recycle unit wastewater treatment in petrochemical complex using reverse osmosis process.  


The implementation of reverse osmosis (RO) process is a solution for increasing water demand. In this work the treatment feasibility of effluent wastewater in Tabriz Petrochemical Complex was evaluated using RO pilot plant. After a pretreatment with cartridge filters, wastewater was introduced to RO unit with a rate of 2000-12,000 l/h. The permeated rate was 600-1500 l/h using different applied pressures of 5-22 bars. The results showed that Chemical Oxygen Demand (COD), Biological Oxygen Demand (BOD), Conductivity, Total Dissolved Solid (TDS), color, turbidity, SO(4), NH(4), Calcium Hardness (CaH), Total Hardness (TH), suspended solid (SS) and SiO(2) of the wastewater were decreased and removed extensively using RO membranes. The flux of permeated stream and the recovery rate were increased with the feed pressure. However the optimum operating pressure for the reverse osmosis pilot was determined as 15 bars leading to a recovery rate of 45%. The results indicate that achieving the "Zero Discharge" goal is possible using RO system. The plan for zero discharge is conducting the concentrated waste from the reverse osmosis system to evaporation pond. PMID:19836881

Madaeni, S S; Eslamifard, M R



Endoscopic thoracic sympathicotomy for the treatment of complex regional pain syndrome.  


Complex regional pain syndrome (CRPS) is a neurological syndrome that usually affects one or more extremities, and can cause chronic pain and permanent deformities. This study aimed to analyze the efficacy of endoscopic thoracic sympathicotomy (ETS) in the treatment of pain in patients with CRPS stage II and III operated on in our clinic. Seven patients (four males and three females; mean age 34.7 years; American Society of Anesthesiologists physical status 1 and 3; post-operative follow-up from 5 to 49, mean 33.6 months), with diagnoses of CRPS type I and II, stages II and III, were operated on as outpatients. The sympathetic chain was severed over the ribs from T2 to T5, along with the communicating rami of these segments, including the Kuntz nerve. The ETS was performed bilaterally in four patients. Pain was assessed using a visual analogic scale (VAS) from 0 to 10. Pain disappeared in all patients operated on during rest (VAS = 0). Four patients reported pain during repeated movement of the affected limb, the intensity being lower than before surgery (mean VAS = 2.62 vs 8.46). Analgesics were no longer needed after surgery. All patients had their quality of life improved. According to the present investigation, ETS, as described, was efficient for the relief of pain and improvement of the quality of life in patients with CRPS stage II and III. PMID:14673676

Bosco Vieira Duarte, João; Kux, Peter; Duarte, Denise França Magalhães



Performance of anaerobic hybrid reactors for the treatment of complex phenolic wastewaters with biogas recirculation.  


This study investigates the application of a novel anaerobic hybrid reactor (AHR) configuration, incorporating support media for biomass immobilisation and biogas recirculation for improved mixing towards the anaerobic treatment of complex phenolic wastewater. Synthetic coal wastewater with an average phenolics and COD concentration of 752 and 2240 mg L(-1) was used as substrate. Biogas recirculation was employed at four different rates of 11.25, 16.87, 25.30 and 37.95 L d(-1) for 100 days. Phenolics and COD removal improved with increase in biogas recirculation. After 120 days of continuous operation, the results revealed that a high amount (14.0 g VSS) of biomass was able to attach itself to the support medium. The investigated AHR configuration achieved phenolics and COD removal efficiencies of 95% and 92% respectively at a hydraulic retention time (HRT) of 0.33 d. The corresponding average methane production obtained in this study was 0.02 mol methane g(-1) COD. PMID:23232220

Ramakrishnan, Anushuya; Surampalli, Rao Y



Surgical Treatment of Ideberg Type III Glenoid Fractures With Associated Superior Shoulder Suspensory Complex Injury.  


Ideberg type III glenoid fractures with associated superior shoulder suspensory complex (SSSC) injuries are rare, and related treatments have not been reported in the literature. The purpose of this study was to evaluate the clinical outcomes of such injuries treated with open reduction and internal fixation (ORIF). Between July 2007 and April 2012, ten patients with Ideberg type III glenoid fractures were surgically treated using ORIF with 2 cannulated screws or a screw combined with a metacarpal plate through an anterior approach. Patients with associated SSSC injuries underwent ORIF with K-wires or plates. Information was available for 9 patients with a mean follow-up of 24.1±18.2 months. Mean bone-healing time was 8.4±2.2 weeks. At last follow-up, mean forward flexion of the operative shoulder was 157.8°±7.5°, mean external rotation was 62.9°±7.9°, and mean internal rotation was thoracic level T6±0.8. Mean Constant score was 84.1±3.7 points, which was a mean of 92.7%±3.4% of that seen in the contralateral shoulder. Mean UCLA score and Disabilities of the Arm, Shoulder and Hand score were 33.6±1.7 and 16.6±7.7, respectively. The results show that Ideberg type III glenoid fractures with associated SSSC injuries can be successfully treated using ORIF through an anterior approach. Glenoid fractures and SCCC injuries should be treated simultaneously. PMID:24093698

Qin, Hui; Hu, Chuan-Zhen; Zhang, Xian-Long; Shen, Long-Xiang; Xue, Zi-Chao; An, Zhi-Quan



Human pilot studies reveal the potential of a vitronectin: growth factor complex as a treatment for chronic wounds.  


Several different advanced treatments have been used to improve healing in chronic wounds, but none have shown sustained success. The application of topical growth factors (GFs) has displayed some potential, but the varying results, high doses and high costs have limited their widespread adoption. Many treatments have ignored the evidence that wound healing is driven by interactions between extracellular matrix proteins and GFs, not just GFs alone. We report herein that a clinical Good Manufacturing Practice-grade vitronectin:growth factor (cVN:GF) complex is able to stimulate functions relevant to wound repair in vitro, such as enhanced cellular proliferation and migration. Furthermore, we assessed this complex as a topical wound healing agent in a single-arm pilot study using venous leg ulcers, as well as several 'difficult to heal' case studies. The cVN:GF complex was safe and re-epithelialisation was observed in all but 1 of the 30 patients in the pilot study. In addition, the case studies show that this complex may be applied to several ulcer aetiologies, such as venous leg ulcers, diabetic foot ulcers and pressure ulcers. These findings suggest that further evaluation is warranted to determine whether the cVN:GF complex may be an effective topical treatment for chronic wounds. PMID:21914133

Upton, Zee; Wallace, Hilary J; Shooter, Gary K; van Lonkhuyzen, Derek R; Yeoh-Ellerton, Sim; Rayment, Erin A; Fleming, Jacqui M; Broszczak, Daniel; Queen, Douglas; Sibbald, R Gary; Leavesley, David I; Stacey, Michael C



[Endoscopic diagnosis and complex treatment of Barrett's esophagus complicated by hernia of esophageal foramen of the diaphragm].  


A protocol is suggested of complex diagnosis and treatment of Barrett's esophagus using sparing endoscopic removal of Barrett's epithelium in combination with surgery and medicinal antireflux therapy. Eighty-three patients were diagnosed and treated for hernia of esophageal foramen of the diaphragm and gastro-esophageal reflux complicated by Barrett's esophagus. Ninety-two percent of patients receiving our four-component treatment were cured; no recurrent esophageal adenocarcinoma was reported during the 56.7 +/- 2.4 month follow-up. Conversely, in patients receiving three-component treatment, efficacy was 56%; esophageal adenocarcinoma was reported in 3 (12%). PMID:20210013

Burmistrov, M V; Ivanov, A I; Petrov, S V; Akhmetov, T R; Sigal, E I; Murav'ev, V Iu; Moroshek, A A; Broder, I A



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

NASA Astrophysics Data System (ADS)

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.

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



Complex regional pain syndrome: A review of evidence-supported treatment options  

Microsoft Academic Search

Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury.\\u000a In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional\\u000a pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons.\\u000a In florid

E. Daniela Hord; Anne Louise Oaklander



Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study  

PubMed Central

Background: Burden of treatment refers to the workload of health care as well as its impact on patient functioning and well-being. We set out to build a conceptual framework of issues descriptive of burden of treatment from the perspective of the complex patient, as a first step in the development of a new patient-reported measure. Methods: We conducted semistructured interviews with patients seeking medication therapy management services at a large, academic medical center. All patients had a complex regimen of self-care (including polypharmacy), and were coping with one or more chronic health conditions. We used framework analysis to identify and code themes and subthemes. A conceptual framework of burden of treatment was outlined from emergent themes and subthemes. Results: Thirty-two patients (20 female, 12 male, age 26–85 years) were interviewed. Three broad themes of burden of treatment emerged including: the work patients must do to care for their health; problem-focused strategies and tools to facilitate the work of self-care; and factors that exacerbate the burden felt. The latter theme encompasses six subthemes including challenges with taking medication, emotional problems with others, role and activity limitations, financial challenges, confusion about medical information, and health care delivery obstacles. Conclusion: We identified several key domains and issues of burden of treatment amenable to future measurement and organized them into a conceptual framework. Further development work on this conceptual framework will inform the derivation of a patient-reported measure of burden of treatment.

Eton, David T; Ramalho de Oliveira, Djenane; Egginton, Jason S; Ridgeway, Jennifer L; Odell, Laura; May, Carl R; Montori, Victor M



Wherefore the Oedipus Complex in Adolescence? Its Relevance, Evolution, and Appearance in Treatment  

Microsoft Academic Search

This article is a critique of the frequent and reflexive use of the Oedipus complex in clinical discussions as a constellation that refers specifically to experiences of young children. A more fluid concept of the Oedipus complex is described in which it is seen as a constellation of issues that derives from early childhood and recurs throughout development. The adolescent

Marsha H. Levy-Warren



Complexity in Late-Life Depression: Impact of Confounding Factors on Diagnosis, Treatment, and Outcomes  

Microsoft Academic Search

Late-life depression is a heterogeneous syndrome. Although depression in elderly patients is highly treatable, a number of factors or confounds create complexity in its overall management. Patient factors, such as medical illness, neuropsychiatric comorbidity, and race, may interact with provider factors to make management more complex. Outcomes and services research indicate that these factors, particularly medical illness, affect whether late-life

Helen C. Kales; Marcia Valenstein



Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears.  


Ulnar-sided wrist pain is a common cause of upper extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the "black box" of the wrist, and its pathology has been compared with low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilaginous complex injuries, lunotriquetrial ligament injuries, and ulnar impaction syndrome. PMID:22721461

Sachar, Kavi



Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears.  


Ulnar-sided wrist pain is a common cause of upper-extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the "black box" of the wrist, and its pathology has been compared with that of low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilage complex injuries, lunotriquetral ligament injuries, and ulnar impaction syndrome. PMID:18984356

Sachar, Kavi



Circulatory arrest and deep hypothermia for the treatment of complex intracranial aneurysms—results from a single European center  

Microsoft Academic Search

Background  Vascular neurosurgery faces the controversial discussion about the need for deep hypothermia and circulatory arrest (dh\\/ca)\\u000a for the treatment of complex cerebral aneurysms. In this retrospective analysis, we present our experience in the treatment\\u000a of 26 giant and large cerebral aneurysms under profound hypothermia and circulatory arrest.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All patients were treated surgically under dh\\/ca. Seventeen patients had aneurysms of the

Karl-Michael Schebesch; Martin Proescholdt; Odo-Winfried Ullrich; Daniele Camboni; Stefan Moritz; Christoph Wiesenack; Alexander Brawanski



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

SciTech Connect

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.

Becthel Jacobs Company LLC



Predicting stabilizing treatment outcomes for complex posttraumatic stress disorder and dissociative identity disorder: an expertise-based prognostic model.  


The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex PTSD therapists), and in the second round we surveyed a subset of 22 of the 42 therapists (13 DID and 9 complex PTSD therapists). First, we drew on therapists' knowledge of prognostic factors for stabilization-oriented treatment of complex PTSD and DID. Second, therapists prioritized a list of prognostic factors by estimating the size of each variable's prognostic effect; we clustered these factors according to content and named the clusters. Next, concept mapping methodology and statistical analyses (including principal components analyses) were used to transform individual judgments into weighted group judgments for clusters of items. A prognostic model, based on consensually determined estimates of effect sizes, of 8 clusters containing 51 factors for both complex PTSD and DID was formed. It includes the clusters lack of motivation, lack of healthy relationships, lack of healthy therapeutic relationships, lack of other internal and external resources, serious Axis I comorbidity, serious Axis II comorbidity, poor attachment, and self-destruction. In addition, a set of 5 DID-specific items was constructed. The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. Further research is needed to test the model's statistical and clinical validity. PMID:21240739

Baars, Erik W; van der Hart, Onno; Nijenhuis, Ellert R S; Chu, James A; Glas, Gerrit; Draijer, Nel



Use of rotation thromboelastometry (ROTEM) to achieve successful treatment of polytrauma with fibrinogen concentrate and prothrombin complex concentrate.  


Goal-directed coagulation therapy is essential in the management of trauma patients with severe bleeding. Due to the complex nature of coagulation disorders in trauma, a quick and reliable diagnostic tool is essential. We report a severely injured multiple trauma patient who received haemostatic therapy with coagulation factor concentrates, guided by rotational thromboelastometry (ROTEM). Initial therapy consisted of fibrinogen concentrate (Haemocomplettan P), as maximum clot firmness in the ROTEM analyses was low, whereas clotting time was normal. Later on, prothrombin complex concentrate was given to optimise thrombin generation. This approach enabled extended emergency hemihepatectomy to be performed without using fresh frozen plasma. As the EXTEM maximum clot firmness showed good clot quality, no platelets were transfused despite low platelet counts. This case shows the potential success of treatment using both fibrinogen concentrate and prothrombin complex concentrate, not only in restoring haemostasis but also in minimising requirement for transfusion of allogeneic blood products. PMID:19995349

Schöchl, H; Forster, L; Woidke, R; Solomon, C; Voelckel, W



Caffeine Salt Complexes and Methods for Using the Same in the Prevention or Treatment of Cancer.  

National Technical Information Service (NTIS)

The present invention relates to pharmaceutical compositions containing a caffeine salt complex and a pharmaceutically acceptable carrier for use in methods for preventing or treating cancer or solar dermatitis. Methods for inducing apoptosis or inhibitin...

Y. Lu A. H. Conney Y. Lou



Ethambutol Ocular Toxicity in Treatment Regimens for Mycobacterium avium Complex Lung Disease  

Microsoft Academic Search

Ethambutol (EMB) is an important component of multidrug treat- mentregimens forMycobacteriumaviumcomplexlung disease.Ocu- lar toxicity is the most important potential EMB toxicity, especially in the elderly population with M. avium complex lung disease. Two hundred twenty-nine patients with M. avium complex lung disease, 55% women and 53% with nodular\\/bronchiectatic disease, re- ceived a mean of 16.1 10.8 months of multidrug therapy

David E. Griffith; Barbara A. Brown-Elliott; Sara Shepherd; Jerry McLarty; Lee Griffith; Richard J. Wallace


Treatment of complexed Copper(II) solutions with electrochemical membrane processes  

Microsoft Academic Search

An electrochemical membrane process was used to treat complexed CuII solutions of citric acid, nitrilotriacetic acid (NTA), and ethylenediaminetetraacetic acid (EDTA). An equimolar solution of CuII and complexing agent was focused. The iridium oxide (IrO2\\/Ti) and Pt (Pt\\/Ti) coated on titanium were used as anode and cathode, respectively. The cation exchange membrane Neosepta CM-1 was adopted. Experiments were carried out

Ruey-Shin Juang; Li-Chun Lin



Electrochemical treatment of dilute cyanide solutions containing zinc complexes by oxidation at carbon felt (Sigratherm)  

Microsoft Academic Search

The electrochemical oxidation of dilute solutions containing cyanide complexes of zinc using a carbon felt anode is described. The composition of the solution was determined using stability constants for particular complexes. The application of a GFA5 electrode enables the oxidation of cyanides (10 mmol dm-3) in 99.2% at 0.7 V and 30 C (1.5 Qt). Under these conditions, the electrical

A. Socha; E. Ku?mierek; E. Chrze?cija?ska



Peripheral median nerve stimulation for the treatment of iatrogenic complex regional pain syndrome (CRPS) type II after carpal tunnel surgery  

Microsoft Academic Search

We report on the use and follow-up of direct peripheral nerve stimulation of the median nerve for the treatment of iatrogenic complex regional pain syndrome (CRPS). A 56-year-old woman presented with CRPS type II in the right forearm and hand, which had started after multiple carpal tunnel surgeries and had lasted for 2 years. The visual analogue scale (VAS) score

G. Mirone; M. Natale; M. Rotondo



The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study  

Microsoft Academic Search

To compare the effects of two free radical scavengers, dimethylsulfoxide 50% (DMSO) and N-acetylcysteine (NAC), for treatment of complex regional pain syndrome I (CRPS I), a randomized, double-dummy controlled, double-blind trial was conducted. Two outpatient clinics of two university hospitals in The Netherlands participated in the study and 146 patients, were included over a period of 24 months. Patients were

R. S. G. M. Perez; W. W. A. Zuurmond; P. D. Bezemer; D. J. Kuik; A. C. van Loenen; J. J. de Lange; A. J. Zuidhof



Stabilizing Group Treatment for Complex Posttraumatic Stress Disorder Related to Child Abuse Based on Psychoeducation and Cognitive Behavioural Therapy: A Multisite Randomized Controlled Trial  

Microsoft Academic Search

Background: Evidence-based treatments for complex posttraumatic stress disorder (PTSD) related to childhood abuse are scarce. This is the first randomized controlled trial to test the efficacy of psycho-educational and cognitive behavioural stabilizing group treatment in terms of both PTSD and complex PTSD symptom severity. Methods: Seventy-one patients with complex PTSD and severe comorbidity (e.g. 74% axis II comorbidity) were randomly

Ethy Dorrepaal; Kathleen Thomaes; Johannes H. Smit; Dick J. Veltman; Adriaan W. Hoogendoorn; Nel Draijer



The treatment of complex regional pain syndrome (CRPS) involving upper extremity with continuous sensory analgesia  

Microsoft Academic Search

Continuous sensory analgesia of brachial plexus (CSA BP) was only occasionally reported to have been used in the treatment of CRPS. In the past four years, we have treated 21 patients with a working diagnosis of CRPS. The treatment was instituted one to six months after inciting injury. All patients were admitted to hospital. In the first two days, the

Krunoslav Margi?; Jelka Pirc



Oral Delivery of Meglumine Antimoniate-?-Cyclodextrin Complex for Treatment of Leishmaniasis  

PubMed Central

The need for daily parenteral administration represents one of the most serious limitations in the clinical use of pentavalent antimonials against leishmaniasis. In this work, we investigated the ability of ?-cyclodextrin to enhance the oral absorption of antimony and to promote the oral efficacy of meglumine antimoniate against experimental cutaneous leishmaniasis. The occurrence of interactions between ?-cyclodextrin and meglumine antimoniate was demonstrated through the changes induced in the spin lattice relaxation times of protons in both compounds. When free and complexed meglumine antimoniate were given orally to Swiss mice, plasma antimony levels were found to be about three times higher for the meglumine antimoniate-?-cyclodextrin complex than for the free drug. Antileishmanial efficacy was evaluated in BALB/c mice experimentally infected with Leishmania amazonensis. Animals treated daily with the complex (32 mg of Sb/kg of body weight) by the oral route developed significantly smaller lesions than those treated with meglumine antimoniate (120 mg of Sb/kg) and control animals (treated with saline). The effectiveness of the complex given orally was equivalent to that of meglumine antimoniate given intraperitoneally at a twofold-higher antimony dose. The antileishmanial efficacy of the complex was confirmed by the significantly lower parasite load in the lesions of treated animals than in saline-treated controls. This work reports for the first time the effectiveness of an oral formulation for pentavalent antimonials.

Demicheli, Cynthia; Ochoa, Rosemary; da Silva, Jose B. B.; Falcao, Camila A. B.; Rossi-Bergmann, Bartira; de Melo, Alan L.; Sinisterra, Ruben D.; Frezard, Frederic



Identification and releasing characteristics of high-amylose corn starch-cinnamaldehyde inclusion complex prepared using ultrasound treatment.  


In this study, the high-amylose corn starch-cinnamaldehyde inclusion complex was prepared by an ultrasound treatment and its releasing characteristic was investigated. The results showed that the ultrasound treatment (35°C, 10min and 250W) generated a higher encapsulation rate of 40.2% than the conventional treatment (encapsulation rate, 5.7%). Data obtained from Fourier-transform infrared (FT-IR) spectroscopy and thermogravimetric analysis (TGA) indicated that cinnamaldehyde was successfully encapsulated by high-amylose corn starch and the encapsulation significantly increased the dissociation temperature of cinnamaldehyde by around 70°C. Compared to the physical mixture of high-amylose corn starch and cinnamaldehyde, the formed inclusion complex had good retention ability and reduced the releasing rate of cinnamaldehyde from 57.5% to 28.4% in the first week. These results suggest that cinnamaldehyde could be encapsulated by high-amylose corn starch with an ultrasound treatment for presenting the releasing behavior in food preservation. PMID:23121949

Tian, Yaoqi; Zhu, Yanqiao; Bashari, Mohanad; Hu, Xiuting; Xu, Xueming; Jin, Zhengyu



The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study.  


To compare the effects of two free radical scavengers, dimethylsulfoxide 50% (DMSO) and N-acetylcysteine (NAC), for treatment of complex regional pain syndrome I (CRPS I), a randomized, double-dummy controlled, double-blind trial was conducted. Two outpatient clinics of two university hospitals in The Netherlands participated in the study and 146 patients, were included over a period of 24 months. Patients were randomized into two treatment groups, one was instructed to apply DMSO 50% five times daily to the affected extremity, the second was treated with NAC 600mg effervescent tablets three times daily, both combined with placebo. Interventions were accompanied by pain medication, occupational therapy for upper extremity CRPS I and physical therapy for lower extremity CRPS I in specific circumstances. Treatment was given for 17 weeks, with a possibility to continue or switch medication after this period, up to 1 year following the onset of treatment. An impairment level sum score was the primary outcome measure. Upper and lower extremity skills and functions, and general health status were also evaluated. Overall, no significant differences were found between NAC and DMSO after 17 and 52 weeks on impairment level and general health status. Significant differences were found for subscores of lower extremity function, in favor of DMSO-treatment. Subgroup analysis showed more favorable results for DMSO for warm CRPS I and significantly better performance of NAC for patients with a cold CRPS I. Results tended to be negatively influenced if the duration of the complaint was longer. Treatment with DMSO and NAC are generally equally effective in treatment of CRPS I. Strong indications exist for differences in effects for subgroups of patients with warm or cold CRPS I: for warm CRPS I, DMSO-treatment appears more favorable, while for cold CRPS I, NAC-treatment appears to be more effective. PMID:12670672

Perez, R S G M; Zuurmond, W W A; Bezemer, P D; Kuik, D J; van Loenen, A C; de Lange, J J; Zuidhof, A J



[Application of discrete plasmapheresis in complex treatment of patients with sepsis].  


There were examined 226 patients, in whom sepsis had occurred as a consequence of purulent-inflammatory diseases of soft tissues. The discrete plasmapheresis application in complex of intensive therapy had promoted the rapidest elimination of homeostasis disorders in the survived patients, but the influence on the lethality level was not revealed. PMID:19673114

Shapoval, S D; Savon, I L; Martyniuk, V B; Sazanov, M V



Impact of Vanadium Complexes Treatment on the Oxidative Stress Factors in Wistar Rats Plasma  

PubMed Central

The aim of this study was to investigate the clinical efficacy of vanadium complexes on triglycerides (TG), total cholesterol (Chol), uric acid (UA), urea (U), and antioxidant parameters: nonenzymatic (FRAP—ferric reducing ability of plasma, and reduced glutathione—GSH) and enzymatic (glutathione peroxidase—GPx, catalase—CAT, and GPx/CAT ratio) activity in the plasma of healthy male Wistar rats. Three vanadium complexes: [VO(bpy)2]SO4·2H2O, [VO(4,4?Me2bpy)2]SO4·2H2O, and Na[VO(O2)2(bpy)]·8H2O are administered by gavage during 5 weeks in two different diets such as control (C) and high fatty (F) diets. Changes of biochemical and antioxidants parameters are measured in plasma. All three vanadium complexes statistically decrease the body mass growth in comparison to the control and fatty diet. In plasma GSH was statistically increased in all vanadium complexes-treated rats from control and fatty group in comparison to only control group. Calculated GPX/CAT ratio was the highest in the control group in comparison to others.

Francik, R.; Krosniak, M.; Barlik, M.; Kudla, A.; Grybos, R.; Librowski, T.



Impact of vanadium complexes treatment on the oxidative stress factors in wistar rats plasma.  


THE AIM OF THIS STUDY WAS TO INVESTIGATE THE CLINICAL EFFICACY OF VANADIUM COMPLEXES ON TRIGLYCERIDES (TG), TOTAL CHOLESTEROL (CHOL), URIC ACID (UA), UREA (U), AND ANTIOXIDANT PARAMETERS: nonenzymatic (FRAP-ferric reducing ability of plasma, and reduced glutathione-GSH) and enzymatic (glutathione peroxidase-GPx, catalase-CAT, and GPx/CAT ratio) activity in the plasma of healthy male Wistar rats. Three vanadium complexes: [VO(bpy)(2)]SO(4)·2H(2)O, [VO(4,4'Me(2)bpy)(2)]SO(4)·2H(2)O, and Na[VO(O(2))(2)(bpy)]·8H(2)O are administered by gavage during 5 weeks in two different diets such as control (C) and high fatty (F) diets. Changes of biochemical and antioxidants parameters are measured in plasma. All three vanadium complexes statistically decrease the body mass growth in comparison to the control and fatty diet. In plasma GSH was statistically increased in all vanadium complexes-treated rats from control and fatty group in comparison to only control group. Calculated GPX/CAT ratio was the highest in the control group in comparison to others. PMID:22007153

Francik, R; Kro?niak, M; Barlik, M; Kud?a, A; Grybo?, R; Librowski, T



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

ERIC Educational Resources Information Center

|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,…

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



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

ERIC Educational Resources Information Center

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…

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



Operations management for solid waste treatment Development of a system for modelling complex facilities  

Microsoft Academic Search

The most recent targets of the European Union - to increase the recovery of bulk materials from post-consumer waste and start up the recycling of the specialty elements (1) - are likely to result in more complex and more capital-intensive material recovery plants than are operated today. Even today, recycling facilities are difficult plants to manage, for almost every aspect

W. Kuilman; P. C. Rem; R. B. Leeftink


Phase-Oriented Treatment of Structural Dissociation in Complex Traumatization: Overcoming Trauma-Related Phobias  

Microsoft Academic Search

The theory of structural dissociation of the personality proposes that patients with complex trauma-related disorders are characterized by a division of their personality into different prototypical parts, each with its own psychobiological underpinnings. As one or more “apparently normal” parts (ANPs), patients have a propensity toward engaging in evolutionary prepared action systems for adaptation to daily living to guide their

Kathy Steele; Onno van der Hart; Ellert R. S. Nijenhuis



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

Microsoft Academic Search

A homeopathic complex medication (HCM), with immunomodulatory properties, is recom- mended 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

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



The diverse and complex roles of radiation on cancer treatment: therapeutic target and genome maintenance  

PubMed Central

Cancer is a genetic disease, grows exponentially with the development of intrinsic and acquired treatment resistance. Past decade has witnessed a considerable progress towards the treatment and understanding of proposed hallmarks of cancer and together with advances in early detection and various treatment modalities. Radiation therapy is an integral part of cancer treatment armamentarium. In developed countries more than half of all cancer patients receive radiation therapy during their course of illness. Although radiation damages both cancer and normal cells, the goal of radiation therapy is to maximize the radiation dose to abnormal cancer cells while minimizing exposure to normal cells, which is adjacent to cancer cells or in the path of radiation. In recent years, life expectancy increases among cancer patients and this increase is due to the results of early diagnosis, screening efforts, improved treatments and with less late effects mostly secondary cancer development. Therefore, cancer survivorship issues have been gaining prominence in the area of radiation oncology research. Understanding the tradeoff between the expected decreases in normal tissue toxicity resulting from an improved radiation dose distribution to the targeted site is an increasingly pertinent, yet needed attention and research in the area of radiation oncology. In recent years, a number of potential molecular targets that involve either with radiation increased tumor cell killing or protecting normal cells have been identified. For clinical benefits, translating these findings to maximize the toxicity of radiation on tumor cells while safeguarding early or late normal cell toxicities using molecular targeted radioprotectors will be useful in radiation treatment.

Baskar, Rajamanickam; Yap, Swee Peng; Chua, Kevin Lee Min; Itahana, Koji



A new treatment for focal dystonias: incobotulinumtoxinA (Xeomin®), a botulinum neurotoxin type A free from complexing proteins.  


Dystonia is a movement disorder of uncertain pathogenesis that is characterized by involuntary and inappropriate muscle contractions which cause sustained abnormal postures and movements of multiple or single (focal) body regions. The most common focal dystonias are cervical dystonia (CD) and blepharospasm (BSP). The first-line recommended treatment for CD and BSP is injection with botulinum toxin (BoNT), of which two serotypes are available: BoNT type A (BoNT/A) and BoNT type B (BoNT/B). Conventional BoNT formulations include inactive complexing proteins, which may increase the risk for antigenicity, possibly leading to treatment failure. IncobotulinumtoxinA (Xeomin(®); Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a BoNT/A agent that has been recently Food and Drug Administration-approved for the treatment of adults with CD and adults with BSP previously treated with onabotulinumtoxinA (Botox(®); Allergen, Inc, Irvine, CA) - a conventional BoNT/A. IncobotulinumtoxinA is the only BoNT product that is free of complexing proteins. The necessity of complexing proteins for the effectiveness of botulinum toxin treatment has been challenged by preclinical and clinical studies with incobotulinumtoxinA. These studies have also suggested that incobotulinumtoxinA is associated with a lower risk for stimulating antibody formation than onabotulinumtoxinA. In phase 3 noninferiority trials, incobotulinumtoxinA demonstrated significant improvements in CD and BSP symptoms in both primary and secondary measures, compared with baseline, and met criteria for noninferiority versus onabotulinumtoxinA. In placebo-controlled trials, incobotulinumtoxinA also significantly improved the symptoms of CD and BSP, with robust outcomes in both primary and secondary measures. The use of incobotulinumtoxinA has been well tolerated in all trials, with an adverse event profile similar to that of onabotulinumtoxinA. Based on these data, incobotulinumtoxinA is a safe and effective BoNT/A for the treatment of CD and BSP, and may pose a lower risk for immunogenicity leading to treatment failure compared with other available BoNT agents. This paper reviews the treatment of focal dystonias with BoNTs, in particular, incobotulinumtoxinA. Controlled trials from the existing incobotulinumtoxinA literature are summarized. PMID:22275842

Jimenez-Shahed, Joohi



[Selective trabeculoplasty in combination with vasoactive agents in the complex treatment of primary open-angle glaucoma].  


The purpose of the present study was to evaluate the efficiency of complex treatment that has pathogenetic effects on the developmental stages of primary open-angle glaucoma (POAG), by activating the trabecular network via selective laser trabeculoplasty (SLT) and by improving microcirculation with the vasodilator Cavinton Forte. Fifty-seven patients aged 48 to 70 years (72 eyes) who had a developed stage of POAG with uncompensated ophthalmotonus were followed up. Group 1 (a study group) comprised 35 patients (42 years) who received complex therapy (the vasodilator Cavinton Forte 10 mg thrice daily for 2 months along with beta-blockers and prostaglandins. Group 2 (a control group) consisted of 22 patients (30 years) who were first only antihypertensive therapy that did not differ from that taken in Group 1. The complex treatment in patients with the uncompensated developed stage of POAG made it possible to reduce opththalmotonus in 80.9% of the patients to 35% after single application of SLT, to lower intraocular pressure stably, to cause easy outflow of intraocular fluid 2 weeks after SLT, to have positive changes in the stereometric parameters in the optic disk and structural alterations in accordance with the GPS classification, and to discontinue topical antihypertensive agents in 14.3% of the patients. PMID:19916330

Shaimova, V A; Shaimov, R B; Goloshchapov, K P


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


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

Roig, José V; García-Armengol, Juan



Effects of heat treatment on the protein secondary structure and pigment microenvironment in photosystem 1 complex  

Microsoft Academic Search

The protein secondary structure and pigments' microenvironment in photosystem 1 (PS1) complexes were studied in the temperature range of 25–80 °C using Fourier transform infrared (FT-IR) and circular dichroism (CD) spectroscopy, respectively. Quantitative analysis of the component bands of the amide I band (1 700–1 600 cm?1) showed no significant change below 50 °C. However, apparent conformational changes occurred at

Z.-H. Hu; Y.-N. Xu; Y.-D. Gong; T.-Y. Kuang



Use of clobazam for the treatment of refractory complex partial seizures  

Microsoft Academic Search

Clobazam (CLB) add-on therapy was attempted in 183 patients with intractable complex partial seizures in whom conventional benzodiazepines had been successfully discontinued before initiation of CLB. Although complete remission was initially achieved in 61, tolerance developed in almost half (49.2%) within the first 3 months, whereas 23 out of 31 patients (74.2%) who remained seizure free for the first 3




Stability of Biopolymer Particles Formed by Heat Treatment of ?-lactoglobulin\\/Beet Pectin Electrostatic Complexes  

Microsoft Academic Search

The purpose of this study was to examine the stability of biopolymer particles formed by heating electrostatic complexes of\\u000a ?-lactoglobulin and sugar beet pectin together (pH 5, 80 °C for 15 min). The effects of electrostatic interactions on the\\u000a formation and stability of the particles were investigated by incorporation of different salt levels (0 to 200 mM NaCl) during\\u000a the preparation procedure.

Owen G. Jones; D. Julian McClements



Dissolution and demetallation treatment of asphaltene in resid using adsorbent and oil-soluble Mo complex  

Microsoft Academic Search

Dissolution and demetallation behaviors of vacuum residues (Arabian Heavy:AH-VR and Brazilian Marlim: Ma-VR) were investigated using carbon adsorbent and\\/or an oil-soluble Mo complex (Mo-DTC: Modithiocarbamate) with an aromatic solvent (LCO: Light cycle oil) at variable temperatures of 60–200 °C under the atmospheric pressure. An Arabian-Light atmospheric residue (AR) was also treated under the same conditions without addition of solvent and

Kinya Sakanishi; Ikuo Saito; Izumi Watanabe; Isao Mochida



Efficiencies of electrolytic treatment of complexed metal solutions in a stirred cell having a membrane separator  

Microsoft Academic Search

Electrolytic recovery of metals such as Cu(II) and strong chelating agents such as EDTA (ethylenediaminetetraacetic acid) from their equimolar complexed solutions was investigated in a stirred cell having a membrane separator. The iridium oxide coated on titanium (IrO2\\/Ti) was used as the anode. Experiments were performed as a function of membrane-type (Neosepta CM-1 and CM-2), current density (18.5–185A\\/m2), cathode material

Ruey-Shin Juang; Li-Chun Lin



Profound Hypothermia and Circulatory Arrest with Skull Base Approaches for Treatment of Complex Posterior Circulation Aneurysms  

Microsoft Academic Search

Summary  ?Objective. Cardiopulmonary bypass with profound hypothermia and circulatory arrest has seen a resurgence as an adjunct technique in\\u000a neurological surgery. We report our experience with this technique in treating seven complex vertebro-basilar aneurysms.\\u000a \\u000a ?Methods. Skull base approaches were used in all cases, providing excellent exposure and minimizing brain retraction. There were six\\u000a basilar artery aneurysms and one giant fusiform vertebro-basilar

B. J. Sullivan; L. N. Sekhar; D. H. Duong; G. Mergner; D. Alyano



Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex posttraumatic stress disorder.  


This article reviews the complexity of adaptation and symptomatology in adult survivors of childhood neglect and abuse who meet criteria for the proposed diagnosis of Complex Posttraumatic Stress Disorder (Complex PTSD), also known as Disorders of Extreme Stress, Not Otherwise Specified (DESNOS). A specific EMDR protocol, Resource Development and Installation (RDI), is proposed as an effective intervention in the initial stabilization phase of treatment with Complex PTSD/DESNOS. Descriptive psychometric and behavioral outcome measures from two single case studies are presented which appear to support the use of RDI. Suggestions are offered for future treatment outcome research with this challenging population. PMID:12455016

Korn, Deborah L; Leeds, Andrew M



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


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

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



Towards a low complexity carbon removal model for the optimal design of compact decentralised wastewater treatment systems.  


On-site decentralised wastewater treatment systems can provide a financially attractive alternative to a sewer connection in locations far from existing sewer networks. Operational problems and shortcomings in the design of these systems still occur frequently. The aim of this paper is to provide a low complexity (i.e. easy to calibrate) but still accurate mathematical model that can be used to optimise the operational design of compact individual wastewater treatment systems. An integrated hydraulic and biological carbon removal model of a biofilm-based compact decentralised treatment system is developed. The procedure for drafting the model is generic and can be used for similar types of wastewater treatment systems since (i) the hydraulic model is based on an N-tanks-in-series model inferred from tracer test experiments and (ii) (biofilm) respirometry experiments are exploited to determine the biodegradation kinetics of the biomass. Based on the preliminary validation results of the integrated model, the carbon removal in the system can be predicted quite accurately. While some adjustments could further improve the modelling strategy, the here presented results can already assist the manufacturers of compact treatment systems in efficiently (re)designing their systems. PMID:20351438

Moelants, N; Smets, I Y; Van Den Broeck, R; Lambert, N; Liers, S; Declerck, P; Vanysacker, L; Van Impe, J F



Quasi-analytical treatment of spatially averaged radiation transfer in complex terrain  

NASA Astrophysics Data System (ADS)

We provide a new quasi-analytical method to compute the topographic influence on the effective albedo of complex topography as required for meteorological, land-surface or climate models. We investigate radiative transfer in complex terrain via the radiosity equation on isotropic Gaussian random fields. Under controlled approximations we derive expressions for domain averages of direct, diffuse and terrain radiation and the sky view factor. Domain averaged quantities are related to a type of level-crossing probability of the random field which is approximated by longstanding results developed for acoustic scattering at ocean boundaries. This allows us to express all non-local horizon effects in terms of a local terrain parameter, namely the mean squared slope. Emerging integrals are computed numerically and fit formulas are given for practical purposes. As an implication of our approach we provide an expression for the effective albedo of complex terrain in terms of the sun elevation angle, mean squared slope, the area averaged surface albedo, and the direct-to-diffuse ratio of solar radiation. As an application, we compute the effective albedo for the Swiss Alps and discuss possible generalizations of the method.

Löwe, H.; Helbig, N.



Quasi-analytical treatment of spatially averaged radiation transfer in complex terrain  

NASA Astrophysics Data System (ADS)

We provide a new quasi-analytical method to compute the subgrid topographic influences on the shortwave radiation fluxes and the effective albedo in complex terrain as required for large-scale meteorological, land surface, or climate models. We investigate radiative transfer in complex terrain via the radiosity equation on isotropic Gaussian random fields. Under controlled approximations we derive expressions for domain-averaged fluxes of direct, diffuse, and terrain radiation and the sky view factor. Domain-averaged quantities can be related to a type of level-crossing probability of the random field, which is approximated by long-standing results developed for acoustic scattering at ocean boundaries. This allows us to express all nonlocal horizon effects in terms of a local terrain parameter, namely, the mean-square slope. Emerging integrals are computed numerically, and fit formulas are given for practical purposes. As an implication of our approach, we provide an expression for the effective albedo of complex terrain in terms of the Sun elevation angle, mean-square slope, the area-averaged surface albedo, and the ratio of atmospheric direct beam to diffuse radiation. For demonstration we compute the decrease of the effective albedo relative to the area-averaged albedo in Switzerland for idealized snow-covered and clear-sky conditions at noon in winter. We find an average decrease of 5.8% and spatial patterns which originate from characteristics of the underlying relief. Limitations and possible generalizations of the method are discussed.

LöWe, H.; Helbig, N.



[Preventive lymphadenectomy in complex treatment of melanoma of the skin, trunk and extremities].  


Results of treatment of 90 patients with primary melanoma of the skin, trunk and extremities with stages T2-T4N0M0 were analyzed. Different strategies were used in relation to regional lymph nodes. It was found that prophylactic lymphadenectomy in terms of more than 4 weeks after excision of primary cutaneous melanoma reliably prolongs total and recurrence-free survival as compared with the method without fulfilling prophylactic lymphadenectomy. Prophylactic lymphadenectomy fulfilled in terms less than 4 weeks fails to have statistically significant influence on the results of treatment. PMID:21506347

Akhmetov, I R; Vazhenin, A V; Ia?tsev, S V; Privalov, A V



Osteoid Osteoma Mimicking Triangular Fibrocartilage Complex Injury: Diagnosis and Review of Treatment  

PubMed Central

We report the case of osteoid osteoma (OO) with ulnar styloid involvement. A review of the literature has been made with the aim of defining the special behaviour of OO when it is near the articular surface. That behaviour can affect the diagnosis, masking the real etiology of the pain, delaying the diagnosis, missing the diagnosis, or what is more serious, conducting an inadequate treatment. We propose a treatment algorithm conducted based on the localization near or far from articular surface and the superficial or deep localization.

Lamo-Espinosa, J. M.; Gonzalez, A.; Amillo, S.



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

NASA Astrophysics Data System (ADS)

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.

Gong, Xinwei


Complex estimation of bending elasticity of hemp woven fabric after washing treatment  

Microsoft Academic Search

Purpose – This paper aims to investigate the elasticity of hemp woven fabric under action of bending force, before and after washing treatment. Design\\/methodology\\/approach – Bending elasticity was monitored in three different ways: through the value of bending modulus, on the basis of fabric's resistance to creasing expressed through the value of quality number, and through the value of bending

T. V. Mihailovic



Semantic Complexity in Treatment of Naming Deficits in Aphasia: Evidence from Well-Defined Categories  

ERIC Educational Resources Information Center

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…

Kiran, Swathi; Johnson, Lauren



[The effectiveness of SCENAR therapy in complex treatment of duodenal ulcer, and the mechanisms of its action].  


A new technique of low-frequency modulated electric current therapy, SCENAR therapy, was used in treatment of 103 patients with duodenal ulcer (DU). The influence of SCENAR therapy on the main clinical and functional indices of a DU relapse was studied. It was shown that SCENAR therapy, which influences disturbed mechanisms of adaptive regulation and self-regulation, led to positive changes in most of the parameters under study. Addition of SCENAR therapy to the complex conventional pharmacotherapy fastened ulcer healing, increased the effectiveness of Helicobacter pylori eradication, and improved the condition of the gastroduodenal mucosa. PMID:16924799

Tsimmerman, Ia S; Kochurova, I A; Vladimirski?, E V



Mirror visual feedback for the treatment of complex regional pain syndrome (type 1).  


Mirror visual feedback was originally devised as a therapeutic tool to relieve perceived involuntarily movements and paralysis in the phantom limb. Since this pioneering work was conducted in the mid-1990s, the technique has been applied to relieve pain and enhance movement in other chronic conditions such as stroke and complex regional pain syndrome (CRPS) type 1. This review describes how mirror visual feedback was first developed with amputees, its original application in CRPS, and how further research has demonstrated its potential benefit within graded motor imagery programs. We discuss the potential mechanisms behind this technique and consider the implications for clinical practice. PMID:18474189

McCabe, Candida S; Haigh, Richard C; Blake, David R



Association of topical amphotericin B lipid complex treatment to standard therapy for rhinomaxillary mucormycosis after liver transplantation: a case report.  


Solid organ transplantation is becoming increasingly more common in the treatment of end-stage organ failure. The advent of newer immunosuppressive protocols and refined surgical techniques has allowed therapy to become standard care. Infection is a major and frequently life-threatening complication after transplantation and the incidence of opportunistic fungal infections in organ transplant recipients ranges from 2%-50% depending on the type of organ transplanted. We present a case of rhinomaxillary form of mucormycosis infection after liver transplantation. The succession of multiple risk factors in a torpid postoperative period was a key factor in the development of this disease. Multidisciplinary management with an early diagnosis, aggressive surgery, and intravenous and topical antifungal therapy care were definitive for the eradication of infection. The goal of the present report was to show efficacious management including the association of topical treatment with amphotericin B complex lipid to standard therapy and the absence of side effects. PMID:22974930

Trasmonte, M V; Jiménez, J D; Santiago, M Á; Gálvez, E; Jerez, V; Pérez, D; Robles, M; Farje, V K; Martínez, P; Nieto, P; Rubio, J A



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

PubMed Central

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.

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



[Bronchoscopic methods in complex diagnosis and treatment of burned patients with inhalation injuries].  


Chromobronchoscopy was first used in treatment of 37 burned patients with inhalation injuries for better visual manifestation of the injuries of the tracheobronchial tree mucosa. The trachea and bronchi mucosa was irrigated with a viral stain--0.25% aqueous solution of methylene blue. The intensity of staining the mucosa in light blue colour showed the true limits and depth of the injury. Resulting from the clinico-endoscopic examinations supplemented with findings of chromobronchoscopy, cytological and bacteriological analyses, a working classification of inhalation injuries in burned people was developed which allowed the adequate methods of local treatment during fiber bronchoscopy to be worked out taking into account the degree of thermochemical injuries of the respiratory pathways. It resulted in 19.7% lower lethality of burned patients. PMID:10481880

Shpakov, I F; Venevitinov, I O; Inshakov, L N; Palamarchuk, G F; Shlyk, I V



Optimizing treatment for complex cases of childhood obsessive compulsive disorder: a preliminary trial.  


Family factors such as conflict, blame, and poor cohesion have been found to attenuate response to cognitive behavior therapy (CBT) for pediatric obsessive compulsive disorder (OCD). This study examined the feasibility and acceptability of a brief, personalized intervention for cases of pediatric OCD complicated by these family features. Twenty youth with a primary Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of OCD (M age = 12.50 years; 55% male; 60% Caucasian) and their families participated. To be included in the study, families were required to evidence poor functioning on measures of blame, conflict, and/or cohesion. Eligible families were randomly assigned either to standard treatment (ST) with 12 weeks of individual child CBT that included weekly parent check-ins and psychoeducation or to Positive Family Interaction Therapy (PFIT), which consisted of 12 weeks of individual child CBT plus an additional 6 sessions of family treatment aimed at shifting family dynamics. Clinical outcomes were determined by blind independent evaluators using the Clinician's Global Impressions-Improvement (CGI-I) scale. All families completed the study. High levels of satisfaction were reported among participants in both arms of the study, despite the added burden of attending the PFIT sessions. Both mothers and fathers attended 95% of the PFIT family sessions. Families in the ST condition demonstrated a 40% response rate on the CGI-I; families in the PFIT condition demonstrated a 70% response rate. Treatment gains were maintained in both conditions at 3-month follow-up. Preliminary data suggest that PFIT is acceptable and feasible. Further testing and treatment development are needed to optimize outcomes for complicated cases of pediatric OCD. PMID:22548378

Peris, Tara S; Piacentini, John



[The Melkersson-Rosenthal syndrome as a problem of complex treatment].  


The Melkersson-Rosenthal syndrome consists of triad of symptoms: recurrent oedema of lips, recurrent facial nerve paralysis and lingua plicata. Treatment is usually symptomatic and required cooperation of different specialists as: dermatologists, neurologists, dentists, laryngologists, surgeons. A rare case of Melkersson-Rosenthal syndrome in 49-year-old man was observed in the Clinic of Dermatology Silesian Medical Academy in Katowice. PMID:15865255

Trzmiel, Dorota; Kozak-Gawron, Karina; Krauze, Ewa



[Therapeutic blockades and reflexotherapy in the complex treatment of tension headache].  


The analysis of treatment effectiveness was carried out in 138 patients with tension headache. Patients of group 1 received fluoxetine in dose 20-40 mg/day during not less than 3 months and tizanidini in dose 4-8 mg/day during not less than 2 weeks. Patients of group 2 were assigned to therapeutic blockades of the occipital nerve and trigger points of cervico-cranial area using local anesthetics (2.5 ml of 0.5% marcain solution and 0.5-1 ml dexazone, for 1-5 blockades course) and needle reflexotherapy. The further treatment was based on the decision of the necessity of using analogous drugs in dose regime. Effectiveness was assessed on the basis of clinical neuroorthopedical examination, scores on the Visual Analogous Scale and questionnaires of McGill and A.M. Vein. The inclusion of therapeutic blockades of the cervical zone and reflexotherapy increased the effectiveness of the treatment and minimized the use of drugs. In group 2, the amount of analgesics was decreased by more than 60%, central myorelaxants were prescribed in 34.8% of cases and antidepressants - in 19.1%. The decrease of daily and course doses of the drugs allowed to completely avoid the side-effects. PMID:20436446

Medvedeva, L A; Avakian, G N; Zagorul'ko, O I; Gnezdilov, A V



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

PubMed Central

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.

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



[Experimental and clinical study of nitazol as an antibacterial drug in the complex treatment of peritonitis].  


Antibacterial properties of the Soviet drug nitazol which is a derivative of imidazole were studied. It was shown that nitazol in a dose of 4-8 micrograms/ml was highly active against gram-negative nonsporulating anaerobes, gram-positive anaerobic cocci and spore-forming Clostridia spp. Unlike metronidazole, it was efficient against both standard and clinical strains of facultative anaerobes such as E. coli, S. aureus and Klebsiella spp. isolated from patients with peritonitis and being poly-resistant to antibiotics. It was found in vitro that the antibacterial effect of nitazol was higher when it was used in combination with some antibiotics. It was demonstrated on experimental models of peritonitis caused by Staphylococcus spp. and E. coli in mice that nitazol used alone or in combination with gentamicin had a favourable effect on the animal survival and lifespan. The combination of nitazol with gentamicin was applied in the combined treatment of appendicular peritonitis in 80 children and its high therapeutic efficacy was stated. Nitazol is useful as an antibacterial drug in the combined treatment of children with purulent peritonitis. PMID:2264753

Tsyganenko, A Ia; Topuzov, V S; Kalinichenko, N F; Kovalenko, N I; Davidenko, V B; Gabysheva, L S; Liapunov, N A; Starobinets, Z G; Osolodchenko, T P; Vasil'chenko, V N



In vivo complementation of complex I by the yeast Ndi1 enzyme. Possible application for treatment of Parkinson disease.  


Recent studies suggest that dysfunction of the NADH-quinone oxidoreductase (complex I) is associated with a number of human diseases, including neurodegenerative disorders such as Parkinson disease. We have shown previously that the single subunit rotenone-insensitive NADH-quinone oxidoreductase (Ndi1) of Saccharomyces cerevisiae mitochondria can restore NADH oxidation in complex I-deficient mammalian cells. The Ndi1 enzyme is insensitive to complex I inhibitors such as rotenone and 1-methyl-4-phenylpyridinium ion, known as a metabolite of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). To test the possible use of the NDI1 gene as a therapeutic agent in vivo, we chose a mouse model of Parkinson disease. The NDI1-recombinant adeno-associated virus particles (rAAV-NDI1) were injected unilaterally into the substantia nigra of mice. The animals were then subjected to treatment with MPTP. The degree of neurodegeneration in the nigrostriatal system was assessed immunohistochemically through the analysis of tyrosine hydroxylase and glial fibrillary acidic protein. It was evident that the substantia nigra neurons on the side used for injection of rAAV-NDI1 retained a high level of tyrosine hydroxylase-positive cells, and the ipsilateral striatum exhibited significantly less denervation than the contralateral striatum. Furthermore, striatal concentrations of dopamine and its metabolites in the hemisphere that received rAAV-NDI1 were substantially higher than those of the untreated hemisphere, reaching more than 50% of the normal levels. These results indicate that the expressed Ndi1 protein elicits resistance to MPTP-induced neuronal injury. The present study is the first successful demonstration of complementation of complex I by the Ndi1 enzyme in animals. PMID:16543240

Seo, Byoung Boo; Nakamaru-Ogiso, Eiko; Flotte, Terence R; Matsuno-Yagi, Akemi; Yagi, Takao



Use of the Environmental Simulation Program (ESP) to Simulate Complex Waste Treatment Processes  

SciTech Connect

The Environmental Simulation Program is a process simulator designed for aqueous based chemical processes. ESP, which is produced by OLI Systems, Inc., utilizes sophisticated activity coefficient models and predictive equations that result in the ability to simulate very complex electrolyte systems (OLI, 2002). The software comes with databanks of regressed parameters for a large number of aqueous, vapor, and solid species covering most of the elements. ESP has been used extensively at the U. S. Department of Energy Hanford Site to predict nuclear waste slurry vapor-liquid-solid equilibrium. It has and is being used to model leaching and washing of nuclear waste sludges, evaporation of nuclear waste solutions, crystallization of salts, precipitation of plutonium and other metals from waste solutions, and other processing of dilute and concentrated aqueous solutions, sludges, and slurries. The software is also used extensively to rationalize the characterization of nuclear wastes using limited data from analyses of waste samples. The OLI provided databanks suffer from a legacy interaction model that limits the accuracy when neutral solutes are important. Also, the nitrate-nitrite systems typically found in nuclear wastes are not properly parameterized in ESP databases because of the existence of sodium nitrate and nitrite ion pairs. Properties databanks for ESP have been developed at Flour Federal Services that eliminate the legacy model and provide more accurate simulation results than the OLI supplied databases for such concentrated solutions and slurries.

MacLean, G. T.; Ho, Q. T.; Berger, S. R. K.



[Jehova's Witnesses and severe injury with impending hemorrhaging : how complex is the treatment?].  


Hemorrhage is frequently seen during the early phases of polytrauma management and intensive care treatment of the severely injured. Traumatic coagulopathy as well as the sometimes overlooked hyperfibrinolysis may lead to further complications. Therefore, transfusion of blood products and coagulation factors is often crucial. Jehova's Witnesses reject transfusions of blood and blood products due to religious convictions. In this case report a therapeutic approach of a multiple trauma patient suffering from traumatic brain injury, blunt chest trauma and liver laceration is described, who has been treated without blood products. As one main focus, ethical as well as legal aspects are discussed. Beside therapeutic concepts, such as the administration of coagulation factors, recombinant erythropoietin and iron, ethical and legal aspects remain part of the controversial discussion. PMID:21088815

Zeckey, C; Vanin, N; Neitzke, G; Mommsen, P; Bachmann, S; Frink, M; Wilhelmi, M; Krettek, C; Hildebrand, F



Multiple treatment comparison meta-analyses: a step forward into complexity  

PubMed Central

The use of meta-analysis has become increasingly useful for clinical and policy decision making. A recent development in meta-analysis, multiple treatment comparison (MTC) meta-analysis, provides inferences on the comparative effectiveness of interventions that may have never been directly evaluated in clinical trials. This new approach may be confusing for clinicians and methodologists and raises specific challenges relevant to certain areas of medicine. This article addresses the methodological concepts of MTC meta-analysis, including issues of heterogeneity, choice of model, and adequacy of sample sizes. We address domain-specific challenges relevant to disciplines of medicine, including baseline risks of patient populations. We conclude that MTC meta-analysis is a useful tool in the context of comparative effectiveness and requires further study, as its utility and transparency will likely predict its uptake by the research and clinical community.

Mills, Edward J; Bansback, Nick; Ghement, Isabella; Thorlund, Kristian; Kelly, Steven; Puhan, Milo A; Wright, James



[Certain principles for differential utilization of metabolic treatment preparations in the complex therapy of mental disorders].  


A study of 246 patients (with schizophrenia, manic depressive psychoses and psychoorganic syndrome) treated by some drugs of a metabolic action (encephalotropic", "nootropic" drugs, piracetam, piriditol and pantogam) permitted one to determine the place of these preparations in a comprehensive treatment of mental disorders. On the basis of clinical studies of the above-mentioned preparations, the conclusion is made about desirability (and in some cases about necessity) of including them into pharmacotherapy. During such studies certain traits of the clinical effect in each of these drugs was examined, permitting the comparative spectra of the pharmacological activity of piracetam, piriditol and pantogam to be determined. The clinical studies of these patients indicate the necessity of a differentiated use of the mentioned drugs having in view the state of the patient and detected clinical profile of the drugs. PMID:484144

Avrutski?, G Ia; Laskova, N B



Ketamine treatment for intractable pain in a patient with severe refractory complex regional pain syndrome: a case report.  


In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractable pain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Future research on this treatment is needed. PMID:18523505

Shirani, Peyman; Salamone, Alicia R; Schulz, Paul E; Edmondson, Everton A


Treatment Strategies for Complex Intracranial Aneurysms: Review of a 12-Year Experience at the University of Cincinnati  

PubMed Central

Complex intracranial aneurysms (CIAs) include those classified as giant, those located in brain regions of technically difficult access, or that involve arterial trunks/branches, and/or have complicated wall structure. We reviewed retrospectively our management of such lesions in a 12-year period. From 1997 to 2009, 192 patients were admitted with CIAs (133 females, 59 males; average age 55 years); 128 presented with subarachnoid hemorrhage (SAH) and 64 with unruptured, symptomatic CIAs. The SAH group had 73 anterior- and 55 posterior-circulation aneurysms. Most frequent location was middle cerebral artery. Treatment strategies included clipping (65.6%), coiling/stenting (28.1%), bypass (3.1%), no treatment (3.1%). Coiling/stenting was exclusively used for posterior-circulation aneurysms. Outcomes were good (modified Rankin Scale [mRS] 0 to 2) in 54 patients (42.2%), fair (mRS?=?3 to 4) in 38 (29.7%), and poor (mRS?=?5 to 6) in 36 (28.1%). Among unruptured CIAs, there were 47 anterior- and 17 posterior-circulation aneurysms. Most frequent location was ophthalmic. Thirty (46.9%) were clipped, 19 (29.7%) coiled, 6 (9.4%) by-passed, 2 (3.1%) wrapped, and 7 (10.9%) had no treatment. Outcomes were good in 57 patients (89%) and fair in 7 (11%). Good outcomes were obtained in unruptured CIAs using a multidisciplinary approach. Ruptured CIAs carry a significantly worse prognosis than overall SAH patients.

Andaluz, Norberto; Zuccarello, Mario



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

PubMed Central

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.

Sirikurnpiboon, Siripong; Awapittaya, Burin; Jivapaisarnpong, Paiboon



[Efficacy of the complex drug cytoflavin in the treatment of consequences of mild brain injury].  


Sixty outpatients, aged 18-50 years, with mild cranial-brain trauma (brain concussion, mild brain injury), occurred 21-180 days before the enrollment in the study, were examined. Patients of the main group received cytoflavin in dose 425 mg, 2 tablets twice a day during 25 days, patients of the control group received aminalon in dose 500 mg, 2 tablets 3 times a day during 25 days. The therapeutic efficacy was assessed on days 1, 30 and 60 with the battery of neuropsychological scales. The efficacy and safety of cytoflavin in the monotherapy of patients with remote consequences of mild cranial-brain trauma was shown. The effect of cytoflavin was developed significantly more rapidly compared to aminalon. There were positive changes on scales of pain severity, psychoemotional disorders (anxiety, depression, asthenia), sleep quality, autonomic dysfunctions as well as in the performance on neurocognitive tests assessing memory, sustained attention, information processing speed, productivity. The duration of using analgesics and sedatives as add-on drugs was reduced significantly. The drug remained effective till the 60th day after the 30 day withdrawal. Side-effects of cytoflavin (the short-term rise of arterial pressure, insomnia and abdominalgia) did not last long and no additional treatment, withdrawal or reduction of cytoflavin dose was needed. PMID:20517223

Skoromets, A A; Pugacheva, E L



[Comparative assessment of the effectiveness of traditional and videothoracoscopic thymectomies in complex treatment of myasthenic thymomas].  


A retrospective matched-pair comparison was undertaken to evaluate the surgical and neurological outcomes after open and VATS thymectomy for patients with myasthenia gravis (MG) and thymoma. Ten women and seven men aged 14-77 years were operated upon in St. Petersburg Center of intensive pulmanology and thoracic surgery during the years 1995-2002. Results of two groups were compared: 1 - operated by VATS (9 patients) and 2 - operated via sterno- or thoracotomy (8 patients). The first step evaluated the distribution of age, gender, myasthenia severity, size, type of thymoma and Masaoka's stage. No difference between the groups was found. At the same time, the length of chest tube, blood loss, severity of postoperative pains were significantly lower in the first group as compared with the second one: 1.3+/-0.9 vs 6.2+/-4.5 days; 82.5+/-22.7 vs 557.1+/-212 ml; and 1.9+/-0.8 vs 6.1+/-1.2 points respectively. The number of postoperative complications was almost the same. All the patients were followed up during 24-96 months. There were no thymoma recurrences in the both groups. No statistical differences were found in MG course between the groups. A conclusion is made that VATS removing of noninvasive thymoma is technically feasible and safe for the patients. VATS thymectomy can provide the same results in MG treatment as the open approaches. PMID:16281396

Iablonski?, P K; Pishchik, V G; Nuraliev, S M



Comparative performance of UASB and anaerobic hybrid reactors for the treatment of complex phenolic wastewater.  


The performance of an upflow anaerobic sludge blanket (UASB) reactor and an anaerobic hybrid reactor (AHR) was investigated for the treatment of simulated coal wastewater containing toxic phenolics at different hydraulic retention times (0.75-0.33d). Fast start-up and granulation of biomass could be achieved in an AHR (45d) than UASB (58d) reactor. Reduction of HRT from 1.5 to 0.33d resulted in a decline in phenolics removal efficiency from 99% to 77% in AHR and 95% to 68% in UASB reactor respectively. AHR could withstand 2.5 times the selected phenolics loading compared to UASB reactor that could not withstand even 1.2 times the selected phenolics loading. Residence time distribution (RTD) study revealed a plug flow regime in the AHR and completely mixed regime in UASB reactor respectively. Energy economics of the reactors revealed that 12,159MJd(-1) more energy can be generated using AHR than UASB reactor. PMID:22940341

Ramakrishnan, Anushuya; Surampalli, Rao Y



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


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. PMID:22010706

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



A pilot study of trans-arterial injection of 166Holmium-Chitosan complex for treatment of small hepatocellular carcinoma.  


Percutaneous approaches, such as percutaneous ethanol injection and radiofrequency ablation, have been most widely used for hepatocellular carcinoma patients who were not eligible for surgery. New technologies to improve the efficacy are currently needed. (166)Holmium is a neutron activated radionuclide, and has several beneficial radiophysical characteristics for internal radiation therapy. (166)Holmium-Chitosan complex, in which chitosan is chelated with (166)Holmium, was developed as a radiopharmaceutical for cancer therapy. We have conducted a pilot study to evaluate the clinical efficacy of transarterial administration of (166)Holmium-Chitosan complex in patients with a single and small (< 3 cm) hepatocellular carcinoma. (166)Holmium-Chitosan complex, at a dose of 20 mCi per cm of tumor mass-diameter, was administered through the artery that directly fed the tumor. Twelve patients were treated with a median follow-up duration of 26 (range: 12-61) months. The tumor diameter ranged between 1.5 and 2.5 cm. Ten patients (83%) had complete response and two (17%) had partial response. The median complete response duration was not reached. The median AFP level declined from 83.8 to 8.3 ng/mL within 2 months after treatment. No grade III/IV toxicity was observed. Grade I and II toxicities were observed in four patients (2 abdominal pain, 1 fever, and 1 AST/ALT elevation). No toxic death occurred. This preliminary study shows a promising and durable complete response rate with an acceptable safety profile. Further studies with greater accrual of patients are warranted. PMID:16385656

Cho, Byoung Chul; Kim, Eun Hee; Choi, Hye Jin; Kim, Joo Hang; Roh, Jae Kyung; Chung, Hyun Cheol; Ahn, Joong Bae; Lee, Jong Doo; Lee, Jong Tae; Yoo, Nae Choon; Sohn, Joo Hyuk



A Pilot Study of Trans-Arterial Injection of 166Holmium-Chitosan Complex for Treatment of Small Hepatocellular Carcinoma  

PubMed Central

Percutaneous approaches, such as percutaneous ethanol injection and radiofrequency ablation, have been most widely used for hepatocellular carcinoma patients who were not eligible for surgery. New technologies to improve the efficacy are currently needed. 166Holmium is a neutron activated radionuclide, and has several beneficial radiophysical characteristics for internal radiation therapy. 166Holmium-Chitosan complex, in which chitosan is chelated with 166Holmium, was developed as a radiopharmaceutical for cancer therapy. We have conducted a pilot study to evaluate the clinical efficacy of transarterial administration of 166Holmium-Chitosan complex in patients with a single and small (< 3 cm) hepatocellular carcinoma. 166Holmium-Chitosan complex, at a dose of 20 mCi per cm of tumor mass-diameter, was administered through the artery that directly fed the tumor. Twelve patients were treated with a median follow-up duration of 26 (range: 12-61) months. The tumor diameter ranged between 1.5 and 2.5 cm. Ten patients (83%) had complete response and two (17%) had partial response. The median complete response duration was not reached. The median AFP level declined from 83.8 to 8.3 ng/mL within 2 months after treatment. No grade III/IV toxicity was observed. Grade I and II toxicities were observed in four patients (2 abdominal pain, 1 fever, and 1 AST/ALT elevation). No toxic death occurred. This preliminary study shows a promising and durable complete response rate with an acceptable safety profile. Further studies with greater accrual of patients are warranted.

Cho, Byoung Chul; Kim, Eun Hee; Choi, Hye Jin; Kim, Joo Hang; Roh, Jae Kyung; Chung, Hyun Cheol; Ahn, Joong Bae; Lee, Jong Doo; Lee, Jong Tae; Yoo, Nae Choon



Everolimus in the treatment of subependymal giant cell astrocytomas, angiomyolipomas, and pulmonary and skin lesions associated with tuberous sclerosis complex  

PubMed Central

Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder caused by inactivating mutations in either the TSC1 or TSC2 genes. It is characterized by the development of multiple, benign tumors in several organs throughout the body. Lesions occur in the brain, kidneys, heart, liver, lungs, and skin and result in seizures and epilepsy, mental retardation, autism, and renal and pulmonary organ system dysfunction, as well as other complications. Elucidation of the molecular pathways and etiological factors responsible for causing TSC has led to a paradigm shift in the management and treatment of the disease. TSC1 or TSC2 mutations lead to constitutive upregulation of the mammalian target of rapamycin pathway, which affects many cellular processes involved in tumor growth. By targeting mammalian target of rapamycin with everolimus, an orally active rapamycin derivative, clinically meaningful and statistically significant reductions in tumor burden have been achieved for the main brain (subependymal giant cell astrocytoma) and renal manifestations (angiomyolipoma) associated with TSC. This review provides an overview of TSC, everolimus, and the clinical trials that led to its approval for the treatment of TSC-associated subependymal giant cell astrocytoma and renal angiomyolipoma.

Franz, David Neal



Bortezomib (PS-341) treatment decreases inflammation and partially rescues the expression of the dystrophin-glycoprotein complex in GRMD dogs.  


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

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



Chronic Electroconvulsive Seizure (ECS) Treatment Results in Expression of a Long-lasting AP1 Complex in Brain with Altered Composition and Characteristics  

Microsoft Academic Search

Gene transcription is likely to play a role in the biochemical adaptations thought to underlie the long-term behavioral changes observed following various chronic treatments. The AP-1 (activator protein-l) complex is a well-studied tran- scription factor capable of regulating gene transcription. We therefore examined the regulation of the AP-1 complex in rat cerebral cortex and hippocampus following electrocon- vulsive seizures (ECS),

Bruce T. Hope; Max B. Kelz; Ronald S. Duman; Eric J. Nestler



Use of Fine-threaded K-wires in the Treatment of Coronoid Fractures in Complex Elbow Instability.  


The coronoid process is one of the main elbow constraints that provides ulnohumeral joint stability. Coronoid fractures may be fixed using multiple techniques, including transosseous sutures, screws, and plates. The goal of this study was to analyze the clinical and radiographic outcomes in a series of patients with complex elbow instability in whom coronoid fractures were repaired using fine-threaded K-wires. Eight men and 10 women (mean age, 47 years) were followed prospectively for a mean of 26 months. Surgical treatment consisted of open reduction and internal fixation of all fractures; radial head replacement in Mason III injuries; lateral collateral ligament repair in all patients; and, in cases of persistent instability, medial collateral ligament repair, hinged fixator application, or both. Coronoid fixation was performed using 2 or more fine-threaded K-wires, depending on the fragment size, inserted from the posterior aspect of the ulna and directed toward the coronoid fragment using a 1-step fixation technique. At last follow-up, mean extension was 15°, mean flexion was 133°, mean pronation was 78°, and mean supination was 69°; mean Disabilities of the Arm, Shoulder and Hand score was 9.7, mean American Shoulder and Elbow Surgeons score was 85, and mean Mayo Elbow Performance Score was 89. According to the Mayo Elbow Performance Index, 10 excellent, 7 good, and 1 fair result were recorded. All but 1 patient had a stable elbow. Fracture healing was observed in all but 1 patient. No secondary coronoid fragment dislocation or implant failures were reported. This study shows that using fine-threaded K-wires provides easy, minimally invasive, stable, and successful 1-step fixation that can be used to obtain osteosynthesis of coronoid fractures in patients with complex elbow instability. PMID:24093696

Giannicola, Giuseppe; Polimanti, David; Gumina, Stefano; Cinotti, Gianluca



Polymorphism in the Human Major Histocompatibility Complex and Early Viral Decline during Treatment of Chronic Hepatitis C ? ‡  

PubMed Central

The dynamics of the viral decline immediately after the start of therapy for chronic hepatitis C virus (HCV) infection may have prognostic potential for ultimate sustained virologic response. Considerable interindividual variability in the decline has been reported, including differences by race. The human major histocompatability complex (MHC) genes encode the human leukocyte antigens, which are important in the immune response to viral infections. We examined whether carriage of specific human MHC alleles are associated with the rate of the early viral decline. Longitudinal viral level data (baseline and days 1, 2, 7, 14, and 28 of treatment), medium resolution MHC genotyping, and random coefficients models were used to examine associations between MHC class I and class II allele carriage and the dynamics of the viral decline in 180 African-Americans (AAs) and 194 Caucasian Americans (CAs) with genotype-1 HCV infection over the first 28 days of treatment with peginterferon ?2a plus ribavirin. Baseline viral levels were similar by race, irrespective of allele carriage. However, the rate of change in the viral decline was associated with both allele and race. Among the four subgroups defined by race and specific allele, the fastest rates of decline were observed (in terms of estimated mean viral declines log10 IU/ml during the first four weeks) in CA noncarriers for A*03 (2.75; P = 0.018), in CA carriers for Cw*03 (2.99; P = 0.046), and in CA noncarriers for DQA1*04 (2.66; P = 0.018) or DQB1*0402 (2.65; P = 0.018). MHC alleles are associated with the viral decline during the first 28 days of peginterferon therapy.

Yee, Leland J.; Im, KyungAh; Wahed, Abdus S.; Bugawan, Teodorica; Li, Jia; Rhodes, Shannon L.; Erlich, Henry; Rosen, Hugo R.; Liang, T. Jake; Yang, Huiying



NOTE: Linking computer-aided design (CAD) to Geant4-based Monte Carlo simulations for precise implementation of complex treatment head geometries  

Microsoft Academic Search

Most of the treatment head components of medical linear accelerators used in radiation therapy have complex geometrical shapes. They are typically designed using computer-aided design (CAD) applications. In Monte Carlo simulations of radiotherapy beam transport through the treatment head components, the relevant beam-generating and beam-modifying devices are inserted in the simulation toolkit using geometrical approximations of these components. Depending on

Magdalena Constantin; Dragos E. Constantin; Paul J. Keall; Anisha Narula; Michelle Svatos; Joseph Perl



The use of pulsed electromagnetic fields with complex modulation in the treatment of patients with diabetic polyneuropathy.  


Clinical and electroneuromyographic studies were performed in 121 patients with diabetic polyneuropathy (DPN) before and after courses of treatment with pulsed electromagnetic fields with complex modulation (PEMF-CM) at different frequencies (100 and 10 Hz). Testing of patients using the TSS and NIS LL scales demonstrated a correlation between the severity and frequency of the main subjective and objective effects of disease and the stage of DPN. The severity of changes in the segmental-peripheral neuromotor apparatus--decreases in muscle bioelectrical activity, the impulse conduction rate along efferent fibers of peripheral nerves, and the amplitude of the maximum M response--depended on the stage of DPN and the duration of diabetes mellitus. The earliest and most significant electroneuromyographic signs of DPN were found to be decreases in the amplitude of the H reflex and the Hmax/Mmax ratio in the muscles of the lower leg. Application of PEMF-CM facilitated regression of the main clinical symptoms of DPN, improved the conductive function of peripheral nerves, improved the state of la afferents, and improved the reflex excitability of functionally diverse motoneurons in the spinal cord. PEMF-CM at 10 Hz was found to have therapeutic efficacy, especially in the initial stages of DPN and in patients with diabetes mellitus for up to 10 years. PMID:14635988

Musaev, A V; Guseinova, S G; Imamverdieva, S S



Infraclavicular brachial plexus block and infusion for treatment of long-standing complex regional syndrome type 1: a case report.  


Complex regional pain syndrome type 1 (CRPS 1) is a perplexing chronic pain condition that frustrates physicians and patients alike. The etiology of the condition resides in multiple theories and diagnosis can be difficult. Therapy focuses on pain management and restoration of physical function. Conservative treatment includes both non-pharmacological and pharmacological methods. Invasive therapy centers on sympathetic and somatic blocks and may evolve to neuromodulatory or neuraxial techniques. In patients with severe pain and extremity contractures with CRPS, often times the invasive blocks help in reduction of resting pain, but are ineffective in alleviating pain related to aggressive physical therapy. Continuous regional blockade with a percutaneous catheter is an effective, but seldom reported technique that can be used to treat both resting and movement related pain. This presentation reviews the results of an infraclavicular brachial plexus infusion used to treat CRPS 1 that developed in a 49 year-old woman following a work-related upper extremity injury. The patient made a dramatic recovery with the infusion, which was maintained for two weeks. A T2-T3 sympathetic radiofrequency thermocoagulation was then performed to maintain pain relief and the infusion was stopped. The patient returned to work and has done well over the ensuing 19 months. PMID:16868602

Day, Miles; Pasupuleti, Ram; Jacobs, Scott



Adiabatic eigenfunction-based approach for coherent excitation transfer: an almost analytical treatment of the Fenna-Matthews-Olson complex.  


We suggest a method of studying coherence in finite-level systems coupled to the environment and use it for the Hamiltonian that has been used to describe the light-harvesting pigment-protein complex. The method works with the adiabatic states and transforms the Hamiltonian to a form in which the terms responsible for decoherence and population relaxation are separated out. Decoherence is then accounted for nonperturbatively and population relaxation using a Markovian master equation. Almost analytical results can be obtained for the seven-level system, and the calculations are very simple for systems with more levels. We apply the treatment to the seven-level system, and the results are in excellent agreement with the exact numerical results of Nalbach et al. [Nalbach, Braun, and Thorwart, Phys. Rev. E 84, 041926 (2011)]. Our approach is able to account for decoherence and population relaxation separately. It is found that decoherence causes only damping of oscillations and does not lead to transfer to the reaction center. Population relaxation is necessary for efficient transfer to the reaction center, in agreement with earlier findings. Our results show that the transformation to the adiabatic basis followed by a Redfield type of approach leads to results in good agreement with exact simulation. PMID:23848720

Bhattacharyya, Pallavi; Sebastian, K L



Treatment of nickel containing industrial effluents with a hybrid process comprising of polymer complexation–ultrafiltration–electrolysis  

Microsoft Academic Search

A process was studied at the laboratory level and on a pre-industrial pilot for pollutant removal from industrial waste waters containing nickel cations. Five successive steps are involved: (1) complexation of the metal by means of polymeric ligands; (2) ultrafiltration of the complex, which produced a purified effluent and a concentrated metal complex solution; (3) decomplexation by acidification; (4) ultrafiltration

P. Baticle; C. Kiefer; N. Lakhchaf; O. Leclerc; M. Persin; J. Sarrazin




Microsoft Academic Search

Few clinical issues have been more hotly contested than the treatment of ADHD, particularly the relative value of medication\\u000a versus behavioral\\/psychosocial treatments (DuPaul & Power, 2008; Toplak, Connors, Shuster, Knezevic, & Parks, 2008; Wauschbusch\\u000a & Hill, 2003). Treatment decisions are often complicated by biases reflecting media coverage of diagnostic and treatment controversies,\\u000a cultural background, previous experiences or anecdotal stories from

Stephen E. Brock; Shane R. Jimerson; Robin L. Hansen


Comparing Two Service Delivery Models for Homeless Individuals With Complex Behavioral Health Needs: Preliminary Data From Two SAMHSA Treatment for Homeless Studies  

Microsoft Academic Search

Assertive Community Treatment (ACT) and the Comprehensive, Continuous, Integrated System of Care (CCISC) are two models for delivering services to homeless persons with complex behavioral health needs. This quasi-experimental study presents preliminary data comparing these two programs. The first program was based out of a community mental health center and utilized the ACT model of care with supported housing (ACT-SH),

M. Scott Young; Colleen Clark; Kathleen Moore; Blake Barrett



Linking computer-aided design (CAD) to Geant4-based Monte Carlo simulations for precise implementation of complex treatment head geometries.  


Most of the treatment head components of medical linear accelerators used in radiation therapy have complex geometrical shapes. They are typically designed using computer-aided design (CAD) applications. In Monte Carlo simulations of radiotherapy beam transport through the treatment head components, the relevant beam-generating and beam-modifying devices are inserted in the simulation toolkit using geometrical approximations of these components. Depending on their complexity, such approximations may introduce errors that can be propagated throughout the simulation. This drawback can be minimized by exporting a more precise geometry of the linac components from CAD and importing it into the Monte Carlo simulation environment. We present a technique that links three-dimensional CAD drawings of the treatment head components to Geant4 Monte Carlo simulations of dose deposition. PMID:20348609

Constantin, Magdalena; Constantin, Dragos E; Keall, Paul J; Narula, Anisha; Svatos, Michelle; Perl, Joseph



NOTE: Linking computer-aided design (CAD) to Geant4-based Monte Carlo simulations for precise implementation of complex treatment head geometries  

NASA Astrophysics Data System (ADS)

Most of the treatment head components of medical linear accelerators used in radiation therapy have complex geometrical shapes. They are typically designed using computer-aided design (CAD) applications. In Monte Carlo simulations of radiotherapy beam transport through the treatment head components, the relevant beam-generating and beam-modifying devices are inserted in the simulation toolkit using geometrical approximations of these components. Depending on their complexity, such approximations may introduce errors that can be propagated throughout the simulation. This drawback can be minimized by exporting a more precise geometry of the linac components from CAD and importing it into the Monte Carlo simulation environment. We present a technique that links three-dimensional CAD drawings of the treatment head components to Geant4 Monte Carlo simulations of dose deposition.

Constantin, Magdalena; Constantin, Dragos E.; Keall, Paul J.; Narula, Anisha; Svatos, Michelle; Perl, Joseph



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

SciTech Connect

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.

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



Ab initio treatment of the chemical reaction precursor complex Cl(P-2)HF. 2 : Bound states and infrared spectrum  

Microsoft Academic Search

Bound energy levels and properties of the Cl((2)p)-HF complex were obtained from full three-dimensional (3D) calculations, with the use of the ab initio computed diabatic potential surfaces from the preceding paper and the inclusion of spin-orbit coupling. For a better understanding of the dynamics of this complex we also computed a 21) model in which the HF bond length r

Anna V. Fishchuk; Gerrit C. Groenenboom; Ad van der Avoird



[Autologous transfusion of UV-irradiated blood in the complex treatment of children with dysplasia of deep veins of the extremities].  


Under examination there were 12 patients aged from 5 till 14 years. An investigation of hemostatic potential of blood in the diseased extremity and peripheral blood was performed. A mosaic character of blood coagulative alterations in this category of patients was detected. Autotransfusion of UV-irradiated blood is a pathogenetically grounded and accessible method of correction of hemocoagulation and may be included in the complex treatment of patients with dysplasia of the profound veins of lower extremities. PMID:1652859

Levanovich, V V; Kupatadze, D D; Endzhibadze, Iu G; Nabokov, V V; Mazurova, E V; Ivanov, A P; Chirovich, M



A phase I\\/IIa study on intra-articular injection of holmium-166-chitosan complex for the treatment of knee synovitis of rheumatoid arthritis  

Microsoft Academic Search

Previous animal studies have established that the intra-articular injection of holmium-166-chitosan complex (DW-166HC) causes effective necrosis of the inflamed synovium with little leakage of radioactivity from the injected joint. Based on these findings, we conducted a phase I\\/IIa study to examine the biodistribution of DW-166HC and to assess the safety of DW-166HC for the treatment of knee synovitis in patients

Jungsik Song; Chang Hee Suh; Yong Beom Park; Seung Hoon Lee; Nae Chun Yoo; Jong Doo Lee; Kyoung Hwan Kim; Soo Kon Lee




Microsoft Academic Search

Intensity modulated radiation therapy (IMRT) is a technique that delivers a highly conformal dose distribution to a target volume while attempting to maximally spare the surrounding normal tissues. IMRT is a common treatment modality used for treating head and neck (H&N) cancers, and the presence of many critical structures in this region requires accurate treatment delivery. The Radiological Physics Center

Jacqueline R Tonigan



Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: A randomized comparison of a simple versus complex strategy  

Microsoft Academic Search

BackgroundRapamycin-eluting stents (RES) have been shown to reduce restenosis in many types of lesions. However, the ideal strategy for the treatment of coronary bifurcated lesions has not been established to date. This randomized study compares 2 strategies for the RES treatment of bifurcation lesions: a simple approach (stenting the main vessel and balloon dilatation for the side branch [SB]) versus

Manuel Pan; José Suárez de Lezo; Alfonso Medina; Miguel Romero; José Segura; Djordje Pavlovic; Antonio Delgado; Soledad Ojeda; Francisco Melián; Juan Herrador; Isabel Ureña; Luis Burgos



Tautomerism and metal complexation of 2-acylmethyl-2-oxazolines: a combined synthetic, spectroscopic, crystallographic and theoretical treatment.  


A synthetic, structural and theoretical investigation into the solid-state, solution and gas phase structure(s) of six 2-acylmethyl-4,4-dimethyl-2-oxazolines is reported. Four of these materials, viz.?-[(4,5-dihydro-4,4-dimethyl-2-oxazolyl)methylene]benzenemethanol (3a), ?-[(4,5-dihydro-4,4-dimethyl-2-oxazolyl)methylene]-(4-nitrobenzene)methanol (3b), 1-(4,5-dihydro-4,4-dimethyl-2-oxazolyl)-3,3-dimethyl-1-buten-2-ol (3d) and (E)-1-phenyl-2-((3aR)-3,3a,8,8a-tetrahydro-2H-indeno[1,2-d]oxazol-2-ylidene)ethanone (3f) have been characterised in the solid-state by single crystal X-ray diffraction studies. These data represent the first solid-state structural studies of this class of compounds and details the first synthesis and full characterisation of chiral derivative 3f. All four of these materials are shown to exist in the solid phase in the enamine tautomeric form (e.g., 3a is best described as 2-[4,4-dimethyl-2-oxazolidinylidene]-1-phenylethanone) and it is suggested (NMR, IR) that this isomeric form is likely also retained in solution (e.g., CDCl3) as the more stable isomer. An investigation of the relative gas phase stabilities of the three possible (i.e., the (Z)-enol, keto and enamine) isomers of all five compounds by DFT at the B3LYP/6-311G(d) level of theory confirms the latter as the most stable form. The energy differences between the enamine and keto tautomers have been calculated to be the lowest for derivative 3d. These results are compared and contrasted with the previously reported NMR studies of such compounds which have identified the keto form as being a minor (albeit solution) tautomer. Equilibrium solution tautomer distributions for 3d are found to be solvent dependent. The protonated form of 3a, isolated as the HSO4(-) salt (i.e.4a), has been further characterised in the solid state by single crystal X-ray diffraction. These data represent the first example of a protonated oxazoline to be structurally elucidated and confirms that upon protonation, the keto (oxazoline) tautomer is the energetically favoured form in the solid-state. This observation is further supported by DFT studies for the gas phase protonated forms of such materials. Further DFT (B3LYP/6-311G(d)) calculations employing the SM8 or SMD solvation models were then applied to address the observed solution isomeric distribution for 3d; these results corroborate the gas phase theoretical treatment and also yield values that predict the higher solution stability of the enamine form as observed, although they fail to account for the existence of the keto form as a minor solution state tautomer. To access the availability of an enol-form, via hypothetical de-protonation to the enolate, compound 3a was treated with hydrated Cu(NO3)2 in EtOH solution. The resulting isolated green-coloured product (5), the first metal derivative of this entire class of ligands, is best described (IR, X-ray diffraction) as a coordinated enolate complex, i.e., Cu(3a-H)2. Complex 5 crystallizes in the P21/c space group with four molecules in the unit cell. The coordination geometry around the formal Cu(2+) metal centre is determined to be highly distorted square planar in nature (?4 = 0.442). TD-DFT is used to give a reasonable explanation for the intensity of the absorbance band observed in the visible region for solutions of 5. These latter experiments strongly suggest that the title class of compounds may have considerable potential as ligands in coordination chemistry and/or metal-mediated catalysis. PMID:23591452

Jones, Roderick C; Herasymchuk, Khrystyna; Mahdi, Tayseer; Petrov, Anna; Resanovi?, Sanja; Vaughan, Douglas G; Lough, Alan J; Quail, J Wilson; Koivisto, Bryan D; Wylie, R Stephen; Gossage, Robert A



Development of an acid soil conditioning agent from lignin by ozone treatment III: improvement of ability of lignin to form an aluminum complex and to reduce aluminum toxicity after ozone treatment  

Microsoft Academic Search

Lignin prepared by a modified Klason method (KSL) was modified with ozone followed by alkaline treatments. The original and\\u000a modified KSLs were subjected to a plant growth test with radish (Raphanus sativus L. var. radicula Pers.) in the presence of AlCl3 (37.5 ?M) to assess their ability to reduce aluminum toxicity. The formation of an aluminum complex with these KSLs

Hikaru Aimi; Yasuji Kurimoto; Shigeru Yamauchi


Efficacies of Amphotericin B (AMB) Lipid Complex, AMB Colloidal Dispersion, Liposomal AMB, and Conventional AMB in Treatment of Murine Coccidioidomycosis  

PubMed Central

The therapeutic efficacy of three lipid formulations of amphotericin B was compared with that of conventional amphotericin B in treatment of murine coccidioidomycosis. All treatments prolonged survival compared with the no-treatment group (P < 0.0001). Although conventional amphotericin B was more active than lipid formulations on reducing quantitative fungal load on a milligram-per-kilogram basis (P < 0.003 to 0.0002), the lipid preparations could be administered at higher doses, sterilizing liver and spleen tissues. The efficacies of the lipid preparations were similar in this murine model of coccidioidomycosis.

Gonzalez, Gloria M.; Tijerina, Rolando; Najvar, Laura K.; Bocanegra, Rosie; Rinaldi, Michael G.; Graybill, John R.



Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study  

Microsoft Academic Search

Complex regional pain syndrome (CRPS) is a severe chronic pain condition that most often develops following trauma. The pathophysiology of CRPS is not known but both clinical and experimental evidence demonstrate the important of the NMDA receptor and glial activation in its induction and maintenance. Ketamine is the most potent clinically available safe NMDA antagonist that has a well established

Robert J. Schwartzman; Guillermo M. Alexander; John R. Grothusen; Terry Paylor; Erin Reichenberger; Marielle Perreault



Evaluation of new complexes of biocompatible magnetic fluid and third generation of photosensitizer useful to cancer treatment  

Microsoft Academic Search

In this study, we performed in vitro evaluation of the dark and light toxicity of a third-generation photosensitizer (PS), a biocompatible magnetic fluid (BMFs), and the BMF\\/PS complex using the J774-A cell line. The BMFs used is based on maghemite nanoparticles surface-coated with phosphate whereas for photosensitizer the Chlorine e6 (Chle6) was employed.

P. P. Macaroff; D. M. Oliveira; K. F. Ribeiro; Z. G. M. Lacava; E. C. D. Lima; P. C. Morais; A. C. Tedesco



A new treatment for focal dystonias: incobotulinumtoxinA (Xeomin(R)), a botulinum neurotoxin type A free from complexing proteins  

PubMed Central

Dystonia is a movement disorder of uncertain pathogenesis that is characterized by involuntary and inappropriate muscle contractions which cause sustained abnormal postures and movements of multiple or single (focal) body regions. The most common focal dystonias are cervical dystonia (CD) and blepharospasm (BSP). The first-line recommended treatment for CD and BSP is injection with botulinum toxin (BoNT), of which two serotypes are available: BoNT type A (BoNT/A) and BoNT type B (BoNT/B). Conventional BoNT formulations include inactive complexing proteins, which may increase the risk for antigenicity, possibly leading to treatment failure. IncobotulinumtoxinA (Xeomin®; Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a BoNT/A agent that has been recently Food and Drug Administration-approved for the treatment of adults with CD and adults with BSP previously treated with onabotulinumtoxinA (Botox®; Allergen, Inc, Irvine, CA) – a conventional BoNT/A. IncobotulinumtoxinA is the only BoNT product that is free of complexing proteins. The necessity of complexing proteins for the effectiveness of botulinum toxin treatment has been challenged by preclinical and clinical studies with incobotulinumtoxinA. These studies have also suggested that incobotulinumtoxinA is associated with a lower risk for stimulating antibody formation than onabotulinumtoxinA. In phase 3 noninferiority trials, incobotulinumtoxinA demonstrated significant improvements in CD and BSP symptoms in both primary and secondary measures, compared with baseline, and met criteria for noninferiority versus onabotulinumtoxinA. In placebo-controlled trials, incobotulinumtoxinA also significantly improved the symptoms of CD and BSP, with robust outcomes in both primary and secondary measures. The use of incobotulinumtoxinA has been well tolerated in all trials, with an adverse event profile similar to that of onabotulinumtoxinA. Based on these data, incobotulinumtoxinA is a safe and effective BoNT/A for the treatment of CD and BSP, and may pose a lower risk for immunogenicity leading to treatment failure compared with other available BoNT agents. This paper reviews the treatment of focal dystonias with BoNTs, in particular, incobotulinumtoxinA. Controlled trials from the existing incobotulinumtoxinA literature are summarized.

Jimenez-Shahed, Joohi



Effective Tumor Treatment by VEGF siRNA Complexed with Hydrophobic Poly(Amino Acid)-Modified Polyethylenimine.  


Two copolymers are designed and synthesised for siRNA delivery based on polyethylenimine by grafting hydrophilic acrylamide segments and hydrophobic poly(?-benzyl L-glutamate). The amphiphilic PEI-PBLG/siRNA complex demonstrates high gene silencing efficiency in the absence or presence of 10?vol% and 50?vol% sera in vitro. The anti-tumor effects in vivo are evaluated in luciferase-bearing mice expressing CT26 tumors. PEI-PBLG/siVEGF complex provides a higher and more sustained suppressive effect by reducing VEGF mRNA expression in the tumors, leading to higher tumor growth inhibition efficacy. Further studies on the potential use of the PEI-PBLG carrier system in mediating the silencing of genes other than VEGF or in other tumor models are recommended. PMID:23873676

Chen, Jie; Tian, Huayu; Dong, Xuan; Guo, Zhaopei; Jiao, Zixue; Li, Feifan; Kano, Arihiro; Maruyama, Atsushi; Chen, Xuesi



Target specific tumor treatment by VEGF siRNA complexed with reducible polyethyleneimine-hyaluronic acid conjugate.  


Target specific delivery of small interfering RNA (siRNA) has been regarded as one of the most important technologies for the development of siRNA therapeutics. In this work, non-toxic low molecular weight (MW) polyethyleneimine (PEI, 2000 Da) was cross-linked with cystamine bisacrylamide (CBA) to prepare reducible PEI-SS in the body. Then, PEI-SS was conjugated with hyaluronic acid (HA) in the form of block-copolymer to enhance serum stability and facilitate target specific cellular uptake of siRNA by HA receptor mediated endocytosis. The cytotoxicity of (PEI-SS)-b-HA conjugate appeared to be negligible likely due to the degradation of PEI-SS to low MW PEI in the cytosol. Flow cytometric and confocal microscopic analyses confirmed the HA receptor mediated endocytosis of siRNA/(PEI-SS)-b-HA complex. The siRNA/(PEI-SS)-b-HA complex demonstrated an excellent in vitro gene silencing efficiency in the range of 50-80% reducing the mRNA expression level in the absence and presence of 50 vol% serum. Moreover, intra-tumoral injection of vascular endothelial growth factor (VEGF) siRNA/(PEI-SS)-b-HA complex resulted in dramatically inhibited tumor growth with reduced VEGF mRNA and VEGF levels in the tumors. PMID:20378167

Park, Kitae; Lee, Min-Young; Kim, Ki Su; Hahn, Sei Kwang



Delamination technique together with longitudinal incisions for treatment of Chiari I\\/syringomyelia complex: a prospective clinical study  

Microsoft Academic Search

BACKGROUND: Treatment modalities in Chiari malformation type 1(CMI) accompanied by syringomyelia have not yet been standardized. Pathologies such as a small posterior fossa and thickened dura mater have been discussed previously. Various techniques have been explored to enlarge the foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision

Kadir Kotil; Tu?rul Ton; Rabia Tari; Yildiray Savas



The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients  

Microsoft Academic Search

Objective: This study assesses the results of the ‘clover technique’ (suturing together the middle point of the free edges of the tricuspid leaflets) for the treatment of tricuspid regurgitation (TR) due to severe prolapse or tethering. Methods: From 2001, 66 patients with severe TR due to prolapsing or tethered leaflets underwent ‘clover repair’. Annuloplasty was associated in 64 patients (97%).

Elisabetta Lapenna; Michele De Bonis; Alessandro Verzini; Giovanni La Canna; David Ferrara; Maria Chiara Calabrese; Maurizio Taramasso; Ottavio Alfieri



Preliminary Research Articles Efficacy of 5Day Continuous Lidocaine Infusion for the Treatment of Refractory Complex Regional Pain Syndrome  

Microsoft Academic Search

Objective. Chronic regional pain syndrome (CRPS) is a severe pain condition that usually results from an injury or surgical procedure. The pain in CRPS often spreads from the site of injury, and with time becomes refractory to conventional therapy. The present study was undertaken to evaluate the effects of 5-day continuous intravenous lidocaine treatment in patients afflicted with CRPS. Methods.

Robert J. Schwartzman; Mona Patel; John R. Grothusen; Guillermo M. Alexander



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

ERIC Educational Resources Information Center

Four patients with fluent aphasia received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories. Patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. Patients trained on typical items demonstrated no generalized naming…

Kiran, Swathi; Thompson, Cynthia K.



Complex-Scaling Treatment for Doubly Excited Inter-Shell Resonances in H- Interacting with Screened Coulomb (Yukawa) Potentials  

NASA Astrophysics Data System (ADS)

The doubly-excited inter-shell resonance states of the hydrogen negative ion with screened Coulomb potentials are investigated in the framework of complex-scaling method. Highly correlated wave functions with terms up to 1078 in Hylleraas coordinates are used. The resonance parameters for the 2 s3 s 1 S e associated with the H ( N = 2) threshold and the 3 s4 s 1 S e state associated with the H ( N = 3) threshold for various screening strengths are reported. Comparisons are made with other available data in the literature.

Ho, Y. K.; Kar, S.



Two-phase orthodontic treatment of a complex malocclusion: giving up efficiency in favor of effectiveness, quality of life, and functional rehabilitation?  


The interceptive orthodontic treatment of patients with complex dentofacial abnormalities is frequently inefficient and produces less than ideal outcomes. Therefore, postponing therapy to a single-phase surgical-orthodontic approach might be considered a reasonable option. However, other relevant aspects of the patient's quality of life, such as possible psychosocial problems and functional impairments, should also be considered before deciding whether to intercept a severe dentofacial malocclusion while the patient is still growing, or wait and treat later. This case report describes the nonsurgical treatment of a young patient with a severe Class III open-bite malocclusion associated with a cervical cystic lymphangioma. Despite the poor interceptive therapy prognosis, a 2-phase approach was effective. A reflection about giving up efficiency in favor of effectiveness, functional rehabilitation, and the patient's quality of life is included. PMID:23561417

Souki, Bernardo Quiroga; Figueiredo, Daniel Santos Fonseca; Lima, Izabella Lucas de Abreu; Oliveira, Dauro Douglas; Miguel, José Augusto Mendes



Comparison of Wallgraft and Wallstent for treatment of complex iliac artery stenosis and occlusion. Preliminary results of a prospective randomized study.  

PubMed Central

We performed a prospective randomized study to compare the use of a bare metal stent (WALLSTENT Endoprosthesis) with use of a covered stent (WALLGRAFT Endoprosthesis)-both made by Schneider, Inc.; Minneapolis, Minn-for the treatment of complex iliac artery stenosis and occlusion. We report the preliminary results of a study performed at our institution from 1 February 1997 through 31 April 1997. The patient group was composed of 6 women and 4 men, with a mean age of 61.8 years (range, 47 to 73 years). Six WALLGRAFT endoprostheses (4 in the left iliac artery and 2 in the right) and 9 WALLSTENT endoprostheses (5 in the left iliac artery and 4 in the right) were implanted. The mean percent stenosis before treatment was similar in both groups (84.17% in the WALLGRAFT group and 82.14% in the WALLSTENT group). The post-treatment stenosis and peak systolic gradients were negligible or zero in both groups. The devices were safely deployed and technical success (< 30% residual stenosis) was achieved in both groups. The mean thigh-brachial index was similar in the 2 groups, both before treatment (0.65 in the WALLGRAFT group and 0.64 in the WALLSTENT group) and after treatment (1.12 in the WALLGRAFT group and 1.12 in the WALLSTENT group). Evaluation of clinical success revealed that symptoms of intermittent claudication improved markedly in 4 of 5 patients who received the WALLGRAFT Endoprosthesis. In the WALLSTENT group, 1 patient had symptomatic improvement, another had 1 limb improve and the other worsen, and the rest had no improvement. Clinical complications were observed in only 1 patient in the WALLGRAFT group and in 2 patients in the WALLSTENT group. These preliminary results indicate very good technical and early success at the 1-month follow-up with the use of the WALLGRAFT Endoprosthesis in complex iliac artery stenosis and occlusion. Despite these promising preliminary results, a longer follow-up study with a larger number of patients is needed to determine the benefits of the WALLGRAFT Endoprosthesis in patients with complex iliac artery stenosis or occlusion. Images

Krajcer, Z; Sioco, G; Reynolds, T



The efficient synthesis of a molybdenum carbide catalyst via H2-thermal treatment of a Mo(VI)-hexamethylenetetramine complex.  


An efficient method for preparation of Mo(2)C catalyst is described, where Mo(2)C is obtained by the heat treatment of a single solid precursor containing (NH(4))(6)Mo(7)O(24) and hexamethylenetetramine (HMT) at 923 K in H(2) flow without conventional prolonged carbonization. The catalysts are characterized by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), BET surface area measurement, and transmission electron microscopy (TEM). Furthermore, these catalysts are evaluated in the dibenzothiophene (DBT) hydrodesulfurization (HDS) reaction, and proved to be superior to those prepared by a temperature-programmed reduction (TPRe) method. The better catalytic performance is ascribed to higher dispersion of Mo(2)C on the support and a lower surface polymeric carbon content. This hydrogen thermal treatment (HTT) method provided a new strategy for the preparation of a highly active molybdenum carbide catalyst. PMID:21157590

Wang, Zhi-Qiang; Zhang, Zhong-Biao; Zhang, Ming-Hui



Lapita Burial Practices: Evidence for Complex Body and Bone Treatment at the Teouma Cemetery, Vanuatu, Southwest Pacific  

Microsoft Academic Search

Excavation of the 3,000-year-old Lapita cemetery of Teouma (Efate, Central Vanuatu) has allowed the first detailed investigation of mortuary practices of these initial colonizers of the Vanuatu archipelago. Focusing on one component of funerary practice: the adult corpse and bone treatment of 25 mortuary contexts recovered at the site during excavations in 2004 and 2005, the present study reveals that

Frédérique Valentin; Stuart Bedford; Hallie R. Buckley; Matthew Spriggs



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


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

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



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

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.

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



Ab initio treatment of the chemical reaction precursor complex Cl(2P)-HF. 2. Bound states and infrared spectrum.  


Bound energy levels and properties of the Cl(2P)-HF complex were obtained from full three-dimensional (3D) calculations, with the use of the ab initio computed diabatic potential surfaces from the preceding paper and the inclusion of spin-orbit coupling. For a better understanding of the dynamics of this complex we also computed a 2D model in which the HF bond length r was frozen at the vibrationally averaged values r0 and r1 and a 2 + 1D model in which the 3D potentials were averaged over the v(HF) = 0 and v(HF) = 1 vibrational wave functions of free HF. Also 1D calculations were made in which both r and the Cl-HF distance R were frozen. The complex is found to have the linear hydrogen bonded Cl-HF structure, with ground-state quantum numbers J = 3/2 for the overall angular momentum and /omega/ = 3/2 for its projection on the intermolecular axis R. The binding energy is D0 = 432.25 cm(-1) for v(HF) = 0 and D0 = 497.21 cm(-1) for v(HF) = 1. Bending modes with /omega/ = 1/2 and /omega/ = 5/2 are split by the Renner-Teller effect, since the electronic ground state is a degenerate 2pi state. A series of intermolecular (R) stretch modes was identified. Rotational constants and e-f parity splittings were extracted from the levels computed for J = 1/2 to 7/2. The computed red shift of the HF stretch frequency of 64.96 cm(-1) and the 35Cl-37Cl isotope shift of 0.033 cm(-1) are in good agreement with the values of 68.77 and 0.035 cm(-1) obtained from the recent experiment of Merritt et al. (Phys. Chem. Chem. Phys. 2005, 7, 67), after correction for the effect of the He nanodroplet matrix in which they were measured. PMID:16623453

Fishchuk, Anna V; Groenenboom, Gerrit C; van der Avoird, Ad



The mechanism of alternative splicing of the X-linked NDUFB11 gene of the respiratory chain complex I, impact of rotenone treatment in neuroblastoma cells.  


A study is presented on the regulation of alternative splicing (AS) of the Ndufb11 gene of complex I of the mitochondrial respiratory chain and the impact on this process of rotenone treatment in neuroblastoma cells. In physiological conditions the Ndufb11 gene produces at high level a short transcript isoform encoding for a 153 aa protein. This subunit is essential for the assembly of a functional and stable mammalian complex I. The gene produces also, at low level, a longer transcript isoform encoding for a 163 aa protein whose role is unknown. Evidence is presented here showing that the level of the two isoforms is regulated by three DGGGD ESS elements located in exon 2 which can bind the hnRNPH1 protein. In neuronal cells rotenone treatment affects the Ndufb11 alternative splicing pathway, with the increase of the 163/153 mRNAs ratio. This effect appears to be due to the down-regulation of the hnRNPH1 protein. Since rotenone induces apoptosis in neuronal cells, the post-transcriptional regulation of the Ndufb11 gene can be involved in the programmed cell death process. PMID:23246602

Panelli, Damiano; Lorusso, Francesca Paola; Papa, Francesco; Panelli, Patrizio; Stella, Alessandro; Caputi, Massimo; Sardanelli, Anna Maria; Papa, Sergio



[Silver-containing hydrocarbonate-calcium-magnesium mineral water in complex treatment of patients with chronic pyelonephritis].  


95 patients suffering from chronic pyelonephritis in active inflammation phase received antibacterial therapy with adjuvant drinking of silver-containing mineral water Serebryany klyuch (21 patients) or without such drinking (17 patients). Spa treatment with mineral water Serebryany klyuch in combined therapy of chronic pyelonephritis is shown to relieve clinical symptoms, decontaminate urine completely in 88.6% cases, to eliminate signs of immunodeficiency and endotoxicosis and to produce a 25.6% decrease in the recurrences for the nearest 2 years. PMID:12945141

Ne?mark, A I; Davydov, A V; Lebedev, E V


Compulsory community treatment? II. The collision of views and complexities involved: is it "the best possible alternative"?  


This paper pursues our exploration of the highly controversial issue concerning the compulsory treatment of allegedly mentally disordered persons within the community. We contrast, in their most basic arguments, the discourses which proponents and opponents of CCT characteristically construct for the specific purposes of convincing policy makers of the rightfulness of their respective positions and of ultimately influencing the legislative choices to be made. We identify key practical questions which have to be addressed in order to further our thinking on the issue and suggest that what today's mental health system unequivocally requires is real commitment on the part of government to make a greater political, organizational, and financial commitment to effective partnership models and to a balanced mental health system. PMID:10146509

Boudreau, F; Lambert, P



Effects of Combining Case-Based Instruction and Mindfulness Activities on the Acquisition, Application, and Transfer of Complex Knowledge: An Experimental Comparison of Two Multiple-Case Treatments on Videodisc.  

ERIC Educational Resources Information Center

|Two multiple-case instructional treatments were compared to determine their relative effectiveness for helping program participants acquire, apply, and transfer complex knowledge about Assistive Technology (AT) available to help people with impaired vision. Thirty-eight college students were randomly assigned to two conditions. Both treatments

Cunningham, Thomas H.; Thorkildsen, Ron J.


Advanced monitoring and supervision of biological treatment of complex dairy effluents in a full-scale plant.  


The operation of a wastewater treatment plant treating effluents from a dairy laboratory was monitored by an advanced system. This plant comprises a 12 m(3) anaerobic filter (AF) reactor and a 28 m(3) sequential batch reactor (SBR) coupled in series and is equipped with the following on-line measurement devices: biogas flow meter, feed and recycling flow meters, temperature sensor, dissolved oxygen analyzer, and redox meter. Other parameters such as chemical oxygen demand (COD), volatile fatty acids (VFA), etc. were determined off-line. The plant has been in operation for 634 days, the influent flow rate being 6-8 m(3)/d. COD concentration of the influent ranged between 8 and 12 kg COD/m(3), resulting in COD values in the effluent around 50-200 mg/L. The behavior of the system was studied using the set of measurements collected by the data acquisition program especially developed for this purpose. Monitoring of variables such as anaerobic reactor temperature permitted the detection and prevention of several failures such as temperature shocks in the AF reactor. Besides, off-line measurements such as the alkalinity or the VFA content, together with the on-line measurements, provided immediate information about the state of the plant and the detection of several anomalies, such as organic overloads in the SBR, allowing the implementation of several fast control actions. PMID:15176911

Carrasco, Eugenio F; Omil, Francisco; Garrido, Juan M; Arrojo, Belén; Méndez, Ramón


[Long-term effect of one-stage urethroplasty with perineoscrotal insular skin tube in the treatment of complex posterior urethral stricture].  


Thirty-one cases with complex stricture of posterior urethra were treated with one stage urethroplasty adopted perineoscrotal insular skin tube. The results of follow-up for 1 to 6 years were as follows: All cases urinated normally; The cystourethrography in 21 cases showed that urethrae were unobstructed; The urinary flow studies were carried out in 16 cases and the results showed that urinary flow rate curves were normal and that the maximum flow rate, the mean flow rate and the voiding time were all beyond normal values; The urethroscopy in 8 cases revealed that the surfaces of skin tubes remained smooth and without growth of hair stem. The facts stated as above indicated that this procedure was an ideal method for the treatment of long posterior urethral stricture. PMID:1499427

Wang, L L



Multimodality treatment of a complex series of parallel pathologies in a 16-year-old male that ultimately leads to bilateral hip arthroplasty surgery: A case report  

PubMed Central

INTRODUCTION Femoral head osteonecrosis is associated with significant sequelae for the patient in the long-term. A combination of factors are thought to contribute to the pathophysiology behind this debilitating disease process. PRESENTATION OF CASE We report on a 16-year-old adolescent male requiring staged bilateral hybrid hip arthroplasty within 3 years of diagnosis of acute lymphoblastic leukaemia that ran a complicated course of multimodality treatment. DISCUSSION The case examines the literature on femoral head osteonecrosis in this population cohort and the challenge for the orthopaedic surgeon in the management of this increasingly prevalent condition. CONCLUSION In a young population cohort, it is important to have arthroplasty surgery as part of the management armamentarium, especially when coupled with complex pathology.

Cullen, Emmet; Quinlan, John; Fogarty, Esmond; Keogh, Peter



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

SciTech Connect

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.

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



"Waffle Cone" Technique for Intra/Extra-Aneurysmal Stent Placement for the Treatment of Complex and Wide-Necked Bifurcation Aneurysm  

PubMed Central

Summary Endovascular treatment of intracranial aneurysms by coiling has become an accepted alternative to surgical clipping1. In cases of wide-necked and sidewall aneurysms, selective embolization is difficult because of the risk of coil protrusion into the parent vessel. The use of three-dimensional coils, stents2, and balloon remodeling have all aided the attempt to adequately manage such lesions. However, compared with sidewall aneurysms, bifurcation aneurysms are more challenging from an endovascular standpoint. Because of their specific anatomy and hemodynamics, the tendency to recur and rerupture is higher. Several authors have reported successful treatment of these complex and wide-necked bifurcation aneurysms by using Y-configured dual stent-assisted coil embolization3,4, the double microcatheter technique5, a more compliant balloon remodeling technique6, the TriSpan neck-bridge device7, or the waffle cone technique8. We describe two cases of wide-necked bifurcation aneurysms in which the waffle cone technique was used for coil embolization. The waffle cone technique was first described in 2006; however, the small number of published cases and the lack of follow-up prevent one from assessing this technique's durability and the probability of recanalization. We report the cases of two patients harboring unruptured wide-necked bifurcation aneurysms that were treated and followed-up for six months.

Yang, Tzu-Hsien; Wong, Ho-Fai; Yang, Ming-Shiang; Ou, Chang-Hsien; Ho, Tzu-Lung



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

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.

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



Targeting Oxidative Injury and Cytokines' Activity in the Treatment with Anti-Tumor Necrosis Factor-? Antibody for Complex Regional Pain Syndrome 1.  


Cytokines and oxygen free radicals have been implicated in the potential pathogenic development of complex regional pain syndrome (CRPS). We aimed to analyze the relationship between clinical status, circulating levels of cytokines, and markers of oxidative damage during the treatment with anti-TNF? antibodies. The patient chosen for treatment had not had improvement through a number of conventional therapies and fulfilled the current diagnostic criteria for CRPS-1. We investigated the clinical variables before and after systemic administration of 1.4 mg/kg anti-TNF? antibody (infliximab), repeated after 1 month in a dose of 3 mg/kg. Blood samples were collected before and after anti-TNF? antibodies administration, and plasma was analyzed for 8-isoprostane-prostaglandin F2? (8-iso-PGF2?, a marker of oxidative injury) and cytokines (TNF-?, IL-4, IL-6, IL-7, IL-8, IL-10, IL-17A). Plasma concentrations of 8-iso-PGF2? were measured with radioimmunoassay (RIA), and the kinetics of cytokines were detected in plasma by antibody-based proximity ligation (PLA). Pathologically high levels of 8-iso-PGF2? were found in the patient. Immediately after each administration of infliximab, the levels of 8-iso-PGF2? decreased. Although the patient showed an improvement of the cutaneous dystrophic symptoms and diminished pain associated with these lesions, the levels of circulating TNF? increased after the administration of anti-TNF? antibodies. In a patient with CRPS-1 treated with anti-TNF? antibodies, we report increased levels of circulating TNF? and a temporary mitigation of oxidative stress as measured by plasma F(2) -isoprostane. This case report provides evidence 2 supporting the indication of monitoring the oxidative stress biomarkers during treatment with anti-TNF? antibodies in CRPS 1. PMID:23336526

Miclescu, Adriana A; Nordquist, Lena; Hysing, Eva-Britt; Butler, Stephen; Basu, Samar; Lind, Anne-Li; Gordh, Torsten



Nanoscaled poly(L-glutamic acid)/doxorubicin-amphiphile complex as pH-responsive drug delivery system for effective treatment of nonsmall cell lung cancer.  


Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide. Herein, we develop a polypeptide-based block ionomer complex formed by anionic methoxy poly(ethylene glycol)-b-poly(L-glutamic acid) (mPEG-b-PLG) and cationic anticancer drug doxorubicin hydrochloride (DOX·HCl) for NSCLC treatment. This complex spontaneously self-assembled into spherical nanoparticles (NPs) in aqueous solutions via electrostatic interaction and hydrophobic stack, with a high loading efficiency (almost 100%) and negative surface charge. DOX·HCl release from the drug-loaded micellar nanoparticles (mPEG-b-PLG-DOX·HCl) was slow at physiological pH, but obviously increased at the acidic pH mimicking the endosomal/lysosomal environment. In vitro cytotoxicity and hemolysis assays demonstrated that the block copolypeptide was cytocompatible and hemocompatible, and the presence of copolypeptide carrier could reduce the hemolysis ratio of DOX·HCl significantly. Cellular uptake and cytotoxicity studies suggested that mPEG-b-PLG-DOX·HCl was taken up by A549 cells via endocytosis, with a slightly slower cellular internalization and lower cytotoxicity compared with free DOX·HCl. The pharmacokinetics study in rats showed that DOX·HCl-loaded micellar NPs significantly prolonged the blood circulation time. Moreover, mPEG-b-PLG-DOX·HCl exhibited enhanced therapeutic efficacy, increased apoptosis in tumor tissues, and reduced systemic toxicity in nude mice bearing A549 lung cancer xenograft compared with free DOX·HCl, which were further confirmed by histological and immunohistochemical analyses. The results demonstrated that mPEG-b-PLG was a promising vector to deliver DOX·HCl into tumors and achieve improved pharmacokinetics, biodistribution and efficacy of DOX·HCl with reduced toxicity. These features strongly supported the interest of developing mPEG-b-PLG-DOX·HCl as a valid therapeutic modality in the therapy of human NSCLC and other solid tumors. PMID:23410916

Li, Mingqiang; Song, Wantong; Tang, Zhaohui; Lv, Shixian; Lin, Lin; Sun, Hai; Li, Quanshun; Yang, Yan; Hong, Hua; Chen, Xuesi



Radial side (1D) tears.  


The triangular fibrocartilage complex (TFCC) is the key structure at the wrist that facilitates the rotation of the radius and the carpus on the distal ulnar. The radial or type 1D tears of the TFCC are uncommon, but they pose a major disruption of the articular contact between the carpus and the distal ulna. The tears can heal by arthroscopically repairing the TFCC back to the radius using sutures through bone tunnels. This procedure allows patients to return to their work and sports activities with significant recovery of strength and range of motion. PMID:21871347

Trumble, Thomas



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

PubMed Central

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.



[Carney complex].  


Carney complex is a clinically and genetically heterogeneous disease, with at least two genetic loci including the PRKAR1A gene located on chromosome 17 and the CNC2 locus mapped to chromosome 2. Clinically this syndrome is characterized by multiple myxomas occurring in different anatomic sites, mucocutaneous pigmentary lesions, and a variety of non-endocrine and endocrine tumors, often causing endocrine abnormalities, involving various organs. Knowledge of morphological findings in CNC patients with their typical locations is necessary to raise suspicion of this syndrome by pathologists. Confirmation of the diagnosis allows regular clinical check-ups and early treatment of these patients. PMID:22145222

Kacerovská, D; Michal, M; Síma, R; Grossmann, P; Kazakov, D V



Meisenheimer Complexes (sigma Complexes).  

National Technical Information Service (NTIS)

Meisenheimer complexes are known to form in aromatic nucleophilic substitution reactions. The purpose of the present study is to collect as much information as possible in this important field of organic chemistry. The interaction of nitro aromatics with ...

A. S. Mirza



Complex patterns of protease inhibitor resistance among antiretroviral treatment-experienced HIV-2 patients from Senegal: implications for second-line therapy.  


Protease inhibitor (PI)-based antiretroviral therapy (ART) can effectively suppress HIV-2 plasma load and increase CD4 counts; however, not all PIs are equally active against HIV-2, and few data exist to support second-line therapy decisions. To identify therapeutic options for HIV-2 patients failing ART, we evaluated the frequency of PI resistance-associated amino acid changes in HIV-2 sequences from a cohort of 43 Senegalese individuals receiving unboosted indinavir (n = 18 subjects)-, lopinavir/ritonavir (n = 4)-, or indinavir and then lopinavir/ritonavir (n = 21)-containing ART. Common protease substitutions included V10I, V47A, I54M, V71I, I82F, I84V, L90M, and L99F, and most patients harbored viruses containing multiple changes. Based on genotypic data, we constructed a panel of 15 site-directed mutants of HIV-2ROD9 containing single- or multiple-treatment-associated amino acid changes in the protease-encoding region of pol. We then quantified the susceptibilities of the mutants to the HIV-2 "active" PIs saquinavir, lopinavir, and darunavir using a single-cycle assay. Relative to wild-type HIV-2, the V47A mutant was resistant to lopinavir (6.3-fold increase in the mean 50% effective concentration [EC50]), the I54M variant was resistant to darunavir and lopinavir (6.2- and 2.7-fold increases, respectively), and the L90M mutant was resistant to saquinavir (3.6-fold increase). In addition, the triple mutant that included I54M plus I84V plus L90M was resistant to all three PIs (31-, 10-, and 3.8-fold increases in the mean EC50 for darunavir, saquinavir, and lopinavir, respectively). Taken together, our data demonstrate that PI-treated HIV-2 patients frequently harbor viruses that exhibit complex patterns of PI cross-resistance. These findings suggest that sequential PI-based regimens for HIV-2 treatment may be ineffective. PMID:23571535

Raugi, Dana N; Smith, Robert A; Ba, Selly; Toure, Macoumba; Traore, Fatou; Sall, Fatima; Pan, Charlotte; Blankenship, Lindsey; Montano, Alexandra; Olson, Julia; Dia Badiane, Ndeye Mery; Mullins, James I; Kiviat, Nancy B; Hawes, Stephen E; Sow, Papa Salif; Gottlieb, Geoffrey S



Design, synthesis and characterization of zinc-3 hydroxy flavone, a novel zinc metallo complex for the treatment of experimental diabetes in rats.  


Zinc is essential in the physiology of insulin and has prominent roles in the structural and functional aspects of insulin. Most of the zinc complexes so far tested for their antidiabetic potential exerts significant toxicity. Hence, the development of zinc complexes with various ligands in order to reduce the toxicity of zinc continues. In the present study, an attempt has been made to synthesize zinc-3-hydroxy flavone (Zn-flavonol) complex and it was subjected to spectral characterization. The UV-visible, IR, fluorescence, mass and NMR spectral studies provide information that complexation involves the binding of zinc ion with ? hydroxyl keto group of the 3-hydroxy flavone (flavonol). Acute toxicity and dosage fixation studies revealed that the Zn-flavonol complex is non toxic and oral administration of the complex at a concentration of 5mg/kg b.w./rat/day for 30days to streptozotocin induced diabetic rats showed significant reduction in blood glucose, glycosylated hemoglobin (HbA1c), urea, uric acid and creatinine with concomitant improvement in plasma insulin and C-peptide levels. Further, the oral glucose tolerance test performed in experimental rats indicated that the Zn-flavonol complex has significant antihyperglycemic activity in streptozotocin induced diabetic rats. Also, the reduced activities of serum AST, ALT and ALP in the diabetic rats treated with the complex revealed the non-toxic nature of the zinc-flavonol complex. The antidiabetic activity of the complex was comparable with gliclazide, a standard antidiabetic drug. PMID:22327044

Vijayaraghavan, Kalavakunda; Iyyam Pillai, Subramanian; Subramanian, Sorimuthu Pillai



Aortic arch/elephant trunk procedure with SiennaTM graft and endovascular stenting of thoraco-abdominal aorta for treatment of complex chronic dissection  

PubMed Central

Aneurismal dilatation of the remaining thoracic aorta after ascending aortic interposition grafting for type ‘A’ aortic dissection is not uncommon. For such complex cases, one treatment option is total arch replacement and elephant trunk procedure with the SiennaTM collared graft (Vascutek, Inchinnan, UK) technique followed by a staged thoracic endovascular aortic repair (TEVAR). The video illustrates our technique in a 56-year-old man with an extensive aortic arch and descending thoracic aortic dissecting aneurysm. For the ‘open’ procedure femoral arterial and venous cannulation was used along with systemic cooling and circulatory arrest at 22 °C. Upon circulatory arrest, the aortic arch was incised and antegrade cerebral perfusion achieved via selective cannulation to the right brachiocephalic and left common carotid artery, keeping flow rates at 10-15 mL/kg/min and perfusion pressure at 50-60 mmHg. Arch replacement with an elephant trunk component was then performed and after completion of the distal aortic anastomosis antegrade perfusion via a side-arm in the graft was started and the operation completed using a variation of the ‘sequential’ clamping technique to maximize cerebral perfusion. The second endovascular stage was performed two weeks after discharge. Two covered stents were landing from the elephant trunk to the distal descending thoracic aorta, to secure the distal landing a bare stent of was placed to cover the aorta just distal to the origin of the celiac axis. The left subclavian artery was embolised with fibre coils. Post TEVAR angiogram showed no endoleak Although re-operative total arch replacement and elephant trunk procedure and subsequent TEVAR remained a challenging procedure, we believe excellent surgical outcome can be achieved with carefully planned operative strategy.

Wong, Randolph H.L.; Baghai, Max; Yu, Simon C.H.



Aortic arch/elephant trunk procedure with Sienna(TM) graft and endovascular stenting of thoraco-abdominal aorta for treatment of complex chronic dissection.  


Aneurismal dilatation of the remaining thoracic aorta after ascending aortic interposition grafting for type 'A' aortic dissection is not uncommon. For such complex cases, one treatment option is total arch replacement and elephant trunk procedure with the Sienna(TM) collared graft (Vascutek, Inchinnan, UK) technique followed by a staged thoracic endovascular aortic repair (TEVAR). The video illustrates our technique in a 56-year-old man with an extensive aortic arch and descending thoracic aortic dissecting aneurysm. For the 'open' procedure femoral arterial and venous cannulation was used along with systemic cooling and circulatory arrest at 22 °C. Upon circulatory arrest, the aortic arch was incised and antegrade cerebral perfusion achieved via selective cannulation to the right brachiocephalic and left common carotid artery, keeping flow rates at 10-15 mL/kg/min and perfusion pressure at 50-60 mmHg. Arch replacement with an elephant trunk component was then performed and after completion of the distal aortic anastomosis antegrade perfusion via a side-arm in the graft was started and the operation completed using a variation of the 'sequential' clamping technique to maximize cerebral perfusion. The second endovascular stage was performed two weeks after discharge. Two covered stents were landing from the elephant trunk to the distal descending thoracic aorta, to secure the distal landing a bare stent of was placed to cover the aorta just distal to the origin of the celiac axis. The left subclavian artery was embolised with fibre coils. Post TEVAR angiogram showed no endoleak Although re-operative total arch replacement and elephant trunk procedure and subsequent TEVAR remained a challenging procedure, we believe excellent surgical outcome can be achieved with carefully planned operative strategy. PMID:23977606

Wong, Randolph H L; Baghai, Max; Yu, Simon C H; Underwood, Malcolm J



Colostrinin®: a Proline-Rich Polypeptide (PRP) Complex Isolated from Ovine Colostrum for Treatment of Alzheimer's Disease. A Double-Blind, Placebo-Controlled Study  

Microsoft Academic Search

A proline-rich polypeptide (PRP) complex, subsequently called Colostrinin® , was isolated from ovine c olostrum. The complex showed immunomodulatory properties in mice, rats, and chickens, inducing maturation and differentiation of thymocytes. It was recently found that Colostrinin® is a cytokine-like factor that acts as an i nducer of interferon ? (IFN-? ) and other cytokines in human peripheral blood and



Estrus synchronization and ovarian hyper-stimulation treatments have negligible effects on cumulus oocyte complex gene expression whereas induction of ovulation causes major expression changes.  


The effects of exogenous hormones, used for estrus synchronization and ovarian hyper stimulation, on cumulus oocyte complexes (COCs) gene expression in sexually mature rats were determined using microarrays. Gene expression in COCs collected from GnRH (G(trt)), GnRH + eCG (G + E(trt)), and GnRH + eCG + hCG (G + E + H(trt)) treatments were compared to COCs from naturally cycling (NC) rats before the preovulatory luteninizing hormone surge. There was no significant difference in gene expression among NC, G(trt), and G + E(trt); however, over 2,600 genes were significantly different between NC and G + E + H(trt) (P < 0.05). Genes upregulated in G + E + H(trt) encode for: proteins that are involved in prostaglandin synthesis (Ptgs2, Pla2g4a, and Runx1) and cholesterol biosynthesis (Hmgcr, Sc4mol, and Dhcr24); receptors that allow cholesterol uptake (Ldlr and Scarb1), regulate progesterone synthesis (Star), and inactivate estrogen (Sult1e1); and downstream effectors of LH signal (Pgr, Cebpb, Creb3l1, Areg, Ereg, and Adamts1). Conversely, G + E + H(trt) downregulated genes encoding proteins involved in: DNA replication and cell cycle progression (Ccne2, Orc5l, Rad50, and Mcm6); reproductive developmental process; and granulosa cell expansion (Gdf9, Bmp15, Amh, Amhr2, Bmpr1b, Tgfb2, Foxl2, Pde3a, Esr2, Fshr, Ybx2, Ccnd2, Ccnb1ip1, and Zp3); maternal effect genes required for embryo development (Zar1, Npm2, Nlrp5, Dnmt1, H1foo, and Zfp57); amino acid degradation; and ketogenesis (Hmgcs2, and Cpt1b). These results from the rat show that hormones used for estrus synchronization (G(trt)) and ovarian hyper stimulation (G + E(trt)) had minimal effects on gene expression, whereas induction of ovulation (G + E + H(trt)) caused major changes in gene expression of rat COCs. This study provides comprehensive information about regulated genes during late follicle development and ovulation induction. PMID:23239112

Agca, Cansu; Yakan, Akin; Agca, Yuksel



The effect of laser consolidation and nitriding complex surface treatment on microstructure and properties of 3Cr2W8V steel  

Microsoft Academic Search

3Cr2W8V steel is first dealed with laser consolidation, then treated by QPQ salt-bath nitriding complex technology. The treated surface microstructure was analyzed by using JSM-6360LV type SEM. The hardness and wear-resistance were tested for both laser consolidation plus QPQ salt-bath nitriding complex technology and only QPQ salt-bath nitriding. The experimental results indicate that the 3Cr2W8V steel has good nitriding efficiency

Y. X. Yu; B. L. He



The Value of Plain X-Rays in Predicting TFCC Injury after Distal Radial Fractures  

Microsoft Academic Search

In this prospective study, the plain X-rays and MRI scans of 60 patients with intraarticular distal radius fractures were examined in random order. MRI evaluation revealed that 27 of the 60 patients (45%) had triangular fibrocartilage lesions. No correlation was found between triangular fibrocartilage injury and the Melone classification system, the presence of an ulnar styloid fracture, comminution of the




The complexity of the adherence-response relationship in tuberculosis treatment: why are we still in the dark and how can we get out?  


Non-adherence to tuberculosis (TB) treatment is a major challenge to global TB control because it increases the risk of treatment failure, relapse and the emergence of drug-resistant TB. Although the problem is widely acknowledged, there is still no clarity about the exact impact of different levels and patterns of non-adherence on treatment outcome. This hampers the provision of adequate advice to patients and clinicians, and it challenges the development and evaluation of adherence-promoting interventions. In this article, we explain why we are still in the dark with respect to predicting how different types of non-adherence to TB treatment affect treatment outcome. We show that we lack uniformity in how we define and measure non-adherence, that we have no easily accessible treatment success indicators, and that the relationship between treatment adherence and outcome is influenced by a number of pathogenic, immunological and pharmacological factors that are only partly understood. We conclude that an integral 'bench and bedside approach' that incorporates experimental studies with in vitro models and animals, as well as observational studies in patients with TB, is needed to help us get out of the dark regarding the adherence-response relationship in TB treatment. PMID:21375681

van den Boogaard, Jossy; Boeree, Martin J; Kibiki, Gibson S; Aarnoutse, Rob E



Prospective analysis of neutralising antibody titres in secondary non-responders under continuous treatment with a botulinumtoxin type A preparation free of complexing proteins--a single cohort 4-year follow-up study  

PubMed Central

Objectives In long-term botulinum neurotoxin treatment, loss of therapeutic efficacy may occur due to neutralising antibody formation. Preliminary results with incobotulinumtoxinA, a preparation free of complexing/accessory proteins, have indicated a low antigenicity. We hypothesised that continuous treatment with this botulinum neurotoxin preparation would not result in an increase in neutralising antibody titres (NABTs) in patients with pre-existing NABTs. Design Prospective, blinded cohort study. Setting Single centre in Germany. Participants Thirty-seven cervical dystonia patients with NABTs and partial secondary non-responsiveness to their previous botulinum neurotoxin type A treatment. Intervention Three-monthly intramuscular injections of incobotulinumtoxinA with a constant dose of 200?MU per injection during the first year; thereafter up to 500?MU for the next 36?months. Outcome measures Primary outcome measure: number of patients in whom NABTs declined below the initial titre after 48?months of incobotulinumtoxinA treatment or in whom titres had become negative within the 48?months. Secondary outcome measure: steepness of changes in NABT. NABTs were determined by mouse hemidiaphragm assay. Findings were compared to long-term data from 24 cervical dystonia patients who had developed NABTs and in whom treatment had been discontinued. Results Following a transient increase in the first 24?months under incobotulinumtoxinA treatment in some patients, NABTs declined well below the initial titre in the majority of patients. Test assay results were negative in most of the patients followed for more than 36?months. NABTs seemed to decline into the negative detection range as rapidly under incobotulinumtoxinA treatment as after cessation of botulinum neurotoxin therapy. Conclusions The reduction of NABTs despite continuous treatment with incobotulinumtoxinA indicates low antigenicity of incobotulinumtoxinA. This might have implications on restrictions such as minimum injection intervals of ?10?weeks currently in place for maintaining successful long-term application of botulinum neurotoxin.

Hefter, Harald; Hartmann, Christian; Kahlen, Ulrike; Moll, Marek; Bigalke, Hans



Surgical treatment of hiatus hernia and gastroesophageal reflux disease in complex cases using robotic-assisted laparoscopic surgery: a prospective study\\/consistent experience in a single institution  

Microsoft Academic Search

The aim of this study was to report our experience in robotic-assisted surgery of hiatus hernia and gastroesophageal reflux\\u000a disease in a large series of complex cases. From March 2009 until July 2010, 21 patients were operated due to hiatus hernia\\u000a or reflux disease using robotic-assisted surgery at Albert Einstein Hospital, São Paulo, Brazil. All patients were selected\\u000a for the

Vladimir Schraibman; Antonio Luiz de Vasconcellos Macedo; Samuel Okazaki; Fernando Concilio Mauro; Marina Gabrielle Epstein; Suzan Menasce Goldman; Suzana Lustosa; Delcio Matos



Transplacental passage of Pt after treatment with the new triamine complex cis-diaminechloro-[2-(diethylamino) ethyl 4-amino-benzoate, N 4 ]-chloride platinum (II) monohydrochloride monohydrate  

Microsoft Academic Search

Cis-diaminechloro-[2-(diethylamino) ethyl 4-amino-benzoate, N 4]-chloride platinum (II) monohydrochloride monohydrate (DPR) is a monofunctional Pt triamine complex synthesized starting from cisplatin and procaine hydrochloride, characterized by a good antitumor activity coupled with low toxic effects and able to impair prenatal development of mice but at doses outside or just in the upper range of therapeutic doses. In the present paper the

Emanuela Ognio; Barbara Chiavarina; Gabriele Caviglioli; Maddalena Lapide; Maurizio Viale



Chronic treatment with 1-aminocyclopropanecarboxylic acid desensitizes behavioral responses to compounds acting at the N-methyl- d -aspartate receptor complex  

Microsoft Academic Search

Functional antagonists at the N-methyl-d-aspartate (NMDA) receptor complex produce anti-depressant-like actions in preclinical models. Thus, an injection of a glycine partial agonist (1-aminocyclopropanecarboxylic acid; ACPC), a competitive NMDA antagonist (2-amino-7-phosphonoheptanoic acid; AP-7) or a use-dependent cation channel blocker (MK-801) reduced immobility in the forced swim test (FST) with efficacies comparable to imipramine (Trullas and Skolnick 1990). Seven daily injections of

Phil Skolnick; Rachel Miller; Andrew Young; Kathleen Boje; Ramon Trullas



Amphotericin B lipid complex is efficacious in the treatment of Candida albicans biofilms using a model of catheter-associated Candida biofilms  

Microsoft Academic Search

The purpose of this study was to determine the efficacy of amphotericin B lipid complex (ABLC) against Candida albicans biofilms using a rabbit model of catheter-associated candidal biofilm. A clinical C. albicans isolate was allowed to form biofilms on catheters placed in vivo and was then exposed to lock therapy with ABLC (1.5mg, locked for 4h or 8h for 7

Pranab K. Mukherjee; Lisa Long; Hyung Gun Kim; Mahmoud A. Ghannoum



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


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

Schumacher, Joseph E; 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



Longterm Follow-Up of Patients in CSP 298 'Treatment of Patients with Acquired Deficiency Syndrome (AIDS) and AIDS Related Complex'.  

National Technical Information Service (NTIS)

In order to determine whether there is a long-term benefit to initial versus delayed treatment with AZT, a long-term follow-up study is being conducted for patients enrolled in a USAMRDC funded, randomized trial of early versus later zidovudine (AZT) ther...

M. S. Simberkoff J. Hamilton



Complex elbow instability.  


Complex elbow instability consists of dislocation of the ulnohumeral joint with a concomitant fracture of one or several of the bony stabilizers of the elbow, including the radial head, proximal ulna, coronoid process, or distal humerus. Recurrent instability is not often associated with simple dislocation, but an improperly managed complex dislocation may be a prelude to chronic, recurrent elbow instability. Complex instability is significantly more demanding to manage than simple instability. Radial head, coronoid, and olecranon fracture associated with dislocation each must be assessed and often require surgery. Long-term outcome with surgical management of complex elbow injuries is unknown. A few published series examine combinations of different injury patterns managed with various methods. Recently, however, several well-designed prospective outcome studies have evaluated management of several different individual fracture-dislocation patterns with a unified treatment algorithm. Fixation or replacement of injured bony elements, ligamentous repair, and hinged fixation may be used to successfully manage complex elbow instability. PMID:16675621

Tashjian, Robert Z; Katarincic, Julia A



Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study  

PubMed Central

Purpose Partial wrist arthrodesis is a commonly performed procedure for the treatment of posttraumatic wrist arthritis because of its ability to provide pain relief without sacrificing complete wrist motion. The purpose of this study was to evaluate the redistribution of force after four-corner fusion and scaphoid excision, and to correlate the findings with the reported clinical outcomes. Methods Fifteen cadaveric wrists were used to study the biomechanics of the four-corner fusion. Pressure-sensitive film (super-low-pressure-indicating film—Pressurex, Sensor Products Inc, Madison, NJ) was inserted into the radiocarpal joint. Using the MTS 858 Mini Bionix (MTS System, Eden Prairie, MN), 50-kg loads (220 N) were applied to the wrists before and after simulated four-corner fusion and scaphoid excision. Statistically, we compared the pressure in the normal (intact) wrists versus four-corner fusion and scaphoid excision. The pressure measurements across the scaphoid fossa, lunate fossa, and triangular fibrocartilage complex (TFCC) were compared. Results There is a statistical significant difference between scaphoid, lunate, and TFCC mean total force when pre and post-fusion were compared (p?=?0.0001). Our study revealed a statistical significant decrease in the mean scaphoid total force after scaphoid excision and four-corner fusion (p?=?0.0001). We also found a subsequent increase in mean total force after scaphoid excision and four-corner fusion for the lunate fossa that did not reach statistical significance (p?=?0.08), and no difference in load across the TFCC area (p?=?0.995). Conclusions Our findings suggest that load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion.

Grothaus, Matt; Ciocanel, Despina; Goel, Vijay



Ab initio treatment of the chemical reaction precursor complex Br(2P)-HCN. 2. Bound-state calculations and infrared spectra.  


Rovibronic energy levels and properties of the Br(2P)-HCN complex were obtained from three-dimensional calculations, with HCN kept linear and the CN bond frozen. All diabatic states that correlate to the 2P3/2 and 2P1/2 states of the Br atom were included and spin-orbit coupling was taken into account. The 3 x 3 matrix of diabatic potential surfaces was taken from the preceding paper (paper 1). In agreement with experiment, we found two linear isomers, Br-NCH and Br-HCN. The calculated binding energies are very similar: D0 = 352.4 cm(-1) and D0 = 349.1 cm(-1), respectively. We established, also in agreement with experiment, that the ground electronic state of Br-NCH has |Omega| = (1/2) and that Br-HCN has a ground state with |Omega| = (3/2), where the quantum number, Omega, is the projection of the total angular momentum, J, of the complex on the intermolecular axis R. This picture can be understood as being caused by the electrostatic interaction between the quadrupole of the Br(2P) atom and the dipole of HCN, combined with the very strong spin-orbit coupling in Br. We predicted the frequencies of the van der Waals modes of both isomers and found a direct Renner-Teller splitting of the bend mode in Br-HCN and a smaller, indirect, splitting in Br-NCH. The red shift of the CH stretch frequency in the complex, relative to free HCN, was calculated to be 1.98 cm(-1) for Br-NCH and 23.11 cm(-1) for Br-HCN, in good agreement with the values measured in helium nanodroplets. Finally, with the use of the same potential surfaces, we modeled the Cl(2P)-HCN complex and found that the experimentally observed linear Cl-NCH isomer is considerably more stable than the (not observed) Cl-HCN isomer. This was explained mainly as an effect of the substantially smaller spin-orbit coupling in Cl, relative to Br. PMID:17567109

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



Phonological Complexity and Language Learnability  

PubMed Central

Purpose To extend formal models of language learnability to applications in clinical treatment of children with functional phonological delays. Method The focus of the narrative review is on phonological complexity. This follows from learnability theory, whereby complexity in the linguistic input to children has been shown to trigger language learning. Drawing from the literature, phonological complexity is defined from epistemic, ontological, and functional perspectives, with specific emphasis on the application of language universals in the selection of target sounds for treatment. Results The cascading effects of phonological complexity on children’s generalization learning are illustrated, and frequently asked questions about complexity in treatment are addressed. Conclusion The role of complexity in cognitive development is introduced to demonstrate the apparent robustness of effects.

Gierut, Judith A.



Evaluation of the effect of betapropiolactone/ultraviolet irradiation (BPL/UV) treatment of source plasma on hepatitis transmission by factor IX complex in chimpanzees.  


To evaluate the safety of a beta-Propiolactone/Ultraviolet (BPL/UV), irradiated Factor IX complex preparation we inoculated 8 chimpanzees with 25 units Factor IX/Kilo from a pool of 5 production lots which had been treated in this manner. These lots were derived from approximately 1,000 donors. Animals were followed with weekly tests for hepatitis B serologic markers and transaminases, and biweekly liver biopsies, for 6 months. No evidence of transmission of hepatitis B, or non-A, non-B viruses was observed. To further evaluate the BPL/UV procedure a plasma pool was intentionally contaminated with hepatitis B virus and one half of the pool treated with BPL/UV. Factor IX complex was isolated from the treated and untreated pools and each was inoculated into 4 chimpanzees. The Factor IX derived from untreated plasma infected all four animals with an average incubation period of 10.5 weeks, whereas that prepared from PBL/UV treated plasma infected only one of four animals with an incubation period of 21 weeks. These results were interpreted as suggesting that BPL/UV can inactivate approximately 99.9% of hepatitis B virus infectivity. PMID:7466740

Prince, A M; Stephan, W; Brotman, B; van den Ende, M C



Changes in the structure of chlorophyll–protein complexes and excitation energy transfer during photoinhibitory treatment of isolated photosystem I submembrane particles  

Microsoft Academic Search

The activity of light-induced oxygen consumption, absorption spectra, low temperature (77 K) chlorophyll fluorescence emission and excitation spectra were studied in suspensions of photosystem (PS) I submembrane particles illuminated by 2000 ?E m?2 s?1 strong white light (WL) at 4°C. A significant stimulation of oxygen uptake was observed during the first 1–4 h of photoinhibitory treatment, which rapidly decreased during

S Rajagopal; N. G Bukhov; R Carpentier



EBT2 radiochromic film for quality assurance of complex IMRT treatments of the prostate: micro-collimated IMRT, RapidArc, and TomoTherapy  

Microsoft Academic Search

In response to the clinical need for a dosimetry system with both high resolution and minimal angular dependence, this study\\u000a demonstrates the utility of Gafchromic EBT2 radiochromic dosimetry film for the quality assurance of micro-collimated IMRT,\\u000a RapidArc and TomoTherapy treatments. Firstly, preliminary measurements indicated that the dose response of EBT2 film does\\u000a not appreciably vary with either the angle of

T. Kairn; N. Hardcastle; J. Kenny; R. Meldrum; W. A. Tomé; T. Aland


Complex Regional Pain Syndrome Revived by Epileptic Seizure Then Disappeared Soon during Treatment with Regional Intravenous Nerve Blockade: A Case Report.  


We present a case of complex regional pain syndrome (CRPS), in which symptoms, including burning pain and severe allodynia, were alleviated by using a regional intravenous nerve blockade (Bier block) combined with physiotherapy, but reappeared following an epileptic seizure. Symptoms disappeared again following control of epileptic discharges, as revealed by single-photon emission computed tomography (SPECT) and electroencephalography (EEG) results. Although systemic toxicity of a local anesthetic applied by Bier block was suspected as a cause of the first seizure, the patient did not present any other toxic symptoms, and seizures repeatedly occurred after Bier block cessation; the patient was then diagnosed as having temporal symptomatic epilepsy. This case suggests that symptoms of CRPS may be sustained by abnormal brain conditions, and our findings contribute to the understanding of how the central nervous system participates in maintaining pain and allodynia associated with CRPS. PMID:21716732

Sumitani, Masahiko; Yozu, Arito; Tomioka, Toshiya; Miyauchi, Satoru; Yamada, Yoshitsugu



Participation-engagement: a philosophically based heuristic for prioritizing clinical interventions in the treatment of comorbid, complex, and chronic psychiatric conditions.  


We propose Participation-Engagement (PAR-EN) as a philosophically based heuristic for prioritizing interventions in comorbid, complex, and chronic psychiatric conditions. Drawing from 1) the sociologist Talcott Parsons, 2) the continental-philosophical tradition, and 3) our own previous work (Davidson & Shahar, 2009; Shahar, 2004, 2006), we argue that participation in personally meaningful life goals represents a hallmark of mental health. Symptoms and vulnerabilities that impede such participation should therefore be targeted vigorously, whereas others which do not pose such imminent threats should assume a secondary focus, if at all. Winnicott's (1987) notion of the spontaneous gesture, the importance of daily activities as reflecting patients' participation, and the dialectics of interpersonal relatedness and self-definition, are introduced as guidelines for implementing PAR-EN. Implications for clinical assessment and the therapeutic relationship are discussed. PMID:19614554

Shahar, Golan; Davidson, Larry



Efficacy of adjunctive ablation of complex fractionated atrial electrograms and pulmonary vein isolation for the treatment of atrial fibrillation: a meta-analysis of randomized controlled trials  

PubMed Central

Aims Although useful, percutaneous left atrial ablation for pulmonary vein isolation (PVI) does not eliminate atrial fibrillation (AF) in all patients. The ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as an adjunctive strategy to improve the maintenance of sinus rhythm after PVI. Our objective was to analyse the efficacy of adjunctive CFAE ablation. Methods and results We meta-analysed six randomized controlled trials (total, n= 538) using random-effects modelling to compare PVI (n= 291) with PVI plus CFAE ablation (PVI + CFAE) (n= 237). The primary outcome was freedom from AF or other atrial tachyarrhythmias (ATs) after a single ablation with or without antiarrhythmic drugs. Following a single ablation, PVI + CFAE improved the odds of freedom from any AF/AT compared with PVI alone (odds ratio 2.0, 95% confidence interval 1.04–3.8, P = 0.04) at ?3-month follow-up. There was moderate heterogeneity among trials (I2= 63.0%). Complex fractionated atrial electrogram ablation significantly increased mean procedural (178.5 ± 66.9 vs. 331.5 ± 92.6 min, P< 0.001), mean fluoroscopy (59.5 ± 22.2 vs. 115.5 ± 35.3 min, P< 0.001), and mean radiofrequency (RF) energy application times (46.9 ± 36.6 vs. 74.4 ± 43.0 min, P< 0.001). Conclusions Pulmonary vein isolation followed by adjunctive CFAE ablation is associated with increased freedom from AF after a single procedure. Adjunctive CFAE ablation increased procedural, fluoroscopy, and RF application times, and the risk/benefit profile of adjunctive CFAE ablation deserves further evaluation with additional studies and longer-term follow-up.

Kong, Melissa H.; Piccini, Jonathan P.; Bahnson, Tristram D.



8-Cl-Adenosine Inhibits Proliferation and Causes Apoptosis in B-Lymphocytes via Protein Kinase A-Dependent and Independent Effects: Implications for Treatment of Carney Complex-Associated Tumors  

PubMed Central

Context: Carney complex, a multiple neoplasia syndrome, characterized primarily by spotty skin pigmentation and a variety of endocrine and other tumors, is caused by mutations in PRKAR1A, the gene that codes for the RI? subunit of protein kinase A (PKA). PKA controls cell proliferation in many cell types. The cAMP analogue 8-Cl-adenosine (8-Cl-ADO) is thought to inhibit cancer cell proliferation. Objective: The objective of the study was to study the antiproliferative effects of 8-Cl-ADO on growth and proliferation in B-lymphocytes of Carney complex patients that have PKA defects and to determine whether 8-CL-ADO could be used as a therapeutic agent in the treatment of Carney complex-associated tumors. Design: We used a multiparametric approach (i.e. growth and proliferation assays, PKA, and PKA subunit assays, cAMP and 3H-cAMP binding assays, and apoptosis assays) to understand the growth and proliferative effects of 8-Cl-ADO on human B-lymphocytes. Results: 8-Cl-ADO inhibited proliferation, mainly through its intracellular transport and metabolism, which induced apoptosis. PKA activity, cAMP levels, and 3H-cAMP binding were increased or decreased, respectively, by 8-Cl-ADO, whereas PKA subunit levels were differentially affected. 8-Cl-ADO also inhibited proliferation induced by G protein-coupled receptors for isoproterenol and adenosine, as well as proliferation induced by tyrosine kinase receptors. Conclusions: 8-Cl-ADO in addition to unambiguously inhibiting proliferation and inducing apoptosis in a PKA-independent manner also has PKA-dependent effects that are unmasked by a mutant PRKAR1A. Thus, 8-Cl-ADO could serve as a therapeutic agent in patients with Carney complex-related tumors.

Robinson-White, Audrey J.; Bossis, Ioannis; Hsiao, Hui-Pin; Nesterova, Maria; Leitner, Wolfgang W.; Stratakis, Constantine A.



Improvement of hyperglycaemia and metabolic syndromes in type 2 diabetic KKAy mice by oral treatment with [meso-tetrakis(4-sulfonatophenyl) porphyrinato]oxovanadium(IV)(4-) complex.  


Recently, we reported that [meso-tetrakis(4-sulfonatophenyl)porphyrinato]oxovanadium(IV)(4-), VO(tpps), shows in-vitro insulin-mimetic and in-vivo anti-diabetic activity in streptozotocin (STZ)-induced type 1 diabetic mice. This result prompted us to examine its ability in type 2 diabetic model KKA(y) mice with insulin resistance. We studied the in-vivo anti-diabetic activity of VO(tpps), compared with that of vanadium(IV) oxide sulfate, VS, as control. Both compounds were orally administered at doses of 5-10 mg (0.1-0.2 mmol) V/kg body weight to the KKA(y) mice for 28 days. VO(tpps) normalized the hyperglycaemia within 15 days, while VS lowered the blood glucose concentration only by a small degree. In addition, metabolic syndromes characterized by insulin and leptin resistance were significantly improved in VO(tpps)-treated KKA(y) mice compared with those treated with VS. The improvement in diabetes was validated by oral glucose tolerance test and decrease in HbA(1c) concentration. Based on these observations, VO(tpps) is proposed to be an orally active oxovanadium(IV)-porphyrin complex for treating not only type 2 diabetes but also metabolic syndromes in animals. PMID:17331348

Saha, Tapan Kumar; Yoshikawa, Yutaka; Sakurai, Hiromu



Designing Complexity  

ERIC Educational Resources Information Center

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…

Glanville, Ranulph



Hamiltonian complexity  

NASA Astrophysics Data System (ADS)

In recent years we have seen the birth of a new field known as Hamiltonian complexity lying at the crossroads between computer science and theoretical physics. Hamiltonian complexity is directly concerned with the question: how hard is it to simulate a physical system? Here I review the foundational results, guiding problems, and future directions of this emergent field.

Osborne, Tobias J.



Hamiltonian complexity.  


In recent years we have seen the birth of a new field known as Hamiltonian complexity lying at the crossroads between computer science and theoretical physics. Hamiltonian complexity is directly concerned with the question: how hard is it to simulate a physical system? Here I review the foundational results, guiding problems, and future directions of this emergent field. PMID:22790342

Osborne, Tobias J



Complex derivatives  

NASA Astrophysics Data System (ADS)

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.

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



Cost-effectiveness of recombinant activated factor VII vs. plasma-derived activated prothrombin complex concentrate in the treatment of mild-to-moderate bleeding episodes in patients with severe haemophilia A and inhibitors in Spain.  


Several analyses have shown that recombinant activated factor VII (rFVIIa) is a cost-effective intervention compared with plasma-derived activated prothrombin complex concentrate (pd-aPCC) for the on-demand treatment of mild-to-moderate bleeds in haemophilia patients with inhibitors. The aim of the study was to assess the cost-effectiveness of rFVIIa vs. pd-aPCC in the treatment of bleeding episodes in severe haemophilia A patients with inhibitors in Spain. A decision analytic model was designed to evaluate the costs and clinical outcomes of using rFVIIa or pd-aPCC to treat mild-to-moderate joint bleeds in children (?14 years old) and adults with inhibitors. Data were obtained from a published meta-analysis and a panel of haemophilia experts. The analysis was conducted from the perspective of the Spanish National Healthcare System. One-way sensitivity analyses were performed to assess the impact of model assumptions on study results. In the Treur meta-analysis, rFVIIa resulted in cumulative joint bleed resolution of 88% and 95% after 24 and 36 h, respectively, compared with 62% and 76%, respectively, with pd-aPCC (Treur et al. Haemophilia 2009; 15: 420-36). Here, the mean cost per bleed was estimated at €8473 and €15 579 in children and adults treated with rFVIIa, vs. €8627 and €15 677 in children and adults treated with pd-aPCC. rFVIIa treatment was found to be the dominating option (cheaper and more effective). The one-way sensitivity analysis also confirmed that rFVIIa was less costly than pd-aPCC. The model suggests that rFVIIa is a cost-effective option compared with pd-aPCC for the treatment of mild-to-moderate bleeding episodes in a Spanish setting. PMID:23758100

Jimenez-Yuste, V; Núñez, R; Romero, J A; Montoro, B; Espinós, B



Complex Numbers  

NSDL National Science Digital Library

Written by Tony R. Kuphaldt and Jason Starck, this chapter of All About Circuit's second volume on Alternating Current describes complex numbers: "In order to successfully analyze AC circuits, we need to work with mathematical objects and techniques capable of representing these multi-dimensional quantities. Here is where we need to abandon scalar numbers for something better suited: complex numbers." In addition to the introduction and credits to contributors, the chapter has seven sections: Vectors and AC waveforms, Simple vector addition, Complex vector addition, Polar and rectangular notation, Complex number arithmetic, More on AC "polarity," and Some examples with AC circuits. Each section has clear illustrations and a concise, bulleted review of what was covered at the end.

Kuphaldt, Tony R.



Complex societies  

Microsoft Academic Search

The complexity of human societies of the past few thousand years rivals that of social insect societies. We hypothesize that\\u000a two sets of social “instincts” underpin and constrain the evolution of complex societies. One set is ancient and shared with\\u000a other social primate species, and one is derived and unique to our lineage. The latter evolved by the late Pleistocene,

Peter J. Richerson; Robert Boyd



A prospective study on the initial results of a low profile ulna shortening osteotomy system.  


Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna shortening system was designed to decrease these potential complications. A single-surgeon prospective study was performed to evaluate this system. Ten consecutive patients undergoing ulna shortening for ulnar-sided wrist pain compatible with TFCC pathology participated in the study. Subjective, objective, and radiographic assessments were performed preoperatively and up to 24 weeks postoperatively. Based on visual analog scale (VOS) ratings (0 to 10), pain scores significantly improved (p?

Isaacs, Jonathan; Howard, Susan B; Gulkin, Daniel



Pediatric Complex Regional Pain Syndrome  

Microsoft Academic Search

Complex regional pain syndrome (CRPS) is a relatively new diagnostic entity in pediatrics. There is debate as to what constitutes the most effective treatment for pediatric CRPS. This study presents the patient characteristics, clinical course, a~d treatment outcome of 20 children diagnosed with CRPS at a major children's hospital during a 4·year period. The results showed that pediatric CRPS occurs

Adrian K. Low; Kate Ward; Andrew P. Wines


Controlling complexity  

NASA Astrophysics Data System (ADS)

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.

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



Complexity and \\  

Microsoft Academic Search

This paper has two main purposes. First, it will provide an introductory discussion of hyperset theory, and show that it is useful for modeling complex systems. Second, it will use hyperset theory to analyze Robert Rosen's metabolism- repair systems and his claim that living things are closed to efficient cause. It will also briefly compare closure to efficient cause to

Anthony Chemero; Michael T. Turvey



Complex PTSD  


... PTSD Overview - Types of Trauma - Assessment - Treatment Overview - Early Intervention - Co-Occurring Problems - Treating Specific Groups - Working with Families - For Specific Providers - Continuing Education - Research on PTSD - Biology of PTSD - PILOTS Database - Types of Products/ ...


Management of Gingivobuccal Complex Cancer  

PubMed Central

INTRODUCTION Squamous cell carcinoma of the oral cavity ranks as the 12th most common cancer in the world and the 8th most frequent in males. It accounts for up to one-third of all tobacco-related cancers in India. Cancer of the gingivobuccal complex is especially common in Indians due to their tobacco habits. This review focuses on the management of lower gingivobuccal complex cancers. PATIENTS AND METHODS References for this review were identified by search of Medline and other bibliographic information available in the PubMed database. The search terms carcinoma oral cavity, and cancer oral cavity, buccal mucosa, gingiva, gingivobuccal complex, and alveolus cancer/carcinoma were used. References from relevant articles and abstracts from international conferences were also included. Only articles published in the English language were used. RESULTS Treatment of gingivobuccal complex cancer is primarily surgical. Radical neck dissection, or its modification, is the standard treatment for the node-positive neck. Supraomohyoid neck dissection is the accepted treatment for the node-negative neck. Radiotherapy is usually not the preferred modality of treatment for early gingivobuccal complex cancer. It is used either as postoperative adjuvant treatment or as definitive treatment for advanced cancer with or witihout chemotherapy. Chemotherapy has been used as neo-adjuvant, adjuvant or palliative treatment. Advanced cancers are common and continue to pose a challenge to the multidisciplinary team. CONCLUSIONS Gingivobuccal complex cancer remains a major public health problem despite being highly preventable and easily detectable. Advanced cancers constitute a major proportion of patients presenting for treatment. These patients are difficult to treat and have a poor outcome.

Misra, Sanjeev; Chaturvedi, Arun; Misra, NC



Time complexity and gate complexity  

SciTech Connect

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.

Koike, Tatsuhiko [Department of Physics, Keio University, Yokohama (Japan); Okudaira, Yosuke [Department of Physics, Tokyo Institute of Technology, Tokyo (Japan)



Managing Complexity  

SciTech Connect

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.

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



Autologous transplantation of gingival fibroblast-like cells and a hydroxylapatite complex graft in the treatment of periodontal osseous defects: cell cultivation and long-term report of cases.  


Autogenous cell transplantation via hydroxylapatite (HA) vehicle has been reported to have beneficial effects on the treatment of human periodontal osseous defects. The aim of this study was to explore the possibility of using gingival fibroblast-like cells in the therapy of osseous defects caused by inflammatory periodontitis by reporting long-term results of gingival fibroblast-coated hydroxylapatite (GF-HA) grafting for healing these defects. Gingival fibroblasts were cultured from healthy gingivae of treated subjects. Growth of cells on HA particles was established in vitro, and then the GF-HA complex was transplanted into the periodontal osseous defects. Clinical parameters of gingival and plaque indices, probing depth, and periapical x-ray were monitored at baseline and at various periods from 50 months to 6 years after surgery. Grafting with only HA in the osseous defects of the same patient was used for comparison. The present study shows that GF-HA-treated sites could achieve marked pocket reduction and probing attachment gain at reentry and later recalls. Good clinical bone filling of osseous defects in GF-HA-treated sites was also demonstrated in periapical radiographs (increased bone height and reappearance of the crestal cortex) and in some reentry sites. One HA-treated site was filled with connective tissue only, and the absence of new bone formation was noted during a reentry operation. Another HA-treated site exhibited a comparable increase in radiographic density, while part of HA particles were gradually lost in longer recalls. These limited observations conclude that GF-HA grafting may provide a treatment modality leading to regeneration of periodontal tissues in periodontitis-affected osseous defects. Further studies including more cases and demonstration of the deposition of differentiated periodontal tissues are necessary before further application of this therapy. PMID:14653625

Hou, L-T; Tsai, Alex Yi-Min; Liu, C-M; Feng, F



Complex articular cartilage restoration.  


Articular cartilage injury and degeneration occurs frequently in athletes and results from the significant chronic joint stress and acute traumatic injuries associated with high-impact sports. These injuries do not heal spontaneously and often lead to progressive painful impairment of joint function and limitation of sports participation. Untreated articular cartilage defects frequently lead to chronic joint degeneration and disability. Treatment of articular cartilage injury in athletes can be complex and requires effective and durable joint surface restoration that can withstand even the significant joint stresses generated during sports activity. Several established articular cartilage repair techniques have been shown to successfully return the athlete with articular cartilage injury to high-impact sports. In addition, novel treatment concepts and techniques that apply modern tissue engineering technologies promise further advancement in the treatment of these challenging injuries in the demanding athletic population. PMID:23314266

Mithoefer, Kai



[Treatment of hypertensic crises].  


The paper deals with application of modern medicines (ebrantil, dalargin, dilzem-retard, nematop, enalapril) for treatment of hypertensic crisis, and the authors' experience in application of the antioxidative agent mexicor in complex therapy of this disorder. PMID:15984584

Golikov, A P



Bimetallic complexes  

Microsoft Academic Search

The synthesis and reactions of bimetallic Zr(II)–Mo(0) complexes with bridging C5H4PPh2 ligands (henceforth abbreviated as Cp?) are described. Reaction of Cp2?ZrCl2 (1) with n-butyllithium in THF produces a metastable material tentatively formulated as Cp2?Zr·2 LiCl·4 THF (2). Diphenyldisulfide instantaneously converts 2 into the Zr(IV) dithiolate Cp2?Zr(SPh)2 (3). When 2 is treated with [Mo(CO)4(norbornadiene)], an unstable intermediate is formed which can

Wolfdieter A. Schenk; Thomas Gutmann



Complex bile duct injuries: management  

PubMed Central

Background. Laparoscopic cholecystectomy is the present treatment of choice for patients with gallbladder stones, despite its being associated with a higher incidence of biliary injuries compared with the open procedure. Injuries occurring during the laparoscopic approach seem to be more complex. A complex biliary injury is a disease that is difficult to diagnose and treat. We considered complex injuries: 1) injuries that involve the confluence; 2) injuries in which repair attempts have failed; 3) any bile duct injury associated with a vascular injury; 4) or any biliary injury in association with portal hypertension or secondary biliary cirrhosis. The present review is an evaluation of our experience in the treatment of these complex biliary injuries and an analysis of the international literature on the management of patients.

Ardiles, V.; Pekolj, J.



Carney complex.  


Carney complex is a rare, dominantly inherited multiple endocrine neoplasia syndrome, affecting endocrine glands as the adrenal cortex (causing Cushing's syndrome), the pituitary and the thyroid. It is associated with many other nonendocrine tumors, including cardiac myxomas, testicular tumors, melanotic schwannoma, breast myxomatosis, and abnormal pigmentation (lentiginosis) or myxomas of the skin. The gene located on the CNC1 locus was identified 12 years ago as the regulatory subunit 1A (R1A) of the protein kinase A (PRKAR1A) located at 17q22-24. Inactivating heterozygous germline mutations of PRKAR1A are observed in about two thirds of Carney complex patients with some genotype-phenotype correlation useful for follow-up and prognosis. More rarely, mutations of phosphodiesterase genes have been reported in patients presenting mainly with Cushing's syndrome. In vitro and in vivo studies help to understand how R1A inactivation leads to tumorigenesis. PRKAR1A appears to be a relatively weak tumorigenic signal which can cooperate with other signaling pathways and tumor suppressors. PMID:23652670

Espiard, Stéphanie; Bertherat, Jérôme



Narrow-complex tachycardia.  


The term "narrow-complex tachycardia" is applied to a number of common and rare arrhythmias. Atrial fibrillation is the narrow-complex tachycardia most frequently seen in clinical practice. Sinus tachycardia is associated with underlying metabolic abnormalities, and paroxysmal atrial tachycardia most often results from digitalis toxicity. Multifocal atrial tachycardia usually occurs in older adults with chronic obstructive pulmonary disease. Atrioventricular nodal reentrant tachycardia is commonly found in otherwise healthy children and adolescents. The initial diagnosis should be reconsidered if drug therapy is unsuccessful, because differences in rhythm disturbances are often subtle. Radiofrequency catheter ablation is an effective treatment for atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia (Wolff-Parkinson-White syndrome) and the permanent form of junctional reentrant tachycardia. Catheter ablation should also be considered in difficult cases of atrial flutter, intra-atrial reentry and automatic atrial tachycardia. PMID:8116517

Giudici, M C; Gumpert, T J; Heathman, L L



[Carney complex].  


Carney complex (CNC) is an autosomal dominantly inherited syndrome characterized by spotty skin pigmentation, cardiac and cutaneous myxoma, and endocrine overactivity. Skin pigmentation includes lentigines and blue nevi. Myxomas may occur in breast, skin and heart. Cardiac myxomas may be multiple and occur in any cardiac chamber, and are more prone to recurrence. The most common endocrine gland manifestation is an ACTH-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD). PPNAD may occur isolated, with no other signs of CNC. Pituitary and thyroid glands and gonads are also involved. The PRKAR1A gene, located in 17 q22-24, encodes type 1A regulatory subunit of protein kinase A. Inactivating germline mutations of this gene are found in 70% of patients with CNC. PRKAR1A is a key component of the c-AMP signaling pathway that has been implicated in endocrine tumorigenesis. Many different mutations have been reported in the PRKAR1A gene. In almost all cases the sequence change was predicted to lead to a premature stop codon and the resultant mutant mRNA was subject to nonsense-mediated mRNA decay. There is no clear genotype-phenotype correlation in patients with CNC. Genetic analysis should be performed in all CNC index cases. All affected patients should be monitored for clinical signs of CNC at least once a year. Genetic diagnosis allows for more effective preparation of more appropriate and effective therapeutic strategies and genetic counseling for patients and gene carriers, and to avoid unnecessary tests to relatives not carrying the gene. PMID:21536508

Losada Grande, Eladio José; Al Kassam Martínez, Daniel; González Boillos, Margarita



Complex fuzzy logic  

Microsoft Academic Search

A novel framework for logical reasoning, termed complex fuzzy logic, is presented in this paper. Complex fuzzy logic is a generalization of traditional fuzzy logic, based on complex fuzzy sets. In complex fuzzy logic, inference rules are constructed and \\

D. Ramot; M. Friedman; G. Langholz; A. Kandel



Complex Partial Seizures  


Complex Partial Seizures You are here: Home About Epilepsy Seizures Partial Seizures Complex Partial Seizures Email Print Twitter Facebook MySpace Delicous ... Complex Partial Seizures ] First Aid for Complex Partial Seizures Do not restrain the person. Remove dangerous objects ...



Microsoft Academic Search

Background. CRPS\\/RSD still offers more questions then answers. The initial events and pathophysiology are un- known, the treatment is unsuccessful and the results are poor. The authors have transmitted their experiences with continu- ous sensory analgesia of brachial plexus in the treatment of heavy injured hands to the treatment of CRPS. Efficient anal- gesia, control of vegetative nerve system and

Jelka Pirc


Cognitive complexity, introversion, and preference for complexity  

Microsoft Academic Search

Obtained complexity preferences among random polygons from 40 undergraduates, cross-classified on cognitive complexity-simplicity and introversion-extroversion, while GSR was monitored. Complex Ss manifest higher GSRs in attending to the stimuli. Examinations of preferences across 2 different sets of stimuli and methods of preferential rating demonstrated that (a) extraverts preferred moderate levels of complexity, regardless of classification as cognitively complex or simple;

Jeff B. Bryson; Michael J. Driver




PubMed Central

Ionic lanthanum has been used to study transepithelial ion permeation in in vitro rabbit gallbladder and intestine (ileum) by adding 1 mM La3+ to only the mucosal bathing solution. Transepithelial fluid transport electrical potential differences (p.d.), and resistances were measured. During La3+ treatment the gallbladder's rate of active solute-coupled fluid transport remained constant, the resistance increased, and the 2:1 NaCl diffusion p.d. decreased. Mucosa-to-serosa fluxes of 140La3+ were measured and indicate a finite permeability of the gallbladder to La3+. La3+ also increased the transepithelial resistance and p d. of ileum. Electron microscopic examination of La3+-treated gallbladder showed: (a) good preservation of the fine structure, (b) electron-opaque lanthanum precipitates in almost every lateral intercellular space, most frequently near the apical end of the lateral spaces close to or within the junctional complex, (c) lanthanum among the subjacent muscle and connective tissue layers, and (d) lanthanum filling almost the entire length of so-called "tight" junctions. No observations were made which unequivocally showed the penetration of lanthanum into the gallbladder cells. Electron micrographs of similar La3+-treated ilea showed lanthanum deposits penetrating the junctional complexes. These results coupled with other physiological studies indicate that the low resistance pathway for transepithelial ion permeation in gallbladder and ileum is through the tight junctions A division of salt-transporting epithelia into two main groups, those with "leaky" junctional complexes and those with tight junctional complexes, has been proposed.

Machen, Terry E.; Erlij, David; Wooding, F. B. P.



Complex sleep apnea syndrome.  


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

Wang, Juan; Wang, Yan; Feng, Jing; Chen, Bao-Yuan; Cao, Jie



Labeling, characterization, and in vivo localization of a new 90Y-based phosphonate chelate 2,3-dicarboxypropane-1,1-diphosphonic acid for the treatment of bone metastases: Comparison with 99mTc–DPD complex  

Microsoft Academic Search

The goal of this investigation was to examine the possibilities for yttrium-90-labeling of the 2,3-dicarboxypropane-1,1-diphosphonic acid (DPD), which is currently labeled with technetium-99m and as a 99mTc–DPD clinically used as bone imaging agent. Analysis of the complex enclosed the radiochemical quality control methods, biodistribution studies, as well as the determination of pharmacokinetic parameters. The biological behavior of complexes 90Y–DPD, 99mTc–DPD

Divna Dj. Djoki?; Drina Lj. Jankovi?; Nadežda S. Nikoli?



Labeling, characterization, and in vivo localization of a new 90Y-based phosphonate chelate 2,3-dicarboxypropane-1,1-diphosphonic acid for the treatment of bone metastases: Comparison with 99mTc-DPD complex.  


The goal of this investigation was to examine the possibilities for yttrium-90-labeling of the 2,3-dicarboxypropane-1,1-diphosphonic acid (DPD), which is currently labeled with technetium-99m and as a (99m)Tc-DPD clinically used as bone imaging agent. Analysis of the complex enclosed the radiochemical quality control methods, biodistribution studies, as well as the determination of pharmacokinetic parameters. The biological behavior of complexes (90)Y-DPD, (99m)Tc-DPD and (90)Y-labeled DPD-kit formulation [(90)Y-(Sn)-DPD] in animal model was compared. The labeling conditions were standardized to give the maximum yield, which ranged between 93% and 98%. The examined (90)Y complex could be easily prepared, with an outstanding yield and was also found to be very stable for at least 10h after (90)Y-labeling. Protein binding value was 4.6+/-0.7% for (90)Y-DPD complex and the complex possess a hydrophilic character. The satisfactory results of (90)Y-DPD biodistribution in healthy test animals were obtained; the uptake in the bone was 11-13%ID/g after 24h depending on the pH value during the preparation. With high skeletal uptake, a minimum uptake in soft tissues and rapid blood clearance the (90)Y-DPD complex proved to be an excellent candidate for targeting tumor therapy. PMID:18331797

Djoki?, Divna Dj; Jankovi?, Drina Lj; Nikoli?, Nadezda S



Molecular Modeling: Where Fundamental Physics Meets Complexity  

Microsoft Academic Search

Was Dirac right when he claimed that having quantum mechanics established, all problems of chemistry can be solved in principle, the only limitation being complexity? Reliable modeling of molecules requires quantum mechanical treatment. However, the complexity of even small molecules implies considerable computational difficulties. Accurate description of the simplest of molecules, for example, a water molecule, composed only from three

Paul G. Mezey



ICD Complex Operations and Maintenance Plan  

SciTech Connect

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.

Gibson, P. L.




Microsoft Academic Search

Five cases of symptomatic acquired positive ulnar variance are described. All cases occurred due to premature physeal closure of the growth plate in teenage girl gymnasts. All cases demonstrated ulnocarpal impingement, for which we describe a clinical test.Arthroscopic assessment of the wrist allowed us to assess the integrity of the TFCC (triangular fibrocartilaginous complex) and decide on the most appropriate




Intelligent Track Analysis on Navy Platforms Using Soft Computing  

Microsoft Academic Search

We have developed and continue to enhance automated intelligent software that performs the tasks and decision making which now occurs by the personnel manning watch stations in the Combat Direction Center (CDC) and Task Force Combat Center (TFCC), on-board aircraft carriers and other Navy ships. Integrating information from various sources in a combat station is a complex task; disparate sources

Robert Richards; Richard Stottler; Ben Ball; Coskun Tasoluk



Complexity modeling: identify instability early.  


Biological systems are innately complex, display nonlinear behavior, and respond to both disease and its treatment in similar complex ways. Complex systems display self-organization and predictive behavior along a range of possible states, often referred to as chaotic behavior, and can be both characterized and quantified in terms of this chaotic behavior, which defined strange attractors (?) and variability. In this context, disease can be characterized as a difference in a disease state ? and a healthy ?. Furthermore, effectiveness of treatment can be defined as a minimization problem to decrease the phase-state difference between disease and health ? values, such that effective treatment is defined as the ability to restore the healthy ?. Importantly, this approach will be effective without anything being known about the physiologic processes that define health or disease. The implication is that this approach is a powerful tool to define the determinants of instability as compared with normal variability, to answer why disease is not healthy, and to identify all potentially effective treatment options independent of known pharmacology and physiology. PMID:21164410

Pinsky, Michael R



Crystallization of macromolecular complexes: combinatorial complex crystallization  

Microsoft Academic Search

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

Enrico A Stura; Marc Graille; Jean-Baptiste Charbonnier



On State Complexes and Special Cube Complexes  

ERIC Educational Resources Information Center

|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,…

Peterson, Valerie J.



MR arthrography of the wrist: controversies and concepts.  


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

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



MR Arthrography of the Wrist: Controversies and Concepts  

PubMed Central

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.

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



Topical treatment of ichthyoses.  


Management of ichthyoses is a complex and continuously dynamic process. Primary treatments of ichthyosis are by means of topical moisturizers and topical medications. Patients and families need to have reasonable and realistic expectations when it comes to topical therapy. Topical medications cannot cure the scaling, but can gradually reduce it and thus improve their condition. No one treatment regimen works for everyone, and the best topical therapy for each patient may be the result of months (or years) of painstaking effort on both the physician's and the patient's behalf. As patients get older and their activities and lifestyles change, so should their topical treatment regimen. Bear in mind that the more complex the skin care regimen and costly the topical treatments, the less likely a patient and their family will be compliant. PMID:23384017

Fleckman, Philip; Newell, Brandon D; van Steensel, Maurice A; Yan, Albert C


On complex Douglas spaces  

NASA Astrophysics Data System (ADS)

In this paper we survey projective curvature invariants of Douglas type and use these to give some generalizations for the notion of a complex Berwald space. Various descriptions of complex Douglas spaces are given in relation to other special classes of complex Finsler spaces. This study was performed from the viewpoint of the equations of a complex geodesic curve. Complex Randers spaces offer examples of complex Douglas spaces.

Aldea, Nicoleta; Munteanu, Gheorghe



Advances in sepsis treatment  

Microsoft Academic Search

Investigations of novel sepsis treatments have proven ineffective in the past. Despite advances in overall care of critically\\u000a ill patients, therapies specifically designated for sepsis were lacking. However, research unveiled a complex interaction\\u000a between the coagulation and inflammation systems, which has served as an impetus for innovative pharmacologic therapies in\\u000a the treatment of patients with sepsis. This article summarizes the

Todd W. Rice; Gordon R. Bernard



The Mycobacterium avium complex.  

PubMed Central

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

Inderlied, C B; Kemper, C A; Bermudez, L E



Biomechanics of complex shoulder instability.  


Surgical management of recurrent shoulder instability can be complicated in the setting of associated osseous defects of the glenoid, humeral head, or both. A wide variety of surgical options exist for the management of complex shoulder instability. Interventions for addressing glenoid and humeral head bone defects, and their biomechanical effects, are reviewed. Further studies are required to delineate critical defect values and develop validated treatment algorithms. PMID:24079425

Degen, Ryan M; Giles, Joshua W; Thompson, Stephen R; Litchfield, Robert B; Athwal, George S



Carney complex (CNC)  

PubMed Central

The Carney complex (CNC) is a dominantly inherited syndrome characterized by spotty skin pigmentation, endocrine overactivity and myxomas. Skin pigmentation anomalies include lentigines and blue naevi. The most common endocrine gland manifestations are acromegaly, thyroid and testicular tumors, and adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD). PPNAD, a rare cause of Cushing's syndrome, is due to primary bilateral adrenal defect that can be also observed in some patients without other CNC manifestations or familial history of the disease. Myxomas can be observed in the heart, skin and breast. Cardiac myxomas can develop in any cardiac chamber and may be multiple. One of the putative CNC genes located on 17q22-24, (PRKAR1A), has been identified to encode the regulatory subunit (R1A) of protein kinase A. Heterozygous inactivating mutations of PRKAR1A were reported initially in 45 to 65 % of CNC index cases, and may be present in about 80 % of the CNC families presenting mainly with Cushing's syndrome. PRKAR1A is a key component of the cAMP signaling pathway that has been implicated in endocrine tumorigenesis and could, at least partly, function as a tumor suppressor gene. Genetic analysis should be proposed to all CNC index cases. Patients with CNC or with a genetic predisposition to CNC should have regular screening for manifestations of the disease. Clinical work-up for all the manifestations of CNC should be performed at least once a year in all patients and should start in infancy. Cardiac myxomas require surgical removal. Treatment of the other manifestations of CNC should be discussed and may include follow-up, surgery, or medical treatment depending on the location of the tumor, its size, the existence of clinical signs of tumor mass or hormonal excess, and the suspicion of malignancy. Bilateral adrenalectomy is the most common treatment for Cushing's syndrome due to PPNAD.

Bertherat, Jerome



On the Complexities of Complex Economic Dynamics  

Microsoft Academic Search

Complex economic nonlinear dynamics endogenously do not converge to a point, a limit cycle, or an explosion. Their study developed out of earlier studies of cybernetic, catastrophic, and chaotic systems. Complexity analysis stresses interactions among dispersed agents without a global controller, tangled hierarchies, adaptive learning, evolution, and novelty, and out-of-equilibrium dynamics. Complexity methods include interacting particle systems, self-organized criticality, and

J. Barkley Rosser Jr.



Financial Market Complexity  

Microsoft Academic Search

Financial markets are a fascinating example of 'complexity in action': a real-world complex system whose evolution is dictated by the decisions of crowds of traders who are continually trying to win in a vast global 'game'. This book draws on recent ideas from the highly-topical science of complexity and complex systems, to address the following questions: how do financial markets

Neil F. Johnson; Paul Jefferies; Pak Ming Hui


The complex LMS algorithm  

Microsoft Academic Search

A least-mean-square (LMS) adaptive algorithm for complex signals is derived. The original Widrow-Hoff LMS algorithm is Wj+l= Wj+ 2µ?jXj. The complex form is shown to be Wj+1= Wj+ 2µ?jX-j, where the boldfaced terms represent complex (phasor) signals and the bar above Xjdesignates complex conjugate.




Narrow complex (supraventricular) tachycardias  

Microsoft Academic Search

Patients experiencing a narrow complex tachycardia are usually at a lower risk than those in whom a broad complex tachycardia occurs. Therefore, in the UK cardiologists are frequently involved in broad complex dysrhythmias at an early stage, while general physicians and general practitioners will often have greater involvement in the management of patients with narrow complex arrhythmias. We describe the

N W F Linton; S W Dubrey



A method to increase tetramer staining efficiency of CD8+ T cells with MHC–peptide complexes: therapeutic applications in monitoring cytotoxic T lymphocyte activity during hepatitis B and C treatment  

Microsoft Academic Search

The development of peptide–MHC tetrameric complexes heralds a new era in the study of antigen-specific T cells and their role in viral infections. However, the frequencies of tetramer-staining CD8+ T cells in fresh peripheral blood mononuclear cells (PBMCs) are usually below 1% in patients with chronic hepatitis B and C viruses (HBV and HCV) as well as human immunodeficiency virus

Sun-Lung Tsai; Tzong-Hsien Lee; Rong-Nan Chien; Shuen-Kuei Liao; Chen-Lung Lin; George C. Kuo; Yun-Fan Liaw



[Considerations regarding Spa treatments].  


Spa treatments constitute complex therapeutic processes, spanning multiple millennia. These treatments have had and retain multiple indications in the cure of multiple chronic affections, functional deficiencies, senile troubles, etc. Additionally it is omportant to consider the influence of climatic circumstances as well as social and psychic factors. The spa treatment in all its coplexity can play the role of therapeutic agent in various pathologic processes, but also be an important factor to consider in healthcare education. However, many professionals consider these procedures as an obsolete therapy of little justification today. PMID:15751835

Armijo Valenzuela, Manuel



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

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.

Hazen, Terry



HIFU: Local Treatment of Prostate Cancer  

Microsoft Academic Search

ObjectiveTreatment of carcinoma of the prostate (CaP) begs some complex questions. Different disease stages call for different treatment modalities and no universally ‘gold standard’ treatment has yet been agreed upon. In the present work we will present the results, indications and limitations of HIFU in the treatment of CaP.

H. Azzouz; J. J. M. C. H. de la Rosette



Complex regional pain syndrome.  


As suggested by this article, considerable advances in clinical management and research have taken place during the past 20 years. Although mechanisms underlying the pain syndrome CRPS I and CRPS II remain far from one's understanding, glimpses of the pathophysiology are beginning to take shape. There is now strong evidence that these syndromes exemplify a complex neurologic disease involving the brain at several integrated levels. The changes that occur in CRPS I patients involve somatosensory, sympathetic, and somatomotor systems. The diagnostic criteria have helped to focus on aspects of these foregoing systems and whereas there is no specific laboratory test for CRPS, enough is now known about the pathophysiology to use the following tests: quantitative sensory testing (QST), autonomic testing that include quantitative sudomotor axon reflex test (QSART) for sweating abnormalities, the cold pressor test in conjunction with thermographic imaging to observe the vasoconstrictor response, and laser Doppler flowmetry to monitor background vasomotor control. Recognition of a motor disorder requires accurate documentation and may be a component of the diagnostic criteria in the future. Until a better understanding of mechanistic overtones that would help to put in place mechanism-based therapeutic strategies, current management is built around a rehabilitation model. For this to be successful, as described in the foregoing pages, different non-interventional and interventional modalities are applied in a time-restricted manner to facilitate those modalities that favor progress in the treatment algorithm. As has been described, it is important when using physiotherapeutic maneuvers to minimize joint movement in the affected region to reduce the mechanorecpetor barrage and its increase in perceived pain to encourage and maintain a patient's compliance with their rehabilitation. Finally, of greater significance is the understanding that sympatholysis per se is not a "diagnostic" test for CRPS, but rather a useful procedure that may facilitate treatment for pain that is sympathetically maintained. PMID:14719716

Stanton-Hicks, Michael



Complex networks analysis of language complexity  

NASA Astrophysics Data System (ADS)

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.

Amancio, Diego R.; Aluisio, Sandra M.; Oliveira, Osvaldo N., Jr.; Costa, Luciano da F.



Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model  

PubMed Central

Background and purpose Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model. Methods Fresh frozen human cadaver arms were used. A dorsal open-wedge osteotomy was performed in the distal radius. In 8 specimens, pressure was applied to the palm with the wrist in dorsiflexion and ulnar-sided stabilizing structures subsequently severed. Dorsal angulation was measured on digitized radiographs. In 8 other specimens, the triangular fibrocartilage complex (TFCC) was forced into rupture by axially loading the forearm with the wrist in dorsiflexion. The ulnar side was dissected and injuries were recorded. Results Intact ulnar soft tissues limited the dorsal angulation of the distal radius fragment to a median of 32o (16–34). A combination of bending and shearing of the distal radius fragment was needed to create TFCC injuries. Both palmar and dorsal injuries were observed simultaneously in 6 of 8 specimens. Interpretation A TFCC injury can be expected when dorsal angulation of a distal radius fracture exceeds 32o. The extensor carpi ulnaris subsheath may be a functionally integral part of the TFCC. Both dorsal and palmar structures can tear simultaneously. These findings may have implications for reconstruction of ulnar sided soft tissue injuries.



[Treatment of limbs lymphedema].  


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

Vaillant, Loïc; Müller, Christine; Goussé, Pascal



Complex Object Hashing.  

National Technical Information Service (NTIS)

An important characteristic of many new data models is the capability of constructing complex data objects. These complex data objects usually include set valued attributes. The efficiency of the implementation of sets heavily depends on the efficiency of...

H. Duchene V. Turau



Cognitive Complexity and Persuasion.  

National Technical Information Service (NTIS)

A number of approaches to complexity, both from the stimulus and the personality vantage point as they affect attitudes, and specifically influence and persuasion are reviewed. The paper discusses the specific predictions that can be made with complexity ...

S. Streufert H. L. Fromkin



Oligocyclopentadienyl transition metal complexes  

SciTech Connect

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.

de Azevedo, Cristina G.; Vollhardt, K. Peter C.



The Macquarie Ridge Complex.  

National Technical Information Service (NTIS)

The north-east-south-west trending Macquarie Ridge-Trench complex and its intersection with the Indian-Pacific-Antarctic Ridge provides a unique morphological connection between New Zealand and Antarctica. The seismically active Macquarie complex has been...

D. E. Hayes M. Talwani D. A. Christoffel



Software complexity measurement  

Microsoft Academic Search

Inappropriate use of software complexity measures can have large, damaging effects by rewarding poor programming practices and demoralizing good programmers. Software complexity measures must be critically evaluated to determine the ways in which they can best be used.

Joseph P. Kearney; Robert L. Sedlmeyer; William B. Thompson; Michael A. Gray; Michael A. Adler



Daunorubicin Lipid Complex Injection  


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 ...


Sodium Ferric Gluconate Complex  

Center for Drug Evaluation (CDER)

Text Version... Draft Guidance on Sodium Ferric Gluconate Complex ... Active ingredient: Sodium Ferric Gluconate Complex Form/Route: Injectable; Injection ... More results from


The complex injury of the elbow  

Microsoft Academic Search

Summary  \\u000a The complex injury is characterized by a fracture and\\/or dislocation of the elbow in association with a serial injury of the upper extremity,\\u000a or a severe soft tissue trauma , or a prolonged ischemia caused by vascular injury or compartment syndrom. They are defined\\u000a as complex injuries because their treatment differs from that of a simple fracture implying that

G. Regel; A.-M. Weinberg; A. Seekamp; M. Blauth; H. Tscherne



Strategies for managing uncertainty and complexity  

Microsoft Academic Search

OBJECTIVES: To identify strategies involved in the diagnosis and treatment plans of primary care problems that are uncertain and complex.\\u000a \\u000a \\u000a METHODS: In this exploratory study we observed primary care physicians encountering standardized patients who portrayed typical primary\\u000a care problems involving uncertainty and complexity. First, we analyzed 10 tapes of nine physicians with a range of clinical\\u000a experience (first-year residents through

Mariana G. Hewson; Phillips J. Kindy; Judith Van Kirk; Virginia A. Gennis; Richard P. Day



Incontinence Treatment: Newer Treatment Options  


... Tips Medication Bowel Management Dealing with Anal Discomfort Biofeedback Surgical Treatments Newer Treatment Options Talking to Your ... changes Dietary changes Medication Bowel management/retraining program Biofeedback therapy Surgical treatments Newer procedures or devices Talking ...


Cyanobacterial NADPH dehydrogenase complexes  

Microsoft Academic Search

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\\u000a presence of subunits involved in CO2 uptake. Other than CO2 uptake, chloroplastic NDH-1 complex has a similar role as cyanobacterial NDH-1 complexes in photosystem-1 cyclic electron\\u000a transport and respiration (chlororespiration).

Teruo Ogawa; Hualing Mi



Planning with complex actions  

Microsoft Academic Search

In this paper we address the problem of planning with complex actions. We are motivated by the problem of automated Web service composition, in which planning must be performed using pre- defined complex actions or services as the build- ing blocks of a plan. Planning with complex ac- tions is also compelling in primitive action plan- ning domains because it

Sheila A. Mcilraith; Ronald Fadel



Complexity, creativity and computers  

Microsoft Academic Search

Creativity, one of the hallmarks of the human spirit, has yet to travel deep into the domain of artificial intelligence and computers. We argue that creativity intrinsically requires and exploits complexity. The dynamic multilevel properties of complex systems give us a natural way of scaling creative solutions, from the everyday to the paradigm shift. In particular, the complexity model implies

T. R. J. Bossomaier; A. W. Snyder


Toward complex fuzzy logic  

Microsoft Academic Search

Complex fuzzy logic is a postulated logic system that is isomorphic to the complex fuzzy sets recently described in a previous paper. This concept is analogous to the many-valued logics that are isomorphic to type-1 fuzzy sets, commonly known as fuzzy logic. As with fuzzy logics, a complex fuzzy logic would be defined by particular choices of the conjunction, disjunction

Scott Dick



Nuclear weapons complex  

Microsoft Academic Search

In this book, GAO characterizes DOE's January 1991 Nuclear Weapons Complex Reconfiguration Study as a starting point for reaching agreement on solutions to many of the complex's safety and environmental problems. Key decisions still need to be made about the size of the complex, where to relocate plutonium operations, what technologies to use for new tritium production, and what to




Complex General Relativity  

Microsoft Academic Search

The statement is made by the author that Complex General Relativity is written for theoretical and mathematical physicists and mathematicians to describe recent developments in the area of complex general relativity and their application to classical and quantum gravity. It succeeds in doing this well in the area of complex relativity that deals with spinor and twistor techniques and discusses

C B G McIntosh



Leadership in complex organizations  

Microsoft Academic Search

This paper asks how complexity theory informs the role of leadership in organizations. Complexity theory is a science of complexly interacting systems; it explores the nature of interaction and adaptation in such systems and how they influence such things as emergence, innovation, and fitness. We argue that complexity theory focuses leadership efforts on behaviors that enable organizational effectiveness, as opposed

Russ Marion; Mary Uhl-Bien



A Complexity Measure  

Microsoft Academic Search

This paper describes a graph-theoretic complexity measure and illustrates how it can be used to manage and control program complexity. The paper first explains how the graph theory concepts apply and gives an intuitive explanation of the graph concepts in programming terms. The control graphs of several actual FORTRAN programs are then presented to illustrate the correlation between intuitive complexity

Thomas J. McCabe



Acetic acid treatment in S. cerevisiae creates significant energy deficiency and nutrient starvation that is dependent on the activity of the mitochondrial transcriptional complex Hap2-3-4-5.  


Metabolic pathways play an indispensable role in supplying cellular systems with energy and molecular building blocks for growth, maintenance and repair and are tightly linked with lifespan and systems stability of cells. For optimal growth and survival cells rapidly adopt to environmental changes. Accumulation of acetic acid in stationary phase budding yeast cultures is considered to be a primary mechanism of chronological aging and induction of apoptosis in yeast, which has prompted us to investigate the dependence of acetic acid toxicity on extracellular conditions in a systematic manner. Using an automated computer controlled assay system, we investigated and model the dynamic interconnection of biomass yield- and growth rate-dependence on extracellular glucose concentration, pH conditions and acetic acid concentration. Our results show that toxic concentrations of acetic acid inhibit glucose consumption and reduce ethanol production. In absence of carbohydrates uptake, cells initiate synthesis of storage carbohydrates, trehalose and glycogen, and upregulate gluconeogenesis. Accumulation of trehalose and glycogen, and induction of gluconeogenesis depends on mitochondrial activity, investigated by depletion of the Hap2-3-4-5 complex. Analyzing the activity of glycolytic enzymes, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), pyruvate kinase (PYK), and glucose-6-phosphate dehydrogenase (G6PDH) we found that while high acetic acid concentration increased their activity, lower acetic acids concentrations significantly inhibited these enzymes. With this study we determined growth and functional adjustment of metabolism to acetic acid accumulation in a complex range of extracellular conditions. Our results show that substantial acidification of the intracellular environment, resulting from accumulation of dissociated acetic acid in the cytosol, is required for acetic acid toxicity, which creates a state of energy deficiency and nutrient starvation. PMID:23050242

Kitanovic, Ana; Bonowski, Felix; Heigwer, Florian; Ruoff, Peter; Kitanovic, Igor; Ungewiss, Christin; Wölfl, Stefan



Process waste treatment system upgrades: Clarifier startup at the nonradiological wastewater treatment plant.  

National Technical Information Service (NTIS)

The Waste Management Operations Division at Oak Ridge National Laboratory recently modified the design of a reactor/clarifier at the Nonradiological Wastewater Treatment Plant, which is now referred to as the Process Waste Treatment Complex--Building 3608...

A. J. Lucero D. R. McTaggart D. C. Van Essen T. E. Kent G. D. West



Complex partial status epilepticus in a child.  


Complex partial status epilepticus (SE) has been reported rarely in children. We describe the clinical case of a 14 year-old girl with complex partial seizures (CPS) since age 10 who developed a complex partial SE probably because she was not adherent to treatment. The neurologic examination and computed tomography scan were normal. During the SE she received diazepam and phenytoin and became free of the seizures after 5 minutes. The ictal EEG showed spikes and slow waves over the right temporal region. PMID:7487537

Silva, D F; Zanoteli, E; Lima, M M; Anghinah, R; Lima, J G



Introducing recursive complexity  

NASA Astrophysics Data System (ADS)

In this paper a possibility of introducing new software metric is explored. The new metric reflects the recursive complexity i.e., the complexity of recursive calls appearing in the source code for the purpose of maintainability analysis. The purpose of recursive complexity is to fulfill the gap in complexity and maintainability measurements. Intention of this paper is to provoke the discussion on the needs in the field of maintainability analysis regarding complexity measures. Therefore only the basic concepts of the new metric are discussed.

Raki?, Gordana; Budimac, Zoran; Bothe, Klaus



Complex Correspondence Principle  

SciTech Connect

Quantum mechanics and classical mechanics are distinctly different theories, but the correspondence principle states that quantum particles behave classically in the limit of high quantum number. In recent years much research has been done on extending both quantum and classical mechanics into the complex domain. These complex extensions continue to exhibit a correspondence, and this correspondence becomes more pronounced in the complex domain. The association between complex quantum mechanics and complex classical mechanics is subtle and demonstrating this relationship requires the use of asymptotics beyond all orders.

Bender, Carl M.; Meisinger, Peter N. [Department of Physics, Washington University, St. Louis, Missouri 63130 (United States); Hook, Daniel W. [Theoretical Physics, Imperial College London, London SW7 2AZ (United Kingdom); Wang Qinghai [Department of Physics, National University of Singapore, Singapore 117542 (Singapore)



Transcription factor complexes.  


Considerable progress has been made during the past year on structural studies of the eukaryotic and bacterial transcription factors that control RNA polymerase function via the formation of multiprotein complexes on promoter DNA. Recently determined structures include negative cofactor 2 recognizing a preformed TATA-box-binding protein-DNA binary complex, a dimer of BmrR bound to both DNA and tetra-phenylphosphonium, DNA-bound complexes of SarA and FadR, leukemia-associated AML1-CBFbeta-DNA ternary complexes and a SAP1-SRF-DNA ternary complex. PMID:11959501

Burley, Stephen K; Kamada, Katsuhiko



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

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

Wu, Yong-De; Cai, Xian-Hua; Liu, Xi-Ming; Zhang, Hong-Xi



Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol.  


Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (delta9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic delta9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic delta9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the "high" on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia. PMID:18496477

Deutsch, Stephen I; Rosse, Richard B; Connor, Julie M; Burket, Jessica A; Murphy, Mary E; Fox, Fiona J



[Metabolic syndrome and its complexity].  


Changes in human lifestyle over the last century have produced a dramatic increase of diabetes and obesity worldwide. These two chronic diseases are components of the metabolic syndrome, which is associated with high incidence of cardiovascular disease. Genetic and environmental factors such as high calories diet and inactivity are clearly associated with the metabolic syndrome. The science of complex adaptative systems provides important concepts and perspectives to better understand the pathophysiology and the multi-dimensional approach of the treatment of "diabesity". New treatment frameworks are needed to improve the effectiveness of clinicians in promoting behavioural changes and therapeutic adherence. Goal setting should focus on the individual with a metabolic syndrome and not only to the biological and hemodynamic components of the disease. We should take into account the life circumstances of the patient, his motivations and his therapeutic priorities. PMID:12094496

Ruiz, Juan



Vigabatrin treatment in children  

Microsoft Academic Search

Sixty-nine children, aged from 2 months to 16 years and suffering from different types of drugresistant epileptic seizures, mostly complex partial and secondary generalised, were recruited in an open, uncontrolled, prospective study of treatment with vigabatrin (?-vinyl GABA). Following a 3-month baseline observation of 10 mg\\/kg per day was progressively increased up to a maximum of 140 mg\\/kg per day,

Alberto Fois; Sabrina Buoni; Rosanna Maria Bartolo; Virginia Marco; Rosa Mostardini



Hypergraph coloring complexes  

PubMed Central

The aim of this paper is to generalize the notion of the coloring complex of a graph to hypergraphs. We present three different interpretations of those complexes–a purely combinatorial one and two geometric ones. It is shown, that most of the properties, which are known to be true for coloring complexes of graphs, break down in this more general setting, e.g., Cohen–Macaulayness and partitionability. Nevertheless, we are able to provide bounds for the f- and h-vectors of those complexes which yield new bounds on chromatic polynomials of hypergraphs. Moreover, though it is proven that the coloring complex of a hypergraph has a wedge decomposition, we provide an example showing that in general this decomposition is not homotopy equivalent to a wedge of spheres. In addition, we can completely characterize those hypergraphs whose coloring complex is connected.

Breuer, Felix; Dall, Aaron; Kubitzke, Martina



Treatment Options  


... When a child gives consent, it is called assent. You should take time to read any materials ... Immunotherapy Targeted therapy Your child may receive one form of treatment or a combination of treatments (called ...


Complex nursing systems.  


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

Clancy, Thomas R; Delaney, Connie-White



The Evolution of Complexity  

Microsoft Academic Search

The evolution of the biosphere exhibits a trend of increasing complexity of the most complex organisms. Even though we are\\u000a uncertain about the proper way to measure complexity, it is hard to deny that the earliest prokaryotic cells were simpler\\u000a than the eukaryotic cells that arose from them, and these were simpler than the multicellular life forms that evolved from

Mark A. Bedau


Nuclear weapons complex  

Microsoft Academic Search

In addition to long-standing safety and environmental problems plaguing the nuclear weapons complex, this paper reports that the Department of Energy (DOE) faces a major new challenge-how to reconfigure the weapons complex to meet the nation's defense needs in the 21st century. Key decisions still need to be made about the size of the complex; where, if necessary, to relocate




Constructing a Golgi complex.  


In this issue, Short et al. report the discovery of a protein named Golgin-45 that is located on the surface of the middle (or medial) cisternae of the Golgi complex. Depletion of this protein disrupts the Golgi complex and leads to the return of a resident, lumenal, medial Golgi enzyme to the endoplasmic reticulum. These findings suggest that Golgin-45 serves as a linchpin for the maintenance of Golgi complex structure, and offer hints as to the mechanisms by which the polarized Golgi complex is constructed. PMID:11739400

Pfeffer, S R



Genomic mining for complex disease traits with \\  

Microsoft Academic Search

Our rapidly growing knowledge regarding genetic variation in the human genome offers great potential for understanding the genetic etiology of disease. This, in turn, could revolutionize detection, treatment, and in some cases prevention of disease. While genes for most of the rare monogenic diseases have already been discovered, most common diseases are complex traits, resulting from multiple gene-gene and gene-environment

Margaret J. Eppstein; Joshua L. Payne; Bill C. White; Jason H. Moore



School Phobia: Understanding a Complex Behavioural Response  

ERIC Educational Resources Information Center

|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…

Chitiyo, Morgan; Wheeler, John J.



Child health in complex emergencies.  

PubMed Central

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.

Moss, William J.; Ramakrishnan, Meenakshi; Storms, Dory; Henderson Siegle, Anne; Weiss, William M.; Lejnev, Ivan; Muhe, Lulu



Heat Treatment of New Cast Aluminum Alloys.  

National Technical Information Service (NTIS)

Contents: Brief outline of new thermally hardenable aluminum alloys included in GOST 2685-63; Heat treatment of alloys of the system Al-Mg; Heat treatment of new complex alloys based on the Al-Cu system; Heat treatment of alloys of the Al-Zn-Mg system; Ty...

N. N. Belousov E. N. Mikheeva M. N. Sarafanova



Complexity Measures for Programming Languages.  

National Technical Information Service (NTIS)

A theory of complexity is developed for algorithms implemented in typical programming languages. The complexity of a program may be interpreted in many ways; a method for measuring a specific type of complexity is a complexity measure -- some function of ...

L. I. Goodman



[Spa treatment and health status].  


Spa treatment, in its global complexity, is an active therapeutic way of treatment, capable to have an influence on the somatic and psychological status of the patient, seen its proven utility for protecting and restoring health. Spa treatment acts on the patient, in his body and mind, being a valuable complement of usual medical practices, at any age and circumstances. In spite of the short period of application (2 to 4 weeks), a considerable wellness is obtained when the indication and way of treatment are adequate, valuing the good results that can be reached in people of advanced age, depressive status and some other illnesses. PMID:18069602

Armijo Valenzuela, Manuel




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...


Nerves of Simplicial Complexes.  

National Technical Information Service (NTIS)

If a simplicial complex K is considered as covered by its maximal (closed) faces, its nerve N(K) may be defined in the usual manner. Generalizing known results on interchange graphs of graphs, simplicial complexes which are nerves of d-dimensional simplic...

B. Grunbaum



Evolution in complex systems  

Microsoft Academic Search

What features characterize complex system dynamics? Power laws and scale invariance of fluctuations are often taken as the hallmarks of complexity, drawing on analogies with equilibrium critical phenomena. Here we argue that slow, directed dynamics, during which the system's properties change significantly, is fundamental. The underlying dynamics is related to a slow, decelerating but spasmodic release of an intrinsic strain

Paul E. Anderson; Henrik Jeldtoft Jensen; L. P. Oliveira; Paolo Sibani



Complexity distortion theory  

Microsoft Academic Search

Complexity distortion theory (CDT) is a mathematical framework providing a unifying perspective on media representation. The key component of this theory is the substitution of the decoder in Shannon's classical communication model with a universal Turing machine. Using this model, the mathematical framework for examining the efficiency of coding schemes is the algorithmic or Kolmogorov (1965) complexity. CDT extends this

Daby M. Sow; Alexandros Eleftheriadis



Knitted Complex Networks  

Microsoft Academic Search

To a considerable extent, the continuing importance and popularity of complex networks as models of real-world structures has been motivated by scale free degree distributions as well as the respectively implied hubs. Being related to sequential connections of edges in networks, paths represent another important, dual pattern of connectivity (or motif) in complex networks (e.g., paths are related to important

Luciano da Fontoura Costa



Human complex sound analysis  

Microsoft Academic Search

The analysis of complex sound features is important for the perception of environmental sounds, speech and music, and may be abnormal in disorders such as specific language impairment in children, and in common adult lesions including stroke and multiple sclerosis. This work addresses the problem of how the human auditory system detects features in complex sound, and uses those features




Minimum complexity density estimation  

Microsoft Academic Search

The authors introduce an index of resolvability that is proved to bound the rate of convergence of minimum complexity density estimators as well as the information-theoretic redundancy of the corresponding total description length. The results on the index of resolvability demonstrate the statistical effectiveness of the minimum description-length principle as a method of inference. The minimum complexity estimator converges to

Andrew R. Barron; Thomas M. Cover



Complex Regional Pain Syndrome  


... any treatment? Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. Doctors may ... cord. What is the prognosis? The prognosis for CRPS ... What research is being done? The National Institute ...


Treatment of Lyme borreliosis  

PubMed Central

Borrelia burgdorferi sensu lato is the causative agent of Lyme borreliosis in humans. This inflammatory disease can affect the skin, the peripheral and central nervous system, the musculoskeletal and cardiovascular system and rarely the eyes. Early stages are directly associated with viable bacteria at the site of inflammation. The pathogen-host interaction is complex and has been elucidated only in part. B. burgdorferi is highly susceptible to antibiotic treatment and the majority of patients profit from this treatment. Some patients develop chronic persistent disease despite repeated antibiotics. Whether this is a sequel of pathogen persistence or a status of chronic auto-inflammation, auto-immunity or a form of fibromyalgia is highly debated. Since vaccination is not available, prevention of a tick bite or chemoprophylaxis is important. If the infection is manifest, then treatment strategies should target not only the pathogen by using antibiotics but also the chronic inflammation by using anti-inflammatory drugs.



[Complex pelvic injury in childhood].  


Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. Combination of a rare injury and the capability of children to compensate blood loss for a long time may implicate a wrong security and prolong diagnostic and therapeutic procedures--a problem that definitely should be avoided. Three cases were analyzed and established algorithms for treatment of patients matching these special injury-features demonstrated. A good outcome may only be achieved when all components of injury pattern get recognized and treatment is organized following the hierarchy of necessity. Therefore in the time table first life-saving steps have to be taken and then accompanying injuries can be treated that often decisively influence life quality. As seen in our cases unstable and dislocated fractures require open reduction and internal fixation ensuring nerval decompression, stop of hemorrhage and realizing the prerequisite for effective treatment of soft tissue damage. The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center. PMID:12243021

Schmal, H; Klemt, C; Haag, C; Bonnaire, F



Evidence based guidelines for complex regional pain syndrome type 1  

Microsoft Academic Search

BACKGROUND: Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. METHOD: A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were

Roberto S Perez; Paul E Zollinger; Pieter U Dijkstra; Ilona L Thomassen-Hilgersom; Wouter WA Zuurmond; Jan H Geertzen



Pyrromethene-BF2 Complexes as Laser Dyes: 2.  

National Technical Information Service (NTIS)

Pyrromethene--BF2 complexes were obtained from alpha-unsubstituted pyrroles by acylation and condensation to give intermediate pyrromethene hydrohalides followed by treatment with boron trifluoride entherate. Conversion of ethyl alpha-pyrrolecarboxylates ...

J. H. Boyer A. M. Haag G. Sathyamoorthi M.-L. Soong K. Thangaraj



Window treatments  

SciTech Connect

This book includes basic material as well as information the professional needs for designing appropriate window treatments for residential and nonresidential buildings: site, orientation, climate, energy efficiency, sound-proofing, privacy, protection, view, ventilation and interior and exterior aesthetics. Also includes a guide to the window treatment industry, a list of manufacturers, distributors, and retailers, information on window treatment fibers and fabrics, three glossaries, an extensive bibliography, and over 800 illustrations.

Nielson, K.J.



Wastewater Treatment  

NSDL National Science Digital Library

This lesson introduces students to the basics of wastewater treatment. Topics include the variety of materials that enter the wastewater system, septic tanks, and municpal treatment systems. Students can review online resources that describe the processes of wastewater treatment and septic tank operation in detail, and listen to a National Publc Radio (NPR) show that discusses the use of treated wastewater to make snow at a ski resort in Maine. The lesson includes an activity in which students participate in virtual tours of wastewater treatment facilities and answer questions about what they see.

Laposata, Mark


Complex equiangular tight frames  

NASA Astrophysics Data System (ADS)

A complex equiangular tight frame (ETF) is a tight frame consisting of N unit vectors in Cd whose absolute inner products are identical. One may view complex ETFs as a natural geometric generalization of an orthonormal basis. Numerical evidence suggests that these objects do not arise for most pairs (d, N). The goal of this paper is to develop conditions on (d, N) under which complex ETFs can exist. In particular, this work concentrates on the class of harmonic ETFs, in which the components of the frame vectors are roots of unity. In this case, it is possible to leverage field theory to obtain stringent restrictions on the possible values for (d, N).

Tropp, Joel A.



Complexity and robustness  

PubMed Central

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.

Carlson, J. M.; Doyle, John



Controllability of Complex Systems  

NASA Astrophysics Data System (ADS)

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.[4pt] 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.

Slotine, Jean-Jacques



Assay of immune complexes in infantile hydrocephalus among Nigerians  

Microsoft Academic Search

The immune complexes in infantile hydrocephalic CSF in Nigerian children using a laser nephelometer were quantified. The values obtained were relatively low when compared with the serum levels. There was no evidence of selective admixture or of a breakdown of blood-brain-barrier (BBB). The low levels of immune complexes, when associated with implantation of shunt device for treatment of the hydrocephalus,

A. A. Kazeem; S. O. Arigbabu



Silver iodide burn complex and silver phosphate effects oh methanogenesis  

Microsoft Academic Search

Weather modification nucleating agents may accumulate in anaerobic environments such as aquatic muds and anaerobic sewage treatment facilities. Silver iodide burn complex and silver phosphate effects on methanogenesis were investigated to assess the possible ecological impacts of these agents. Enriched cultures of methanogenic organisms did not significantly alter methanogenesis when seeding generator burn complexes of silver iodide?ammonium iodide, silver iodide?titanium

Domenic Castignetti; Donald A. Klein



Cytarabine Lipid Complex Injection  


Cytarabine lipid complex is used to treat lymphomatous meningitis (a type of cancer in the covering of ... to take.tell your doctor if you have meningitis. Your doctor will probably not want you to ...


Complex Auditory Signals.  

National Technical Information Service (NTIS)

Human detection of complex sounds as examined experimentally and theoretically. Three separate phenomena were studied: comodulation effects, perception of nonstationary spectra and detection of changes in static spectra. Results are briefly outlined and d...

D. M. Green



Measurement of complex surfaces.  

National Technical Information Service (NTIS)

Several of the components used in coil fabrication involve complex surfaces and dimensions that are not well suited to measurements using conventional dimensional measuring equipment. Some relatively simple techniques that are in use in the SSCL Magnet Sy...

G. M. Brown



Contracting for Complex Products.  

National Technical Information Service (NTIS)

The US Federal Government spends just under twenty percent of its budget buying everything from paper clips to complex weapons systems. Effective contracting promises win-win exchanges: governments gain efficiency and qualities not available through in-ho...

D. M. Van Slyke M. Potoski T. L. Brown



Pigment-protein complexes  

SciTech Connect

The photosynthetically-active pigment protein complexes of procaryotes and eucaryotes include chlorophyll proteins, carotenochlorophyll proteins, and biliproteins. They are either integral components or attached to photosynthetic membranes. Detergents are frequently required to solubilize the pigment-protein complexes. The membrane localization and detergent solubilization strongly suggest that the pigment-protein complexes are bound to the membranes by hydrophobic interactions. Hydrophobic interactions of proteins are characterized by an increase in entropy. Their bonding energy is directly related to temperature and ionic strength. Hydrophobic-interaction chromatography, a relatively new separation procedure, can furnish an important method for the purification of pigment-protein complexes. Phycobilisome purification and properties provide an example of the need to maintain hydrophobic interactions to preserve structure and function.

Siegelman, H W



Cell cycle: Complex evolution  

Microsoft Academic Search

Cell division is fundamental to life, and so might be expected to have changed little during evolution. Data from four species show that the genes involved can vary, but the regulation of complexes is a common theme.

Gavin Sherlock



Trauma-focused CBT for youth with complex trauma  

PubMed Central

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.

Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.



Complex/Symplectic Mirrors  

SciTech Connect

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.

Chuang, Wu-yen; Kachru, Shamit; /Stanford U., ITP /SLAC; Tomasiello, Alessandro; /Stanford U., ITP



Complexity of PL manifolds  

Microsoft Academic Search

We extend Matveev's complexity of 3-manifolds to PL compact manifolds of\\u000aarbitrary dimension, and we study its properties. The complexity of a manifold\\u000ais the minimum number of vertices in a simple spine. We study how this quantity\\u000achanges under the most common topological operations (handle additions, finite\\u000acoverings, drilling and surgery of spheres, products, connected sums) and its\\u000arelations

Bruno Martelli



Complex Numbers and Trigonometry  

NSDL National Science Digital Library

Complex numbers have applications in many applied sciences. This online text begins with an introduction to trigonometry, which serves as a starting point for additional discussion about complex numbers (also known as imaginary numbers). The drawings and figures are the only notable downside to this excellent resource, because many of them are somewhat crude; however, they are still fairly easy to follow. The book can be read online or downloaded for offline viewing.

Hillman, Abraham P.; Alexanderson, Gerald L.; Newton, Mervin E.


Complex Networks and Graphs  

NSDL National Science Digital Library

Students learn about complex networks and how to represent them using graphs. They also learn that graph theory is a useful mathematical tool for studying complex networks in diverse applications of science and engineering, such as neural networks in the brain, biochemical reaction networks in cells, communication networks, such as the internet, and social networks. Topics covered include set theory, defining a graph, as well as defining the degree of a node and the degree distribution of a graph.

Complex Systems Science Laboratory


Knitted Complex Networks  

Microsoft Academic Search

To a considerable extent, the continuing importance and popularity of complex\\u000anetworks as models of real-world structures has been motivated by scale free\\u000adegree distributions as well as the respectively implied hubs. Being related to\\u000asequential connections of edges in networks, paths represent another important,\\u000adual pattern of connectivity (or motif) in complex networks (e.g., paths are\\u000arelated to important

Luciano da Fontoura Costa



Treatment of the neglected and relapsed clubfoot.  


Treatment of the neglected and the relapsed clubfoot is one of the most controversial topics in pediatric foot care. This article reviews the breadth of treatment options for practicing podiatrists or orthopedists with a specialty in complex clubfoot treatment. Discussion includes the appropriate circumstances for the use of the different procedures presented and the author's preferred treatment algorithm, based on 15 years of treating neglected, relapsed, and nonidiopathic clubfeet. PMID:24075134

van Bosse, Harold Jacob Pieter



Alternative management of complex renal stones  

Microsoft Academic Search

Introduction  The gold standard for treatment of large and complex renal stones is percutaneous nephrolithotomy (PCNL). However, in patients\\u000a with significant comorbididties, this option may be suboptimal. We reviewed our experiences with ureterorenoscopy and Holmium\\u000a laser lithotripsy (UL) for the primary management of large and complex intrarenal calculi.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Forty-three patients with large (2 cm or greater in diameter) renal or

Millie Pevzner; Brian C. Stisser; Jordan Luskin; Jeffrey C. Yeamans; Marina Cheng-Lucey; John J. Pahira


Reliable modeling of complex behavior  

SciTech Connect

The status of modeling for large-strain plasticity is assessed, and this overview is used to emphasize some general points concerning modeling in Materials Science. While a physical foundation is essential in order to achieve generality and some measure of confidence in extrapolations, phenomenological constraint is equally crucial to achieve reliability and predictive value in descriptions of the macroscopic behavior despite the enormous complexity of the underlying physics. Many details that may be of interest in modeling the physical foundation lose importance in the integration to an overall materials response, which depends on few parameters and is quite reproducible. From this point of view, the current understanding of large-strain plasticity is adequate in many respects. However, some problems are highlighted in which more quantitative modeling results would impact the reliability and generality of macroscopic properties descriptions, and which seem amenable to treatment with current techniques and resources. 21 refs., 6 figs., 1 tab.

Kocks, U.F.



ICDF Complex Remedial Action Report  

SciTech Connect

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.

W. M. Heileson



Finding and reducing needless complexity  

Microsoft Academic Search

Purpose – The purpose of this paper is to present a structure for identifying complexity that is not needed in an enterprise, and describe a methodology for eliminating it. Whether it is process complexity, product complexity, or organizational complexity, investments in managing higher levels of complexity often offer businesses significant value by enabling them to offer more and better products

Eric G. Olson; Sara J. Moulton Reger; David S. Singer



Cell complexes through time  

NASA Astrophysics Data System (ADS)

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.

Klette, Reinhard



Water Treatment  

NSDL National Science Digital Library

This web site showcases Lenntech's Complete Water treatment and Air filtration solutions. This company designs, manufactures and installs complete air and water treatment system solutions. Lenntech proclaims, "Our wide range of technologies and extended know-how in all water-related sectors will guarantee you a cost-efficient solution meeting your water quality requirements." Whether or not you're looking to purchase one of these fine water treatment systems, the site will still provide beneficial resources about how said systems operate.



Late transition metal. mu. -oxo and. mu. -imido complexes  

SciTech Connect

The synthesis and reactions of late-transition-metal oxo and imido complexes was explored. The deprotonation of platinum(II) hydroxo complexes yielded new oxo complexes. Attempted deprotonation of Cp*Rh(III) hydroxo complexes did not give oxo complexes but complex mixtures probably resulting from reduction of the Rh(III) center. The reaction of Na/Hg with (Cp*RhCl{sub 2}){sub 2} gave the very reactive Rh(II) dimer, (Cp*RhCl){sub 2}. Rhodium(I) imido complexes with the bis(dimethylphosphino)methane ligand were prepared and found to be similar to the previously prepared bis(diphenylphosphino)methane complexes. Attempts to prepare bis(diphenylphosphino)methylamine, bis(diphenylphosphino)phenylamine, PMe{sub e} and NO{sup +} analogues were not successful. Attempts to prepare Cp*Rh(III) imido complexes resulted in amido complexes and reduction. Rhodium (III) tris(3.5-dimethylpyrazoyl)borate analogues are reduction resistant but have not yet yielded imido complexes. The first imido complexes of Au were prepared by treating a Au oxo complex with amines or isocyanates. Dimeric Cp*Rh dioxygen and nitrosobenzene complexes were prepared by insertion into the Rh-Rh bond of (Cp*RhCl){sub 2}. The dioxygen complex activates a C-H bond of the Cp* ligand on treatment with PMe{sub 3}. Imido and oxo complexes nitrene and oxygen atom transfer product in reactions with CO. A novel electrophilic ring addition was observed with sterically protected aryl imido complexes. 15 refs.

Sharp, P.R.



Aminophosphonate metal complexes of biomedical potential.  


Metals and their complexes with organic ligands have an important role in biochemical systems such as enzymatic catalysis, metal ion transfer across the cell membranes, treatment of malignancy, rheumatoid arthritis, ulcer and other types of diseases. Special attention is directed to metal complexes with ligands which are important in biological systems, as their incorporation into metallo-organic compounds offers much scope for design of potential metal-based agents that provide new opportunities in the medicinal chemistry. In view of this, derivatives of aminophosphonic acids, owing to their broad spectrum of biological activities and wide range of applications in the medicinal and agrochemical fields, are very attractive metal-ligand agents that might form biomedical important metal complexes. Thus, a number of aminophosphonate complexes of platinum group metals have been found to possess remarkable antitumor activity while complexes of some other transition and rare-earth metals like technetium, rhenium, samarium and gadolinium have been used either as therapeutic and diagnostic radiopharmaceuticals or as magnetic resonance imaging (MRI) contrast agents. In addition, the high phosphonate affinity towards bone and other calcified tissues may be utilized for the drug targeting based on synthesis of metal complexes linked to bioactive carrier systems, affording better modalities of attack to the site of pathology. In this review article, aminophosphonate metal-based compounds with potential biomedical applications are described. PMID:23432587

Tušek-Boži?, L J



Treatment of subepidermal immunobullous diseases  

PubMed Central

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.

Culton, Donna A.; Diaz, Luis A.



Ecology, Complexity, and Metaphor  

NSDL National Science Digital Library

This peer-reviewed article from Bioscience is about Ecology, Complexity and Metaphor.Complexity has recently risen to prominence in ecology as part of a broader interest that suggests its status is something more than just a scientific theory or property of reality. It may be helpful to consider complexity, and related terms such as "self-organization," as recent metaphors deployed to advance knowledge on fundamental questions in ecology, including the relationship between parts and wholes, and between order and disorder. Though not commonly viewed as such, metaphors are an indispensable component of science, and should not be appraised as true or false, but rather in terms of how they help or hinder knowledge. By understanding metaphor as a necessary ally and not a threat to ecological knowledge, we may enrich our contextual understanding of complexity while continuing to invoke it in useful ways. The special section introduced by this article features essays by two prominent experts in ecology, complexity, and metaphor: science studies scholar Evelyn Fox Keller and theoretical ecologist Simon Levin




Quantum Complexity in Graphene  

NASA Astrophysics Data System (ADS)

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.

Baskaran, G.


Wastewater Treatment.  

ERIC Educational Resources Information Center

|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)|

Zoltek, J., Jr.; Melear, E. L.



Treatment Adherence  


... an HIV treatment regimen also helps prevent drug resistance . Drug resistance develops when the virus mutates (changes form), becoming “ ... can become ineffective as a result of drug resistance. Skipping medications makes it easier for drug resistance ...


Seeking Treatment  


... children. You should seek treatment whenever changes in your bowel or bladder habits keep you from going and doing what you want to do. Ten Warning Signs of Bladder Control Problems: Leakage of urine which ...


Fibromyalgia Treatment  


Donate | Join | Shop | eAlert | Contact Us About Fibromyalgia Symptoms Diagnosis Treatment Prevalence Causes Prognosis Science of FM Newly Diagnosed Patients FM Fact Sheet Economic Burden Research Abstract Clinical Trials Home > Fibromyalgia > ...


Sores -- Treatment  

MedlinePLUS Videos and Cool Tools

... called debridement. There are many different ways your healthcare provider may remove and clean off the dead ... substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment ...


Coccygodynia: treatment.  


This article presents a retrospective review of the treatment of coccygodynia. The past 5 years of conservative treatment for coccygodynia were reviewed, including local injection. The results were evaluated. Retrospectively, the past 20 years of surgical treatment for coccygodynia were reviewed and the clinical results were evaluated. Twenty-four patients were treated with local injection and 15 patients were treated with coccygectomy. Local injection was successful in 78% of patients. Coccygectomy was successful in 87% of patients. The results of conservative treatment with local injection for coccygodynia appear to be successful. However, no other historical literature exists to compare these results. The results of coccygectomy for coccygodynia were also highly successful, and the success rate compares favorably to previous historical data in the literature. PMID:12722911

Ramsey, Michael L; Toohey, John S; Neidre, Arvo; Stromberg, Lynn J; Roberts, David A



Cryptosporidium: Treatment  


... should be consulted before such medicine is taken. Nitazoxanide has been FDA-approved for treatment of diarrhea ... is available by prescription. However, the effectiveness of nitazoxanide in immunosuppressed individuals is unclear. HIV-positive individuals ...


Peripheral neuropathy: evidence-based treatment of a complex disorder.  


Peripheral neuropathy (PN) is a common and often progressive condition frequently seen in primary care. The chronic pain associated with PN, or neuropathic pain, can significantly diminish patients' quality of life and be challenging to treat. PMID:22460540

Hammersla, Margaret; Kapustin, Jane Faith



Evolution of Endovascular Treatment for Complex Thoracic Aortic Disease  

PubMed Central

In a relatively short period of time, transcatheter and endovascular approaches to treat thoracic aortic and structural heart disease have exploded onto the scene. New device frontiers already being forged in the experimental stages include expanded indications and variations of fenestrated and branch stentgrafting to treat thoracoabdominal and arch disease, endovascular ascending and aortic root repair, and all of the cardiac valves. A fundamental concept to optimize durability of endovascular repair is the need for fixation and seal in healthy tissue. Before long, the entire vascular and cardiovascular system will be within the reach of endovascular interventions. Ultimately, achieving success in this endeavor will require a combination of skill sets including familiarity with high definition imaging, surgical access, and the mastery of interventional techniques, as well as the development of better anatomy-specific and disease-specific devices.



Heat treatment  

Microsoft Academic Search

Most ferrous materials are not subjected to a separate heat treatment. Their microstructure results directly from solidification\\u000a and\\/or controlled hot working and cooling. Semi-finished steel products (strip, section, pipe, wire) undergo a combination\\u000a of hot working and heat treatment during thermomechanical processing, which is also used e.g. for drop-forged parts. The desired\\u000a microstructure of cast iron is often obtained by

Hans Berns


Global complexes of activity  

NASA Astrophysics Data System (ADS)

A new concept of "Global Complexes of Activity" on the Sun is presented, which brings together objects associated with both global and local fields in a single framework. Activity complexes have traditionally been identified purely from observations of active regions. We show here that a global complex also includes coronal holes and active regions. Our analysis is based on a large dataset on magnetic fields on various scales, SOHO/MDI observations of active regions and magnetic fields, and UV observations of coronal holes. It is shown that the evolution of coronal holes and active regions are parts of a single process. The relationships between the fields on different scales during the generation of the cycle is discussed.

Obridko, V. N.; Shelting, B. D.



Synchronization in complex networks  

SciTech Connect

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.

Arenas, A.; Diaz-Guilera, A.; Moreno, Y.; Zhou, C.; Kurths, J.



Controllability of complex networks.  


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

Liu, Yang-Yu; Slotine, Jean-Jacques; Barabási, Albert-László



Localizations on complex networks.  


We study the structural characteristics of complex networks using the representative eigenvectors of the adjacent matrix. The probability distribution function of the components of the representative eigenvectors are proposed to describe the localization on networks where the Euclidean distance is invalid. Several quantities are used to describe the localization properties of the representative states, such as the participation ratio, the structural entropy, and the probability distribution function of the nearest neighbor level spacings for spectra of complex networks. Whole-cell networks in the real world and the Watts-Strogatz small-world and Barabasi-Albert scale-free networks are considered. The networks have nontrivial localization properties due to the nontrivial topological structures. It is found that the ascending-order-ranked series of the occurrence probabilities at the nodes behave generally multifractally. This characteristic can be used as a structural measure of complex networks. PMID:18643342

Zhu, Guimei; Yang, Huijie; Yin, Chuanyang; Li, Baowen



The multitalented Mediator complex.  


The Mediator complex is needed for regulated transcription of RNA polymerase II (Pol II)-dependent genes. Initially, Mediator was only seen as a protein bridge that conveyed regulatory information from enhancers to the promoter. Later studies have added many other functions to the Mediator repertoire. Indeed, recent findings show that Mediator influences nearly all stages of transcription and coordinates these events with concomitant changes in chromatin organization. We review the multitude of activities associated with Mediator and discuss how this complex coordinates transcription with other cellular events. We also discuss the inherent difficulties associated with in vivo characterization of a coactivator complex that can indirectly affect diverse cellular processes via changes in gene transcription. PMID:24074826

Carlsten, Jonas O P; Zhu, Xuefeng; Gustafsson, Claes M



The complex pendulum  

SciTech Connect

In this talk we propose to broaden the conventional notion of quantum mechanics. In conventional quantum mechanics one imposes the condition H{sup {dagger}}=H, where {dagger} represents complex conjugation and matrix transpose, to ensure that the Hamiltonian has a real spectrum. Replacing this mathematical condition by the weaker and more physical requirement H{sup {double_dagger}}=H, where {double_dagger}=PT represents combined parity reflection and time reversal, one obtains new infinite classes of complex Hamiltonians whose spectra are also real and positive. These PT-symmetric theories may be viewed as analytic continuations of conventional theories from real to complex phase space. This talk describes the unusual classical and quantum properties of PT-symmetric quantum mechanical and quantum field theoretic models. {copyright} {ital 1998 American Institute of Physics.}

Bender, C.M. [Department of Physics, Washington University, St. Louis, Missouri 63130 (United States)



The complex pendulum  

SciTech Connect

In this talk we propose to broaden the conventional notion of quantum mechanics. In conventional quantum mechanics one imposes the condition H{sup {dagger}}=H, where {dagger} represents complex conjugation and matrix transpose, to ensure that the Hamiltonian has a real spectrum. Replacing this mathematical condition by the weaker and more physical requirement H{sup {dagger}}=H, where {dagger}=PT represents combined parity reflection and time reversal, one obtains new infinite classes of complex Hamiltonians whose spectra are also real and positive. These PT-symmetric theories may be viewed as analytic continuations of conventional theories from real to complex phase space. This talk describes the unusual classical and quantum properties of PT-symmetric quantum mechanical and quantum field theoretic models.

Bender, Carl M. [Department of Physics, Washington University, St. Louis, Missouri 63130 (United States)



[Multipurpose treatment of vaginal infections].  


Untreated bacterial vaginosis is related with many complications for non-pregnant women in reproductive age, most common from them are vaginal discharge and postoperative infections. The aim of our investigation was to compare the effectiveness of two therapeutic regimes which consist in Macmiror/Macmiror Complex alone and in combination with Feminella Vagi C for treatment of bacterial vaginosis (BV) and/or mycotic infection. 117 non-pregnant women with symptoms of vaginal infection were prospectively enrolled into two groups according their treatment. First group consist 66 women treated with Macmiror tablets and vaginal capsules followed with local application of Feminella Vagi C, the second group consist 54 women treated with Macmiror tablets and vaginal capsules only. The impact of treatment on clinical symptoms was observed at the end of medication and 20 days after it. Microbiological testing was repeated 20 days after treatment. Over than 80% (78.6 divided by 86.7%) of the cases with vaginal infection (BV and mycotic one) were successfully treated with Macmiror/Macmiror Complex. Supplement treatment with Feminella Vagi C lead to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment. Used medication showed higher efficacy against BV than to fungal infection. According obtained results we may conclude that bacterial vaginosis was better treated with multipurpose treatment (Nifuratel, Nistatin and vit. C) than with Macmiror alone. PMID:23234030

Nikolov, A; Masseva, A; Shopova, E; Georgiev, S



Immunodetection assay for Mycobacterium tuberculosis complex  

US Patent & Trademark Office Database

The present invention provides a method for specifically detecting a Mycobacterium tuberculosis complex-specific secretory protein MPT64 antigen in a biological sample, whereby diagnosis of infection with Mycobacterium tuberculosis is carried out rapidly and safely with higher accuracy than before. An antibody that recognizes an epitope for MPB64 located in any one of amino acid sequences of SEQ ID NOS: 2 to 4, particularly a monoclonal antibody was obtained. Thus, an immunoassay using the antibody, particularly a sandwich immunoassay using first and second antibodies to MPB64, particularly an immunochromatographic assay and an immunochromatographic test strip are provided. A biological sample can be rapidly subjected to the immunoassay without culturing or after culturing for a time before Mycobacterium tuberculosis complex bacteria in the sample substantially start to grow. The biological sample may be pretreated by treatment for inactivation of Mycobacterium tuberculosis, or treatment by dispersion or solubilization.

Namba; Yasuharu (Numazu, JP)



Metabolic oxidative stress elicited by the copper(II) complex [Cu(isaepy)2] triggers apoptosis in SH-SY5Y cells through the induction of the AMP-activated protein kinase/p38MAPK/p53 signalling axis: evidence for a combined use with 3-bromopyruvate in neuroblastoma treatment.  


We have demonstrated previously that the complex bis[(2-oxindol-3-ylimino)-2-(2-aminoethyl)pyridine-N,N']copper(II), named [Cu(isaepy)(2)], induces AMPK (AMP-activated protein kinase)-dependent/p53-mediated apoptosis in tumour cells by targeting mitochondria. In the present study, we found that p38(MAPK) (p38 mitogen-activated protein kinase) is the molecular link in the phosphorylation cascade connecting AMPK to p53. Transfection of SH-SY5Y cells with a dominant-negative mutant of AMPK resulted in a decrease in apoptosis and a significant reduction in phospho-active p38(MAPK) and p53. Similarly, reverse genetics of p38(MAPK) yielded a reduction in p53 and a decrease in the extent of apoptosis, confirming an exclusive hierarchy of activation that proceeds via AMPK/p38(MAPK)/p53. Fuel supplies counteracted [Cu(isaepy)(2)]-induced apoptosis and AMPK/p38(MAPK)/p53 activation, with glucose being the most effective, suggesting a role for energetic imbalance in [Cu(isaepy)(2)] toxicity. Co-administration of 3BrPA (3-bromopyruvate), a well-known inhibitor of glycolysis, and succinate dehydrogenase, enhanced apoptosis and AMPK/p38(MAPK)/p53 signalling pathway activation. Under these conditions, no toxic effect was observed in SOD (superoxide dismutase)-overexpressing SH-SY5Y cells or in PCNs (primary cortical neurons), which are, conversely, sensitized to the combined treatment with [Cu(isaepy)(2)] and 3BrPA only if grown in low-glucose medium or incubated with the glucose-6-phosphate dehydrogenase inhibitor dehydroepiandrosterone. Overall, the results suggest that NADPH deriving from the pentose phosphate pathway contributes to PCN resistance to [Cu(isaepy)(2)] toxicity and propose its employment in combination with 3BrPA as possible tool for cancer treatment. PMID:21548882

Filomeni, Giuseppe; Cardaci, Simone; Da Costa Ferreira, Ana Maria; Rotilio, Giuseppe; Ciriolo, Maria Rosa