Near-Term Electric Vehicle Program. Phase II: Mid-Term Summary Report.

SciTech Connect

None

1978-08-01

The Near Term Electric Vehicle (NTEV) Program is a constituent elements of the overall national Electric and Hybrid Vehicle Program that is being implemented by the Department of Energy in accordance with the requirements of the Electric and Hybrid Vehicle Research, Development, and Demonstration Act of 1976. Phase II of the NTEV Program is focused on the detailed design and development, of complete electric integrated test vehicles that incorporate current and near-term technology, and meet specified DOE objectives. The activities described in this Mid-Term Summary Report are being carried out by two contractor teams. The prime contractors for these contractormore » teams are the General Electric Company and the Garrett Corporation. This report is divided into two discrete parts. Part 1 describes the progress of the General Electric team and Part 2 describes the progress of the Garrett team.« less

Mid-Term Vascular Safety of Renal Denervation Assessed by Follow-up MR Imaging

SciTech Connect

Schmid, Axel, E-mail: axel.schmid@uk-erlangen.de; Schmieder, Raphael; Lell, Michael

Background/AimsRenal denervation (RDN) emerged as a treatment option for reducing blood pressure (BP) in patients with treatment-resistant hypertension (TRH). However, concerns have been raised regarding the incidence of late renal artery stenosis or thromboembolism after RDN. The goal of the current study was, therefore, to conduct a prospective clinical trial on the mid-term vascular integrity of the renal arteries and the perfusion of the renal parenchyma assessed by magnetic resonance imaging (MRI) in the follow-up after catheter-based RDN.MethodsIn our single-centre investigator initiated study, 51 patients with true TRH underwent catheter-based RDN using the Symplicity Flex{sup TM} catheter (Medtronic Inc., Palomore » Alto, CA). Follow-up MRI was performed at a median of 11 months (interquartile range 6–18 months) after RDN on a 1.5T MR unit. High-resolution MR angiography (MRA) and MRI results were compared to the baseline digital angiography of renal arteries obtained at time of RDN. In case of uncertainties (N = 2) catheter angiography was repeated.ResultsBoth office and 24-h ambulatory BP were significantly reduced 6 and 12 months after RDN. Renal function remained unchanged 6 and 12 months after RDN. In all patients, MRA excluded new or progression of pre-existing low grade renal artery stenosis as well as focal aneurysms at the sites of radiofrequency ablation. In none of the patients new segmental perfusion deficits in either kidney were detected on MRI.ConclusionsNo vascular or parenchymal complications after radiofrequency-based RDN were detected in 51 patients followed up by MRI.« less

Short and medium term outcomes after rollerball endometrial ablation for menorrhagia.

PubMed

Fraser, I S; Angsuwathana, S; Mahmoud, F; Yezerski, S

1993-04-05

To review prospectively the intraoperative, short and medium term outcomes of patients treated by rollerball endometrial ablation during the learning curve for this relatively new procedure. Seventy-seven women with menorrhagia (71 with dysfunctional bleeding; six with additional small intramural myomas) underwent hysteroscopic rollerball endometrial ablation by coagulation diathermy during 1.5% glycine irrigation, after a two-month period of hormonal suppression. OPERATIVE AND SHORT-TERM EFFECTS: These were recorded at operation and six-week follow-up. No serious short-term complications were recorded. Objective measurement of intraoperative blood loss was always less than 20 mL. One woman experienced uterine perforation with a narrow cervical dilator which did not interfere with the ablation, and two patients had mild postoperative uterine infections. One patient experienced persistent postoperative pain. MEDIUM-TERM OUTCOME: This was recorded at each visit, or by telephone, and confirmed by questionnaire at one year. Twenty-five per cent achieved complete amenorrhoea, 29% staining only, 30% light periods, 10% "normal" or erratic periods and 6% were unchanged. Five patients underwent a second ablation, and three of these later underwent hysterectomy. Measured menstrual blood loss fell from 104 +/- 19 mL (mean +/- standard error of mean) to 1.7 +/- 1.1 mL at six months in 18 women. Other menstrual symptoms were also often dramatically reduced. Of those women with dysmenorrhoea, 33% were cured and 43% markedly improved; of those with midcycle pain, 28% were cured and 53% markedly improved; of those with significant premenstrual symptoms, 13% were cured, 47% markedly improved, 11% unchanged, and 6% were worse. This new procedure is a safe and effective treatment for menorrhagia caused by dysfunctional uterine bleeding, with impressive ancillary benefits for dysmenorrhoea, midcycle pain and premenstrual tension. It is often called minimally invasive surgery, but it

Hot Balloon Versus Cryoballoon Ablation for Atrial Fibrillation: Lesion Characteristics and Middle-Term Outcomes.

PubMed

Nagashima, Koichi; Okumura, Yasuo; Watanabe, Ichiro; Nakahara, Shiro; Hori, Yuichi; Iso, Kazuki; Watanabe, Ryuta; Arai, Masaru; Wakamatsu, Yuji; Kurokawa, Sayaka; Mano, Hiroaki; Nakai, Toshiko; Ohkubo, Kimie; Hirayama, Atsushi

2018-05-01

Hot balloon ablation (HBA) and cryoballoon ablation (CBA) were developed to simplify ablation for atrial fibrillation. Because the lesion characteristics and efficacy of these balloon modalities have not been clarified, we compared lesion characteristics and outcomes of HBA and CBA. Of 165 consecutive patients who underwent initial catheter ablation for atrial fibrillation, 74 propensity scorematched (37 HBA and 37 CBA) patients were included in our study. Patients' clinical characteristics, including age, sex, body mass index, atrial fibrillation subtype, CHA 2 DS 2 -VASc score, and left atrial dimension, were similar between the 2 groups. Touch-up radiofrequency ablation was required for residual/dormant pulmonary vein conduction in 52% of the patients with HBA versus 24% of the patients with CBA ( P =0.02) and often in the anterior aspect of the left superior pulmonary vein after HBA (41%) versus the inferior aspect of the inferior pulmonary veins after CBA (22%). HBA lesions were smaller than CBA lesions (23.8±7.9 versus 33.5±14.5 cm 2 ; P =0.0007). Similar results were observed when lesions in each pulmonary vein were compared between groups. Twentyfour hours after the procedure, serum levels of the cardiac biomarkers, including troponin-T, creatine kinase, and creatine kinase-MB, were higher in the HBA group than in the CBA group. Atrial fibrillation recurrence did not differ between the groups within 6 (3% versus 11%; P =0.36) or 12 months (16% versus 16%; P =1.00). Although HBA lesions appear to be smaller than CBA lesions, middle-term outcomes are not statistically different between these balloon modalities. © 2018 American Heart Association, Inc.

Long-Term Outcome With Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy.

PubMed

Santangeli, Pasquale; Zado, Erica S; Supple, Gregory E; Haqqani, Haris M; Garcia, Fermin C; Tschabrunn, Cory M; Callans, David J; Lin, David; Dixit, Sanjay; Hutchinson, Mathew D; Riley, Michael P; Marchlinski, Francis E

2015-12-01

Catheter ablation of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy improves short-term VT-free survival. We sought to determine the long-term outcomes of VT control and need for antiarrhythmic drug therapy after endocardial (ENDO) and adjuvant epicardial (EPI) substrate modification in patients with arrhythmogenic right ventricular cardiomyopathy. We examined 62 consecutive patients with Task Force criteria for arrhythmogenic right ventricular cardiomyopathy referred for VT ablation with a minimum follow-up of 1 year. Catheter ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal substrate for unmappable VT. Adjuvant EPI ablation was performed when recurrent VT or persistent inducibility after ENDO-only ablation. Endocardial plus adjuvant EPI ablation was performed in 39 (63%) patients, including 13 who crossed over to ENDO-EPI after VT recurrence during follow-up, after ENDO-only ablation. Before ablation, 54 of 62 patients failed a mean of 2.4 antiarrhythmic drugs, including amiodarone in 29 (47%) patients. During follow-up of 56±44 months after the last ablation, VT-free survival was 71% with only a single VT episode in additional 9 patients (15%). At last follow-up, 39 (64%) patients were only on β-blockers or no treatment, 21 were on class 1 or 3 antiarrhythmic drugs (11 for atrial arrhythmias), and 2 were on amiodarone as a bridge to heart transplantation. The long-term outcome after ENDO and adjuvant EPI substrate ablation of VT in arrhythmogenic right ventricular cardiomyopathy is good. Most patients have complete VT control without amiodarone therapy and limited need for antiarrhythmic drugs. © 2015 American Heart Association, Inc.

Image-guided tumor ablation: proposal for standardization of terms and reporting criteria.

PubMed

Goldberg, S Nahum; Charboneau, J William; Dodd, Gerald D; Dupuy, Damian E; Gervais, Debra A; Gillams, Alice R; Kane, Robert A; Lee, Fred T; Livraghi, Tito; McGahan, John P; Rhim, Hyunchul; Silverman, Stuart G; Solbiati, Luigi; Vogl, Thomas J; Wood, Bradford J

2003-08-01

The field of image-guided tumor ablation requires standardization of terms and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments with different technologies, such as chemical ablation (ethanol or acetic acid) and thermal therapies, such as radiofrequency, laser, microwave, ultrasound, and cryoablation. On the basis of this premise, a working committee was established with the goal of producing a proposal on such standardization. The intent of the Working Group is to provide a framework that will facilitate the clearest communication between investigators and will provide the greatest flexibility in comparisons between the many new, exciting, and emerging technologies. The members of the Working Group now propose a vehicle for reporting the various aspects of image-guided ablation therapy, including classifications of therapies and procedures, appropriate descriptors of image guidance, and terms to define imaging and pathologic findings. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's hope and intention that adherence to the recommendations of this proposal will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and ultimately to improved patient outcomes. Copyright RSNA, 2003.

Long-Term Natural History of Adult Wolff-Parkinson-White Syndrome Patients Treated With and Without Catheter Ablation.

PubMed

Bunch, T Jared; May, Heidi T; Bair, Tami L; Anderson, Jeffrey L; Crandall, Brian G; Cutler, Michael J; Jacobs, Victoria; Mallender, Charles; Muhlestein, Joseph B; Osborn, Jeffrey S; Weiss, J Peter; Day, John D

2015-12-01

There are a paucity of data about the long-term natural history of adult Wolff-Parkinson-White syndrome (WPW) patients in regard to risk of mortality and atrial fibrillation. We sought to describe the long-term outcomes of WPW patients and ascertain the impact of ablation on the natural history. Three groups of patients were studied: 2 WPW populations (ablation: 872, no ablation: 1461) and a 1:5 control population (n=11 175). Long-term mortality and atrial fibrillation rates were determined. The average follow-up for the WPW group was 7.9±5.9 (median: 6.9) years and was similar between the ablation and nonablation groups. Death rates were similar between the WPW group versus the control group (hazard ratio, 0.96; 95% confidence interval, 0.83-1.11; P=0.56). Nonablated WPW patients had a higher long-term death risk compared with ablated WPW patients (hazard ratio, 2.10; 95% confidence interval: 1.50-20.93; P<0.0001). Incident atrial fibrillation risk was higher in the WPW group compared with the control population (hazard ratio, 1.55; 95% confidence interval, 1.29-1.87; P<0.0001). Nonablated WPW patients had lower risk than ablated patients (hazard ratio, 0.39; 95% confidence interval, 0.28-0.53; P<0.0001). Long-term mortality rates in WPW patients are low and similar to an age-matched and gender-matched control population. WPW patients that underwent the multifactorial process of ablation had a lower mortality compared to nonablated WPW patients. Atrial fibrillation rates are high long-term, and ablation does not reduce this risk. © 2015 American Heart Association, Inc.

Long-term outcomes following high intensity focused ultrasound ablation for atrial fibrillation.

PubMed

Davies, Edward J; Bazerbashi, Samer; Asopa, Sanjay; Haywood, Guy; Dalrymple-Hay, Malcolm

2014-01-01

The aim of this study is to assess the safety and efficacy of the Epicor high intensity focused ultrasound (St. Jude, Inc.®, Minneapolis, MN, USA) system using seven-day ambulatory electrocardiogram (ECG) monitoring over a two-year follow-up period. One hundred and ten patients undergoing ablation were included from a single center between January 2006 and December 2009. Rhythm was assessed using seven-day ambulatory ECG or permanent pacemaker interrogation. Seventeen patients were lost to follow-up, seven through death. Results were reported according to atrial fibrillation (AF) class preoperatively: paroxysmal, persistent, and long-standing persistent (LSP). Forty-nine percent of patients remained in sinus rhythm at greater than two years. The percentage of patients in sinus rhythm according to preoperative AF class were 81% (paroxysmal AF), 56% (persistent AF), and 18% (long-standing AF). The class of AF prior to surgery, left atrium size, and body mass index determined the long-term outcome. There were no procedure-related complications. We conclude that high intensity focused ultrasound ablation for atrial fibrillation using the Epicor system is safe and effective for surgical patients with paroxysmal AF. The persistent and LSP AF results suggest that alternative ablation strategies should be considered for these patients. © 2013 Wiley Periodicals, Inc.

Long-term efficacy of single procedure remote magnetic catheter navigation for ablation of ischemic ventricular tachycardia: a retrospective study.

PubMed

Dinov, Borislav; Schönbauer, Robert; Wojdyla-Hordynska, Agnieska; Braunschweig, Frieder; Richter, Sergio; Altmann, David; Sommer, Philipp; Gaspar, Thomas; Bollmann, Andreas; Wetzel, Ulrike; Rolf, Sascha; Piorkowski, Christopher; Hindricks, Gerhard; Arya, Arash

2012-05-01

Remote magnetic navigation (RMN) aims to reduce some inherent limitations of manual radiofrequency (RF) ablation. However, data comparing the effectiveness of both methods are scarce. This study evaluated the acute and long-term success of RMN guided versus manual RF ablation in patients with ischemic sustained ventricular tachycardia (sVT). One hundred two consecutive patients (age 68 ± 10 years, LVEF 32 ± 12%, 88 men) with ischemic sVT were ablated with RMN (Stereotaxis; 49%) or manually (51%) using substrate and/or activation mapping (Carto) and open-irrigated-tip catheters. All received implantable defibrillators or loop recorders. Acute success was defined as noninducibility of any sVT at the end of the ablation procedure and long-term success as freedom from VT upon follow-up. There was no difference in the baseline characteristics between the groups. Three patients died in hospital. Acute success rate was similar for RMN and manual ablation (82% vs 71%, P = 0.246). RMN was associated with significantly shorter fluoroscopy time (13 ± 12 minutes vs 32 ± 17 minutes, P = 0.0001) and RF time (2337.59 ± 1248.22 seconds vs 1589.95 ± 1047.42 seconds, P = 0.049), although total procedure time was similar (157 ± 40 minutes vs 148 ± 50 minutes, P = 0.42). There was a nonsignificant trend toward better long-term success in RMN group: after a median of 13 (range 1-34) months, 63% in the RMN and 53% in the manual ablation group were free from VT recurrence (P = 0.206). RMN guided RF ablation of ischemic sustained VT is equally efficient compared with manual ablation in terms of acute and long-term success rate. These results are achieved with a significantly reduced fluoroscopy time and shorter RF time. © 2012 Wiley Periodicals, Inc.

Impact of obesity on atrial fibrillation ablation: Patient characteristics, long-term outcomes, and complications.

PubMed

Winkle, Roger A; Mead, R Hardwin; Engel, Gregory; Kong, Melissa H; Fleming, William; Salcedo, Jonathan; Patrawala, Rob A

2017-06-01

There is an association between obesity and atrial fibrillation (AF). The impact of obesity on AF ablation procedures is unclear. The purpose of this study was to evaluate the influence of body mass index (BMI) on patient characteristics, long-term ablation outcomes, and procedural complications. We evaluated 2715 patients undergoing 3742 AF ablation procedures. BMI was ≥30 kg/m 2 in 1058 (39%) and ≥40 kg/m 2 in 129 (4.8%). Patients were grouped by BMI ranges (<25, 25-<30, 30-<35, 35-<40, and ≥40 kg/m 2 ). As BMI increased from <25 to ≥40 kg/m 2 , age decreased from 65.3 ± 11.2 to 61.2 ± 9.2 years (P < .001), left atrial size increased from 3.91 ± 0.68 to 4.72 ± 0.62 cm (P < .005), and CHADS 2 scores increased from 1.24 ± 1.10 to 1.62 ± 1.09 (P < .001). As BMI increased, paroxysmal AF decreased from 48.0% to 16.3% (P < .0001) and there was an increase in dilated cardiomyopathy (from 7.6% to 12.4%; P < .0001), hypertension (from 41.0% to 72.9%; P < .0001), diabetes (from 4.3% to 23.3%; P < .0001), and sleep apnea (from 7.0% to 46.9%; P < .0001). For the entire cohort, for BMI ≥35 kg/m 2 the 5-year ablation freedom from AF decreased from 67%-72% to 57% (P = .036). For paroxysmal AF, when BMI was ≥40 kg/m 2 ablation success decreased from 79%-82% to 60% (P = .064), and for persistent AF, when BMI was ≥35 kg/m 2 ablation success decreased from 64%-70% to 52%-57% (P = .021). For long-standing AF, there was no impact of BMI on outcomes (P = .624). In multivariate analysis, BMI ≥35 kg/m 2 predicted worse outcomes (P = .036). Higher BMI did not impact major complication rates (P = .336). However, when BMI was ≥40 kg/m 2 , minor (from 2.1% to 4.4%; P = .035) and total (from 3.5% to 6.7%; P = .023) complications increased. In patients undergoing AF ablation, increasing BMI is associated with more patient comorbidities and more persistent and long-standing AF. BMI ≥35 kg/m 2 adversely impacts ablation outcomes, and BMI ≥40 kg/m 2 increases minor

Long-Term Effects of Atrial Ganglionated Plexi Ablation on Function and Structure of Sinoatrial and Atrioventricular Node in Canine.

PubMed

Zhang, Ming; Wang, Ximin; Xie, Xinxing; Wang, Zhongsu; Liu, Xiaoyan; Guan, Juan; Wang, Weizong; Li, Zhan; Wang, Jiangrong; Gao, Mei; Hou, Yinglong

2015-10-01

Long-term effects of ganglionated plexi (GP) ablation on sinoatrial node (SAN) and atrioventricular node (AVN) remain unclear. This study is to investigate the long-term effects of ablation of cardiac anterior right GP (ARGP) and inferior right GP (IRGP) on function and structure of SAN and AVN in canine. Thirty-two dogs were randomly divided into an operated group (n = 24) and sham-operated group (n = 8). ARGP and IRGP were ablated in operated group which was randomly divided into three subgroups according to the period of evaluation after operation (1 month, 6 months, 12 months). The functional and histological characteristics of SAN and AVN, as well as the expression of connexin (Cx) 43 and Cx 45 in SAN and AVN, were evaluated before and after ablation. Resting heart rate was increased and AVN effective refractory period was prolonged and sinus node recovery time (SNRT) and corrected SNRT were shortened immediately after ablation. These changes were reverted to preablation level after 1 month. At 1 month, ventricular rate during atrial fibrillation was slowed, atria-His intervals were prolonged, and Cx43 and Cx45 expression in SAN and AVN were downregulated. At 6 months, all changes were reverted to preablation level. The histological characteristics of SAN and AVN did not change. Ablation of ARGP and IRGP has short-term effects on function and structure of SAN and AVN rather than long-term effects, which suggests that ablation of ARGP and IRGP is safe. Atrioventricular conduction dysfunction after ablation may be related to downregulated Cx43 and Cx45 expression in AVN. © 2015 Wiley Periodicals, Inc.

Short-term and mid-term results with the Sorin Freedom Solo aortic valve.

PubMed

Ustunsoy, Hasim; Yasim, Alptekin; Deniz, Hayati; Gokaslan, Gokhan; Ozcaliskan, Ozerdem

2013-03-01

The study aim was to present the short- and mid-term results for patients who underwent aortic valve replacement (AVR) with the Sorin Freedom Solo third-generation stentless prosthetic valve. AVR with a Sorin Freedom Solo valve was performed in 14 patients between March 2006 and March 2011. Patients aged > or = 60 years (male:female ratio 6:8; mean age 73.28 +/- 5.42 years) who required AVR with the Sorin Freedom Solo valve according to the surgeon's choice were included in the study. The valvular prosthesis was implanted in the supra-annular position, using a single suture line. Eight patients underwent an isolated AVR; combined interventions were carried out in the other patients due to concomitant cardiac disease. One patient died during the immediate perioperative period, and two more during the follow up, from non-cardiac causes. The mean maximum transvalvular gradient of patients with aortic stenosis was 88.1 +/- 20.2 mmHg, and this fell to 26.4 +/- 7.6 mmHg during the early postoperative period. The mean gradient at one year of follow up was further decreased to 19.4 +/- 5.3 mmHg. The left ventricular end-diastolic and end-systolic diameters were also significantly reduced, from 4.8 +/- 0.9 to 4.3 +/- 0.6 cm and from 3.2 +/- 0.6 to 2.8 +/- 5.3 cm, respectively. The average left ventricular ejection fraction was 60.2 +/- 4.9% preoperatively, and 63.2 +/- 2.1% at one year after surgery (p = NS). No paravalvular leakage, endocarditis, prosthesis failure or neurologic events were reported among patients. The Sorin Freedom Solo stentless valve has provided good early and intermediate-term results. Implantation of the prosthesis is straightforward, with low rates of morbidity and mortality. However, these data require further support from larger patient series and long-term follow up.

Radiofrequency ablation vs. surgery for perivascular hepatocellular carcinoma: Propensity score analyses of long-term outcomes.

PubMed

Lee, Sunyoung; Kang, Tae Wook; Cha, Dong Ik; Song, Kyoung Doo; Lee, Min Woo; Rhim, Hyunchul; Lim, Hyo Keun; Sinn, Dong Hyun; Kim, Jong Man; Kim, Kyunga

2018-07-01

The therapeutic outcomes of surgical resection (SR) or radiofrequency ablation (RFA) for perivascular hepatocellular carcinoma (HCC) have not been compared. The aim of this study was to compare SR with RFA as first-line treatment in patients with perivascular HCC and to evaluate the long-term outcomes of both therapies. This retrospective study was approved by the institutional review board. The requirement for informed consent was waived. Between January 2006 and December 2010, a total of 283 consecutive patients with small perivascular HCCs (≤3 cm, Barcelona Clinic Liver Cancer stage 0 or A) underwent SR (n = 182) or RFA (n = 101) as a first-line treatment. The progression-free survival (PFS) and overall survival (OS) rates were compared by propensity score matching. Subgroup analysis of these outcomes was conducted according to the type of hepatic vessels. The median follow-up was 7.8 years. Matching yielded 62 pairs of patients. In the two matched groups, the PFS rates at 5 and 10 years were 58.0% and 17.8%, respectively, in the SR group, and 25.4% and 14.1%, respectively, in the RFA group (p <0.001). The corresponding OS rates at 5 and 10 years were 93.5% and 91.9% in the SR group and 82.3% and 74.1% in the RFA group, respectively (p <0.001). In contrast to those in patients with perivenous HCCs, subgroup analysis indicated that extrahepatic recurrence and OS were significantly different according to the treatment modality in patients with periportal HCCs (p = 0.004 and p <0.001, respectively). In patients with small perivascular HCCs, SR provided better long-term tumor control and OS than RFA, particularly for periportal tumors. Surgical resection and radiofrequency ablation are both treatment options for perivascular hepatocellular carcinoma. We compared outcomes in patients treated with either method. Surgical resection provided better long-term tumor control and overall survival than radiofrequency ablation for patients with a

A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein.

PubMed

Sydnor, Malcolm; Mavropoulos, John; Slobodnik, Natalia; Wolfe, Luke; Strife, Brian; Komorowski, Daniel

2017-07-01

Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved

Long‐term Outcomes of Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta‐analysis

PubMed Central

Ganesan, Anand N.; Shipp, Nicholas J.; Brooks, Anthony G.; Kuklik, Pawel; Lau, Dennis H.; Lim, Han S.; Sullivan, Thomas; Roberts‐Thomson, Kurt C.; Sanders, Prashanthan

2013-01-01

Background In the past decade, catheter ablation has become an established therapy for symptomatic atrial fibrillation (AF). Until very recently, few data have been available to guide the clinical community on the outcomes of AF ablation at ≥3 years of follow‐up. We aimed to systematically review the medical literature to evaluate the long‐term outcomes of AF ablation. Methods and Results A structured electronic database search (PubMed, Embase, Web of Science, Cochrane) of the scientific literature was performed for studies describing outcomes at ≥3 years after AF ablation, with a mean follow‐up of ≥24 months after the index procedure. The following data were extracted: (1) single‐procedure success, (2) multiple‐procedure success, and (3) requirement for repeat procedures. Data were extracted from 19 studies, including 6167 patients undergoing AF ablation. Single‐procedure freedom from atrial arrhythmia at long‐term follow‐up was 53.1% (95% CI 46.2% to 60.0%) overall, 54.1% (95% CI 44.4% to 63.4%) in paroxysmal AF, and 41.8% (95% CI 25.2% to 60.5%) in nonparoxysmal AF. Substantial heterogeneity (I2>50%) was noted for single‐procedure outcomes. With multiple procedures, the long‐term success rate was 79.8% (95% CI 75.0% to 83.8%) overall, with significant heterogeneity (I2>50%).The average number of procedures per patient was 1.51 (95% CI 1.36 to 1.67). Conclusions Catheter ablation is an effective and durable long‐term therapeutic strategy for some AF patients. Although significant heterogeneity is seen with single procedures, long‐term freedom from atrial arrhythmia can be achieved in some patients, but multiple procedures may be required. PMID:23537812

Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial.

PubMed

Kaitani, Kazuaki; Inoue, Koichi; Kobori, Atsushi; Nakazawa, Yuko; Ozawa, Tomoya; Kurotobi, Toshiya; Morishima, Itsuro; Miura, Fumiharu; Watanabe, Tetsuya; Masuda, Masaharu; Naito, Masaki; Fujimoto, Hajime; Nishida, Taku; Furukawa, Yoshio; Shirayama, Takeshi; Tanaka, Mariko; Okajima, Katsunori; Yao, Takenori; Egami, Yasuyuki; Satomi, Kazuhiro; Noda, Takashi; Miyamoto, Koji; Haruna, Tetsuya; Kawaji, Tetsuma; Yoshizawa, Takashi; Toyota, Toshiaki; Yahata, Mitsuhiko; Nakai, Kentaro; Sugiyama, Hiroaki; Higashi, Yukei; Ito, Makoto; Horie, Minoru; Kusano, Kengo F; Shimizu, Wataru; Kamakura, Shiro; Morimoto, Takeshi; Kimura, Takeshi; Shizuta, Satoshi

2016-02-14

Substantial portion of early arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) is considered to be due to irritability in left atrium (LA) from the ablation procedure. We sought to evaluate whether 90-day use of antiarrhythmic drug (AAD) following AF ablation could reduce the incidence of early arrhythmia recurrence and thereby promote reverse remodelling of LA, leading to improved long-term clinical outcomes. A total of 2038 patients who had undergone radiofrequency catheter ablation for paroxysmal, persistent, or long-lasting AF were randomly assigned to either 90-day use of Vaughan Williams class I or III AAD (1016 patients) or control (1022 patients) group. The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation. Patients assigned to AAD were associated with significantly higher event-free rate from recurrent atrial tachyarrhythmias when compared with the control group during the treatment period of 90 days [59.0 and 52.1%, respectively; adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.73-0.96; P = 0.01]. However, there was no significant difference in the 1-year event-free rates from the primary endpoint between the groups (69.5 and 67.8%, respectively; adjusted HR 0.93; 95% CI 0.79-1.09; P = 0.38). Short-term use of AAD for 90 days following AF ablation reduced the incidence of recurrent atrial tachyarrhythmias during the treatment period, but it did not lead to improved clinical outcomes at the later phase. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Percutaneous thermal ablation for stage IA non-small cell lung cancer: long-term follow-up.

PubMed

Narsule, Chaitan K; Sridhar, Praveen; Nair, Divya; Gupta, Avneesh; Oommen, Roy G; Ebright, Michael I; Litle, Virginia R; Fernando, Hiran C

2017-10-01

Surgical resection is the most effective curative therapy for non-small cell lung cancer (NSCLC). However, many patients are unable to tolerate resection secondary to poor reserve or comorbid disease. Radiofrequency ablation (RFA) and microwave ablation (MWA) are methods of percutaneous thermal ablation that can be used to treat medically inoperable patients with NSCLC. We present long-term outcomes following thermal ablation of stage IA NSCLC from a single center. Patients with stage IA NSCLC and factors precluding resection who underwent RFA or MWA from July 2005 to September 2009 were studied. CT and PET-CT scans were performed at 3 and 6 month intervals, respectively, for first 24 months of follow-up. Factors associated with local progression (LP) and overall survival (OS) were analyzed. Twenty-one patients underwent 21 RFA and 4 MWA for a total of 25 ablations. Fifteen patients had T1a and six patients had T1b tumors. Mean follow-up was 42 months, median survival was 39 months, and OS at three years was 52%. There was no significant difference in median survival between T1a nodules and T1b nodules (36 vs . 39 months, P=0.29) or for RFA and MWA (36 vs . 50 months, P=0.80). Ten patients had LP (47.6%), at a median time of 35 months. There was no significant difference in LP between T1a and T1b tumors (22 vs . 35 months, P=0.94) or RFA and MWA (35 vs . 17 months, P=0.18). Median OS with LP was 32 months compared to 39 months without LP (P=0.68). Three patients underwent repeat ablations. Mean time to LP following repeat ablation was 14.75 months. One patient had two repeat ablations and was disease free at 40-month follow-up. Thermal ablation effectively treated or controlled stage IA NSCLC in medically inoperable patients. Three-year OS exceeded 50%, and LP did not affect OS. Therefore, thermal ablation is a viable option for medically inoperable patients with early stage NSCLC.

Cryogenic Selective Surfaces: A Phase 2 NIAC Project: Mid-Term Continuation Review

NASA Technical Reports Server (NTRS)

Youngquist, Robert; Nurge, Mark; Gibson, Tracy; Johnson, Wesley

2017-01-01

The NASA Innovative Advanced Concepts (NIAC) program has been funding work at KSC (Kennedy Space Center) on a new coating that should allow cryogenic commodities to be stored in deep space. Recently a mid-term review of this work was given. I am requesting that this presentation be cleared for release so that the material can be presented publicly at an upcoming FISO (Future in Space) telecom.

Recognition of predictors for mid-long term runoff prediction based on lasso

NASA Astrophysics Data System (ADS)

Xie, S.; Huang, Y.

2017-12-01

Reliable and accuracy mid-long term runoff prediction is of great importance in integrated management of reservoir. And many methods are proposed to model runoff time series. Almost all forecast lead times (LT) of these models are 1 month, and the predictors are previous runoff with different time lags. However, runoff prediction with increased LT, which is more beneficial, is not popular in current researches. It is because the connection between previous runoff and current runoff will be weakened with the increase of LT. So 74 atmospheric circulation factors (ACFs) together with pre-runoff are used as alternative predictors for mid-long term runoff prediction of Longyangxia reservoir in this study. Because pre-runoff and 74 ACFs with different time lags are so many and most of these factors are useless, lasso, which means `least absolutely shrinkage and selection operator', is used to recognize predictors. And the result demonstrates that 74 ACFs are beneficial for runoff prediction in both validation and test sets when LT is greater than 6. And there are 6 factors other than pre-runoff, most of which are with big time lag, are selected as predictors frequently. In order to verify the effect of 74 ACFs, 74 stochastic time series generated from normalized 74 ACFs are used as input of model. The result shows that these 74 stochastic time series are useless, which confirm the effect of 74 ACFs on mid-long term runoff prediction.

Mid-term results of total knee arthroplasty with a porous tantalum monoblock tibial component.

PubMed

Hayakawa, Kazue; Date, Hideki; Tsujimura, Shunzo; Nojiri, Sho; Yamada, Harumoto; Nakagawa, Kenji

2014-01-01

The objectives of the present study were to assess the mid-term results of cementless total knee arthroplasty (TKA) with the porous tantalum monoblock tibial component and to examine the time course of bone changes on plain radiographs. The subjects were 32 patients, 29 patients were available for follow-up. We investigated the mid-term results of TKA after a mean follow-up period of 7 years and 8 months. We also examined changes of the bone over time on plain radiographs. The Knee Society Clinical Rating scores showed significant improvement. Bone changes around the tibial component were as follows: new bone formation and longitudinal trabecular thickening in 41.4% (Type A), only longitudinal trabecular thickening in 41.4% (Type B), and no changes in 17.2% (Type C). Type A and B changes were more frequent in patients with osteoarthritis, whereas Type C was only seen in patients with rheumatoid arthritis. Three knees had an initial gap, but this disappeared in all cases, and no new radiolucent lines were detected. Stress shielding was observed in seven knees (21.9%), but there was no implant loosening related to it. When we examined the relationship between the mechanical axis and the locations of the tips of the tibial pegs in patients with or without stress shielding, no significant differences were found. The results of mid-term follow-up have demonstrated favorable bone ingrowth, suggesting that porous tantalum is a promising material for cementless TKA. © 2013.

Risk factors for deterioration of long-term liver function after radiofrequency ablation therapy

PubMed Central

Honda, Koichi; Seike, Masataka; Oribe, Junya; Endo, Mizuki; Arakawa, Mie; Syo, Hiroki; Iwao, Masao; Tokoro, Masanori; Nishimura, Junko; Mori, Tetsu; Yamashita, Tsutomu; Fukuchi, Satoshi; Muro, Toyokichi; Murakami, Kazunari

2016-01-01

AIM: To identify factors that influence long-term liver function following radiofrequency ablation (RFA) in patients with viral hepatitis-related hepatocellular carcinoma. METHODS: A total of 123 patients with hepatitis B virus- or hepatitis C virus-related hepatocellular car-cinoma (HCC) (n = 12 and n = 111, respectively) were enrolled. Cumulative rates of worsening Child-Pugh (CP) scores (defined as a 2-point increase) were examined. RESULTS: CP score worsening was confirmed in 22 patients over a mean follow-up period of 43.8 ± 26.3 mo. Multivariate analysis identified CP class, platelet count, and aspartate aminotransferase levels as signi-ficant predictors of a worsening CP score (P = 0.000, P = 0.011 and P = 0.024, respectively). In contrast, repeated RFA was not identified as a risk factor for liver function deterioration. CONCLUSION: Long-term liver function following RFA was dependent on liver functional reserve, the degree of fibrosis present, and the activity of the hepatitis condition for this cohort. Therefore, in order to maintain liver function for an extended period following RFA, suppression of viral hepatitis activity is important even after the treatment of HCC. PMID:27168872

Radiofrequency ablation of accessory pathways in patients with the Wolff-Parkinson-White syndrome: the long-term mortality and risk of atrial fibrillation.

PubMed

Borregaard, Rune; Lukac, Peter; Gerdes, Christian; Møller, Dorthe; Mortensen, Peter Thomas; Pedersen, Lars; Nielsen, Jens Cosedis; Jensen, Henrik Kjærulf

2015-01-01

To assess the long-term mortality and occurrence of post-ablation atrial fibrillation in patients undergoing a radiofrequency ablation for the Wolff-Parkinson-White (WPW) syndrome. A retrospective cohort study of patients (N = 362) subjected to radiofrequency ablation of the WPW syndrome at Aarhus University Hospital from 1990 to 2011. A comparison cohort (N = 3619) was generated from the Danish National Board of Health Central Population Registry. We found no significant difference in all-cause mortality when comparing the WPW group with the control group [hazard ratio (HR): 0.77 and confidence interval (CI): 0.47-1.25]. After radiofrequency ablation, the WPW group had a significantly higher risk of atrial fibrillation than the control group (HR: 4.77 and CI: 3.05-7.43). Atrial fibrillation prior to ablation (HR: 4.66 and CI: 2.09-10.41) and age over 50 years (HR: 9.79 and CI: 4.29-22.36) at the time of ablation were independent risk factors for post-ablation atrial fibrillation in the WPW group. Patients with radiofrequency ablation-treated WPW syndrome have a post-ablation mortality that is similar to the background population. The risk of atrial fibrillation remains high after radiofrequency ablation of the WPW syndrome. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Acute and long term outcomes of catheter ablation using remote magnetic navigation for the treatment of electrical storm in patients with severe ischemic heart failure.

PubMed

Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen; Chen, Xu

2015-03-15

Catheter ablation with remote magnetic navigation (RMN) can offer some advantages compared to manual techniques. However, the relevant clinical evidence for how RMN-guided ablation affects electrical storm (ES) due to ventricular tachycardia (VT) in patients with severe ischemic heart failure (SIHF) is still limited. Forty consecutive SIHF patients (left ventricular ejection fraction, 21 ± 6.9%) presenting with ES underwent ablation using RMN. All the patients received implantable cardioverter-defibrillators (ICDs) either before or after ablation. Acute ablation success was defined as noninducibility of any sustained monophasic VT at the end of the procedure. Long-term analysis addressed VT recurrence, ICD therapies and all-cause death. ES was acutely suppressed by ablation in all patients. Acute ablation success was obtained in 32 of 40 (80%) patients. The procedure time and fluoroscopy time were 105 ± 27 min and 7.5 ± 4.8 min respectively. No major complications occurred during procedures. During a mean follow-up of 17.4 months, 19 patients (47.5%) remained free of VT recurrence. The percentage of patients receiving ICD shocks after ablation was lower than before ablation (30% vs 69%, P<0.01). The mean number of ICD shocks per individual per year was reduced from 4.3 before ablation to 1.9 after ablation (P<0.05). Ten patients died during follow-up. Acute catheter ablation with RMN is safe and effective to suppress ES in SIHF patients. RMN-guided catheter ablation can prevent VT recurrence and significantly reduce ICD shocks, suggesting that this strategy can be used as an alternative therapy for VT storm in SIHF patients with ICDs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage.

PubMed

Sánchez-Recalde, Angel; Moreno, Raúl; Galeote, Guillermo; Jimenez-Valero, Santiago; Calvo, Luis; Sevillano, Joel Hernández; Arroyo-Ucar, Eduardo; López, Teresa; Mesa, José M; López-Sendón, José L

2014-08-01

Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Tape functionality: position, change in shape, and outcome after TVT procedure--mid-term results.

PubMed

Kociszewski, Jacek; Rautenberg, Oliver; Kolben, Sebastian; Eberhard, Jakob; Hilgers, Reinhard; Viereck, Volker

2010-07-01

This study evaluates the relevance of the tape position and change in shape (tape functionality) under in vivo conditions for mid-term outcome. Changes in the sonographic tension-free vaginal tape (TVT) position relative to the percentage urethral length and the tape-urethra distance were determined after 6 and 48 months in 41 women with stress urinary incontinence. At 48 months, 76% (31/41) of women were cured, 17% (7/41) were improved, and 7% (3/41) were failures. Disturbed bladder voiding was present in 12% (5/41), de novo urge incontinence in 7% (3/41). The median TVT position was at 63% of urethral length. Median tape-urethra distance was 2.7 mm, ranging from 2.9 mm in continent patients without complications to 1.1 mm in those with obstructive complications. Patients with postoperative urine loss had a median distance of 3.9 mm. The tape was stretched at rest and C-shaped during straining in 15 of 41 women (37%) at 48 months (all continent). Patients with this tape functionality at 6 months were also cured at 48 months in 86% of cases (19/22), and only 14% (3/22) showed recurrent incontinence. Mid-term data suggest an optimal outcome if the tape is positioned at least 2 mm from the urethra at the junction of the middle and distal thirds. Patients with optimal tape functionality at 6 months are likely to show mid-term therapeutic success.

[Neoadjuvant Chemotherapy Using S-1 for Pancreatic Cancer - Mid-Term Results].

PubMed

Homma, Yuki; Honda, Goro; Sakamoto, Katsunori; Kurata, Masanao; Honjo, Masahiko; Hirata, Yoshihiro; Shinya, Satoshi

2016-10-01

Although surgical resection is the only curative strategy for pancreatic cancer, the prognosis of patients with pancreatic cancer remains poor. Recently, neoadjuvant treatment has been frequently employed as a promising treatment. Here, the mid-term results of neoadjuvant chemoradiotherapy(NACRT)using S-1, which has been performed in our hospital since 2008, are reported. Seventy-nine patients with resectable or borderline resectable pancreatic ductal adenocarcinoma, who had been intended to undergo NACRT treatment using S-1, were enrolled. The NACRT comprised radiotherapy( 1.8 Gy×28 days)and full-dose twice-daily oral S-1 given on the same days as the radiotherapy. The results of the NACRT and pancreatectomy and the patients' prognoses were evaluated. Fifty-five patients(69.6%)underwent pancreatectomy, with no case of mortality. The curative resection rate was 94.5%. Postoperative adjuvant chemotherapy was administered in 46 patients(83.6%). The 3-year survival rates of all 79 patients and 55 pancreatectomy patients were 40.1% and 50.4%, respectively. NACRT using S-1 was found to be feasible, and good mid-term outcomes were obtained. However, analysis of the long-term outcomes and comparisons with other novel anti-cancer drugs are still required.

Mid-term outcomes of patients undergoing adjustable pulmonary artery banding

PubMed Central

Talwar, Sachin; Kamat, Neeraj Aravind; Choudhary, Shiv Kumar; Ramakrishnan, Sivasubramanian; Saxena, Anita; Juneja, Rajnish; Kothari, Shyam Sunder; Airan, Balram

2016-01-01

Objective The adjustable pulmonary artery band (APAB) has been demonstrated by us earlier to be superior to the conventional pulmonary artery banding (CPAB), in terms of reduced early morbidity and mortality. In this study, we assessed the adequacy of the band and its complications over the mid-term. Methods Between 2002 and 2012, 73 patients underwent adjustable PAB, and their operative and follow-up data were collected and analyzed. Results There was one early death following the APAB. Follow-up data were available for 57 patients of which 44 patients (61.7%) underwent definitive repair, 10 were awaiting definitive repair, and 3 patients were kept on medical follow-up because of inadequate fall in pulmonary artery (PA) pressures. 14 patients (19%) were lost to follow-up. Major PA distortion or stenosis was absent in the majority. 1 patient had pseudoaneurysm of the main pulmonary artery (MPA) with sternal sinus infection and required surgical reconstruction. 1 patient had infective endocarditis of the pulmonary valve managed medically. Band migration was not encountered. There were two deaths after definitive repair and one after APAB. Conclusions Patients undergoing APAB fulfilled the desired objectives of the pulmonary artery banding (PAB) with minimum PA complications in the mid-term. This added to the early postoperative benefits, makes the APAB an attractive alternative to the CPAB. PMID:26896271

Microwave Ablation of Lung Tumors Near the Heart: A Retrospective Review of Short-Term Procedural Safety in Ten Patients.

PubMed

Maxwell, Aaron W P; Healey, Terrance T; Dupuy, Damian E

2017-09-01

To evaluate the rate of short-term complications associated with microwave ablation of lung tumors located near the heart. This HIPAA-compliant study was performed with a waiver for informed consent. Patients who underwent microwave ablation of lung tumors located 10 mm or less from the heart were identified by retrospective chart review. Both primary and metastatic tumors were included. Only tumors directly adjacent to one of the four cardiac chambers were included. All patients were treated in a single session using CT guidance with continuous electrocardiographic monitoring. Rates of new-onset arrhythmia and myocardial infarction (MI) within 90 days of the procedure were quantified, and evidence of cardiac or pericardiac injury was assessed for using post-ablation contrast-enhanced chest CT, electrocardiography (EKG), and-when available-echocardiography. Complications were graded using the Common Terminology Criteria for Adverse Events (CTCAE) system. Ten patients (four males, six females; mean age 73.1 ± 9.5 years) met all inclusion criteria. Mean tumor distance from the heart was 3 mm (range, 0-6 mm). New-onset arrhythmia was not observed during or following any of the microwave ablation treatments, and there were no documented 90-day MI events. CTCAE Grade 1 complications were observed by CT in eight patients, most commonly mild focal pericardial thickening. EKG and echocardiography were normal in all patients. No major complications (CTCAE Grade 3 or greater) were observed. Microwave ablation of lung tumors located 10 mm or less from the heart appears to have low associated short-term morbidity and may be appropriate in selected patients.

Early and mid-term results of lung transplantation with donors 60 years and older.

PubMed

López, Iker; Zapata, Ricardo; Solé, Juan; Jaúregui, Alberto; Deu, María; Romero, Laura; Pérez, Javier; Bello, Irene; Wong, Manuel; Ribas, Montse; Masnou, Nuria; Rello, Jordi; Roman, Antonio; Canela, Mercedes

2015-01-01

There are doubts about the age limit for lung donors and the ideal donor has traditionally been considered to be one younger than 55 years. The objective of this study was to compare the outcomes in lung transplantation between organs from donors older and younger than 60 years. We performed a retrospective observational study comparing the group of patients receiving organs from donors 60 years or older (Group A) or younger than 60 years (Group B) between January 2007 and December 2011. Postoperative evolution and mortality rates, short-term and mid-term postoperative complications, and global survival rate were evaluated. We analysed a total of 230 lung transplants, of which 53 (23%) involved lungs from donors 60 years of age or older (Group A), and 177 (77%) were from donors younger than 60 years (Group B). Three (5.7%) patients from Group A and 14 patients (7.9%) from Group B died within 30 days (P = 0.58). The percentage of patients free from chronic lung allograft dysfunction at 1-3 years was 95.5, 74.3 and 69.3% for Group A, and 94.5, 84.8 and 73.3% for Group B, respectively (P = 0.47). There were no statistically significant differences between Groups A and B in terms of survival at 3 years, (69.4 vs 68.8%; P = 0.28). Our results support the idea that lungs from donors aged 60-70 years can be used safely for lung transplantation with comparable results to lungs from younger donors in terms of postoperative mortality and mid-term survival. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis.

PubMed

Muser, Daniele; Santangeli, Pasquale; Pathak, Rajeev K; Castro, Simon A; Liang, Jackson J; Magnani, Silvia; Hayashi, Tatsuya; Garcia, Fermin C; Hutchinson, Mathew D; Supple, Gregory E; Frankel, David S; Riley, Michael P; Lin, David; Schaller, Robert D; Desjardins, Benoit; Dixit, Sanjay; Callans, David J; Zado, Erica S; Marchlinski, Francis E

2016-08-01

Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis. We enrolled 31 patients (age, 55±10 years) with diagnosis of cardiac sarcoidosis based on Heart Rhythm Society criteria and VT who underwent CA. In 23 (74%) patients, preprocedure cardiac magnetic resonance imaging and positron emission tomographic (PET) evaluation were performed. Preprocedure magnetic resonance imaging was positive for late gadolinium enhancement in 21 of 23 (91%) patients, whereas abnormal 18-fluorodeoxyglucose uptake was found in 15 of 23 (65%) cases. In 14 of 15 patients with positive PET at baseline, PET was repeated after 6.1±3.7-month follow-up. After a median follow-up of 2.5 (range, 0-10.5) years, 1 (3%) patient died and 4 (13%) underwent heart transplant. Overall VT-free survival was 55% at 2-year follow-up. Among the 16 (52%) patients with VT recurrences, CA resulted in a significant reduction of VT burden, with 8 (50%) having only isolated (1-3) VT episodes and only 1 patient with recurrent VT storm. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET at baseline, and lack of PET improvement over follow-up were associated with increased risk of recurrent VT. In patients with cardiac sarcoidosis and VT, CA is effective in achieving long-term freedom from VT or improvement in VT burden in the majority of patients. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET scan at baseline, or lack of improvement at repeat PET over follow-up predict worse arrhythmia-free survival. © 2016 American Heart Association, Inc.

Mid-term fire danger index based on satellite imagery and ancillary geographic data

NASA Astrophysics Data System (ADS)

Stefanidou, A.; Dragozi, E.; Tompoulidou, M.; Stepanidou, L.; Grigoriadis, D.; Katagis, T.; Stavrakoudis, D.; Gitas, I.

2017-09-01

Fire danger forecast constitutes one of the most important components of integrated fire management since it provides crucial information for efficient pre-fire planning, alertness and timely response to a possible fire event. The aim of this work is to develop an index that has the capability of predicting accurately fire danger on a mid-term basis. The methodology that is currently under development is based on an innovative approach that employs dry fuel spatial connectivity as well as biophysical and topological variables for the reliable prediction of fire danger. More specifically, the estimation of the dry fuel connectivity is based on a previously proposed automated procedure implemented in R software that uses Moderate Resolution Imaging Spectrometer (MODIS) time series data. Dry fuel connectivity estimates are then combined with other ancillary data such as fuel type and proximity to roads in order to result in the generation of the proposed mid-term fire danger index. The innovation of the proposed index—which will be evaluated by comparison to historical fire data—lies in the fact that its calculation is almost solely affected by the availability of satellite data. Finally, it should be noted that the index is developed within the framework of the National Observatory of Forest Fires (NOFFi) project.

Percutaneous Angioplasty of Portal Vein Stenosis that Complicates Liver Transplantation: The Mid-Term Therapeutic Results

PubMed Central

Park, Kwang Bo; Do, Young Soo; Shin, Sung Wook; Cho, Sung Gi; Choo, In-Wook

2005-01-01

Objective We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. Materials and Methods From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. Results The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. Conclusion Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique. PMID:16145291

Perforated peptic ulcer disease: mid-term outcome among Iranian population.

PubMed

Kamani, Freshteh; Moghimi, Mehrdad; Marashi, Seyed Ali; Peyrovi, Habibollah; Sheikhvatan, Mehrdad

2010-06-01

The aim of this study was to evaluate midterm outcome of patients with perforated peptic ulcer disease and to determine the main predictors of mid-term mortality. Demographic and clinical characteristics of 56 patients with the diagnosis of perforated peptic ulcer who were hospitalized in Taleghani Hospital over a 10-year period (19962005) were retrospectively collected, and in-hospital mortality and morbidity were determined. Patients were also followed for one month, one year and five years after the operation. Among these patients, 85.5% were treated with omental patch closure, 7.1% underwent vagotomy pyloroplasty, 5.3% underwent concurrent vagotomy and gastrojejunostomy, and 1.8% underwent antrectomy. In-hospital mortality and morbidity were 5.3% and 48.2%, respectively. Survival rates at one month, one year and five years after the operation were 92.9%, 89.3% and 78.6%, respectively. Advanced age (p=0.001), preoperative shock (p=0.003), history of malignancy before surgery (p=0.001), treatment delay (p=0.028), intensive care unit admission (p=0.032), and size of ulcer >5 cm (p=0.043) were the main predictors of five-year mortality in the followed patients. Mid-term mortality of treated perforated peptic ulcer disease among our population was notable, and the main predictors of mortality included advanced age, history of malignancy, treatment delay, intensive care unit admission, and ulcer size.

Radiofrequency ablation of accessory pathways in patients with the Wolff-Parkinson-White syndrome: long-term risk of mortality and coronary events.

PubMed

Wongcharoen, Wanwarang; Lin, Yenn-Jiang; Chung, Fa-Po; Chen, Yun-Yu; Chao, Tze-Fan; Chen, Pei-Chun; Chien, Kuo-Liong; Chen, Shih-Ann

2017-06-10

The long-term outcomes of radiofrequency catheter ablation (RFCA) in patients with Wolff-Parkinson-White syndrome (WPW) remain unclear. We investigated the impact of RFCA on the long-term risk of coronary events and mortality in WPW patients. We conducted a prospective cohort study utilizing the Taiwan National Health Insurance Research Database. Between 2000 and 2003, WPW patients with no prior coronary artery disease (CAD) history, aged over 18 years, who underwent RFCA were identified. WPW patients without RFCA were matched with propensity-score 1:4 matching for confounding coronary risk factors. The study outcomes were total mortality and coronary events. A total of 1524 matched non-ablated WPW patients (Group 1) and 381 ablated WPW patients (Group 2) were included. After a mean follow-up of 9.6 ± 2.9 and 10.3 ± 1.9 years, respectively, ablation group demonstrated a lower incidence of mortality compared with non-ablation group (17 vs. 26/1000 person-years, P < 0.001; adjusted HR: 0.57, 95% CI: 0.44-0.7). However, ablation group had a higher incidence of coronary events compared with non-ablation group (47 vs. 82/1000 person-years, P < 0.001; adjusted HR: 1.69, 95% CI: 1.4-2.04). The ablation-treated WPW patients had lower risk of total mortality but higher risk of coronary events than non-ablated WPW patients during the long-term follow-up. Coronary artery injury produced by RFCA may account for the increased risk of coronary events. Therefore, the ablation strategies to avoid coronary artery injury should be implemented. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Radiofrequency ablation of hepatocellular carcinoma in difficult locations: Strategies and long-term outcomes

PubMed Central

Yang, Wei; Yan, Kun; Wu, Gong-Xiong; Wu, Wei; Fu, Ying; Lee, Jung-Chieh; Zhang, Zhong-Yi; Wang, Song; Chen, Min-Hua

2015-01-01

AIM: To investigate the treatment strategies and long-term outcomes of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in difficult locations and to compare the results with non-difficult HCC. METHODS: From 2004 to 2012, a total of 470 HCC patients underwent ultrasound-guided percutaneous RFA. Among these HCC patients, 382 with tumors located ≤ 5 mm from a major vessel/bile duct (n = 87), from peripheral important structures (n = 232) or from the liver capsule (n = 63) were regarded as difficult cases. There were 331 male patients and 51 female patients, with an average age of 55.3 ± 10.1 years old. A total of 235 and 147 patients had Child-Pugh class A and class B liver function, respectively. The average tumor size was 3.4 ± 1.2 cm. Individual treatment strategies were developed to treat these difficult cases. During the same period, 88 HCC patients with tumors that were not in difficult locations served as the control group. In the control group, 74 patients were male, and 14 patients were female, with an average age of 57.4 ± 11.8 years old. Of these, 62 patients and 26 patients had Child-Pugh class A and class B liver function, respectively. Regular follow-up after RFA was performed to assess treatment efficacy. Survival results were generated from Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. RESULTS: Early tumor necrosis rate in the difficult group was similar to that in the control group (97.6% vs 94.3%, P = 0.080). The complication rate in the difficult group was significantly higher than that in the control group (4.9% vs 0.8%, P = 0.041). The follow-up period ranged from 6 to 116 mo, with an average of 28 ± 22.4 mo. Local progression rate in the difficult group was significantly higher than that in the control group (12.7% vs 7.1%, P = 0.046). However, the 1-, 3-, 5-, and 7-year overall survival rates in the difficult group were not significantly different from those in the control

A mid-term analysis of progress toward international biodiversity targets.

PubMed

Tittensor, Derek P; Walpole, Matt; Hill, Samantha L L; Boyce, Daniel G; Britten, Gregory L; Burgess, Neil D; Butchart, Stuart H M; Leadley, Paul W; Regan, Eugenie C; Alkemade, Rob; Baumung, Roswitha; Bellard, Céline; Bouwman, Lex; Bowles-Newark, Nadine J; Chenery, Anna M; Cheung, William W L; Christensen, Villy; Cooper, H David; Crowther, Annabel R; Dixon, Matthew J R; Galli, Alessandro; Gaveau, Valérie; Gregory, Richard D; Gutierrez, Nicolas L; Hirsch, Tim L; Höft, Robert; Januchowski-Hartley, Stephanie R; Karmann, Marion; Krug, Cornelia B; Leverington, Fiona J; Loh, Jonathan; Lojenga, Rik Kutsch; Malsch, Kelly; Marques, Alexandra; Morgan, David H W; Mumby, Peter J; Newbold, Tim; Noonan-Mooney, Kieran; Pagad, Shyama N; Parks, Bradley C; Pereira, Henrique M; Robertson, Tim; Rondinini, Carlo; Santini, Luca; Scharlemann, Jörn P W; Schindler, Stefan; Sumaila, U Rashid; Teh, Louise S L; van Kolck, Jennifer; Visconti, Piero; Ye, Yimin

2014-10-10

In 2010, the international community, under the auspices of the Convention on Biological Diversity, agreed on 20 biodiversity-related "Aichi Targets" to be achieved within a decade. We provide a comprehensive mid-term assessment of progress toward these global targets using 55 indicator data sets. We projected indicator trends to 2020 using an adaptive statistical framework that incorporated the specific properties of individual time series. On current trajectories, results suggest that despite accelerating policy and management responses to the biodiversity crisis, the impacts of these efforts are unlikely to be reflected in improved trends in the state of biodiversity by 2020. We highlight areas of societal endeavor requiring additional efforts to achieve the Aichi Targets, and provide a baseline against which to assess future progress. Copyright © 2014, American Association for the Advancement of Science.

[Comparison of mid-term surgical results between plate and intramedullary nail for humeral shaft fracture].

PubMed

Zhao, G; Liu, H N; Li, N; He, L; Wu, X B

2016-10-11

Objective: To evaluate the mid-term clinical efficacy of plate and intramedullary nail for humeral shaft fracture. Methods: In this retrospective study a total of 122 patients with humeral shaft fracture were divided into 2 groups according to surgery type from May 2010 to July 2012. There were 63 patients in plate group and 59 patients in intramedullary nail group. The factors related to the operation for each group were compared respectively. The clinical outcome was evaluated by the Neer scores, Myao scores and EuroQol 5 dimensions scores (EQ-5D). All the patients were followed up periodically in the next 3 years. Results: There were no significant differences between the two groups on hospital stay and time of returning to work ( P >0.05). While the operation time, amount of intraoperative blood loss and complication rate were less in intramedullary nail group. The mean follow-up duration was (41.2±4.2) months in plate group and (42.1±4.7) months in intramedullary nail group respectively. At the last follow-up the postoperative Neer scores, Myao scores and EQ-5D scores showed no significant differences between the 2 groups[Neer: (93.8±6.1) vs(92.1±4.2); Myao: (94.9±2.9) vs(96.2±1.5), P >0.05]. There were no cases complicated with nonunion, delayed union, infection and deformity during the follow-up period. Conclusions: The mid-term outcome of open reduction and internal fixation with plate and close reduction with intramedullary nail for humeral shaft fracture is satisfactory. Although both surgeries are safe and effective, they also have some defaults. The doctors should choose the right surgery carefully according to the actual situation of the patients.

Mid-Term Clinical Outcome and Reconstruction of Posterior Tibial Slope after UKA.

PubMed

Franz, Alois; Boese, Christoph Kolja; Matthies, Andrej; Leffler, Jörg; Ries, Christian

2018-05-21

Unicompartmental knee arthroplasty (UKA) has gained growing popularity over the last decades. The posterior tibial slope (PTS) has been shown to play a significant role for knee biomechanics and is thought to be crucial for clinical function of the UKA. We evaluated the clinical outcome at mid-term follow-up after UKA. Furthermore, the reconstruction of the individual PTS was analyzed. A total of 91 consecutive patients undergoing medial UKA for osteoarthritis were included. Patients were contacted by telephone for a survival analysis at a minimum of 30 months after surgery. Patient-oriented questionnaires and Knee Osteoarthritis Outcome Score (KOOS) were obtained. A retrospective chart review and radiological analysis of component alignment were performed for all patients before and at 6 weeks after surgery. Of 91 patients (93 knees) undergoing UKA, 69 patients (70 knees) were available for clinical follow-up after a mean of 56.0 (range 31-81) months post-surgery. The clinical results of the examined patients in the present study showed mean subscale scores of the KOOS and Western Ontario and McMaster Universities Osteoarthritis Index between 71 and 91%. Overall 7 of 91 patients were revised during the course of follow-up period and underwent total knee arthroplasty. A Kaplan-Meier analysis showed a survival rate for UKA of 90.5% after 48 months. Calculated implant survival was 75.9 months (95% confidence interval 72.3-79.6) at the mean. The radiographic analysis of pre- and postoperative PTS showed no differences ( p  = 0.113).UKA for osteoarthritis of the medial knee compartment shows encouraging clinical results at mid-term follow-up. The individual PTS could be reconstructed within acceptable ranges. This is a retrospective therapeutic study with Level IV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

PubMed Central

2011-01-01

Background Unicameral (or simple) bone cysts (UBC) are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC. Methods A retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery. Results Forty-six patients (17 female, 29 male) with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%). All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws). Overall recurrence rate after the first surgical treatment was 39% (18/46), second (17.4% of all patients) and third recurrence (4.3%) were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion. Conclusions Our results suggest satisfactory overall long-term outcome for the surgical treatment of UBC

Mid- and long-term clinical results of surgical therapy in unicameral bone cysts.

PubMed

Hagmann, Sébastien; Eichhorn, Florian; Moradi, Babak; Gotterbarm, Tobias; Dreher, Thomas; Lehner, Burkhard; Zeifang, Felix

2011-12-13

Unicameral (or simple) bone cysts (UBC) are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC. A retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery. Forty-six patients (17 female, 29 male) with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%). All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws). Overall recurrence rate after the first surgical treatment was 39% (18/46), second (17.4% of all patients) and third recurrence (4.3%) were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion. Our results suggest satisfactory overall long-term outcome for the surgical treatment of UBC, although short-and mid-term

Optimization of a novel Tm fiber laser lithotripter in terms of stone ablation efficiency and retropulsion reduction

NASA Astrophysics Data System (ADS)

Yaroslavsky, Ilya; Vinnichenko, Victoria; McNeill, Tyler; Novoseltseva, Anna; Perchuk, Igor; Vybornov, Alexander; Altshuler, Gregory; Gapontsev, Valentin

2018-02-01

Recently, a Thulium (Tm) fiber laser operating at a wavelength of 1940 nm and peak power up to 500 W has been introduced as a promising energy source for laser lithotripsy. Direct comparative studies have demonstrated considerable advantages of Tm fiber laser over the current industry-standard 2100 nm Holmium:YAG (Ho:YAG) device in terms of ablation rate and retropulsion effects. In this work, we investigated avenues of further improving stone ablation efficiency and reducing retropulsion. Specifically, the roles of temporal pulse structure and fiber tip preparation were studied in detail. Experiments were conducted on Bego stone phantoms in an aqueous environment using a computerized 2D stage for controlled scanning of the fiber over the stone surface. High-resolution 3D-enabled optical microscopy was employed to assess both fiber tip damage and stone ablation rate. Retropulsion effects were quantified using a high-speed video camera. Fiber burn back was evaluated as well. Fiber performance could be preserved during prolonged (up to 15 min) procedures when the fiber tip was adequately prepared. Furthermore, the results were compared with available literature for similar experiments performed with the Ho:YAG laser. The data obtained provide an important foundation for optimizing clinical performance of Tm fiber systems for lithotripsy.

History of hyperthyroidism and long-term outcome of catheter ablation of drug-refractory atrial fibrillation.

PubMed

Wongcharoen, Wanwarang; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Chung, Fa-Po; Chong, Eric; Chao, Tze-Fan; Tuan, Ta-Chuan; Chang, Yao-Ting; Lin, Chin-Yu; Liao, Jo-Nan; Lin, Yi-Chun; Chen, Yun-Yu; Chen, Shih-Ann

2015-09-01

Hyperthyroidism is a known reversible cause of atrial fibrillation (AF). However, some patients remain in AF despite restoration of euthyroid status. The purpose of this study was to compare the electrophysiologic characteristics and long-term ablation outcome in AF patients with and without history of hyperthyroidism. The study enrolled 717 consecutive patients with AF who underwent first AF ablation, which involved pulmonary vein (PV) isolation in paroxysmal AF and additional substrate modification in nonparoxysmal AF patients. Eighty-four patients (12%) with hyperthyroidism history were compared to those without. Euthyroid status was achieved for ≥3 months before ablation in hyperthyroid patients. Patients with hyperthyroid history were associated with older age, more female gender, lower mean right atrial voltage, higher number of PV ectopic foci (1.3 ± 0.4 vs 1.0 ± 0.2, P < .01), and higher prevalence of non-PV foci (42% vs 23%, P < .01). Ectopic foci from ligament of Marshall were demonstrated more often in hyperthyroid patients (7.1% vs 1.6%, P < .01) in whom alcohol ablations were required. After propensity score matching for potential covariates, history of hyperthyroidism was an independent predictor of AF recurrence after single procedure (hazard ratio 2.07, 95% confidence interval 1.27-3.38). AF recurrence rates after multiple procedures were not different between patients with and those without hyperthyroid history. Patients with hyperthyroid history had a significantly higher number of PV ectopies and higher prevalence of non-PV ectopic foci compared to euthyroid patients, which resulted in a higher AF recurrence rate after a single procedure. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis

PubMed Central

Liu, Xin; Wang, Wei; Wang, Yang; Wang, Yuexiang; Li, Qiuyang; Tang, Jie

2016-01-01

Abstract The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study. A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified. Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18–94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947–0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143–0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079–1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success. USgHIFU ablation is an effective uterus-conserving treatment for symptomatic

Renal Angiomyolipoma: Mid- to Long-Term Results Following Embolization with Onyx

SciTech Connect

Thulasidasan, Narayanan, E-mail: narayanant@doctors.net.uk; Sriskandakumar, Srividhiya; Ilyas, Shahzad

PurposePercutaneous transcatheter embolization is currently the preferred treatment for ruptured or enlarging renal angiomyolipoma (AML), although the optimum choice of embolic material has not yet been established. We present mid- to long-term outcomes following embolization of AMLs with Onyx.Materials and MethodsTen AMLs in seven patients (including two with tuberous sclerosis) were embolized with Onyx. Patients were followed-up clinically, with tumour size and renal function measured pre- and post-procedure.ResultsMean pre-treatment AML size was 63.4 mm (range 42–100). Mean clinical follow-up was 431.4 days (range 153–986) and imaging follow-up 284.2 days (range 30–741). There was no haemorrhage from treated lesions within the follow-up period. Ofmore » patients who had cross-sectional imaging pre- and post-procedure, mean decrease in AML size of 22 mm was seen after Onyx embolization (p = 0.0058, 95 % CI 9.13–34.87). No significant difference between serum creatinine was seen pre- and post-procedure (p = 0.54, 95 % CI 8.63–4.85).ConclusionsOnyx embolization of renal AMLs is effective in the medium to long term, with theoretical benefits in safety and durability of result.« less

Renal Angiomyolipoma: Mid- to Long-Term Results Following Embolization with Onyx.

PubMed

Thulasidasan, Narayanan; Sriskandakumar, Srividhiya; Ilyas, Shahzad; Sabharwal, Tarun

2016-12-01

Percutaneous transcatheter embolization is currently the preferred treatment for ruptured or enlarging renal angiomyolipoma (AML), although the optimum choice of embolic material has not yet been established. We present mid- to long-term outcomes following embolization of AMLs with Onyx. Ten AMLs in seven patients (including two with tuberous sclerosis) were embolized with Onyx. Patients were followed-up clinically, with tumour size and renal function measured pre- and post-procedure. Mean pre-treatment AML size was 63.4 mm (range 42-100). Mean clinical follow-up was 431.4 days (range 153-986) and imaging follow-up 284.2 days (range 30-741). There was no haemorrhage from treated lesions within the follow-up period. Of patients who had cross-sectional imaging pre- and post-procedure, mean decrease in AML size of 22 mm was seen after Onyx embolization (p = 0.0058, 95 % CI 9.13-34.87). No significant difference between serum creatinine was seen pre- and post-procedure (p = 0.54, 95 % CI 8.63-4.85). Onyx embolization of renal AMLs is effective in the medium to long term, with theoretical benefits in safety and durability of result.

Linear ablation of right atrial free wall flutter: demonstration of bidirectional conduction block as an endpoint associated with long-term success.

PubMed

Snowdon, Richard L; Balasubramaniam, Richard; Teh, Andrew W; Haqqani, Haris M; Medi, Caroline; Rosso, Raphael; Vohra, Jitendra K; Kistler, Peter M; Morton, Joseph B; Sparks, Paul B; Kalman, Jonathan M

2010-05-01

Ablation for atypical atrial flutter (AFL) is often performed during tachycardia, with termination or noninducibility of AFL as the endpoint. Termination alone is, however, an inadequate endpoint for typical AFL ablation, where incomplete isthmus block leads to high recurrence rates. We assessed conduction block across a low lateral right atrial (RA) ablation line (LRA) from free wall scar to the inferior vena cava (IVC) or tricuspid annulus in 11 consecutive patients with atypical RA free wall flutter. LRA block was assessed following termination of AFL, by pacing from the ablation catheter in the low lateral RA posterior to the ablation line and recording the sequence and timing of activation anterior to the line with a duodecapole catheter, and vice versa for bidirectional block. LRA block resulted in a high to low activation pattern on the halo and a mean conduction time of 201 +/- 48 ms to distal halo. LRA conduction block was present in only 2 out of 6 patients after termination of AFL by ablation. Ablation was performed during sinus rhythm (SR) in 9 patients to achieve LRA conduction block. No recurrence of AFL was observed at long-term follow-up (22 +/- 12 months); 3 patients developed AF. Termination of right free wall flutter is often associated with persistent LRA conduction and additional radiofrequency ablation (RFA) in SR is usually required. Low RA pacing may be used to assess LRA conduction block and offers a robust endpoint for atypical RA free wall flutter ablation, which results in a high long-term cure rate.

Long-term observations of seafloor pressure variations at Lucky Strike volcano, Mid-Atlantic Ridge

NASA Astrophysics Data System (ADS)

Ballu, V.; de Viron, O.; Crawford, W. C.; Cannat, M.; Escartin, J.

2012-12-01

Lucky Strike volcano is a segment-center volcano on the Mid-Atlantic Ridge at 37°N. Extensive faulting reveals an important tectonic component in its formation, while a seismically imaged axial magma chamber reflector and active high-temperature hydrothermal vents reveal an important present-day magmatic component. Lucky Strike volcano has been the subject of long-term multidisciplinary seafloor observations to understand relations between magmatism, tectonism, hydrothermal circulation, biology and chemistry as part of the MoMAR (Monitoring of the Mid-Atlantic Ridge) program. Absolute pressure gauges have been recording on the volcano since 2007, to identify deformations associated with tectonism or magmatism. Deformation measurements are one of the principal means of determining volcanic activity, but the amount of deformation associated with volcanic events varies greatly between different volcanos. We installed two sites: one in the volcano's summit "lava lake" (1700 m depth) and another on the volcano's flank (2000 m depth). Pressure is recorded every thirty seconds, giving a data set that constrains movements on the scale from minutes to years. No major deformation event has been detected by the instruments since their installation (nor has any significant tectonic event been detected by a seismic network in place since 2007), so we concentrate here on the detection limit of these instruments and on variations in the long-period ocean wave climate. Using the statistical characteristics of the pressure signal, modeled by an auto-regressive process, we determine that a movement between the sites of 1 cm over less than 10 days is detectable; the detection threshold decreases to about 0.2 cm for the shortest time periods and increases for longer time periods due to instrumental drift. We compare the statistical characteristics and short- and long-term sensitivity of three different types of gauges used during the experiment: Paroscientific standard

[Mid-term effectiveness of rotating hinge knee prosthesis for severe knee deformity].

PubMed

Zeng, Min; Hu, Yihe; Xie, Jie; Li, Mingqing; Lin, Shaoru

2014-01-01

To evaluate the mid-term effectiveness of rotating hinge knee prosthesis for severe knee deformity. A retrospective analysis was made on the clinical data of 24 patients (24 knees) who received rotating hinge knee prosthesis for total knee arthroplasty between January 2003 and June 2011. There were 14 males and 10 females, aged from 60 to 81 years (mean, 70 years). The disease causes included osteoarthritis in 5 cases, rheumatoid arthritis in 7 cases, traumatic arthritis in 9 cases, and Charcot's arthropathy in 3 cases. The disease duration ranged from 5 to 25 years (mean, 14.5 years). Of them, 13 cases had flexion deformity, 7 cases had valgus deformity, and 16 cases had varus deformity. The operation time, the amount of bleeding between operation and drainage-tubes removal, hospitalization time, incision healing, and complications were recorded. The results were evaluated according to Knee Society Score (KSS), visual analogue scale (VAS), and the range of motion (ROM) of knee. Short-form 36 health survey scale (SF-36) was used to evaluate the life quality of patients. The position of prosthesis was observed through X-ray examination. The operation time ranged from 70 to 90 minutes (mean, 78 minutes). The amount of bleeding between operation and drainage-tubes removal ranged from 400 to 1 000 mL (mean, 650 mL). The hospitalization time ranged from 14 to 18 days (mean, 15.2 days). Patellar fracture occurred in 1 case (4.17%) during operation, swelling and effusion of incision in 1 case (4.17%), and periprosthetic infections in 2 cases (8.33%) after operation. All patients were followed up 2-10 years (mean, 5.5 years). The X-ray films showed no evidence of obvious radiolucent line, osteolysis, prosthesis subsidence, and limb alignment change. The results of KSS, VAS socres, and ROM of knee at 1 year postoperatively and last follow-up were significantly better than preoperative ones (P < 0.05), but no significant difference was found between at 1 year postoperatively

Mid- and long-term runoff predictions by an improved phase-space reconstruction model.

PubMed

Hong, Mei; Wang, Dong; Wang, Yuankun; Zeng, Xiankui; Ge, Shanshan; Yan, Hengqian; Singh, Vijay P

2016-07-01

In recent years, the phase-space reconstruction method has usually been used for mid- and long-term runoff predictions. However, the traditional phase-space reconstruction method is still needs to be improved. Using the genetic algorithm to improve the phase-space reconstruction method, a new nonlinear model of monthly runoff is constructed. The new model does not rely heavily on embedding dimensions. Recognizing that the rainfall-runoff process is complex, affected by a number of factors, more variables (e.g. temperature and rainfall) are incorporated in the model. In order to detect the possible presence of chaos in the runoff dynamics, chaotic characteristics of the model are also analyzed, which shows the model can represent the nonlinear and chaotic characteristics of the runoff. The model is tested for its forecasting performance in four types of experiments using data from six hydrological stations on the Yellow River and the Yangtze River. Results show that the medium-and long-term runoff is satisfactorily forecasted at the hydrological stations. Not only is the forecasting trend accurate, but also the mean absolute percentage error is no more than 15%. Moreover, the forecast results of wet years and dry years are both good, which means that the improved model can overcome the traditional ''wet years and dry years predictability barrier,'' to some extent. The model forecasts for different regions are all good, showing the universality of the approach. Compared with selected conceptual and empirical methods, the model exhibits greater reliability and stability in the long-term runoff prediction. Our study provides a new thinking for research on the association between the monthly runoff and other hydrological factors, and also provides a new method for the prediction of the monthly runoff. Copyright © 2015 Elsevier Inc. All rights reserved.

Disappointing mid-term results after laparoscopic gastric banding in young patients.

PubMed

Lanthaler, Monika; Sieb, Michael; Strasser, Stefan; Weiss, Helmut; Aigner, Franz; Nehoda, Hermann

2009-01-01

When gastric banding was introduced as a bariatric operation about 12 years previously, its early results were promising, with a low complication rate. Only a few long-term studies on this subject have been published. This study was performed to assess our results with laparoscopic gastric banding in young patients afterterm outcome was regarded as a failure in 40%, fair in 4%, good in 28%, very good in 20%, and excellent in 8% of patients. Our mid-term results were disappointing, with a high complication rate and many dissatisfied patients.

Predictive factors of long-term colorectal cancer survival after ultrasound-controlled ablation of hepatic metastases.

PubMed

Hernández-Socorro, Carmen Rosa; Saavedra, Pedro; Ramírez Felipe, José; Bohn Sarmiento, Uriel; Ruiz-Santana, Sergio

2017-04-21

The risk factors associated to long-term survival were assessed in patients with liver metastases of colorectal carcinoma undergoing ablative therapies. Single-centre cohort study, retrospectively analysed and prospectively collected consecutive patients with unresectable metastatic liver disease of colorectal carcinoma treated with ablative therapies between 1996 and 2013. Factors associated with survival time were identified using Cox's proportional hazard model with time-dependent covariates. A forward variable selection based on Akaike information criterion was performed. Relative risk and 95% confidence intervals for each factor were calculated. Statistical significance was set as P<.05. Seventy-five patients with liver metastases of colorectal cancer, with a mean age of 65.6 (10.3) underwent 106 treatments. Variables selected were good quality of life (RR 0.308, 95% CI 0.150-0.632) and tumour extension (RR 3.070, 95% CI 1.776-5.308). The median overall survival was 18.5 months (95% CI 17.4-24.4). The survival prognosis in median was 13.5 vs. 23.4 months for patients with and without tumour extension, and 23.0 vs. 12.8 months for patients with good and fair or poor quality of life, respectively. Good quality of life and tumour extension were the only statistically significant predictors of long-term survival in patients of colorectal carcinoma with liver metastatic disease undergoing ablative treatment with ultrasound. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Predictors of Intra-Aortic Balloon Pump Insertion in Coronary Surgery and Mid-Term Results

PubMed Central

Yurekli, Ismail; Celik, Ersin; Yetkin, Ufuk; Yilik, Levent; Gurbuz, Ali

2013-01-01

Background We aimed to investigate the preoperative, operative, and postoperative factors affecting intra-aortic balloon pump (IABP) insertion in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). We also investigated factors affecting morbidity, mortality, and survival in patients with IABP support. Methods Between January 2002 and December 2009, 1,657 patients underwent isolated CABG in İzmir Katip Celebi University Atatürk Training and Research Hospital. The number of patients requiring support with IABP was 134 (8.1%). Results In a multivariate logistic regression analysis, prolonged cardiopulmonary bypass time and prolonged operation time were independent predictive factors of IABP insertion. The postoperative mortality rate was 35.8% and 1% in patients with and without IABP support, respectively (p=0.000). Postoperative renal insufficiency, prolonged ventilatory support, and postoperative atrial fibrillation were independent predictive factors of postoperative mortality in patients with IABP support. The mean follow-up time was 38.55±22.70 months and 48.78±25.20 months in patients with and without IABP support, respectively. The follow-up mortality rate was 3% (n=4) and 5.3% (n=78) in patients with and without IABP support, respectively. Conclusion The patients with IABP support had a higher postoperative mortality rate and a longer length of intensive care unit and hospital stay. The mid-term survival was good for patients surviving the early postoperative period. PMID:24368971

Mid-term Results of Total Knee Arthroplasty Using PFC Sigma RP-F.

PubMed

Kim, Jun-Young; Cheon, Sang-Ho; Kyung, Hee-Soo

2012-12-01

We compared the mid-term results after total knee arthroplasty (TKA) using PFC Sigma RP-F mobile model with PFC Sigma PS fixed model. We analyzed 45 knees that underwent TKA with PFC Sigma RP-Fn (study group) and 45 knees with PFC Sigma PS (control group). The mean follow-up period was 65 months (range, 60-69 months). The evaluation system of the American knee society was used for clinical and radiological assessment. Also, the maximal knee flexion angle was assessed. The mean maximum flexion angle in the study group (135°) was greater than that in the control group (125°) at the early post-operation & final follow-up period (p=0.033). The range of motion (ROM) in the study group was recovered earlier at the postoperative 6 months, and ROM gain was improved to a greater extent at the final follow-up period (p=0.039). The knee score and function score and radiographic evaluation were no difference between the two groups (p>0.05) at the final follow-up. The two cases of radiolucency in posterior condyle and medial tibial plateau and one case of patellar elongation were seen in the study group. The PFC Sigma RP-F mobile system appears to facilitate greater maximum flexion angle and ROM gain with two cases of radiolucent line.

Progress and Achievements at the Mid Term of the Dragon 3 Programme

NASA Astrophysics Data System (ADS)

Desnos, Yves-Louis; Li, Zengyuan; Zmuda, Andy; Gao, Zhihai

2014-11-01

The Dragon Programme is a joint undertaking between ESA and the Ministry of Science and Technology (MOST) of China and the National Remote Sensing Center of China (NRSCC). Its purpose is to encourage increased exploitation of ESA and Chinese space resources within China as well as stimulate increased scientific cooperation in the field of Earth Observation (EO) science and applications between China and Europe. Since 2004, this pioneering programme has become a model for scientific and technological cooperation between China and Europe. By successfully encouraging joint research using ESA, Third Party Missions and Chinese EO data across a range of thematic areas, Dragon continues to deliver outstanding scientific results. The programme has successfully completed two phases, Dragon 1 from 2004 to 2008, Dragon 2 from 2008 to 2012. The third phase of Dragon was started in 2012 and will be completed in 2016. The Dragon 3 project teams are led by leading EO scientists and young scientists are also engaged on the projects. Advanced training in land, ocean and atmospheric applications is a feature of the programme and a course on land and one course on ocean applications have been successfully held in 2012 and 2013 in China. Here-in provided is an overview of the results, reporting and training activities at the mid-term stage of the programme.

Progress and Achievements at the Mid Term Stage of the Dragon 3 Programme

NASA Astrophysics Data System (ADS)

Desnos, Yves-Louis; Li, Zengyuan; Zmuda, Andy; Gao, Zhihai

2014-11-01

The Dragon Programme is a joint undertaking between ESA and the Ministry of Science and Technology (MOST) of China and the National Remote Sensing Center of China (NRSCC). Its purpose is to encourage increased exploitation of ESA and Chinese space resources within China as well as stimulate increased scientific cooperation in the field of Earth Observation (EO) science and applications between China and Europe. Since 2004, this pioneering programme has become a model for scientific and technological cooperation between China and Europe. By successfully encouraging joint research using ESA, Third Party Missions and Chinese EO data across a range of thematic areas, Dragon continues to deliver outstanding scientific results. The programme has successfully completed two phases, Dragon 1 from 2004 to 2008, Dragon 2 from 2008 to 2012. The third phase of Dragon was started in 2012 and will be completed in 2016. The Dragon 3 project teams are led by leading EO scientists and young scientists are also engaged on the projects. Advanced training in land, ocean and atmospheric applications is a feature of the programme and a course on land and one course on ocean applications have been successfully held in 2012 and 2013 in China. Here-in provided is an overview of the results, reporting and training activities at the mid-term stage of the programme.

Progress and Achievements At the Mid Term Stage of the Dragon 2 Programme

NASA Astrophysics Data System (ADS)

Desnos, Yves-Louis; Li, Zhengyuan; Zmuda, Andy; Gao, Zhihai

2010-10-01

The cooperation between ESA and National Remote Sensing Center of China (NRSCC) / Ministry Of Science and Technology of China (MOST) in the development of Earth Observation (EO) applications started 15 years ago. In 2004, a new phase in cooperation began with the start of the Dragon Programme which focused on science and application using ESA satellite data. The programme was completed in 2008. Following on, the cooperation took on greater momentum with the start of a four-year EO science and exploitation programme called 'Dragon 2'. This programme brings together joint Sino-European teams to investigate land, ocean and atmospheric applications in P.R. China using data from ESA, Third Party Mission and Chinese Earth Observation satellites. The teams are led by leading EO scientists and young scientists are also engaged on the projects. Advanced training in land, ocean and atmospheric applications is a feature of the programme and after 2 years, two courses on land and one course on atmospheric applications have been successfully held in 2008, 2009 and 2010 in China. Here-in provided is an overview of the results, reporting and training activities at the mid term stage of the programme. The Sino-European teams continue to deliver world-class scientific results across a wide range of disciplines. The programme provides a platform for the joint exploitation of ESA, TPM and Chinese EO data from optical, infrared, thermal and microwave sensors for science and application development.

The AES total ankle replacement: A mid-term analysis of 93 cases.

PubMed

Henricson, Anders; Knutson, Kaj; Lindahl, Johan; Rydholm, Urban

2010-06-01

There are few studies concerning specific total ankle arthroplasties. This study reports mid-term survival data for the AES prosthesis. Ninety-three AES ankle arthroplasties were performed by the senior authors. The mean follow-up was 3.5 years. The 5-year survivorship and also the number of simultaneous procedures, reoperations, additional procedures and revisions are analyzed. The 5-year survivorship with revision for any reason as end-point was 90%. Simultaneous procedures were performed in 25 patients, deltoid release and subtalar fusion being the most common. There were seven revisions, one due to loosening, and two due to infection, instability and fractures, respectively. Twenty-seven reoperations or additional procedures were performed in 23 patients with a procedure for malleolar impingement being the most common reoperation, and correction of hindfoot varus being the most common reason for an additional procedure. The AES total ankle replacement seems to be a reasonably safe procedure in experienced hands. Copyright 2009 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Safety and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using Magnetic Navigation versus Manual Conventional Ablation: A Propensity-Score Analysis.

PubMed

Adragão, Pedro Pulido; Cavaco, Diogo; Ferreira, António Miguel; Costa, Francisco Moscoso; Parreira, Leonor; Carmo, Pedro; Morgado, Francisco Bello; Santos, Katya Reis; Santos, Pedro Galvão; Carvalho, Maria Salomé; Durazzo, Anai; Marques, Hugo; Gonçalves, Pedro Araújo; Raposo, Luís; Mendes, Miguel

2016-03-01

Whether or not the potential advantages of using a magnetic navigation system (MNS) translate into improved outcomes in patients undergoing atrial fibrillation (AF) ablation is a question that remains unanswered. In this observational registry study, we used propensity-score matching to compare the outcomes of patients with symptomatic drug-refractory AF who underwent catheter ablation using MNS with the outcomes of those who underwent catheter ablation using conventional manual navigation. Among 1,035 eligible patients, 287 patients in each group had similar propensity scores and were included in the analysis. The primary efficacy outcome was the rate of AF relapse after a 3-month blanking period. At a mean follow-up of 2.6 ± 1.5 years, AF ablation with MNS was associated with a similar risk of AF relapse as compared with manual navigation (18.4% per year and 22.3% per year, respectively; hazard ratio 0.81, 95% CI 0.63-1.05; P = 0.108). Major complications occurred in two patients (0.7%) using MNS, and in six patients (2.1%) undergoing manually navigated ablation (P = 0.286). Fluoroscopy times were 21 ± 10 minutes in the manual navigation group, and 12 ± 9 minutes in the MNS group (P < 0.001), whereas total procedure times were 152 ± 52 minutes and 213 ± 58 minutes, respectively (P < 0.001). In this propensity-score matched comparison, magnetic navigation and conventional manual AF ablations seem to have similar relapse rates and a similar risk of complications. AF ablations with magnetic navigation take longer to perform but expose patients to significantly shorter fluoroscopy times. © 2015 Wiley Periodicals, Inc.

Mid-Term Assessment of English 10 Students: A Comparison of Methods of Entry into the Course.

ERIC Educational Resources Information Center

Isonio, Steven

In spring 1992, a mid-term assessment of English 10 students was conducted at Golden West College, in California, in order to compare four course placement methods. English 10, "Writing Essentials," is a nontransferrable course which focuses on paragraph writing and grammar review in order to prepare students for entry into English 100.…

Endovascular treatment of penetrating aortic ulcers: mid-term follow-up.

PubMed

Mestres, Gaspar; Rodríguez, Rubén; García-Madrid, Cesar; Montañà, Xavier; Burrel, Marta; Cruz, Luis Fernando; Flores, Carlos; Riambau, Vicente

2012-01-01

The aim of this work is to describe the short- and mid-term results of endovascular treatment of penetrating ulcers in the thoracic aorta. Between 1998 and 2010, 22 patients with penetrating ulcers in the thoracic aorta received endografts (mean age 69.8 years, 91% male); 50% were indicated for acute aortic syndrome (8 chest pain, 1 aortic rupture, 1 aortobronchial fistula, 1 distal embolization) and 50% for aortic or ulcer diameter. All preoperative, operative and follow-up data were recorded prospectively and met EUROSTAR criteria. Technical success was 100% with no intraoperative deaths or open conversions; 6 (27.3%) required preoperative supraaortic trunk debranching and 1.3 endografts were used per patient; 27.3% developed complications in-hospital and 9.1% required reintervention prior to discharge. Mortality at 30 days was 4.5%. After a mean 52.3 month follow-up (range 0.1-122), cumulative survival free from complications and reinterventions at 100 months was 61.7% and 79.5% respectively, with 95.5% cumulative survival free from aorta- or procedure-related death. We identified no factors significantly related to poor intra- or postoperative clinical course. Endovascular treatment of penetrating aortic ulcers is both possible and effective despite high patient comorbidity. Although a substantial rate of complications and reinterventions can be expected-especially in-hospital-(38.3% and 20.5% respectively at 100 months), long-term mortality is low (4.5%). Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Nitrogen Dioxide long term trends at mid and high latitudes by means of ground based observations

NASA Astrophysics Data System (ADS)

Bortoli, D.; Petritoli, A.; Giovanelli, G.; Kostadinov, I.; Ravegnani, F.

2003-04-01

The interactions between mid- and high latitudes atmospheric changes are going to be one of the main issue for the future of stratospheric and tropospheric chemistry research. A more detailed study of the ozone trends as well as a wider comprehension of the interactions with lower and higher latitudes are maybe the main arguments to which scientist should address their works in order to build-up a more detailed picture of what scenarios we have to face in the near future. GASCODs type spectrometers (Gas Analyzer Spectrometer Correlating Optical Differences) are installed at the "Ottavio Vittori" research station (44.11N, 10.42E, 2165 m asl) since June 1993, at the Italian Antarctic Station (74.69S, 164.12E) since December 1995 and at the STIL-BAS station (42.42N, 25.63E) since 1999. The instruments measure zenith scattered solar radiation between 407 and 464 nm. Nitrogen dioxide total column is retrieved with DOAS methodology. The seasonal trend of NO2 vc values is reported and it shows the expected behaviour: maximum values during the summer period while the minimum occur in the winter season in both the hemispheres. A typical behaviour of the AMPM ratio at high latitudes is highlight. A Fourier analysis is proposed as a tool to investigate the long-term components of nitrogen dioxide stratospheric amount. Results are presented and the NO2 trend is evidenced and commented. ACKNOWLEDGMENTS: The author Daniele Bortoli was financially supported by the Subprograma Ciência e Tecnologia do 3° Quadro Comunitário de Apoio. The National Antarctic Research Program (PNRA) and the Quantification and Interpretation of Long-Term UV-Vis Observations of the Stratosphere (QUILT) project supported this research.

Mid-term outcomes of endovascular aortic aneurysm repair with carbon dioxide-guided angiography.

PubMed

Takeuchi, Yuriko; Morikage, Noriyasu; Matsuno, Yutaro; Nakamura, Tamami; Samura, Makoto; Ueda, Koshiro; Harada, Takasuke; Ikeda, Yoshitaka; Suehiro, Kotaro; Ito, Hiroshi; Sakata, Kensuke; Hamano, Kimikazu

2018-05-14

Although iodinated contrast (IC) agents are commonly used in endovascular aneurysm repair (EVAR), perioperative use in patients with renal dysfunction or IC allergies is avoided. Carbon dioxide (CO 2 )-guided angiography is a promising alternative. We aimed to evaluate short-term and mid-term outcomes of EVAR using CO 2 -guided angiography. Three hundred and eighty-one patients who underwent EVAR from January 2012 to September 2016 were retrospectively reviewed and divided into an IC-EVAR group (n=351) and CO 2 -EVAR group (n=30). Subjects in the CO 2 -EVAR group had severe renal dysfunction (n=27) and IC allergy (n=4). Intraoperative, postoperative, and follow-up variables were compared. Compared to the IC-EVAR group, preoperative serum creatinine level was significantly higher (2.0 vs. 0.92 mg/dL, P < .0001) and mean IC dose significantly lower (18 vs. 55 mL P < .0001) in the CO 2 -EVAR group. The fluoroscopy time, operative time, number of stent grafts placed, and technical success rates of the groups were similar; no type I and/or type III endoleaks were detected on completion angiography. There was no acute kidney injury and one case of intestinal necrosis in the CO 2 -EVAR group, potentially due to cholesterol embolism. Postoperative endoleak, enlargement of aneurysms, survival, freedom from secondary intervention, and renal function change up to 3 months postoperatively were similar between groups. CO 2 -EVAR is technically feasible and exhibits prominent renal protection. However, consideration of the aortic lumen status remains an important challenge. Copyright © 2018. Published by Elsevier Inc.

The Boyd–McLeod procedure for tennis elbow: mid- to long-term results

PubMed Central

Jeavons, Richard; Richards, Ian; Bayliss, Neil

2014-01-01

Background Tennis elbow is a common condition that usually responds to conservative measures. In refractory cases, surgical intervention is indicated. A plethora of surgical techniques have been described. We report the mid- to long-term outcomes of the Boyd–McLeod procedure for refractory tennis elbow. Methods A retrospective analysis and current review of patients that had undergone the Boyd–McLeod procedure over a 12-year period was undertaken. Demographics, time to discharge, length of follow-up and outcome scores were collected. Results Seventy patients underwent surgery. Mean time to discharge was 15.35 weeks, with 88% successful outcomes. Fifty-four patients were available for current follow-up at mean of 5.52 years (range 1.17 years to 11.49 years). Range of motion in all patients was unchanged. There were no revision procedures. Mean (SD) Mayo Elbow Performance Score was 90.85 (13.11), with 75.5% returning a good or excellent score and 24.5% a fair outcome. The mean (SD) Oxford Elbow Score was 44.04 (6.92); mean (SD) pain score was 89.5 (17.58); mean (SD) function score was 95.34 (9.59) and mean (SD) socio-psychological score was 91.50 (17.01). Overall, 83% of patients had an Oxford Elbow Score of 43 or greater, suggesting excellent outcome. Conclusions We show that the Boyd–McLeod procedure is an excellent option over both the short- and long-term for refractory tennis elbow. PMID:27582946

Mid-term outcome of endovascular treatment for acute lower extremity deep venous thrombosis.

PubMed

Jiang, Kun; Li, Xiao-Qiang; Sang, Hong-Fei; Qian, Ai-Min; Rong, Jian-Jie; Li, Cheng-Long

2017-04-01

Purposes of the study To evaluate the benefit of stenting the iliac vein in patients with residual iliac vein stenosis treated with catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis. Procedures In this randomized prospective study, patients with a first-time acute lower extremity deep venous thrombosis that had persisted <14 days were treated with catheter-directed thrombolysis. After catheter-directed thrombolysis, patients with >50% residual iliac vein stenosis were randomly divided into two groups: catheter-directed thrombolysis + Stent Group and catheter-directed thrombolysis Alone Group. Patients received urokinase thrombolysis and low-molecular-weight heparin/oral warfarin during the hospitalization period and were administrated oral warfarin after discharge. Cumulative deep vein patency, the Clinical Etiology Anatomic Pathophysiologic classification system, the Venous Clinical Severity Score and the Chronic Venous Insufficiency Questionnaire score were evaluated. Findings The cumulative deep vein patency rate was 74.07% in the catheter-directed thrombolysis + Stent Group and 46.59% in the catheter-directed thrombolysis Alone Group. The mean postoperative Clinical Etiology Anatomic Pathophysiologic classification and Venous Clinical Severity Score was significantly lower in the catheter-directed thrombolysis + Stent Group than in the catheter-directed thrombolysis Alone Group. The mean postoperative Chronic Venous Insufficiency Questionnaire score was significantly higher in the catheter-directed thrombolysis + Stent Group than the catheter-directed thrombolysis Alone Group. Conclusions Placement of an iliac vein stent in patients with residual iliac vein stenosis after catheter-directed thrombolysis for acute lower extremity deep venous thrombosis increases iliac vein patency and improves clinical symptoms and health-related quality of life at mid-term follow-up compared to patients treated with catheter

Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

PubMed Central

Zanettini, Renzo; Gatto, Gemma; Mori, Ileana; Pozzoni, Maria Beatrice; Pelenghi, Stefano; Martinelli, Luigi; Klugmann, Silvio

2014-01-01

Background Evaluation of patient outcomes following transcatheter aortic valve implantation (TAVI) has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days (range: 192–738 days), five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up. PMID:25593575

Donor cause of death and mid-term survival in lung transplantation.

PubMed

Ganesh, J Saravana; Rogers, Chris A; Banner, Nicholas R; Bonser, Robert S

2005-10-01

The influence of donor cause of death (DCD) on survival after lung transplantation (LTx) is uncertain. This was investigated using data from a national prospective cohort study of adult single and bilateral LTx undertaken between July 1995 and June 2002. DCD was categorized a priori into vascular and tumor (V), traumatic (T), hypoxic brain damage (H) and infective (I) causes. All T donor deaths were the result of blunt trauma. Risk factors for early (30 days), late (30 days to 5 years) and overall (5 years) mortality were identified using Cox regression analysis. Of 580 eligible transplants, DCDs were classified as V (n = 372), T (n = 153), H (n = 38) and I (n = 17). V donors were older (median 42 years) than the others (medians < 27 years) (p < 0.001). T donors were more likely to be of male gender (p < 0.001). Two hundred fifty-nine patients died within 5 years of surgery. The median follow-up time of survivors was 37 months. Unadjusted 5-year Kaplan-Meier survival rates did not vary with DCD (p = 0.6). Cox analysis identified donor age group, recipient diagnosis, pre-operative recipient ventilation, donor-recipient size mismatch, donor-recipient blood group variance, cytomegalovirus (CMV) mismatch and recipient creatinine clearance as predictors of mortality. After adjustment for these risk factors, DCD was not identified as a predictor of early (p = 0.2), late (p = 0.5) or overall mortality (p = 0.4) in LTx recipients. We found that DCD did not affect mid-term survival after LTx.

The Mid-Term Efficacy and Safety of a Permanent Nitinol IVC Filter (TrapEase)

PubMed Central

Liu, Wei Chiang; Choo, Sung Wook; Kim, Dong-Ik; Kim, Young Wook; Kim, Duk-Kyung; Shin, Sung Wook; Park, Kwang Bo; Jeon, Yong Hwan; Choo, In-Wook

2005-01-01

Objective 1) To evaluate the mid-term efficacy and safety of a permanent nitinol inferior vena cava (IVC) filter; 2) to evaluate filter effectiveness, filter stability and caval occlusion. Materials and Methods A prospective evaluation of the TrapEase IVC filter was performed on 42 patients (eight men, 34 women) ranging in age from 22 to 78 years (mean age 66 years). All patients were ill with a high risk of pulmonary embolism (PE). Indications for filter placement were: 1) deep vein thrombosis with recurrent thromboembolism; 2) and/or free-floating thrombus with contraindication to anticoagulation; and 3) complications in achieving adequate anticoagulation. Follow-up evaluations (mean: 15.4 months, range: 2 to 28 months) were performed at 6- and 12-month intervals after the procedure and included clinical histories, chart reviews, plain film, Doppler ultrasounds, and contrasted abdominal CT scans. Results In follow-up evaluations, the data analysis revealed no cases of symptomatic PE. There were no cases of filter migration, insertion site thrombosis, filter fracture, or vessel wall perforation. During the study, there was one case of filter thrombosis; early symptomatic thrombosis that was successfully treated in the hospital. Of the 42 subjects, eight died. These deaths were not related to the filter device or the implantation procedure, but to the underlying disease. Conclusion This study demonstrates that the TrapEase permanent IVC filter is a safe and an effective device with low complication rates and is best used in patients with thromboembolic disease with a high risk of PE. PMID:15968150

Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation.

PubMed

Ozcan, C; Jahangir, A; Friedman, P A; Patel, P J; Munger, T M; Rea, R F; Lloyd, M A; Packer, D L; Hodge, D O; Gersh, B J; Hammill, S C; Shen, W K

2001-04-05

In patients with atrial fibrillation that is refractory to drug therapy, radio-frequency ablation of the atrioventricular node and implantation of a permanent pacemaker are an alternative therapeutic approach. The effect of this procedure on long-term survival is unknown. We studied all patients who underwent ablation of the atrioventricular node and implantation of a permanent pacemaker at the Mayo Clinic between 1990 and 1998. Observed survival was compared with the survival rates in two control populations: age- and sex-matched members of the Minnesota population between 1970 and 1990 and consecutive patients with atrial fibrillation who received drug therapy in 1993. A total of 350 patients (mean [+/-SD] age, 68+/-11 years) were studied. During a mean of 36+/-26 months of follow-up, 78 patients died. The observed survival rate was significantly lower than the expected survival rate based on the general Minnesota population (P<0.001). Previous myocardial infarction (P<0.001), a history of congestive heart failure (P=0.02), and treatment with cardiac drugs after ablation (P=0.03) were independent predictors of death. Observed survival among patients without these three risk factors was similar to expected survival (P=0.43). None of the 26 patients with lone atrial fibrillation died during follow-up (37+/-27 months). The observed survival rate among patients who underwent ablation was similar to that among 229 controls with atrial fibrillation (mean age, 67+/-12 years) who received drug therapy (P=0.44). In the absence of underlying heart disease, survival among patients with atrial fibrillation after ablation of the atrioventricular node is similar to expected survival in the general population. Long-term survival is similar for patients with atrial fibrillation, whether they receive ablation or drug therapy. Control of the ventricular rate by ablation of the atrioventricular node and permanent pacing does not adversely affect long-term survival.

Value of an old school approach: safety and long-term success of radiofrequency current catheter ablation of atrioventricular nodal reentrant tachycardia in children and young adolescents.

PubMed

Siebels, Henrike; Sohns, Christian; Nürnberg, Jan-Hendrik; Siebels, Jürgen; Langes, Klaus; Hebe, Joachim

2018-05-15

Radiofrequency current energy (RFC) ablation is still considered as the gold standard for atrioventricular nodal reentrant tachycardia (AVNRT). Success-rates for AVNRT ablation vary irrespective of the ablation technology and strategy. This study aimed to access safety, efficacy, and long-term outcome of RFC catheter ablation for the treatment of AVNRT in children and adolescents aged < 19 years with special focus on modulation versus ablation of the AV nodal slow pathway (SP). A total number of 1143 patients (pts) < 19 years were referred for invasive electrophysiological testing due to paroxysmal supraventricular tachycardia (SVT). Diagnosis of AVNRT was confirmed in 412 pts, and RFC-guided ablation was attempted in 386 pts (age 13.0 ± 3.5 years). No permanent complications were observed. RFC application resulted in SP-ablation in 171/386 (44.3%) and in SP modulation in 208/386 (53.9%) children, whereas attempts for RFC treatment failed in 7 pts. Follow-up was completed for 396/412 patients (96.1%). Within a mean follow-up period of 54.9 ± 39.7 months, in 51/379 pts (13.5%) AVNRT recurrence was observed. The median time until tachycardia recurrence was 19.5 months. No difference for AVNRT recurrence was found comparing SP ablation versus SP modulation (p > 0.05), whereas the recurrence rate was significantly higher in patients with non-inducible SVT and therefore empiric SP treatment as compared to patients with inducible AVNRT (p = 0.01). RFC-guided ablation for AVNRT in children and adolescents is safe and leads to an acceptable long-term freedom from recurrences. SP modulation and SP ablation resulted in comparable acute and long-term success rates. Late AVNRT recurrences can occur even after years of freedom from tachycardia-related symptoms.

Short- and Mid-Term Effects of Violent Victimization on Delinquency: A Multilevel Growth-Curve Modeling Approach.

PubMed

Kim, Young S; Lo, Celia C

2016-10-01

The present study investigates how adolescents' experiences of violent victimization exert short- and mid-term effects on their involvement in delinquency. The study compares and contrasts delinquency trajectories of youths whose experiences of violent victimization differ. A multilevel growth-curve modeling approach is applied to analyze data from five waves of the National Youth Survey. The results show that, although delinquency involvement increases as youths experience violent victimization, delinquency trajectories differ with the type of violent victimization, specifically, parental versus non-parental victimization. Violent victimization by parents produced a sharp initial decline in delinquency (short-term effect) followed by a rapid acceleration (mid-term effect). In turn, non-parental violence showed a stable trend over time. The findings have important implications for prevention and treatment services. © The Author(s) 2015.

Treatment of Recurrent Nonparoxysmal Atrial Fibrillation Using Focal Impulse and Rotor Mapping (FIRM)-Guided Rotor Ablation: Early Recurrence and Long-Term Outcomes.

PubMed

Spitzer, Stefan Georg; Károlyi, László; Rämmler, Carola; Scharfe, Frank; Weinmann, Thomas; Zieschank, Mirko; Langbein, Anke

2017-01-01

A patient-tailored ablation approach focused on the elimination of both pulmonary vein triggers as well as substrate drivers may result in favorable outcomes in recurrent persistent AF patients. We evaluated the long-term outcomes of rotor ablation combined with conventional pulmonary vein isolation (PVI) in patients with recurrent nonparoxysmal AF. Fifty-eight consecutive patients underwent FIRM-guided rotor ablation followed by conventional PVI for the treatment of recurrent nonparoxysmal AF. A software algorithm was used to display rotational activity at rotor sites by creating propagation maps from unipolar electrograms recorded using a 64-electrode basket catheter. These rotor sites were targeted for ablation, followed by conventional PVI. All patients had nonparoxysmal AF (83% longstanding persistent) and a previously failed conventional ablation procedure. Stable rotors were identified in all patients (mean of 3.0 ± 1.6 per patient), with 55.2% having right atrial rotors and 96.6% left atrial rotors, respectively. Complications occurred in 5.2% of patients, none related to the FIRM procedure. The median follow-up was 12 months. At 6 and 12 months of follow-up, 73.2% and 76.9% of patients remained free from AF/AT, respectively. Excluding 2 patients who underwent a successful redo ablation procedure/electrical cardioversion, at 12 months of follow-up, 69.2% were free from any AF/AT and 73.1% were free from AF after a single FIRM-guided ablation procedure. A high degree of success was observed in this cohort of primarily longstanding persistent AF patients treated for recurrent AF with FIRM-guided rotor ablation. Prospective randomized controlled trials are needed. © 2016 Wiley Periodicals, Inc.

Long-term effects of neonatal medial temporal ablations on socioemotional behavior in monkeys (Macaca mulatta).

PubMed

Malkova, Ludise; Mishkin, Mortimer; Suomi, Stephen J; Bachevalier, Jocelyne

2010-12-01

Socioemotional abnormalities, including decreased social interactions and increased self-directed activity, were reported when rhesus monkeys with neonatal ablations of either the medial temporal lobe (AH) or the inferior temporal cortex (TE) were paired with unoperated peers at two and six months of age, though these abnormalities were more severe in Group AH (Bachevalier et al., 2001). As adults (Experiment 1), the monkeys were re-evaluated in the same dyads and their reactivity to novel toys, social status, and reactions to separation were also assessed. Group TE now showed only few if any of the abnormal behaviors observed in infancy. In contrast, Group AH continued to display decreased social interactions and increased self-directed activity and showed also increased submission and reduced responses to separation, but normal reactivity to novel toys. To determine whether this degree of socioemotional impairment was less severe than that produced by the same damage in adulthood, we assessed dyadic social interactions of monkeys raised until adulthood in laboratory conditions similar to those in Experiment 1 and then given the AH ablations (Experiment 2). Two months postoperatively these monkeys showed a small reduction in social interactions that became more pronounced six months postoperatively, yet remained less severe than that seen in the infant-lesioned monkeys. No other socioemotional effects, except for an increase in food/water consumption, were observed. The finding that neonatal AH lesions produce more severe socioemotional disturbances than the same lesion in adulthood is the reverse of the effect commonly reported for other cognitive functions after cerebral damage. © 2010 APA, all rights reserved.

Long-term effects of neonatal medial temporal ablations on socioemotional behavior in monkeys

PubMed Central

Málková, Ludise; Mishkin, Mortimer; Suomi, Stephen J.; Bachevalier, Jocelyne

2010-01-01

Socioemotional abnormalities, including low levels of social interaction and high levels of self-directed activity, were reported when rhesus monkeys with neonatal ablations of either the medial temporal lobe (AH) or the inferior temporal cortex (TE) were paired with unoperated peers at two and six months of age, though these abnormalities were more severe in the AH group (Bachevalier et al., 2001). As they reached adulthood (Experiment 1), the same monkeys were re-evaluated in the same dyads and their reactivity to novel toys, social status, and reactions to separation from age-matched peers were also assessed. Group TE now showed few if any of the abnormal behaviors observed when they were infants. By contrast, Group AH continued to display low levels of social interaction, high levels of self-directed activity and submissive behavior, and reduced responses to separation, although they reacted normally to novel toys. To determine whether this degree of socioemotional impairment was less severe than that produced by the same damage in adulthood, we assessed dyadic social interactions of monkeys raised until adulthood in laboratory conditions similar to those of the earlier groups and then given the AH ablation (Experiment 2). Two months postoperatively these adult-lesioned monkeys showed a small reduction in social interactions that became more pronounced six months postoperatively, yet remained less severe than that seen in the infant-lesioned monkeys. Also, except for an increase in food and water consumption throughout this 6-month period, they showed no other socioemotional effects. The finding that neonatal AH lesions produce more severe socioemotional disturbances than the same lesion in adulthood is the reverse of the effect commonly reported for other cognitive functions after cerebral damage. PMID:21133531

Evaluation of short-term psychological functions in opiate addicts after ablating the nucleus accumbens via stereotactic surgery.

PubMed

He, Fei; Guan, Hao; Zhao, Zhijing; Miao, Xinfang; Zhou, Qin; Li, Lihong; Huang, Dongmei; Liu, Anheng; Miao, Danmin

2008-01-01

To investigate the short-term psychological function of opiate addicts who have undergone ablative stereotactic surgery targeting the nucleus accumbens (NAc) for alleviating opiate drug psychological dependence. The psychological functional status of 14 opiate addicts was assessed by standardized psychological tests both before and approximately 3 months after stereotactic surgery. Standardized tests included the Wechsler Adult Intelligence Scale-Revised Chinese (WAIS-RC), the Clinical Memory Scale of Chinese (CMS), the Eysenck Personality Questionnaire (EPQ) and the Symptom Checklist 90 (SCL-90). The evaluation of psychological dimensions included intelligence, memory, personality characteristics and mental health symptoms. Compared with the preoperative state, there was no statistically significant difference in full-scale intelligence quotient (IQ) postoperatively, but without Bonferroni correction a significant decline by 13.55% (p < 0.05) was observed in the Digit Symbol-Substitution subtest of WAIS-RC. The memory quotient (MQ) of CMS demonstrated a significant decline of 10.65% (p < 0.05) postoperatively. Concerning the participants' personality characteristics, a significant postoperative increase (p < 0.05) was detected in the Psychoticism (P) trait of EPQ. The mental healthy severity indexes of SCL-90 were decreased postoperatively. After Bonferroni correction, however, there was no statistical difference between pre- and postoperative results on all assessments. Although the patients' intelligence measures were not changed significantly, their short-term memory and attention appeared to decline postoperatively. In addition, there was a trend towards change in some personality characteristics postoperatively. The postoperative mental health levels of the patients increased, indicating a trend towards improvement. Stereotactic ablation of the NAc in opiate addicts may be associated with short-term negative psychological functions. Advisement regarding the

Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty.

PubMed

Lee, Y K; Ha, Y C; Yoo, J-I; Jo, W L; Kim, K-C; Koo, K H

2017-06-01

We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

Short term response of herpetofaunal to oak-regeneration treatments on the mid-Cumberland Plateau of southern Tennessee

Treesearch

Andrew W. Cantrell; Yong Wang; Callie J. Schweitzer; Cathryn H. Greenberg

2013-01-01

We examined the short term response of herpetofauna to two treatments designed to regenerate oak in upland hardwood forest: (1) shelterwood (30–40% BA retention), and (2) oak-shelterwood (midstory removal by use of herbicide), along with controls. Research was conducted 1 and 2 years post treatment within an oak-hickory forest within the mid-Cumberland Plateau of...

Short-Term Heparin Kinetics during Catheter Ablation of Atrial Fibrillation.

PubMed

Gabus, Vincent; Rollin, Anne; Maury, Philippe; Forclaz, Andrei; Pascale, Patrizio; Dhutia, Harshil; Bisch, Laurence; Pruvot, Etienne

2015-10-01

Percutaneous catheter ablation of atrial fibrillation (CA-AF) is a treatment option for symptomatic drug-refractory atrial fibrillation (AF). CA-AF carries a risk for thromboembolic complications that has been minimized by the use of intraprocedural intravenous unfractionated heparin (UFH). The optimal administration of UFH as well as its kinetics are not well established and need to be precisely determined. A total 102 of consecutive patients suffering from symptomatic drug-refractory AF underwent CA-AF. The mean age was 61 ± 10 years old. After transseptal puncture of the fossa ovalis, weight-adjusted UFH bolus (100 U/kg) was infused. A significant increase in activated clotting time (ACT) was observed from an average value of 100 ± 27 seconds at baseline, to 355 ± 94 seconds at 10 min (T10), to 375 ± 90 seconds at 20 min (T20). Twenty-four patients failed to reach the targeted ACT value of ≥300 seconds at T10 and more than half of these remained with subtherapeutic ACT values at T20. This subset of patients showed similar clinical characteristics and amount of UFH but were more frequently prescribed preprocedural vitamin K1 than the rest of the study population. In a typical intervention setting, UFH displays unexpected slow anticoagulation kinetics in a significant proportion of procedures up to 20 minutes after infusion. These findings support the infusion of UFH before transseptal puncture or any left-sided catheterization with early ACT measurements to identify patients with delayed kinetics. They are in line with recent guidelines to perform CA-AF under therapeutic anticoagulation. © 2015 Wiley Periodicals, Inc.

Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center.

PubMed

Li, Wenda; Zhou, Xue; Huang, Zejian; Zhang, Kelin; Luo, Xuan; Zhong, Jinyi; Chen, Yajin

2017-06-01

Laparoscopic hepatectomy (LH), microwave ablation (MWA), and open hepatectomy (OH) are three widely used methods to treat small hepatocellular carcinoma (HCC). However, few studies have compared the short- and long-term outcomes of these three treatments. The aim of this study was to investigate their effectiveness. The data were reviewed from 280 patients with HCCs measuring ≤3 cm (Barcelona Clinic Liver Cancer stage 0 or A) who received LH (n = 133), OH (n = 87), or MWA (n = 60) in our research center from 2005 to 2010. Short-term outcomes included intraoperative blood loss, operation time, and length of hospital stay. The disease-free survival and overall survival rates were analyzed as long-term outcomes. The patients in the MWA and LH groups showed better short-term outcomes compared with those in the OH group. There were no significant differences in overall survival rates among the three treatments. The LH group showed significantly lower recurrence rates than the MWA group (P = 0.0146). Laparoscopic hepatectomy may be a better option for patients with small HCC located on the liver surface and left lateral lobe. The short-term outcome of MWA is promising, although the high risk of local recurrence after the operation should be considered when planning treatment. © 2016 The Japan Society of Hepatology.

Eradication of Barrett's mucosa with argon plasma coagulation and acid suppression: immediate and mid term results

PubMed Central

Van Laethem, J-L; Cremer, M; Peny, M; Delhaye, M; Deviere, J

1998-01-01

Background—Intestinal metaplastic mucosa in Barrett's oesophagus can be replaced by squamous epithelium after mucosal thermal ablation associated with acid suppression therapy. 
Aims—To assess whether restoration of squamous epithelium can be obtained after ablation of Barrett's oesophagus using argon plasma coagulation (APC) associated with proton pump inhibitor (PPI) therapy. 
Methods—Thirty one patients with Barrett's oesophagus received APC. Omeprazole (40 mg/day) was given from the first APC application to one month after completion of the treatment, then given symptomatically. Twenty four hour pH-metry was performed during endotherapy. 
Results—Complete re-epithelialisation was visualised at endoscopy in 25/31 patients (81%) after a mean number of 2.4 APC sessions (range 1-4). Only partial squamous re-epithelialisation was observed in three patients and three others had no eradication. At histological assessment, eradication of Barrett's oesophagus was only confirmed in 19/31 patients (61%) due to the presence of a few residual Barrett's glands under the new squamous epithelium. Complete eradication was related to a Barrett's oesophagus segment length of less than 4 cm and the absence of circumferential extension but not to the normalisation of oesophageal acid exposure under PPI therapy. Seventeen patients with apparently complete endoscopic and histological eradication of Barrett's oesophagus were re-evaluated at one year; eight (47%) disclosed relapsing islands of Barrett metaplasia despite continuous omeprazole therapy (10-40 mg/day). 
Conclusions—APC combined with 40 mg omeprazole daily can eradicate Barrett's mucosa with apparent squamous re-epithelialisation in the majority of patients even in the absence of normalisation of oesophageal acid exposure. However, one year after endotherapy for Barrett's oesophagus, relapse is frequent but limited in extent. 

 Keywords: Barrett's oesophagus; argon plasma coagulation; omeprazole

Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry.

PubMed

Veselka, Josef; Jensen, Morten Kvistholm; Liebregts, Max; Januska, Jaroslav; Krejci, Jan; Bartel, Thomas; Dabrowski, Maciej; Hansen, Peter Riis; Almaas, Vibeke Marie; Seggewiss, Hubert; Horstkotte, Dieter; Tomasov, Pavol; Adlova, Radka; Bundgaard, Henning; Steggerda, Robbert; Ten Berg, Jurriën; Faber, Lothar

2016-05-14

The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please

Serum Response Factor (SRF) Ablation Interferes with Acute Stress-Associated Immediate and Long-Term Coping Mechanisms.

PubMed

Zimprich, Annemarie; Mroz, Gabi; Meyer Zu Reckendorf, Christopher; Anastasiadou, Sofia; Förstner, Philip; Garrett, Lillian; Hölter, Sabine M; Becker, Lore; Rozman, Jan; Prehn, Cornelia; Rathkolb, Birgit; Moreth, Kristin; Wurst, Wolfgang; Klopstock, Thomas; Klingenspor, Martin; Adamski, Jerzy; Wolf, Eckhard; Bekeredjian, Raffi; Fuchs, Helmut; Gailus-Durner, Valerie; de Angelis, Martin Hrabe; Knöll, Bernd

2017-12-01

Stress experience modulates behavior, metabolism, and energy expenditure of organisms. One molecular hallmark of an acute stress response is a rapid induction of immediate early genes (IEGs) such as c-Fos and Egr family members. IEG transcription in neurons is mediated by the neuronal activity-driven gene regulator serum response factor (SRF). We show a first role of SRF in immediate and long-lasting acute restraint stress (AS) responses. For this, we employed a standardized mouse phenotyping protocol at the German Mouse Clinic (GMC) including behavioral, metabolic, and cardiologic tests as well as gene expression profiling to analyze the consequences of forebrain-specific SRF deletion in mice exposed to AS. Adult mice with an SRF deletion in glutamatergic neurons (Srf; CaMKIIa-CreERT2 ) showed hyperactivity, decreased anxiety, and impaired working memory. In response to restraint AS, instant stress reactivity including locomotor behavior and corticosterone induction was impaired in Srf mutant mice. Interestingly, even several weeks after previous AS exposure, SRF-deficient mice showed long-lasting AS-associated changes including altered locomotion, metabolism, energy expenditure, and cardiovascular changes. This suggests a requirement of SRF for mediating long-term stress coping mechanisms in wild-type mice. SRF ablation decreased AS-mediated IEG induction and activity of the actin severing protein cofilin. In summary, our data suggest an SRF function in immediate AS reactions and long-term post-stress-associated coping mechanisms.

Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration.

PubMed

Muzaffar, Iqbal; Zula, Pai; Yimit, Yusp; Jaan, Ajim Tuergan; Wen, Hao

2014-11-01

To compare the postoperative short-term and mid-term complications in patients who underwent CBD exploration and closure by using T-tube or primary closure. Prospective randomized clinical trial. Hepatobiliary Department of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China, from August 2009 to March 2013. A total of 148 consecutive patients with Common Bile Duct Stones (CBDS) and CBD dilation were enrolled in this randomized study to undergo open cholecystectomy with CBD exploration. Pre-operative findings, postoperative short-term complications, postoperative follow-up (mid-term), and hospital stay were recorded and analyzed. A T-tube was inserted in 76 (51.35%) patients and the primary closure was done in 72 (48.64%) patients. There were no differences in the demographic characteristics and clinical presentations between the two groups. Compared with the T-tube group 8.97 ± 1.629 days, the postoperative stay in primary closure 5.34 ± 1.25 days was significantly shorter (p < 0.01). The incidence of overall postoperative short-term complications and mid-term complications were statistically but not significantly lower in the primary closure group (9.7%) than that in T-tube group (17.10%, p=0.189). Complications in the primary closure group were lower than that in T-tube group but there was no significant statistical difference. So during open surgery for CBD stones, primary closure of CBD appeared safe and effective with shorter hospital stays and less complications.

A randomised controlled trial of ablation of Barrett's oesophagus with multipolar electrocoagulation versus argon plasma coagulation in combination with acid suppression: long term results

PubMed Central

Sharma, P; Wani, S; Weston, A P; Bansal, A; Hall, M; Mathur, S; Prasad, A; Sampliner, R E

2006-01-01

Background Many modalities have been used to ablate Barrett's oesophagus (BO). However, long term results and comparative effectiveness are unknown. Aims Our aim was to compare the long term efficacy of achieving complete reversal (endoscopic and histological) between multipolar electrocoagulation (MPEC) and argon plasma coagulation (APC) in BO patients and assess factors influencing successful ablation. Methods Patients with BO, 2–6 cm long, underwent 24 hour pH testing on proton pump inhibitor (PPI) therapy. Patients were then randomised by BO length to undergo ablation with MPEC or APC every 4–8 weeks until endoscopic reversal or maximal of six treatment sessions. Results Thirty five BO patients have been followed for at least two years following endoscopic ablation, 16 treated with MPEC and 19 with APC. There was complete reversal of BO in 24 patients (69%); 75% with MPEC and 63% with APC (p = 0.49). There was no difference in the number of sessions required in the two groups. There was no difference in age, pH results, BO length, PPI dose, or hiatal hernia size between patients with and without complete reversal. One patient developed an oesophageal stricture but there were no major complications such as bleeding or perforation. Conclusions In BO patients treated with MPEC or APC in combination with acid suppression, at long term follow up, complete reversal of BO can be maintained in approximately 70% of patients, irrespective of the technique. There are no predictors associated with achieving complete reversal of BO. Continued surveillance is still indicated in the post ablative setting. As yet, these techniques are not ready for clinical application (other than for high grade dysplasia or early oesophageal adenocarcinoma) and cannot be offered outside the research arena. PMID:16905695

The Effect of Synchronized Forced Running with Chronic Stress on Short, Mid and Long- term Memory in Rats.

PubMed

Radahmadi, Maryam; Alaei, Hojjatallah; Sharifi, Mohammad-Reza; Hosseini, Nasrin

2013-03-01

Impairment of learning and memory processes has been demonstrated by many studies using different stressors. Other reports suggested that exercise has a powerful behavioral intervention to improve cognitive function and brain health. In this research, we investigated protective effects of treadmill running on chronic stress-induced memory deficit in rats. Fifty male Wistar rats were randomly divided into five groups (n=10) as follows: Control (Co), Sham (Sh), Stress (St), Exercise (Ex) and Stress and Exercise (St & Ex) groups. Chronic restraint stress was applied by 6h/day/21days and also treadmill running at a speed 20-21m/min for 1h/day/21days. Memory function was evaluated by the passive avoidance test in different intervals (1, 7 and 21 days) after foot shock. OUR RESULTS SHOWED THAT: 1) Although exercise alone showed beneficial effects especially on short and mid-term memory (P<0.05) in comparison with control group, but synchronized exercise with stress had not significantly improved short, mid and long-term memory deficit in stressed rats. 2) Short and mid-term memory deficit was significantly (P<0.05) observed in synchronized exercise with stress and stress groups with respect to normal rats. 3) Memory deficit in synchronized exercise with stress group was nearly similar to stressed rats. 4) Helpful effects of exercise were less than harmful effects of stress when they were associated together. The data correspond to the possibility that although treadmill running alone has helpful effects on learning and memory consolidation, but when it is synchronized with stress there is no significant benefit and protective effects in improvement of memory deficit induced by chronic stress. However, it is has a better effect than no training on memory deficit in stressed rats.

Mid- to long-term outcomes of posterior decompression with instrumented fusion for thoracic ossification of the posterior longitudinal ligament.

PubMed

Koda, Masao; Furuya, Takeo; Okawa, Akihiko; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Ikeda, Osamu; Mannoji, Chikato

2016-05-01

Posterior decompression with instrumented fusion (PDF) surgery has been previously reported as a relatively safe surgical procedure for any type of thoracic ossification of the longitudinal ligament (OPLL). However, mid- to long-term outcomes are still unclear. The aim of the present study was to elucidate the mid- to long-term clinical outcome of PDF surgery for thoracic OPLL patients. The present study included 20 patients who had undergone PDF for thoracic OPLL and were followed for at least 5years. Increment change and recovery rate of the Japanese Orthopaedic Association (JOA) score were assessed. Revision surgery during the follow-up period was also recorded. Average JOA scores were 3.5 preoperatively and 7.1 at final follow-up. The average improvement in JOA score was 3.8 points and the average recovery rate was 47.0%. The JOA score showed gradual increase after surgery, and took 9months to reach peak recovery. As for neurological complications, two patients suffered postoperative paralysis, but both recovered without intervention. Six revision surgeries in four patients were related to OPLL. Additional anterior thoracic decompression for remaining ossification at the same level of PDF surgery was performed in one patient. Decompression surgery for deterioration of symptoms of pre-existing cervical OPLL was performed in three patients. One patient had undergone lumbar and cervical PDF surgery for de novo ossification foci of the lumbar and cervical spine. PDF surgery for thoracic OPLL is thus considered a relatively safe and stable surgical procedure considering the mid- to long-term outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nonthermal ablation in the rat brain using focused ultrasound and an ultrasound contrast agent: long-term effects

PubMed Central

McDannold, Nathan; Zhang, Yongzhi; Vykhodtseva, Natalia

2016-01-01

OBJECTIVE Thermal ablation with transcranial MRI-guided focused ultrasound (FUS) is currently under investigation as a less invasive alternative to radiosurgery and resection. A major limitation of the method is that its use is currently restricted to centrally located brain targets. The combination of FUS and a microbubble-based ultrasound contrast agent greatly reduces the ultrasound exposure level needed to ablate brain tissue and could be an effective means to increase the “treatment envelope” for FUS in the brain. This method, however, ablates tissue through a different mechanism: destruction of the microvasculature. It is not known whether nonthermal FUS ablation in substantial volumes of tissue can safely be performed without unexpected effects. The authors investigated this question by ablating volumes in the brains of normal rats. METHODS Overlapping sonications were performed in rats (n = 15) to ablate a volume in 1 hemisphere per animal. The sonications (10-msec bursts at 1 Hz for 60 seconds; peak negative pressure 0.8 MPa) were combined with the ultrasound contrast agent Optison (100 μl/kg). The rats were followed with MRI for 4–9 weeks after FUS, and the brains were examined with histological methods. RESULTS Two weeks after sonication and later, the lesions appeared as cyst-like areas in T2-weighted MR images that were stable over time. Histological examination demonstrated well-defined lesions consisting of a cyst-like cavity that remained lined by astrocytic tissue. Some white matter structures within the sonicated area were partially intact. CONCLUSIONS The results of this study indicate that nonthermal FUS ablation can be used to safely ablate tissue volumes in the brain without unexpected delayed effects. The findings are encouraging for the use of this ablation method in the brain. PMID:26848919

Percutaneous Transluminal Angioplasty of Hepatic Artery Stenosis in Patients After Orthotopic Liver Transplantation: Mid-term Results

SciTech Connect

Jarmila, Lastovickova, E-mail: jala@ikem.cz; Jan, Peregrin

2011-12-15

Purpose: This study was designed to present our experience with percutaneous treatment of hepatic artery stenosis in orthotopic liver transplant patients and to evaluate the efficacy, technical outcomes, and mid-term clinical results of the procedure. Methods: Twenty-two percutaneous transluminal angioplasties (PTAs) were performed in 19 liver transplant recipients at our institution between 1998 and 2010. Stents were placed into the hepatic/celiac artery in 16 PTAs, but balloon dilatation alone was performed in 6 because of the anatomical condition of the vessel. PTA/stenting was indicated in 17 patients because of elevated liver enzymes; 2 patients were asymptomatic. The objective of treatingmore » stenosis was prevention of long-term complications, including thrombosis. Results: Technical success was achieved in all patients. There was only one complication: dissection of the treated artery without any subsequent adverse effects. In all patients, elevated liver enzyme levels improved after treatment. No restenosis was observed in any patient during a mean follow-up of 2.6 years (1 month to 5.5 years). Conclusions: Percutaneous angioplasty/stent placement is a safe method for the treatment of hepatic artery stenosis after orthotopic liver transplantation, with a high technical success rate and promising mid-term results.« less

Long-term Bat Monitoring on Islands, Offshore Structures, and Coastal Sites in the Gulf of Maine, mid-Atlantic, and Great Lakes—Final Report

SciTech Connect

Peterson, Trevor; Pelletier, Steve; Giovanni, Matt

This report summarizes results of a long-term regional acoustic survey of bat activity at remote islands, offshore structures, and coastal sites in the Gulf of Maine, Great Lakes, and mid-Atlantic coast.

Endometrial Ablation

MedlinePlus

... or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be needed. ... ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding ...

Radiofrequency Ablation of Uterine Fibroids: a Review.

PubMed

Lee, Bruce B; Yu, Steve P

2016-01-01

Laparoscopic, ultrasound-guided radiofrequency ablation (RFA) is a new, FDA-cleared uterine sparing, outpatient procedure for uterine fibroids. The procedure utilizes recent technological advancements in instrumentation and imaging, allowing surgeons to treat numerous fibroids of varying size and location in a minimally invasive fashion. Early and mid-term data from multi-center clinical trials have demonstrated safety and efficacy, with resolution or improvement of symptoms and significant volume reduction. Re-intervention rates for fibroid symptoms have been low. The procedure is well tolerated with a typically uneventful and rapid recovery requiring NSAIDs only for postoperative pain. While post RFA pregnancy data are limited, the results are promising.

Long-Term Clinical Outcomes of Myopic Patients Having Thin Residual Corneal Thickness after Excimer Laser Surface Ablation.

PubMed

Kocamış, Sücattin İlker; Çakmak, Hasan Basri; Gerçeker, Sıdıka; Çağıl, Nurullah

2017-01-01

To investigate and compare the long-term safety, efficacy, and accuracy of PRK (photorefractive keratectomy) and LASEK (laser epithelial keratomileusis) in myopic corneas having residual corneal thickness less than 400 micron meters (µm). The medical reports of the patients who had undergone excimer laser surface ablation between 2007-2011 and had a residual corneal thickness less than 400 µm were retrospectively reviewed. Forty-two eyes of 42 patients with a mean age of 28.79±7.76 years were enrolled into the study. Twenty-two PRK and 20 LASEK procedures were performed. The mean follow-up time was 45.00±11.80 months. At the end of follow-up, no ectasia was detected. Nineteen percent of eyes had trace haze. No eyes lost any lines in corrected distance visual acuity. Eighty-one percent of the patients had an uncorrected distance visual acuity better than 20/40. The regression rate was 16.7%. Sixty-two percent of eyes were within ±1.00 D. The safety and efficacy indexes were 1.19±0.42 and 1.00±0.40, respectively. There was not any difference between LASEK and PRK regarding achieved spherical equivalent refraction, haze ratio, visual acuity, safety, efficacy, and regression. Both PRK and LASEK are safe and effective in myopic corneas having thin residual thickness.

Hepatocellular Carcinoma within Milan Criteria: No-Touch Multibipolar Radiofrequency Ablation for Treatment-Long-term Results.

PubMed

Seror, Olivier; N'Kontchou, Gisèle; Nault, Jean-Charles; Rabahi, Yacine; Nahon, Pierre; Ganne-Carrié, Nathalie; Grando, Véronique; Zentar, Nora; Beaugrand, Michel; Trinchet, Jean-Claude; Diallo, Abou; Sellier, Nicolas

2016-08-01

Purpose To assess the long-term outcome in 108 consecutive patients treated with no-touch multibipolar radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) that met the Milan criteria. Materials and Methods This retrospective study was approved by the ethical review board, and the need to obtain informed consent was waived. Between November 1, 2006, and December 31, 2011, 132 HCC tumors (diameter, 10-45 mm; 39 tumors ≥ 30 mm) in 108 consecutive patients (106 with cirrhosis) that met Milan criteria were treated with no-touch multibipolar RFA, which consisted of activating, in bipolar mode, three or four electrodes inserted just beyond the tumor margins. Follow-up was performed every 3 months for 2 years and every 6 months thereafter with computed tomographic or magnetic resonance imaging. Survival probabilities were computed by using the Kaplan-Meier method. Predictive factors of tumor progression and overall survival were assessed by using the Cox proportional hazard model. Results No technical failure occurred, and complete ablation was achieved for all the nodules. After a median of 40.5 months (range, 2-84 months) of follow-up, 3- and 5-year local and overall tumor progression-free survival were 96%, 94%, 52%, and 32%, respectively. Neither tumor diameter greater than 30 mm nor location abutting a large vessel were associated with local tumor progression. Tumor diameter greater than 30 mm was the only parameter predictive of overall tumor progression (P = .0036). Independent factors associated with shorter overall survival were Child-Pugh class B disease, age greater than 65 years, and platelet count of less than 150 g/L (P < .003). Three major complications occurred (2.7%): hemothorax in one patient and liver failure in two, with major portal-systemic shunts. One patient (0.9%) died, and one underwent transplantation. Conclusion No-touch multibipolar RFA for HCC tumors that meet Milan criteria provides a high local tumor progression-free survival

Long-term outcomes after hepatic resection combined with radiofrequency ablation for initially unresectable multiple and bilobar liver malignancies.

PubMed

Qiu, Jianguo; Chen, Shuting; Wu, Hong

2014-05-01

Hepatic resection (HRE) combined with radiofrequency ablation (RFA) offers a surgical option to a group of patients with multiple and bilobar liver malignancies who are traditionally unresectable for inadequate functional hepatic reserve. The aims of the present study were to assess the perioperative outcomes, recurrence, and long-term survival rates for patients treated with HRE plus RFA in the management of primary hepatocellular carcinoma (HCC) and metastatic liver cancer (MLC). Data from all consecutive patients with primary and secondary hepatic malignancies who were treated with HRE combined with RFA between 2007 and 2013 were prospectively collected and retrospectively reviewed. A total of 112 patients, with 368 hepatic tumors underwent HRE combined with ultrasound-guided RFA, were included in the present study. There were 40 cases of HCC with 117 tumors and 72 cases of MLC with 251 metastases. Most cases of liver metastases originated from the gastrointestinal tract (44, 61.1%). Other uncommon lesions included breast cancer (5, 6.9%), pancreatic cancer (3, 4.2%), lung cancer (4, 5.6%), cholangiocarcinoma (4, 5.6%), and so on. The ablation success rates were 93.3% for HCC and 96.7% for MLC. The 1-, 2-, 3-, 4-, and 5-y overall recurrence rates were 52.5%, 59.5%, 72.3%, 75%, and 80% for the HCC group and 44.4%, 52.7%, 56.1%, 69.4%, and 77.8% for the MLC group, respectively. The 1-, 2-, 3-, 4-, and 5-y overall survival rates for the HCC patients were 67.5%, 50%, 32.5%, 22.5%, and 12.5% and for the MLC patients were 66.5%, 55.5%, 50%, 30.5%, and 19.4%, respectively. The corresponding recurrence-free survival rates for the HCC patients were 52.5%, 35%, 22.5%, 15%, and 10% and for the MLC patients were 58.3%, 41.6%, 23.6%, 16.9%, and 12.5%, respectively. HRE combined with RFA provides an effective treatment approach for patients with primary and secondary liver malignancies who are initially unsuitable for radical resection, with high local tumor control rates and

Ablation of atrial fibrillation with concomitant cardiac surgery.

PubMed

Gillinov, A Marc; Saltman, Adam E

2007-01-01

Atrial fibrillation is present in approximately 35% of patients presenting for mitral valve surgery and in 1 to 6% of adult patients undergoing other forms of cardiac surgery. If left untreated, atrial fibrillation is associated with increased morbidity, and, in some subgroups, increased mortality. Therefore, concomitant management of the arrhythmia is indicated in most cardiac surgery patients with preexisting atrial fibrillation. Although the cut-and-sew Cox-maze III procedure is extremely effective, it has been supplanted by newer operations that rely on alternate energy sources to create lines of conduction block. Early and mid-term results are good with a variety of technologies. Choice of lesion set remains a matter of debate, but results of ablation appear to be enhanced by a biatrial lesion set. Targeted areas for improvement in concomitant ablation include acceptance of uniform standards for reporting results, development of improved technology for ablation and intraoperative assessment, and creation of instrumentation that facilitates minimally invasive approaches.

Percutaneous laser-assisted recanalization of long chronic iliac artery occlusions: primary and mid-term results.

PubMed

Balzer, Jörn O; Gastinger, Verena; Thalhammer, Axel; Ritter, Ralf G; Lindhoff-Last, Edelgard; Schmitz-Rixen, Thomas; Vogl, Thomas J

2006-02-01

We report the primary and mid-term outcome of patients with long chronic iliac artery occlusions after percutaneous excimer-laser-assisted interventional recanalization. Between 2000 and 2001, 43 patients with 46 chronic occlusions of either the common iliac artery (n=27), the external iliac artery ( n=13) or both (n=3) underwent laser-assisted percutaneous transluminal angioplasty and implantation of stents. The average length of the occlusion was 57.1+/-26 mm. After laser-assisted angioplasty and implantation of a total of 60 stents, the patients were followed up for up to 4 years. Patency rates were analyzed by ankle-brachial index (ABI) measurement and duplex ultrasound. The primary technical success rate was 95.3%, with a major complication rate of 6.9%. Clinical improvement as categorized by the Rutherford guidelines could be observed in 97.6% of cases. The ABI of all patients improved from an average of 0.46+/-0.08 before intervention to 0.97+/-0.13 at the end of the follow-up period. The overall primary patency rate was 86.1%. Four reinterventions were successful (secondary patency rate 95.4%). The mid-term results of the percutaneous recanalization of iliac artery occlusions with primary and secondary patency rates of 86.1 and 95.4% are similar to those of the treatment of short stenoses.

US-guided percutaneous microwave ablation versus open radical nephrectomy for small renal cell carcinoma: intermediate-term results.

PubMed

Yu, Jie; Liang, Ping; Yu, Xiao-ling; Cheng, Zhi-gang; Han, Zhi-yu; Zhang, Xu; Dong, Jun; Mu, Meng-juan; Li, Xin; Wang, Xiao-hui

2014-03-01

To review intermediate-term clinical outcomes of microwave ablation (MWA) compared with open radial nephrectomy (ORN) in small renal cell carcinoma (RCC) patients and to identify prognostic factors associated with two techniques. This retrospective study was institutional review board-approved. A total of 163 patients (127 men and 36 women) with small RCC (≤4 cm) were included from April 2006 to March 2012. Sixty-five patients underwent MWA and 98 patients underwent ORN. Survival, recurrence, and renal function changes were compared between the two groups. Effect of changes in key parameters (ie, overall survival, RCC-related survival, and metastasis-free survival) was statistically analyzed with the log-rank test. Although overall survival after MWA was lower than that after ORN (P = .002), RCC-related survival was comparable to ORN (P = .78). Estimated 5-year overall survival rates were 67.3% after MWA and 97.8% after ORN; for RCC-related survival, estimated 5-year rates were 97.1% after MWA and 97.8% after ORN. There was one local tumor recurrence 32 months after MWA and none after ORN. Major complication rates were comparable (P = .81) between the two techniques (MWA, 2.5% vs ORN, 3.1%). The MWA group had less surgical time (P < .001), estimated blood loss (P < .001), and postoperative hospitalization (P < .001). Multivariate analysis showed age (P = .014), tumor type (P = .003), postoperative urea nitrogen (P = .042), comorbid disease (P = .005), and treatment modality (P < .001) may become survival rate predictors. In intermediate term, ultrasonographically guided percutaneous MWA and ORN provide comparable results in oncologic outcomes. MWA appears to be a safe and effective technique for management of small RCC in patients with little loss of renal function. RSNA, 2013

Early and mid-term outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysm†.

PubMed

Hori, Daijiro; Okamura, Homare; Yamamoto, Takahiro; Nishi, Satoshi; Yuri, Koichi; Kimura, Naoyuki; Yamaguchi, Atsushi; Adachi, Hideo

2017-06-01

With the introduction of endovascular stent graft technology, a variety of surgical options are available for patients with aortic aneurysms. We sought to evaluate early-term and mid-term outcomes of patients undergoing endovascular and open surgical repair for non-dissected aortic arch aneurysm. Overall, 200 patients underwent treatment for isolated non-dissected aortic arch aneurysm between January 2008 and February 2016: 133 patients had open surgery and 67, endovascular repair. Early-term and mid-term outcomes were compared. Seventy percent ( n  = 47) needing endovascular repair underwent fenestrated stent graft and 30% ( n  = 20) underwent the debranched technique. Patients in the open surgery group were younger (71 vs 75 years, P  < 0.001) and had a lower prevalence of ischaemic heart disease (11% vs 35%, P  < 0.001). Intensive care unit stay (1 vs 3 days, P  < 0.001), hospital stay (11 vs 17 days, P  < 0.001) and surgical time (208 vs 390 min, P  < 0.001) were lower in the endovascular repair group than in the open surgery group. There were 3 in-hospital deaths each in the open surgery and endovascular groups (2% vs 5%, respectively, P  = 0.40). Mid-term survival ( P  < 0.001) and freedom from reintervention ( P  = 0.009) were better in the open surgery than in the endovascular repair group. No aneurysm-related deaths were observed. The propensity-matched comparison ( n  = 58) demonstrated that survival was better in the open surgery group ( P  = 0.011); no significant difference was seen in the reintervention rate ( P  = 0.28). Close follow-up for re-intervention may reduce the risk for aneurysm-related deaths and provide acceptable outcomes in patients undergoing endovascular repair. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

A Lagrangian analysis of mid-latitude stratospheric ozone variability and long-term trends.

NASA Astrophysics Data System (ADS)

Koch, G.; Wernli, H.; Staehelin, J.; Peter, T.

2002-05-01

A systematic Lagrangian investigation is performed of wintertime high-resolution stratospheric ozone soundings at Payerne, Switzerland, from January 1970 to March 2001. For every ozone sounding, 10-day backward trajectories have been calculated on 16 isentropic levels using NCEP reanalysis data. Both the minimum/maximum latitude and potential vorticity (PV) averaged along the trajectories are used as indicators of the air parcels' ``origin''. The importance of transport for the understandin g of single ozone profiles is confirmed by a statistical analysis which shows that negative/positive ozone deviations gener ally coincide with transport from regions with climatologically low/high ozone values. The stable relationship between PV and ozone for the 32 year period indicates either no direct chemical impact or no temporal change of this impact. In the upper layer the PV-ozone relationship changes significantly after 1987 and a separate trend analysis for air masses transported from the polar, midlatitude and subtropical regions shows negative ozone trends in all three categories (with a maximum for the polar region). This is not direct evidence for, but would be in agreement with, an increased chemical ozone depletion in the Arctic since the late 1980s. The reasons for the negative trend in the mid-stratospheric air masses with subtropical origin that are in qualitative agreement with recent satellite observations are presently unknown.

A patient cohort on long-term sequelae of sepsis survivors: study protocol of the Mid-German Sepsis Cohort.

PubMed

Scherag, André; Hartog, Christiane S; Fleischmann, Carolin; Ouart, Dominique; Hoffmann, Franziska; König, Christian; Kesselmeier, Miriam; Fiedler, Sandra; Philipp, Monique; Braune, Anke; Eichhorn, Cornelia; Gampe, Christin; Romeike, Heike; Reinhart, Konrad

2017-08-23

An increasing number of patients survive sepsis; however, we lack valid data on the long-term impact on morbidity from prospective observational studies. Therefore, we designed an observational cohort to quantify mid-term and long-term functional disabilities after intensive care unit (ICU)-treated sepsis. Ultimately, findings for the Mid-German Sepsis Cohort (MSC) will serve as basis for the implementation of follow-up structures for patients with sepsis and help to increase quality of care for sepsis survivors. All patients surviving ICU-treated sepsis are eligible and are recruited from five study centres in Germany (acute care hospital setting in Jena, Halle/Saale, Leipzig, Bad Berka, Erfurt; large long-term acute care hospital and rehabilitation setting in Klinik Bavaria Kreischa). Screening is performed by trained study nurses. Data are collected on ICU management of sepsis. On written informed consent provided by patients or proxies, follow-up is carried out by trained research staff at 3, 6 and 12 months and yearly thereafter. The primary outcome is functional disability as assessed by (instrumental) activities of daily living. Other outcomes cover domains like mortality, cognitive, emotional and physical impairment, and resource use. The estimated sample size of 3000 ICU survivors is calculated to allow detection of relevant changes in the primary outcome in sepsis survivors longitudinally. The study is conducted according to the current version of the Declaration of Helsinki and has been approved by four local/federal responsible institutional ethics committees and by the respective federal data protection commissioners. Results of MSC will be fed back to the patients and published in peer-reviewed journals. German Clinical Trials Registry DRKS00010050. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Comorbidities and Ventricular Dysfunction Drive Excess Mid-Term Morbidity in an Indigenous Australian Coronary Revascularisation Cohort.

PubMed

Wiemers, Paul D; Marney, Lucy; White, Nicole; Bough, Georgina; Hustig, Alistair; Tan, Wei; Cheng, Ching-Siang; Kang, Dong; Yadav, Sumit; Tam, Robert; Fraser, John F

2018-04-24

There is a paucity of data in regards to longer term morbidity outcomes in Indigenous Australian patients undergoing coronary artery bypass grafting (CABG). No comparative data on re-infarction, stroke or reintervention rates exist. Outcome data following percutaneous coronary intervention (PCI) is also extremely limited. Addressing this gap in knowledge forms the major aim of our study. This was a single centre cohort study conducted at the Townsville Hospital, Australia which provides tertiary adult cardiac surgical services to the northern parts of the state of Queensland. It incorporated consecutive patients (n=350) undergoing isolated CABG procedures, 2008-2010, 20.9% (73/350) of whom were Indigenous Australians. The main outcome measures were major adverse cardiac or cerebrovascular events (MACCE) at mid-term follow-up (mean 38.9 months). The incidence of MACCE among Indigenous Australian patients was approximately twice that of non-Indigenous patients at mid-term follow-up (36.7% vs. 18.6%; p=0.005; OR 2.525 (1.291-4.880)). Following adjustment for preoperative and operative variables, Indigenous Australian status itself was not significantly associated with MACCE (AOR 1.578 (0.637-3.910)). Significant associations with MACCE included renal impairment (AOR 2.198 (1.010-4.783)) and moderate-severe left ventricular impairment (AOR 3.697 (1.820-7.508)). An association between diabetes and MACCE failed to reach statistical significance (AOR 1.812 (0.941-3.490)). Indigenous Australians undergoing CABG suffer an excess of MACCE when followed-up in the longer term. High rates of comorbidities in the Indigenous Australian population likely play an aetiological role. Copyright © 2018. Published by Elsevier B.V.

Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry.

PubMed

Sánchez-Santos, Raquel; Masdevall, Carlos; Baltasar, Aniceto; Martínez-Blázquez, Candido; García Ruiz de Gordejuela, Amador; Ponsi, Enric; Sánchez-Pernaute, Andres; Vesperinas, Gregorio; Del Castillo, Daniel; Bombuy, Ernest; Durán-Escribano, Carlos; Ortega, Luis; Ruiz de Adana, Juan Carlos; Baltar, Javier; Maruri, Ignacio; García-Blázquez, Emilio; Torres, Antonio

2009-09-01

Reports on laparoscopic sleeve gastrectomy (LSG) communicate very good short-term results on very high-risk morbid obese patients. However, mid- and long-term results are still unknown. A National Registry has been created in Spain to achieve information on the outcomes of this bariatric procedure. Data were obtained from 17 centers and collected in a database. Technical issues, preoperative comorbid conditions, hospital stay, early and late complications, and short- and mid-term weight loss were analyzed. Five hundred forty patients were included; 76% were women. Mean BMI was 48.1 +/- 10. Mean age was 44.1 +/- 11.8. Morbidity rate was 5.2% and mortality rate 0.36%. Complications presented more frequently in superobese patients (OR, 2.8 (1.18-6.65)), male (OR, 2.98 (1.26-7.0)), and patients >55 years old (OR, 2.8 (1.14-6.8)). Staple-line reinforcement was related to a lower complication rate (3.7 vs 8.8%; p = 0.039). Mean hospital stay was 4.8 +/- 8.2 days. Mean follow-up was 16.5 +/- 10.6 months (1-73). Mean percent excess BMI loss (EBL) at 3 months was 38.8 +/- 22, 55.6 +/- 8 at 6 months, 68.1 +/- 28 at 12 months, and 72.4 +/- 31 at 24 months. %EBL was superior in patients with lower initial BMI and lower age. Bougie caliber was an inverse predictive factor of %EBL at 12 and 24 months (RR, 23.3 (11.4-35.2)). DM is remitted in 81% of the patients and HTA improved in 63.2% of them. A second-stage surgery was performed in 18 patients (3.2%). LSG provides good short- and mid-term results with a low morbid-mortality rate. Better results are obtained in younger patients with lowest BMI. Staple-line reinforcement and a thinner bougie are recommended to improve outcome.

Early lens ablation causes dramatic long-term effects on the shape of bones in the craniofacial skeleton of Astyanax mexicanus.

PubMed

Dufton, Megan; Hall, Brian K; Franz-Odendaal, Tamara A

2012-01-01

The Mexican tetra, Astyanax mexicanus, exists as two morphs of a single species, a sighted surface morph and a blind cavefish. In addition to eye regression, cavefish have an increased number of taste buds, maxillary teeth and have an altered craniofacial skeleton compared to the sighted morph. We investigated the effect the lens has on the development of the surrounding skeleton, by ablating the lens at different time points during ontogeny. This unique long-term study sheds light on how early embryonic manipulations on the eye can affect the shape of the adult skull more than a year later, and the developmental window during which time these effects occur. The effects of lens ablation were analyzed by whole-mount bone staining, immunohistochemisty and landmark based morphometric analyzes. Our results indicate that lens ablation has the greatest impact on the skeleton when it is ablated at one day post fertilisation (dpf) compared to at four dpf. Morphometric analyzes indicate that there is a statistically significant difference in the shape of the supraorbital bone and suborbital bones four through six. These bones expand into the eye orbit exhibiting plasticity in their shape. Interestingly, the number of caudal teeth on the lower jaw is also affected by lens ablation. In contrast, the shape of the calvariae, the length of the mandible, and the number of mandibular taste buds are unaltered by lens removal. We demonstrate the plasticity of some craniofacial elements and the stability of others in the skull. Furthermore, this study highlights interactions present between sensory systems during early development and sheds light on the cavefish phenotype.

Significant effects of atrioventricular node ablation and pacemaker implantation on left ventricular function and long-term survival in patients with atrial fibrillation and left ventricular dysfunction.

PubMed

Ozcan, Cevher; Jahangir, Arshad; Friedman, Paul A; Munger, Thomas M; Packer, Douglas L; Hodge, David O; Hayes, David L; Gersh, Bernard J; Hammill, Stephen C; Shen, Win-Kuang

2003-07-01

Control of ventricular rate by atrioventricular node ablation and pacemaker implantation in patients with drug-refractory atrial fibrillation (AF) is associated with improved left ventricular (LV) function. The objective of this study was to determine the effect of atrioventricular node ablation on long-term survival in patients with AF and LV dysfunction. Survival was determined by the Kaplan-Meier method for 56 study patients with LV ejection fraction (EF) < or =40% who underwent atrioventricular node ablation and pacemaker implantation and 56 age- and gender-matched control patients with AF and LVEF >40%, and age- and gender-matched control subjects from Minnesota. Groups were compared using the log-rank test. In study patients (age 69 +/- 10 years; 45 men), LVEF was 26% +/- 8% and 34% +/- 13% (p <0.001) before and after ablation, respectively. During follow-up (40 +/- 23 months), 23 patients died. Observed survival was worse than that of normal subjects (p <0.001) and control patients (p = 0.005). After ablation, LVEF nearly normalized (> or =45%) in 16 study patients (29%), in whom observed survival was comparable to that of normal subjects (p = 0.37). Coronary artery disease, hyperlipidemia, chronic renal failure, previous myocardial infarction, and coronary artery operation were independent predictors for mortality. Near normalization of LVEF occurred in 29% of study patients, suggesting that AF-induced EF reduction is reversible in many patients. Normal survival in patients with reversible LV dysfunction highlights potential survival benefits of rate control. Poor survival in patients with persistent LV dysfunction confirms the importance of optimal medical therapy.

Ablation for Atrial Fibrillation

PubMed Central

2006-01-01

. Ablation involves directing an energy source at cardiac tissue. For instance, radiofrequency energy uses heat to burn tissue near the source of the arrhythmia. The purpose is to create a series of scar tissue, so that the aberrant electrical pathways can no longer exist. Because the pulmonary veins are the predominant source of AF initiation, the primary goal of ablation is to isolate the pulmonary veins from the left atria through the creation of a conduction block. There are 2 methods of ablation: catheter ablation and surgical (operative) ablation. Radiofrequency energy is most commonly used for ablation. Catheter ablation involves inserting a catheter through the femoral vein to access the heart and burn abnormal foci of electrical activity by direct contact or by isolating them from the rest of the atrium. The surgical ablation is performed minimally invasively via direct visualization or with the assistance of a special scope for patients with lone AF. Review Strategy In March 2006, the following databases were searched: Cochrane Library International Agency for Health Technology Assessment (first quarter 2006), Cochrane Database of Systematic Reviews (first quarter 2006), Cochrane Central Register of Controlled Trials (first quarter 2006), MEDLINE (1966 to February 2006), MEDLINE In-Process and Other Non-indexed Citations (1966 to March 1, 2006), and EMBASE (1980 to 2006 week 9). The Medical Advisory Secretariat also searched Medscape on the Internet for recent reports on trials that were unpublished but that were presented at international conferences. In addition, the Web site Current Controlled Trials (www.controlled-trials.com) was searched for ongoing trials investigating ablation for atrial fibrillation. Search terms included: radiofrequency ablation, catheter ablation and atrial fibrillation. Summary of Findings Sixteen RCTs were identified that compared ablation methods in patients with AF. Two studies were identified that investigated first-line therapy for

Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview

PubMed Central

2012-01-01

Background The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint. Methods To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years) of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%). Nine patients (32%) developed impingement symptoms and in 7 patients (25%) subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14%) developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11%) had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications. Conclusions The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate. PMID:22236647

Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene.

PubMed

Petis, Stephen M; Vasarhelyi, Edward M; Lanting, Brent A; Howard, James L; Naudie, Douglas D R; Somerville, Lyndsay E; McCalden, Richard W

2016-02-01

The choice of bearing articulation for total hip arthroplasty in younger patients is amenable to debate. We compared mid-term patient-reported outcomes and survivorship across 2 different bearing articulations in a young patient cohort. We reviewed patients with cobalt-chrome or oxidized zirconium on highly crosslinked polyethylene who were followed prospectively between 2004 and 2012. Kaplan-Meier analysis was used to determine predicted cumulative survivorship at 5 years with all-cause and aseptic revisions as the outcome. We compared patient-reported outcomes, including the Harris hip score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short-form 12 (SF-12) scores. A total of 622 patients were followed during the study period. Mean follow-up was 8.2 (range 2.0-10.6) years for cobalt-chrome and 7.8 (range 2.1-10.7) years for oxidized zirconium. Mean age was 54.9 ± 10.6 years for cobalt-chrome and 54.8 ± 10.7 years for oxidized zirconium. Implant survivorship was 96.0% (95% confidence interval [CI] 94.9%-97.1%) for cobalt-chrome and 98.7% (95% CI 98.0%-99.4%) for oxidized zirconium on highly crosslinked polyethylene for all-cause revisions, and 97.2% (95% CI 96.2%-98.2%) for cobalt-chrome and 99.0% (95% CI 98.4%-99.6%) for oxidized zirconium for aseptic revisions. An age-, sex- and diagnosis-matched comparison of the HHS, WOMAC and SF-12 scores demonstrated no significant changes in clinical outcomes across the groups. Both bearing surface couples demonstrated excellent mid-term survivorship and outcomes in young patient cohorts. Future analyses on wear and costs are warranted to elicit differences between the groups at long-term follow-up.

Mid-term morbidity and mortality of patients after arterial switch operation in infancy for transposition of the great arteries.

PubMed

Rodríguez Puras, María José; Cabeza-Letrán, Luisa; Romero-Vazquianez, Manuela; Santos de Soto, José; Hosseinpour, Reza; Gil Fournier, Mauro; Alvarez Madrid, Antonio; González, Antonio; Pérez, Pilar; Gallego, Pastora

2014-03-01

The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. We sought to determine the mid-term results of this intervention. A single-institution retrospective review of clinical records of all consecutive patients who underwent the arterial switch surgery between 1985 and 2010. Overall, the operation was performed on 155 patients (68% boys) at a median age of 13 days: 64% with an intact septum, 46% with a ventricular septal defect, and 4.5% with associated aortic arch anomaly. The usual coronary pattern was found in 63%. Palliative surgery was performed prior to arterial switch in 6.5%. In all, 137 perioperative survivors were followed for a median of 6 years. Late mortality was 2.9%, of which 50% was due to coronary complications. Eighteen percent required surgical and/or percutaneous reintervention: 95.6% for right-sided obstruction and 4.3% for aortic regurgitation. At last follow-up, 92% had functional class I symptoms and 95% were free of arrhythmias. The left ventricular ejection fraction was greater than 55% in 95%, 28% had neoaortic regurgitation (78% mild regurgitation), and 31% had right ventricular outflow tract obstruction with a mean gradient according to echocardiography greater than 25mmHg. Mid-term survival of patients after arterial switch operation is excellent and their functional status is good. However, a few patients have residual lesions and a need for further intervention during follow-up, mostly for right-sided obstructions. Late mortality was uncommon and was related to coronary complications. Neoaortic root dilation and regurgitation are not major issues in early adulthood, but the long-term course of these lesions is still unknown. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Thyroid Lobe Ablation with Radioactive Iodine as an Alternative to Completion Thyroidectomy After Hemithyroidectomy in Patients with Follicular Thyroid Carcinoma: Long-Term Follow-Up

PubMed Central

Goldfarb, Melanie; Parangi, Sareh; Yang, Jingyun; Ross, Douglas S.; Daniels, Gilbert H.

2012-01-01

Background Radioactive iodine lobe ablation (RAI-L-ABL) is a possible alternative to completion thyroidectomy (C-Tx) for follicular thyroid carcinoma (FTC), but no long-term outcome data are available after lobe ablation. We analyzed the long-term outcome of lobe ablation in a series of patients with FTC. Methods This was a retrospective study of patients who were treated with lobe ablation between 1983 and 2008. Of 134 patients with FTC, 37 (27.6%) had lobe ablation with 131I (30–32 mCi) (RAI-L-ABL), 68 (50.7%) had C-Tx, and 29 (21.6%) had initial total thyroidectomy (T-Tx). The main outcomes analyzed were 131I uptake after lobe ablation, C-Tx or T-Tx, serum thyroglobulin (Tg), serum thyroid-stimulating hormone (TSH), long-term disease-specific mortality, and disease-free survival. Results After lobe ablation, radioiodine uptake was significantly lower for the RAI-L-ABL group (0.6%) than for the C-Tx group (2.0%, p<0.005) or T-Tx group (1.3%, p=0.054). Subsequent remnant ablation was performed in 12 of 37 (32%) patients in the RAI-L-ABL group, in 58 of 68 (85.3%) patients in the C-Tx group, and in 25 of 29 (86.2%) patients in the T-Tx group (p<0.01). With median follow-up of 95 months for the RAI-L-ABL group, 47 months for the C-Tx group, and 53 months for the T-Tx group, there was one death in the RAI-L-ABL group and one death in the T-Tx group. No other RAI-L-ABL patients had detectable disease, whereas patients in the C-Tx group and two patients in the T-Tx group had detectable disease (p=0.18). Long-term stimulated or suppressed Tg of <1 ng/mL were found in 87.5% of the RAI-L-ABL group (n=28), 86.3% of the C-Tx group (n=57), and 77.8% of the T-Tx group (n=21). Tg was detectable in 40.6% of the RAI-L-ABL group compared to 13.8% of C-Tx and 28.6% of T-Tx groups (p<0.05, between groups). Conclusions RAI-L-ABL, C-Tx, and T-Tx are equally effective in achieving serum TSH concentrations of >25 mIU/L and preparing patients for conventional 131I treatment and

Mid-term periodicities and heliospheric modulation of coronal index and solar flare index during solar cycles 22-23

NASA Astrophysics Data System (ADS)

Singh, Prithvi Raj; Saxena, A. K.; Tiwari, C. M.

2018-04-01

We applied fast Fourier transform techniques and Morlet wavelet transform on the time series data of coronal index, solar flare index, and galactic cosmic ray, for the period 1986-2008, in order to investigate the long- and mid-term periodicities including the Rieger ({˜ }130 to {˜ }190 days), quasi-period ({˜ }200 to {˜ }374 days), and quasi-biennial periodicities ({˜ }1.20 to {˜ }3.27 years) during the combined solar cycles 22-23. We emphasize the fact that a lesser number of periodicities are found in the range of low frequencies, while the higher frequencies show a greater number of periodicities. The rotation rates at the base of convection zone have periods for coronal index of {˜ }1.43 years and for solar flare index of {˜ }1.41 year, and galactic cosmic ray, {˜ }1.35 year, during combined solar cycles 22-23. In relation to these two solar parameters (coronal index and solar flare index), for the solar cycles 22-23, we found that galactic cosmic ray modulation at mid cut-off rigidity (Rc = 2.43GV) is anti-correlated with time-lag of few months.

Mid-term changes in blood metal ion levels after Articular Surface Replacement arthroplasty of the hip.

PubMed

Galea, V P; Laaksonen, I; Matuszak, S J; Connelly, J W; Muratoglu, O; Malchau, H

2017-04-01

Our first aim was to determine whether there are significant changes in the level of metal ions in the blood at mid-term follow-up, in patients with an Articular Surface Replacement (ASR) arthroplasty. Secondly, we sought to identify risk factors for any increases. The study involved 435 patients who underwent unilateral, metal-on-metal (MoM) hip resurfacing (HRA) or total hip arthroplasty (THA). These patients all had one measurement of the level of metal ions in the blood before seven years had passed post-operatively (early evaluation) and one after seven years had passed post-operatively (mid-term evaluation). Changes in ion levels were tested using a Wilcoxon signed-rank test. We identified subgroups at the highest risk of increase using a multivariable linear logistic regression model. There were significant increases in the levels of metal ions for patients who underwent both MoM HRA (Chromium (Cr): 0.5 parts per billion (ppb); Cobalt (Co): 1.1 ppb) and MoM THA (Cr: 0.5 ppb; Co: 0.7 ppb). In a multivariable model considering MoM HRAs, the change in the levels of metal ions was influenced by female gender (Co: Odds Ratio (OR) 1.42; p = 0.002 and Cr: OR 1.08; p = 0.006). The change was found to be irrespective of the initial level for the MoM HRAs, whereas there was a negative relationship between the initial level and the change in the level for those with a MoM THA (Co: OR -0.43; p < 0.001 and Cr: OR -0.14; p = 0.033). The levels of metal ions in the blood increase significantly over the period until mid-term follow-up in patients with both a MoM HRA and those with a MoM THA. We recommend that the levels of metal ions be measured most frequently for women with a MoM HRA. While those with a MoM THA appear to stabilise at a certain level, the accuracy of this trend is not yet clear. Vigilant follow-up is still recommended. Cite this article: Bone Joint J 2017;99-B(4 Supple B):33-40. ©2017 Galea et al.

Short-term and mid-term effects of fasting and downset meal pattern on lipid profile in Iranian fasted women.

PubMed

Rabiee, Samira; Afghari, Narsis; Rastmanesh, Reza

2014-06-01

It is not clear that whether the effects of fasting and downset meal pattern on lipid profile are limited only to Ramadan or do they remain after that month. The cohort study was conducted on 49 women aged 20-45 who worked at Shahid Motahari hospital in Isfahan. They put on groups of 23 consuming downset meal and 26 non-consuming downset meal persons. Serum triglyceride, cholesterol, LDL, and HDL were measured on the 3 days before the beginning, 3 and 30 days after the end of Ramadan. Repeated measure test was used to determine the changes during times and the interaction effects between times and nocturnal eating pattern. This study showed that fasting causes some short-term and mid-term changes in triglyceride and HDL that is mostly attributable to changes in dietary habits during Ramadan, rather than downset meal pattern.

Remote Magnetic versus Manual Navigation for Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: Long-Term, Controlled Data in a Large Cohort.

PubMed

Kataria, Vikas; Berte, Benjamin; Vandekerckhove, Yves; Tavernier, Rene; Duytschaever, Mattias

2017-01-01

Purpose. We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN). Methods. Three hundred thirty-six patients with symptomatic paroxysmal AF underwent PVI by irrigated point-by-point radiofrequency (RF) ablation (RMN, n = 114 versus MAN, n = 222). Patients were followed up with symptom guided rhythm monitoring for a period up to 43 months. The end point of the study was freedom from repeat ablation after a single procedure and without antiarrhythmic drug treatment (ADT). Results. At the end of follow-up (median 26.3 months), freedom from repeat ablation was comparable between RMN and MAN (70.9% versus 69.5%, p = 0.61). At repeat, mean number of reconnected veins was 2.4 ± 1.2 in RMN versus 2.6 ± 1.0 in MAN ( p = 0.08). The majority of repeat procedures occurred during the first year (82.1% in RMN versus 78.5% in MAN; p = 0.74). Conclusion. On the long term (up to 3 years) and in a large cohort of patients with paroxysmal AF, RMN-guided PVI is as effective as MAN guided PVI. In both strategies the majority of repeat procedures occurred during the first year after index procedure.

Remote Magnetic versus Manual Navigation for Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: Long-Term, Controlled Data in a Large Cohort

PubMed Central

Berte, Benjamin; Vandekerckhove, Yves; Tavernier, Rene

2017-01-01

Purpose. We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN). Methods. Three hundred thirty-six patients with symptomatic paroxysmal AF underwent PVI by irrigated point-by-point radiofrequency (RF) ablation (RMN, n = 114 versus MAN, n = 222). Patients were followed up with symptom guided rhythm monitoring for a period up to 43 months. The end point of the study was freedom from repeat ablation after a single procedure and without antiarrhythmic drug treatment (ADT). Results. At the end of follow-up (median 26.3 months), freedom from repeat ablation was comparable between RMN and MAN (70.9% versus 69.5%, p = 0.61). At repeat, mean number of reconnected veins was 2.4 ± 1.2 in RMN versus 2.6 ± 1.0 in MAN (p = 0.08). The majority of repeat procedures occurred during the first year (82.1% in RMN versus 78.5% in MAN; p = 0.74). Conclusion. On the long term (up to 3 years) and in a large cohort of patients with paroxysmal AF, RMN-guided PVI is as effective as MAN guided PVI. In both strategies the majority of repeat procedures occurred during the first year after index procedure. PMID:28386560

Long-term outcomes of the current remote magnetic catheter navigation technique for ablation of atrial fibrillation.

PubMed

Yuan, Shiwen; Holmqvist, Fredrik; Kongstad, Ole; Jensen, Steen M; Wang, Lingwei; Ljungström, Erik; Hertervig, Eva; Borgquist, Rasmus

2017-12-01

Comparisons between remote magnetic (RMN) and manual catheter navigation for atrial fibrillation (AF) ablation have earlier been reported with controversial results. However, these reports were based on earlier generations of the RMN system. To evaluate the outcomes of the most current RMN system for AF ablation in a larger patient population with longer follow-up time, 112 patients with AF (78 paroxysmal, 34 persistent) who underwent AF ablation utilizing RMN (RMN group) were compared to 102 AF ablation patients (72 paroxysmal, 30 persistent) utilizing manual technique (Manual group). The RMN group was associated with significantly shorter fluoroscopy time (10.4 ± 6.4 vs. 16.3 ± 10.9 min, p < .001) but used more RF energy (64.1 ± 19.4KJ vs. 54.3 ± 24.1 KJ, p < .05), while total procedure time showed no significant difference (201 ± 35 vs. 196 ± 44 min, NS). After 39 ± 9/44 ± 10 months of follow-up, AF-free rates at 1year, 2 years and 3.5 years post ablation were 63%, 46% and 42% in the RMN group vs. 60%, 32% and 30% (survival analysis p < .05) in the Manual group, whereas clinically effective rates were 82%, 73% and 70% for the former vs. 70%, 56% and 49% for the latter (survival analysis p < .005). Differing from previous reports, our data from a larger patient population and longer follow-up time demonstrates that compared to manual technique, the most current RMN technique is associated with better procedural and clinical outcomes for AF ablation.

Percutaneous pulmonary valve implantation in patients with dysfunction of a "native" right ventricular outflow tract - Mid-term results.

PubMed

Georgiev, Stanimir; Tanase, Daniel; Ewert, Peter; Meierhofer, Christian; Hager, Alfred; von Ohain, Jelena Pabst; Eicken, Andreas

2018-05-01

To investigate the feasibility and mid-term results of percutaneous pulmonary valve implantation (PPVI) in patients with conduit free or "native" right ventricular outflow tracts (RVOT). We identified all 18 patients with conduit free or "native" right ventricular outflow tract, who were treated with percutaneous pulmonary valve implantation (PPVI) in our institution. They were divided into two groups - these in whom the central pulmonary artery was used as an anchoring point for the preparation of the landing zone (n=10) for PPVI and these, in whom a pulmonary artery branch was used for this purpose (n=8). PPVI was performed successfully in all patients with significant immediate RVOT gradient and pulmonary regurgitation grade reduction. Four patients had insignificant paravalvular regurgitation. In one patient the valve was explanted after 4months because of bacterial endocarditis. A follow-up of 19 (4-60) months showed sustained good function of the other implanted valves. The MRI indexed right ventricular end diastolic volume significantly decreased from 108(54-174) ml/m 2 before the procedure to 76(60-126) ml/m 2 six months after PPVI, p=0.01. PPVI is feasible with good mid-term results in selected patients with a "native" RVOT without a previously implanted conduit. Creating a stable landing zone with a diameter less than the largest available valve (currently 29mm) is crucial for the technical success of the procedure. Further studies and the development of new devices could widen the indications for this novel treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Percutaneous Mitral Valvuloplasty in a Mid-Term Pregnant Woman with Severe Rheumatic Mitral Stenosis

PubMed Central

Lee, Myoung Mook; Sohn, Dae-Won; Oh, Byung Hee; Kim, Jung Goo; Park, Young Bae; Choi, Yun Shik; Seo, Jung Don; Lee, Young Woo

1992-01-01

A 28-year-old woman with severe mitral stenosis underwent percutaneous mitral valvuloplasty at 26 weeks’ gestation. Balloon dilation using a double 18-18 mm balloon resulted in improvement in mean mitral pressure gradient (32 to 8 mmHg) and in calculated mitral valve area (0.9 to 2.4 cm2) without complications and any evidence of fetal distress during procedures with an estimated radiation exposure to the fetus of 0.13 rem. This procedure resulted in the disappearance of symptoms of congestive heart failure and allowed for normal full term spontaneous delivery of a 3.51 kg boy without any complication. PMID:1477032

Early and Mid-Term Outcome of Pediatric Congenital Mitral Valve Surgery

PubMed Central

Baghaei, Ramin; Tabib, Avisa; Jalili, Farshad; Totonchi, Ziae; Mahdavi, Mohammad; Ghadrdoost, Behshid

2015-01-01

Background: Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge. Objectives: The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death. Patients and Methods: In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 ± 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 ± 38.18 months and 11.92 ± 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two-dimensional echocardiography and then every six months after surgery Results: Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P < 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P < 0.001), weight (P < 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in

Short-term Natural History of High-Risk Human Papillomavirus Infection in Mid-Adult Women Sampled Monthly (Short title: Short-term HPV Natural History in Mid-Adult Women)

PubMed Central

Fu, Tsung-chieh (Jane); Xi, Long Fu; Hulbert, Ayaka; Hughes, James P.; Feng, Qinghua; Schwartz, Stephen M.; Hawes, Stephen E.; Koutsky, Laura A.; Winer, Rachel L.

2015-01-01

Characterizing short-term HPV detection patterns and viral load may inform HPV natural history in mid-adult women. From 2011–2012, we recruited women aged 30–50 years. Women submitted monthly self-collected vaginal samples for high-risk HPV DNA testing for 6 months. Positive samples were tested for type-specific HPV DNA load by real-time PCR. HPV type-adjusted linear and Poisson regression assessed factors associated with 1) viral load at initial HPV detection and 2) repeat type-specific HPV detection. One-hundred thirty-nine women (36% of 387 women with ≥4 samples) contributed 243 type-specific HR HPV infections during the study; 54% of infections were prevalent and 46% were incident. Incident (versus prevalent) detection and past pregnancy were associated with lower viral load, whereas current smoking was associated with higher viral load. In multivariate analysis, current smoking was associated with a 40% (95%CI:5%–87%) increase in the proportion of samples that were repeatedly positive for the same HPV type, whereas incident (versus prevalent) detection status and past pregnancy were each associated with a reduction in the proportion of samples repeatedly positive (55%,95%CI:38%–67% and 26%,95%CI:10%–39%, respectively). In a separate multivariate model, each log10 increase in viral load was associated with a 10% (95%CI:4%–16%) increase in the proportion of samples repeatedly positive. Factors associated with repeat HPV detection were similar to those observed in longer-term studies, suggesting that short-term repeat detection may relate to long-term persistence. The negative associations between incident HPV detection and both viral load and repeat detection suggest that reactivation or intermittent persistence was more common than new acquisition. PMID:25976733

Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma.

PubMed

Manoly, Imthiaz; Whistance, Robert N; Sreekumar, Rahul; Khawaja, Saud; Horton, Joanne M; Khan, Ali Zamir; Casali, Gianluca; Thorpe, James A; Amer, Khalid; Woo, Edwin

2014-06-01

Video-assisted thoracoscopic surgery (VATS) for thymoma has uncertain safety and effectiveness in comparison with trans-sternal resection. This feasibility study compared short- and mid-term outcomes for patients undergoing these two procedures, highlights weaknesses in current research and makes recommendations for long-term technological evaluations in this field. Consecutive thymoma cases between 2004 and 2010 were identified. Patients were divided into two groups according to surgical approach (Group I trans-sternal; Group II VATS) and comparisons were made between groups. The primary outcome was overall survival. Secondary outcomes included operative morbidity and mortality, hospital stay, recurrence rate and disease-free survival. Thirty-nine patients were included (Group I: n = 22 vs Group II: n = 17). There were no differences between groups at baseline for all measured covariates. No deaths occurred within 30 days of surgery. More patients in Group I developed complications (Group I: n = 10 vs Group II: n = 3; P = 0.093), while hospital stay was shorter in Group II (Group I: 6.4 ± 4.6 days vs Group II: 4.4 ± 1.8 days; P = 0.030). Five-year overall survival (Group I: 93.8 ± 6.1% vs Group II: 83.3 ± 11.2%; P = 0.425), 5-year disease-free survival (Group I: 71.0 ± 15.3% vs Group II: 83.3 ± 11.2%; P = 0.827) and recurrence rates at final follow-up (Group I: n = 2 vs Group II: n = 1; P = 0.363) were similar between the groups. VATS thymectomy for thymoma is feasible, safe and has comparable mid-term oncological outcomes to trans-sternal thymectomy. Future research is required to evaluate long-term oncological outcomes of VATS thymectomy for thymoma in national registries and randomized, controlled trials. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Satb2 Ablation Impairs Hippocampus-Based Long-Term Spatial Memory and Short-Term Working Memory and Immediate Early Genes (IEGs)-Mediated Hippocampal Synaptic Plasticity.

PubMed

Li, Ying; You, Qiang-Long; Zhang, Sheng-Rong; Huang, Wei-Yuan; Zou, Wen-Jun; Jie, Wei; Li, Shu-Ji; Liu, Ji-Hong; Lv, Chuang-Ye; Cong, Jin; Hu, Yu-Ying; Gao, Tian-Ming; Li, Jian-Ming

2017-04-18

Special AT-rich sequence-binding protein 2 (Satb2) is a protein binding to the matrix attachment regions of DNA and important for gene regulation. Patients with SATB2 mutation usually suffer moderate to severe mental retardation. However, the mechanisms for the defects of intellectual activities in patients with SATB2 mutation are largely unclear. Here we established the heterozygous Satb2 mutant mice and Satb2 conditional knockout mice to mimic the patients with SATB2 mutation and figured out the role of Satb2 in mental activities. We found that the spatial memory and working memory were significantly damaged in the heterozygous Satb2 mutant mice, early postnatal Satb2-deficient mice (CaMKIIα-Cre + Satb2 fl/fl mice), and adult Satb2 ablation mice (Satb2 fl/fl mice injected with CaMKIIα-Cre virus). Functionally, late phase long-term potentiation (L-LTP) in these Satb2 mutant mice was greatly impaired. Morphologically, in CA1 neurons of CaMKIIα-Cre + Satb2 fl/fl mice, we found decreased spine density of the basal dendrites and less branches of apical dendrites that extended into lacunar molecular layer. Mechanistically, expression levels of immediate early genes (IEGs) including Fos, FosB, and Egr1 were significantly decreased after Satb2 deletion. And, Satb2 could regulate expression of FosB by binding to the promoter of FosB directly. In general, our study uncovers that Satb2 plays an important role in spatial memory and working memory by regulating IEGs-mediated hippocampal synaptic plasticity.

Mid-term results of ankle fractures with and without syndesmotic rupture.

PubMed

Veen, Egbert J D; Zuurmond, Rutger G

2015-03-01

This study investigated the effect of short term removal of syndesmotic screws on the ankle function after 6 years, as there still exists controversy on the duration of screw stabilization. Patients with an ankle fracture who received surgery between 1998 and 2004 were reviewed. One group was composed of patients with an ankle fracture needing a syndesmotic repair with screws. The second was composed of operated patients that did not need syndesmotic repair. The primary scoring used was the Olerud-Molander Ankle Score (OMAS). A total of 59 patients were studied with comparable characteristics, with no significant difference on the OMAS after 6 years between the repair group (81.9) and the non-repair group (90.4). On additional clinical scoring groups remained the same. Joint degeneration was seen in both groups (86.7% vs. 55.5%). Patients with ankle fractures using syndesmotic repair and screw removal after 8 weeks and operated patients without syndesmotic injury have comparable results after 6 years. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Mid-term shoulder functional and quality of life outcomes after shoulder replacement in obese patients.

PubMed

Vincent, Heather K; Struk, Aimee M; Reed, Austin; Wright, Thomas W

2016-01-01

Shoulder pain and loss of function are directly associated with obesity. We hypothesized that significant interactions would exist between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) and obesity status on functional and quality of life (QOL) outcomes over the long term. Clinical and QOL outcomes (American Shoulder and Elbow Surgeons Evaluation form, Shoulder Pain and Disability Index, University of California at Los Angeles Shoulder Rating scale, Medical Outcomes Short Form 12 (SF-12), range of motion (ROM), and strength) were longitudinally compared in patients with low and high body mass index (BMI) after a TSA or a RSA. Prospectively collected data of patients with a TSA or RSA were reviewed (N = 310). Preoperative, 2-year, and final follow-up visits were included (range 3-17 years; mean 5.0 ± 2.5 years). Patient data were stratified for analysis using BMI. Morbidly obese patients had worse preoperative functional scores and QOL compared to the other groups. There were no significant interactions of BMI group by surgery type for any of the outcome variables except for active external rotation ROM. Morbidly obese patients attained lower SF-12 scores compared to the remaining groups at each time point. Both TSA and RSA can be expected to impart positive functional outcomes in patients irrespective of BMI. Morbidly obese patients do not attain the same gains in Medical Outcomes SF-12 scores as the non-morbidly obese patients. The lower improvements in active external ROM may be due to morphological limitations of excessive adiposity. This is a level II study.

Mid-term functional outcome after the internal fixation of distal radius fractures

PubMed Central

2012-01-01

Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention. PMID:22280557

Mid-term functional outcome after the internal fixation of distal radius fractures.

PubMed

Phadnis, Joideep; Trompeter, Alex; Gallagher, Kieran; Bradshaw, Lucy; Elliott, David S; Newman, Kevin J

2012-01-26

Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation=10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention.

Long-term observation of aerosol cloud relationships in the Mid-Atlantic region

NASA Astrophysics Data System (ADS)

Li, S.; Joseph, E.; Min, Q.; Yin, B.

2013-12-01

Long-term ground-based observations of aerosol and cloud properties derived from measurements of Multifilter Rotating Shadow Band Radiometer and microwave radiometer at an atmospheric measurement field station in the Baltimore-Washington corridor operated by Howard University are used to examine the temporal variation of aerosol and cloud properties and moreover aerosol indirect effect on clouds. Through statistical analysis of five years (from 2006 to 2010) of these observations, the proportion of polluted cases is found larger in 2006 and 2007 and the proportion of optically thick clouds cases is also larger in 2006 and 2007 than that in 2008, 2009 and 2010. Both the mean aerosol optical depth (AOD) and cloud optical depth (COD) are observed decreasing from 2006 to 2010 but there is no obvious trend observed on cloud liquid water path (LWP). Because of the limit of AOD retrievals under cloudy conditions surface measurements of fine particle particulate matter 2.5 (PM2.5) were used for assessing aerosol indirect effect. A positive relationship between LWP and cloud droplets effective radius (Re) and a negative relationship between PM2.5 and Re are observed based on a stringent case selection method which is used to reduce the uncertainties from retrieval and meteorological impacts. The total 5 years summer time observations are segregated according to the value of PM2.5. Examination of distributions of COD, cloud condensation nuclei (CCN), cloud droplets effective radius and LWP under polluted and pristine conditions further confirm that the high aerosol loading decreases cloud droplets effective radius and increases cloud optical depth.

CardiaMed mechanical valve: mid-term results of a multicenter clinical trial.

PubMed

Nazarov, Vladimir M; Zheleznev, Sergey I; Bogachev-Prokophiev, Alexandr V; Afanasyev, Alexandr V; Nemchenko, Eugene V; Jeltovskiy, Yuri V; Lavinyukov, Sergey O

2014-01-01

Prosthesis choice is a major concern in valvular surgery. A multicenter clinical trial was performed to assess the efficacy and safety of the CardiaMed prosthetic heart valve. The study enrolled 420 patients who underwent mitral (209) or aortic (211) valve replacement from 2003 to 2004 at 7 institutions in Russia, and who were followed up from 2006 to 2011. The mean age was 52.2 ± 10.2 years (range, 12-78 years), 47.4% were female, and 99.05% completed the study. The maximum observation term was 7.5 years (2188.5 patient-years); 1081.6 patient-years for aortic and 1106.9 patient-years for mitral valve replacement. The overall 7-year survival rate was 85.1%  ± 3.7%; 86.1%  ± 4.8% and 84.4%  ± 5.4% for aortic and mitral valve replacement, respectively. The 7-year freedom from valve-related death was 93.9%  ± 3.7% and 94.5%  ± 3.2% for aortic and mitral valve replacement, respectively. When early mortality (<30 days) was excluded, these rates were 94.8%  ± 3.1% and 93.8%  ± 3.82%, respectively. Linearized valve-dependent complication rates were determined for structural valve failure (0%/patient-year overall), thrombosis (0.63%/patient-year, all for mitral valve replacement), thromboembolic complications including transient neurologic deficits (0.13%/patient-year overall, 0.5%/patient-year for aortic valve replacement, 0.8%/patient-year for mitral valve replacement), hemorrhagic bleeding (0.64%/patient-year overall, 0.55%/patient-year for aortic valve replacement, 0.09%/patient-year for mitral valve replacement), prosthetic endocarditis (0.28%/patient-year overall, 0.28%/patient-year for aortic valve replacement, 0%/patient-year for mitral valve replacement), and hemolysis (0%/patient-year overall). The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.

Pentraxin-3 Predicts Short- and Mid-term Mortality in Patients with Sepsis and Septic Shock During Intensive Care Treatment.

PubMed

Hamed, Sonja; Behnes, Michael; Pauly, Dominic; Lepiorz, Dominic; Barre, Max; Becher, Tobias; Lang, Siegfried; Akin, Ibrahim; Borggrefe, Martin; Bertsch, Thomas; Hoffmann, Ursula

2018-06-01

The prognostic value of the acute phase protein Pentraxin 3 (PTX-3) is not well evaluated in patients with septic shock, which reveal an unacceptably high short- and long-term mortality. New Sepsis-3 definitions are not yet implemented in most biomarker studies. Therefore, this study assesses the prognostic value of PTX-3 for short- and mid-term mortality in patients with sepsis or septic shock, as defined by the latest definitions, treated at a medical intensive care unit (ICU). The study includes 213 ICU patients with clinical criteria of sepsis and septic shock. Plasma levels of PTX-3, procalcitonin (PCT) and interleukin-6 were measured on day 1, 3, and 8. All-cause mortality was followed up to 30 days and at 6 months. On all three days, PTX-3 levels were able to discriminate non-survivors from survivors at 30 days and 6 months (AUC range: 0.59 - 0.70; 95% CI: 0.52 - 0.79; p ≤ 0.02). Highest PTX-3 levels within the fourth quartiles during the first week of ICU treatment were associated with an increased mortality rate at 30 days (OR = 7; 95% CI: 2.0 - 23.5; p ≤ 0.002) and at 6 months (OR = 5; 95% CI: 2.1 - 11.4; p ≤ 0.006). Additionally, the prognostic value of PTX-3 was proven for all patients as well as in subcohorts of patients with sepsis and septic shock, according to Sepsis-3 criteria, both in univariate and multivariate analyses for 30-day and 6-months all-cause mortality, especially predicting all-cause mortality in septic shock (HRs range: 1.0 - 2.9; 95% CI: 0.3 - 5.1; p ≤ 0.03). PTX-3 offers prognostic value for the prediction of short- and mid-term all-cause mortality in patients suffering from sepsis and septic shock according to the latest Sepsis-3 criteria.

Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene

PubMed Central

Petis, Stephen M.; Vasarhelyi, Edward M.; Lanting, Brent A.; Howard, James L.; Naudie, Douglas D.R.; Somerville, Lyndsay E.; McCalden, Richard W.

2016-01-01

Background The choice of bearing articulation for total hip arthroplasty in younger patients is amenable to debate. We compared mid-term patient-reported outcomes and survivorship across 2 different bearing articulations in a young patient cohort. Methods We reviewed patients with cobalt-chrome or oxidized zirconium on highly crosslinked polyethylene who were followed prospectively between 2004 and 2012. Kaplan–Meier analysis was used to determine predicted cumulative survivorship at 5 years with all-cause and aseptic revisions as the outcome. We compared patient-reported outcomes, including the Harris hip score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short-form 12 (SF-12) scores. Results A total of 622 patients were followed during the study period. Mean follow-up was 8.2 (range 2.0–10.6) years for cobalt-chrome and 7.8 (range 2.1–10.7) years for oxidized zirconium. Mean age was 54.9 ± 10.6 years for cobalt-chrome and 54.8 ± 10.7 years for oxidized zirconium. Implant survivorship was 96.0% (95% confidence interval [CI] 94.9%–97.1%) for cobalt-chrome and 98.7% (95% CI 98.0%–99.4%) for oxidized zirconium on highly crosslinked polyethylene for all-cause revisions, and 97.2% (95% CI 96.2%–98.2%) for cobalt-chrome and 99.0% (95% CI 98.4%–99.6%) for oxidized zirconium for aseptic revisions. An age-, sex- and diagnosis-matched comparison of the HHS, WOMAC and SF-12 scores demonstrated no significant changes in clinical outcomes across the groups. Conclusion Both bearing surface couples demonstrated excellent mid-term survivorship and outcomes in young patient cohorts. Future analyses on wear and costs are warranted to elicit differences between the groups at long-term follow-up. PMID:26812409

Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis: A Retrospective Study.

PubMed

Liu, Xin; Wang, Wei; Wang, Yang; Wang, Yuexiang; Li, Qiuyang; Tang, Jie

2016-01-01

The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study.A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified.Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18-94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947-0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143-0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079-1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986-0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success.USgHIFU ablation is an effective uterus-conserving treatment for symptomatic adenomyosis with an acceptable

[Effect of mid- and long-term schistosomiasis control plan and discussion of consolidation strategy in marshland endemic regions].

PubMed

Shen, Xue-hui; Sun, Le-ping; Li, Ye-fang; Wang, Lin; Chen, Xiang-ping; Wang, He-sheng; Dai, Jian-rong

2015-10-01

To evaluate the effectiveness of mid- and long-term schistosomiasis control plan and explore the consolidation strategy in marshland endemic regions, so as to provide an effective approach for interrupting and eliminating schistosomiasis in the regions. A prospective field study was designed. Dantu District of Zhenjiang City, a marshland schistosomiasis endemic region, was selected, and the "key village, key environment, and key water regions" comprehensive control strategy was implemented according to the endemic level of schistosomiasis. The morbidity due to schistosomiasis in humans and domestic animals, and Oncomelania hupensis snails were surveyed, and the data of the implementation of control measures were collected. The schistosomiasis morbidity and snail status were compared before and after the implementation of the mid- and long-term plan for schistosomiasis prevention and control, and the changing trends of human, domestic animal and snail infections were plotted. During the implementation of the plan from 2005 to 2014, 16.84 km concrete and bank protection and 9 snail sinks were built, 10 culverts re-built, 3.85 hm2 fences were constructed, 29.5 thousand domestic animals were examined and treated, 170 cattle were eliminated, 4930 hm2 fishing farms were built for snail control, 1 560.00 hM2 land were improved, and 376.00 hm2 forests were built for snail control. In addition, 19,364.80 hm2 snail areas were surveyed, 4694.6 hm2 area received molluscicide, 207.9 thousand of people (person-times) received the examination and treatment, 69.1 thousand of harmless toilets were built, 282.2 thousand health education materials and protection materials were allocated, 958 warning signs were established, and 5435 slogans were pasted or hung. After the implementation of the mid- and long-term plan, the percentages of human, bovine and snail infections appeared decline tendencies year by year, and reduced from 0.08%, 1.28% and 0.13% in 2005 to 0 in 2014, respectively

The challenge of Monteggia-like lesions of the elbow: mid-term results of 46 cases.

PubMed

Jungbluth, P; Tanner, S; Schneppendahl, J; Grassmann, J-P; Wild, M; Hakimi, M; Windolf, J; Laun, R

2018-02-01

The aim of this retrospective multicentre study was to evaluate mid-term results of the operative treatment of Monteggia-like lesions and to determine the prognostic factors that influence the clinical and radiological outcome. A total of 46 patients (27 women and 19 men), with a mean age of 57.7 years (18 to 84) who had sustained a Monteggia-like lesion were followed up clinically and radiologically after surgical treatment. The Mayo Modified Wrist Score (MMWS), Mayo Elbow Performance Score (MEPS), Broberg and Morrey Score, and Disabilities of the Arm, Shoulder and Hand (DASH) score were used for evaluation at a mean of 65 months (27 to 111) postoperatively. All ulnar fractures were stabilized using a proximally contoured or precontoured locking compression plate. Mason type I fractures of the radial head were treated conservatively, type II fractures were treated with reconstruction, and type III fractures with arthroplasty. All Morrey type II and III fractures of the coronoid process was stabilized using lag screws. Good results were found for the MMWS, with a mean of 88.4 (40 to 100). There were 29 excellent results (63%), nine good (20%), seven satisfactory (15%), and one poor (2%). Excellent results were obtained for the MEPS, with a mean of 90.7 (70 to 100): 31 excellent results (68%), 13 good (28%), and two fair (4%). Good results were also found for the functional rating index of Broberg and Morrey, with a mean score of 86.6 (57 to 100). There were 16 excellent results (35%), 22 good (48%), six fair (13%), and two poor (4%). The mean DASH score was 15.1 (0 to 55.8). Two patients had delayed wound healing; four patients had nonunion requiring bone grafting. One patient had asymptomatic loosening of the radial head prosthesis. Monteggia-like lesions are rare. With correct identification, classification, and understanding using CT scans followed by appropriate surgical treatment that addresses all components of the injury, good to excellent mid-term

Thrust noise minimization in long-term laser ablation of propellant material in the nanosecond and picosecond regime

NASA Astrophysics Data System (ADS)

Lorbeer, Raoul-Amadeus; Scharring, Stefan; Karg, Stephanie; Pastow, Jan; Pastuschka, Lisa; Förster, Daniel Johannes; Eckel, Hans-Albert

2017-01-01

The avoidance of any moving parts in a microthruster exhibits a great potential for low-noise thrust generation in the micronewton range. This is required, e.g., for scientific missions that need attitude and orbit control systems with exquisite precision. Laser ablation propulsion offers the opportunity of permanent inertia-free, electro-optical delivery of laser energy to access the propellant entirely without moving it. New propellant is accessed by ablating the previous surface in layers, essentially damaging the surface with a laser over and over again. The resulting surface properties for different fluences and scanning patterns were investigated for multiple layers of aluminum, copper, and gold. The pulse-length-specific issues of various ablation mechanisms such as vaporization, spallation, and phase explosion are accounted for by the use of a 10-ps laser system and a 500-ps laser system. We show that the surface roughness produced with 500-ps laser pulses is approximately twice the surface roughness generated by using 10-ps laser pulses. Furthermore, with 500-ps pulses, the surface roughness shows low dependency on the fluence for carefully chosen scanning parameters. Therefore, we conclude that laser pulse duration differences in the picosecond and nanosecond regimes will not necessarily alter surface roughness properties.

Repeat prostate biopsies prior to radical prostatectomy do not impact erectile function recovery and mid- to long-term continence.

PubMed

Furrer, Marc A; Vilaseca, Antoni; Corradi, Renato B; Boxler, Silvan; Thalmann, George N; Nguyen, Daniel P

2018-06-01

A growing number of men undergo repeat biopsies prior to radical prostatectomy for prostate cancer. However, the long-term impact of repeat biopsies on functional outcomes in this patient population remains unelucidated. Thus, we compared functional outcomes between patients who underwent single biopsy versus repeat biopsies before radical prostatectomy. From 1996 to 2015, 1015 consecutive patients underwent radical prostatectomy, and subsequently had urinary continence and erectile function assessed for >2 years follow-up. One-fourth of patients (275; 27%) had ≥2 biopsies before prostatectomy. Logistic regression models tested whether repeat biopsy before prostatectomy predicted continence or erectile function recovery. For the overall cohort, continence rates were 84%, 92%, 96%, and 98% at 3, 6, 12, and 24 months, respectively. Repeat biopsy before prostatectomy was associated with lower continence rate at 3 months compared to single biopsy (P = 0.03); however, no significant differences were observed at 6, 12, or 24 months. In multivariable analyses adjusting for age, body mass index and diabetes/cardiovascular disease/smoking, the association between repeat biopsy and lower likelihood of continence at 3 months remained (odds ratio 0.67, 95% confidence interval 0.47-0.97; P = 0.03). Overall erectile function recovery rates were 16%, 33%, 51%, and 55% at 3, 6, 12, and 24 months, respectively. No difference in erectile function recovery rates was seen at any time point for single biopsy versus repeat biopsy. In multivariable analyses, repeat biopsy was not predictive of erectile function recovery at any time point. Repeat biopsy before radical prostatectomy impairs early continence after surgery. However, erectile function recovery and mid-term to long-term continence are not affected. These data support the current trend towards active surveillance and delayed local treatment in patients with low- to intermediate-risk prostate cancer. © 2018 Wiley

Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation.

PubMed

Liang, Jackson J; Elafros, Melissa A; Muser, Daniele; Pathak, Rajeev K; Santangeli, Pasquale; Zado, Erica S; Frankel, David S; Supple, Gregory E; Schaller, Robert D; Deo, Rajat; Garcia, Fermin C; Lin, David; Hutchinson, Mathew D; Riley, Michael P; Callans, David J; Marchlinski, Francis E; Dixit, Sanjay

2016-11-01

Transformation from persistent to paroxysmal atrial fibrillation (AF) after ablation suggests modification of the underlying substrate. We examined the nature of initial arrhythmia recurrence in patients with nonparoxysmal AF undergoing antral pulmonary vein isolation and nonpulmonary vein trigger ablation and correlated recurrence type with long-term ablation efficacy after the last procedure. Three hundred and seventeen consecutive patients with persistent (n=200) and long-standing persistent (n=117) AF undergoing first ablation were included. AF recurrence was defined as early (≤6 weeks) or late (>6 weeks after ablation) and paroxysmal (either spontaneous conversion or treated with cardioversion ≤7 days) or persistent (lasting >7 days). During median follow-up of 29.8 (interquartile range: 14.8-49.9) months, 221 patients had ≥1 recurrence. Initial recurrence was paroxysmal in 169 patients (76%) and persistent in 52 patients (24%). Patients experiencing paroxysmal (versus persistent) initial recurrence were more likely to achieve long-term freedom off antiarrhythmic drugs (hazard ratio, 2.2; 95% confidence interval, 1.5-3.2; P<0.0001), freedom on/off antiarrhythmic drugs (hazard ratio, 2.5; 95% confidence interval, 1.6-3.8; P<0.0001), and arrhythmia control (hazard ratio, 5.2; 95% confidence interval, 2.9-9.2; P<0.0001) after last ablation. In patients with persistent and long-standing persistent AF, limited ablation targeting pulmonary veins and documented nonpulmonary vein triggers improves the maintenance of sinus rhythm and reverses disease progression. Transformation to paroxysmal AF after initial ablation may be a step toward long-term freedom from recurrent arrhythmia. © 2016 American Heart Association, Inc.

Mid-term migration analysis of a femoral short-stem prosthesis: a five-year EBRA-FCA-study.

PubMed

Freitag, Tobias; Fuchs, Michael; Woelfle-Roos, Julia V; Reichel, Heiko; Bieger, Ralf

2018-05-01

The objective of this study was to evaluate the mid-term migration pattern of a femoral short stem. Implant migration of 73 femoral short-stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analysed and compared to the migration pattern of implants "at risk" with a subsidence of more than 1.5 mm 2 years postoperative. Mean axial subsidence was 1.1 mm (-5.0 mm to 1.5 mm) after 60 months. There was a statistical significant axial migration until 2 years postoperative with settling thereafter. 2 years after surgery 18 of 73 Implants were classified "at risk." Nevertheless, all stems showed secondary stabilisation in the following period with no implant failure neither in the group of implants with early stabilisation nor the group with extensive early onset migration. In summary, even in the group of stems with more pronounced early subsidence, delayed settling occurred in all cases. The determination of a threshold of critical early femoral short stem subsidence is necessary because of the differing migration pattern described in this study with delayed settling of the Fitmore stem 2 years postoperatively compared to early settling within the first postoperative year described for conventional stems.

Preparedness actions towards seismic risk mitigation for the general public in Martinique, French Lesser Antilles: a mid-term appraisal

NASA Astrophysics Data System (ADS)

Audru, J. C.; Vernier, J. L.; Capdeville, B.; Salindre, J. J.; Mouly, É.

2013-08-01

Martinique is a French island in the Lesser Antilles, with a high seismic hazard. In 2006, Martinican stakeholders involved in seismic safety formed the "Réplik" working group ("Aftershock" in French), the first of its kind in this region. This paper addresses a mid-term appraisal of the first seismic awareness campaign organised by Réplik from 2006 to 2011, and how it has modified, or not, local earthquake and tsunami preparedness. Despite efforts from Réplik to assess its efficiency through surveys, a growing gap is noted between the observed awareness and the actual preparedness of the public. As usual, gender, age, educational level, then boredom and saturation contribute to this discrepancy; strong cultural items may also influence the perception of actions. To remain efficient and respond to the public's expectations, Réplik must redirect its actions towards a cultural congruence of information: consideration of religion and local beliefs, comprehensive messages on TV and radio, use of the Creole language, participatory experiences and drills, and a little science. With this, the Réplik stakeholders can hope to increase Martinicans' involvement into the preparedness process, to cope quickly with a strong earthquake and this know-how can be shared with other seismically active islands in the Caribbean.

[Mid- to long-term outcomes of cervical disc arthroplasty for symptomatic cervical disc disease: a meta-analysis].

PubMed

Kan, S L; Yang, B; Ning, G Z; Gao, S J; Sun, J C; Feng, S Q

2016-12-01

Objective: To compare the benefits and harms of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion(ACDF) for symptomatic cervical disc disease at mid- to long-term follow-up. Methods: Electronic searches were made in PubMed, EMBASE, and the Cochrane Library for randomized controlled trials with at least 48 moths follow-up.Outcomes were reported as relative risk or standardized mean difference.Meta-analysis was carried out using Revman version 5.3 and Stata version 12.0. Results: Seven trials were included, involving 2 302 participants.The results of this meta-analysis indicated that CDA brought about fewer secondary surgical procedures, lower neck disability index (NDI) scores, lower neck and arm pain scores, greater SF-36 Physical Component Summary (PCS) and Mental Component Summary(MCS) scores, greater range of motion (ROM) at the operative level and less superior adjacent-segment degeneration( P <0.05) than ACDF.CDA was not statistically different from ACDF in inferior adjacent-segment degeneration, neurological success, and adverse events ( P >0.05). Conclusions: CDA can significantly reduce the rates of secondary surgical procedures compared with ACDF.Meanwhile, CDA is superior or equivalent to ACDF in other aspects.As some studies without double-blind are included and some potential biases exites, more randomized controlled trials with high quality are required to get more reliable conclusions.

A Review of Literature on Formative Evaluation of Teachers through Mid-Term Student Feedback and How the Reiser and Dick Instructional Planning Model Can Enhance This Feedback.

ERIC Educational Resources Information Center

Hampton, Scott E.

Research has shown that student mid-term feedback has significantly increased subsequent ratings of teacher effectiveness, student achievement, and student attitudes when the feedback results were accompanied by expert consultation. A gap in the literature is an instrument intended to provide specific feedback on systematic planning and delivery…

Perception of Radiation Risk as a Predictor of Mid-Term Mental Health after a Nuclear Disaster: The Fukushima Health Management Survey

PubMed Central

Miura, Itaru; Nagai, Masato; Maeda, Masaharu; Harigane, Mayumi; Fujii, Senta; Takahashi, Hideto; Ohira, Tetsuya; Yasumura, Seiji; Abe, Masafumi

2017-01-01

Predictive factors including risk perception for mid-term mental health after a nuclear disaster remain unknown. The purpose of this study was to examine the association between perceived radiation risk and other factors at baseline and mid-term mental health after the Fukushima Daiichi nuclear disaster of 2011 in Japan. A mail-based questionnaire survey was conducted in January 2012 and January 2013. Mental health status was assessed using the K6 scale. Psychological distress over the 2-year period was categorized into the following four groups: chronic, recovered, resistant, or worsened. Most participants (80.3%) were resistant to the disaster. A positive association was found between the radiation risk perception regarding immediate effects and the worsened group in women. Baseline post-traumatic stress disorder (PTSD) or a history of psychiatric disease predicted being in the chronic or worsened group in mid-term course. These results suggest that evacuees who believed that their health was substantially affected by the nuclear disaster were at an increased risk of having poor mid-term mental health in women. Careful assessment of risk perception after a nuclear disaster, including the presence of PTSD or a history of psychiatric disease, is needed for appropriate interventions. PMID:28914809

Perception of Radiation Risk as a Predictor of Mid-Term Mental Health after a Nuclear Disaster: The Fukushima Health Management Survey.

PubMed

Miura, Itaru; Nagai, Masato; Maeda, Masaharu; Harigane, Mayumi; Fujii, Senta; Oe, Misari; Yabe, Hirooki; Suzuki, Yuriko; Takahashi, Hideto; Ohira, Tetsuya; Yasumura, Seiji; Abe, Masafumi

2017-09-15

Predictive factors including risk perception for mid-term mental health after a nuclear disaster remain unknown. The purpose of this study was to examine the association between perceived radiation risk and other factors at baseline and mid-term mental health after the Fukushima Daiichi nuclear disaster of 2011 in Japan. A mail-based questionnaire survey was conducted in January 2012 and January 2013. Mental health status was assessed using the K6 scale. Psychological distress over the 2-year period was categorized into the following four groups: chronic, recovered, resistant, or worsened. Most participants (80.3%) were resistant to the disaster. A positive association was found between the radiation risk perception regarding immediate effects and the worsened group in women. Baseline post-traumatic stress disorder (PTSD) or a history of psychiatric disease predicted being in the chronic or worsened group in mid-term course. These results suggest that evacuees who believed that their health was substantially affected by the nuclear disaster were at an increased risk of having poor mid-term mental health in women. Careful assessment of risk perception after a nuclear disaster, including the presence of PTSD or a history of psychiatric disease, is needed for appropriate interventions.

Mid and long term outcomes of dural arteriovenous fistula endovascular management with Onyx. Experience of a single tertiary center.

PubMed

Rangel-Castilla, Leonardo; Barber, Sean M; Klucznik, Richard; Diaz, Orlando

2014-10-01

The natural history of intracranial dural arteriovenous fistulas (DAVFs) with cortical venous drainage is unfavorable, and treatment is recommended in most cases. Early reports have documented excellent initial clinical and radiographic outcomes after Onyx embolization of DAVFs but little evidence is available regarding the long term durability of this technique. We retrospectively reviewed a database of 63 DAVFs in 53 consecutive patients who underwent Onyx embolization of a DAVF between 2001 and 2012 at our institution. Cognard types I and III were seen most commonly. A total of 72 Onyx embolization procedures were successfully completed during the study period, resulting in complete or near complete occlusion by the end of the study period in 58 (92.1%) DAVFs. For DAVFs in which complete or near complete obliteration was attained, stability of obliteration at 6, 12, 24, and 46 months was 100%, 95.4%, 93.8%, and 92.3%, respectively. DAVF recanalization/regrowth was discovered on delayed follow-up angiography in only five instances in which immediate post-embolization angiography revealed complete obliteration. Complications were seen in seven embolization procedures and included cranial nerve palsies (n=3), embolic infarcts (n=2), intraparenchymal hemorrhage (n=1), and unintentional stent deployment (n=1). Early evidence has indicated that endovascular Onyx embolization is safe and effective at achieving an initial angiographic cure. Results of our series suggest that angiographic and clinical outcomes of Onyx embolization remain relatively stable at mid and long term follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Ablation article and method

NASA Technical Reports Server (NTRS)

Erickson, W. D.; Sullivan, E. M. (Inventor)

1973-01-01

An ablation article, such as a conical heat shield, having an ablating surface is provided with at least one discrete area of at least one seed material, such as aluminum. When subjected to ablation conditions, the seed material is ablated. Radiation emanating from the ablated seed material is detected to analyze ablation effects without disturbing the ablation surface. By providing different seed materials having different radiation characteristics, the ablating effects on various areas of the ablating surface can be analyzed under any prevailing ablation conditions. The ablating article can be provided with means for detecting the radiation characteristics of the ablated seed material to provide a self-contained analysis unit.

Reimplantation versus remodelling with ring annuloplasty: comparison of mid-term outcomes after valve-sparing aortic root replacement.

PubMed

Lenoir, Marien; Maesen, Bart; Stevens, Louis-Mathieu; Cartier, Raymond; Demers, Philippe; Poirier, Nancy; Tousch, Michaël; El-Hamamsy, Ismail

2018-02-08

Remodelling with extra-aortic ring annuloplasty has emerged as an alternative approach to root reimplantation. However, no studies have yet compared outcomes between procedures. The aim of this study was to compare mid-term outcomes in patients undergoing reimplantation versus remodelling with extra-aortic annuloplasty. From 2001 to 2017, 142 patients underwent root remodelling with extra-aortic annuloplasty (n = 83, 48 ± 13 years) or a reimplantation technique (n = 59, 48 ± 12 years) at the Montreal Heart Institute. No differences were observed in the incidence of connective tissue disease (24% vs 29%, P = 0.9) or preoperative aortic insufficiency ≥3 (37% vs 23%, P = 0.24). However, in the remodelling group, there were more bicuspid aortic valves (31% vs 9%; P < 0.01), and the mean preoperative aortic annulus diameter was larger (27.2 ± 3.6 mm vs 25.6 ± 2.4 mm; P = 0.01). The mean follow-up duration was 3.9 years (100% complete). There were no hospital deaths and 5 late deaths. At 5 years, overall survival was similar in both groups (100%, P = 0.98). Similarly, 5-year freedom from aortic valve reoperation was equivalent (97 ± 2% in both groups, P = 0.95). Furthermore, 5-year survival free from aortic insufficiency ≥2 or reoperation was 84 ± 5% in the remodelling with annuloplasty group vs 83 ± 6% in the reimplantation group (P = 0.62). The mean annular diameter was 24.3 ± 0.5 mm at 5 years vs 23.6 ± 0.3 mm at discharge in the remodelling group (P = 0.28) and 24.4 ± 0.6 mm vs 23.2 ± 0.3 mm, respectively, in the reimplantation group (P = 0.1). Despite a higher prevalence of bicuspid aortic valves and larger aortic annular diameters, mid-term outcomes after remodelling with extra-aortic annuloplasty and reimplantation are comparable. Extra-aortic ring annuloplasty is effective at stabilizing annular dimensions. © The Author(s) 2018. Published

The challenge of pelvic discontinuity: cup-cage reconstruction does better than conventional cages in mid-term.

PubMed

Abolghasemian, M; Tangsaraporn, S; Drexler, M; Barbuto, R; Backstein, D; Safir, O; Kuzyk, P; Gross, A

2014-02-01

The use of ilioischial cage reconstruction for pelvic discontinuity has been replaced by the Trabecular Metal (Zimmer, Warsaw, Indiana) cup-cage technique in our institution, due to the unsatisfactory outcome of using a cage alone in this situation. We report the outcome of 26 pelvic discontinuities in 24 patients (20 women and four men, mean age 65 years (44 to 84)) treated by the cup-cage technique at a mean follow-up of 82 months (12 to 113) and compared them with a series of 19 pelvic discontinuities in 19 patients (18 women and one man, mean age 70 years (42 to 86)) treated with a cage at a mean follow-up of 69 months (1 to 170). The clinical and radiological outcomes as well as the survivorship of the groups were compared. In all, four of the cup-cage group (15%) and 13 (68%) of the cage group failed due to septic or aseptic loosening. The seven-year survivorship was 87.2% (95% confidence interval (CI) 71 to 103) for the cup-cage group and 49.9% (95% CI 15 to 84) for the cage-alone group (p = 0.009). There were four major complications in the cup-cage group and nine in the cage group. Radiological union of the discontinuity was found in all successful cases in the cup-cage group and three of the successful cage cases. Three hips in the cup-cage group developed early radiological migration of the components, which stabilised with a successful outcome. Cup-cage reconstruction is a reliable technique for treating pelvic discontinuity in mid-term follow-up and is preferred to ilioischial cage reconstruction. If the continuity of the bone graft at the discontinuity site is not disrupted, early migration of the components does not necessarily result in failure.

Early and mid-term outcome of the arterial switch operation in 114 consecutive patients : A single centre experience.

PubMed

Prandstetter, C; Hofer, A; Lechner, E; Mair, R; Sames-Dolzer, E; Tulzer, G

2007-10-01

The arterial switch operation (ASO) has become the treatment of choice in patients with simple or complex transposition of the great arteries (TGA). The purpose of this study was to assess early and mid-term outcome after ASO in a single centre. Between 1995 and December 2005, 114 consecutive patients underwent an ASO at our institution, performed by one single surgeon. Patients charts, surgical reports and echocardiograms were retrospectively reviewed. Patients were analyzed in 3 different groups: Group I consisted of 77 neonates with TGA and intact ventricular septum, group II of 13 patients with TGA and ventricular septal defect which had to be closed surgically and group III of 24 patients with various forms of TGA in a complex setting. The patient's median weight was 3.23 kg (1.65-8.30). Twenty-five neonates were born preterm, 18 were diagnosed prenatally. Median follow-up time was 20.7 months (0.3-128.6). The thirty day mortality was 1.75% (2/114), late mortality 0.88% (1/112) accounting for an overall mortality of 2.63%. There was only one early coronary event and so far no late events. Ten of 111 survivors required reoperation, all but 1 from group III. Prevalence of supravalvular pulmonary stenosis was 4.7%. Freedom from reoperation at 5 years of follow-up time was 87.5%. One patient required permanent pacing, no other late arrhythmias occurred. In our series the only risk factor for increased mortality and morbidity was a body weight of less than 2500 g at the time of operation. No better outcome could be demonstrated in the prenatally diagnosed patients. The ASO can be performed safely and with low mortality and morbidity even in patients with complex TGA. Follow-up of these patients is required to detect residual problems like supravalvular pulmonary stenosis, coronary problems, arrhythmias and aortic valve dysfunction.

Introduction of an interdisciplinary heart team-based transcatheter aortic valve implantation programme: short and mid-term outcomes.

PubMed

Martínez, G J; Seco, M; Jaijee, S K; Adams, M R; Cartwright, B L; Forrest, P; Celermajer, D S; Vallely, M P; Wilson, M K; Ng, M K C

2014-09-01

Transcatheter aortic valve implantation (TAVI) has been developed to treat symptomatic aortic stenosis in patients deemed too high risk for open-heart surgery. To address this complex population, an interdisciplinary heart team approach was proposed. Present the short- and mid-term outcomes of the first 100 patients in the Royal Prince Alfred Hospital multidisciplinary TAVI programme. Single-centre registry. Baseline and procedural data were prospectively recorded. Outcomes were recorded according to Valve Academic Research Consortium - version 2 guidelines. All patients underwent a comprehensive interdisciplinary pre-procedural evaluation. Sixty-eight transfemoral and 32 transapical implantations were performed. Mean age was 82 (±8.9) years old with an average logistic EuroSCORE of 33. Although 13 procedures had major complications, there was no intraprocedural mortality. During the first month, 9% of patients were re-admitted due to heart failure and 13% had a permanent pacemaker implanted. A 3% 30-day and 8% follow-up (mean 17 months) mortalities were recorded. While no significant differences in the rate of complications were found between the first and second half of the experience, all cases of mortality within 30 days (n = 3) occurred in the initial half. Sustained haemodynamic results were obtained with TAVI (immediate mean aortic valve gradient reduction from 47 to 9 mmHg; 1-year echocardiographic gradient 9.9 mmHg, with no moderate or severe aortic regurgitation). Excellent results can be achieved with TAVI in very high-risk patients at an Australian institution. A comprehensive evaluation based on a heart team can overcome most of the difficulties imposed by this challenging population. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Mid-term results of cardiac autotransplantation as method to treat permanent atrial fibrillation and mitral disease.

PubMed

Troise, Giovanni; Cirillo, Marco; Brunelli, Federico; Tasca, Giordano; Amaducci, Andrea; Mhagna, Zen; Tomba, Margherita Dalla; Quaini, Eugenio

2004-06-01

The results of current surgical options for the treatment of permanent atrial fibrillation (AF) associated with mitral surgery are widely different, particularly in very enlarged left atria. The aim of this study was to assess the mid-term efficacy of cardiac autotransplantation for this goal, through a consistent reduction of left atrium volume and a complete isolation of the pulmonary veins. From April 2000 to September 2002, 30 patients (male/female 5/25) underwent cardiac autotransplantation for the treatment of mitral valve disease and concomitant permanent AF (>1 year). Surgical technique of bicaval heart transplantation was modified maintaining the connection of inferior vena cava in all but three cases. Twenty-eight patients had mitral valve replacement and two had mitral valve repair. Associated procedures were: aortic valve replacement (6 cases), tricuspid valve repair (2 cases), coronary re-vascularization (2 cases) and right atrium volume reduction (4 cases). No hospital death occurred; 1 patient died 3 months post-operatively for pneumonia. At a mean follow-up of 21.1+/-7.7 months (range 6-35), 26 patients (89.7%) were in sinus rhythm and 3 (10.3%) in AF. Santa Cruz Score was 0 in 3 patients, 2 in 2 patients and 4 in the remaining 24 patients (82.7%). Mean left atrial diameter and volume decreased from 65.1+/-16.4 mm (range 50-130 mm) to 49.9+/-8.4 mm (range 37-78) (P < 0.001) and from 118.3+/-68.4 ml (range 60-426) to 69.4+/-34.1 ml (range 31-226) (P = 0.001), respectively, after the operation. Cardiac autotransplantation is a safe and effective option for the treatment of permanent AF in patients with mitral valve disease and severe dilation of left atrium.

Acute and mid-term outcomes after treatment of multiple, recurrent restenoses of the lower limb arteries.

PubMed

Meyborg, M; Engelbertz, C; Lüders, F; Gebauer, K; Malyar, N M; Reinecke, H

2015-06-01

Recanalization of long segmental occlusions of femoropopliteal arteries can be achieved by angioplasty and implantation of nitinol stents with high procedural success rates. However, due to recurrent in-stent restenoses (ISR) some patients need repeated interventions and their intermediate success rates are uncertain. Patients who were treated in our center from March 2008 through February 2011 due to symptomatic ISR (as determined by Duplex sonography) were retrospectively included in the study. After endovascular treatment of their ISR, they were prospectively evaluated with regard to recurrent ISR of the target lesions. A total of 36 limbs (=lesions) in 32 patients (69% male, mean age 69±9 years) were successfully treated by balloon-angioplasty. Adjunctive cutting balloons and drug eluting balloons were used in 78% and 8%, respectively. Mean follow-up was 326 days. Recurrent ISR occurred in 10 (28%) lesions, while 26 (78%) lesions showed no recurrence of ISR. In a multivariate logistic regression analysis, age, gender, cardiovascular risk factors, renal failure and medication with cilostazol were not significantly associated with recurrent ISR. Moreover, the number of previous interventions of the target lesions was not an independent predictor of recurrent ISR. Patients with multiple recurrences of ISR seem to have the same prospects of acute and mid-term success for endovascular treatment as those with first presentation of ISR. However, this observation has to be confirmed by prospective, large scale studies with a longer follow-up period to determine the significance of endovascular intervention within the scope of different revascularization approaches for treatment of recurrent ISR.

Does Donor Age of Nonirradiated Achilles Tendon Allograft Influence Mid-Term Results of Revision ACL Reconstruction?

PubMed Central

Zaffagnini, Stefano; Roberti di Sarsina, Tommaso; Bonanzinga, Tommaso; Nitri, Marco; Macchiarola, Luca; Stefanelli, Federico; Lucidi, Gianandrea; Grassi, Alberto

2018-01-01

Purpose  The purpose of the present study was to investigate if the donor age of nonirradiated Achilles tendon allograft could influence the clinical results of revision anterior cruciate ligament (ACL) reconstruction. Methods  All patients that underwent ACL revision between 2004 and 2008 with at least 4 years of follow-up were included. For all the patients that met the inclusion criteria, the age of the graft donor was obtained from the tissue bank. Lysholm score was administered to patients that met inclusion criteria. In addition, patients were divided in two groups based on the donor age (<45 years vs. ≥45 years), and the baseline characteristics and outcomes were compared. Results  Fifty-two patients were evaluated at a mean 4.8 ± 0.8 years follow-up with Lysholm score. The Lysholm significantly improved from 62.3 ± 6.6 at preoperative status to 84.4 ± 12.3 at final follow-up. The mean donor age was 48.7 ± 8.4 years; a significant difference in Lysholm score was noted between patients that received an allograft with a donor age <45 years (14 patients; 27%) and those receiving an allograft with a donor age ≥45 years (38; 73%) (89.5 ± 3.2 vs. 80.1 ± 11.1, respectively; p  = 0.0469). The multiple regression model showed the donor age, the final follow-up, and the preoperative Lysholm score as significant predictors of postoperative Lysholm score ( p  < 0.0002). Conclusion  Donor age of nonirradiated Achilles tendon allograft influenced the mid-term results of revision ACL reconstruction, thus advising the use of grafts from young donors. Level of Evidence  Level III, retrospective comparative study. PMID:29675501

Mid-term prognosis of non-functioning pituitary adenomas with high proliferative potential: really an aggressive variant?

PubMed

Ogawa, Yoshikazu; Jokura, Hidefumi; Niizuma, Kuniyasu; Tominaga, Teiji

2018-05-01

Pituitary adenomas with high proliferation rate and rapid growth are well known, but the clinical characteristics, prognosis, and treatment algorithm remain unclear. The clinical characteristics and mid-term prognosis of patients with non-functioning pituitary adenomas with high proliferative potential were retrospectively investigated. This study identified 53 patients with Ki-67 labeling index of > 3% among 845 patients with non-functioning pituitary adenoma (6.3%) initially treated by surgery. Prophylactic treatment was not applied for patients with residual tumor, but salvage treatment was performed if tumor progression was identified within the follow-up period. Twenty-two patients remained progression-free, whereas 31 patients suffered tumor progression. Comparison of gross total removal (n = 22) and non-total removal (n = 31) groups showed significantly longer progression-free period in the former group (P < 0.001). As salvage treatment gamma knife radiosurgery was applied for 11 patients resulting in 10 patients remaining progression-free and regrowth in 1 patient. Fractionated irradiation was applied for 10 patients, resulting in 2 patients remaining progression-free, deaths in 5 patients including 3 of transformation to pituitary carcinoma, dementia in 1 patient caused by frontal lobe dysfunction, and progression in 2 patients requiring additional surgery and gamma knife radiosurgery. Temozolomide was administered in 2 patients, resulting in deaths in both patients including 1 transformation to pituitary carcinoma. Total removal and gamma knife radiosurgery can result in good outcome. However, the prognosis is extremely poor for patients inadequate for gamma knife radiosurgery. Development of new salvage treatments is essential.

Radiofrequency catheter ablation versus balloon cryoablation of atrial fibrillation: markers of myocardial damage, inflammation, and thrombogenesis.

PubMed

Antolič, Bor; Pernat, Andrej; Cvijić, Marta; Žižek, David; Jan, Matevž; Šinkovec, Matjaž

2016-07-01

Evidence from animal and human studies suggests that cryoablation might be associated with a lesser inflammatory response and activation of coagulation compared with radiofrequency ablation. The study was aimed at comparing the effect of cryoballoon and radiofrequency catheter ablation of paroxysmal atrial fibrillation on markers of myocardial damage, inflammation, and activation of coagulation. Forty-one patients received either cryoballoon (n = 23) or radiofrequency (n = 18) ablation of atrial fibrillation. We measured troponin I, high-sensitivity CRP, and interleukin 6 at baseline from the cubital vein, and from the right and left atrium before and after ablation, and from the cubital vein the following day. Prothrombin fragments 1 + 2, soluble P‑selectin, and D‑dimer were measured before and after ablation from both atria. We observed higher troponin I release in the cryoballoon than in the radiofrequency group (7.01 mcg/l (interquartile range [IQR]: 5.30-9.09) vs 2.32 mcg/l (IQR: 1.45-2.98), p < 0.001). The levels of inflammatory markers (high-sensitivity CRP and interleukin 6) in the two groups were comparable, as were the levels of markers of coagulation activation. Procedure duration, fluoroscopy times, and mid-term success (23 months, IQR 7-32) of the two groups were also comparable. Cryoballoon ablation of atrial fibrillation causes more significant myocardial damage, that is, more extensive ablation lesions, compared with radiofrequency catheter ablation. However, no major differences between these two ablation techniques with regard to the inflammatory response and activation of the coagulation system were observed.

Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction?

PubMed

Di Miceli, Riccardo; Marambio, Carlotta Bustos; Zati, Alessandro; Monesi, Roberta; Benedetti, Maria Grazia

2017-12-01

Purpose  The aim of this study was to assess the effect of knee bracing and timing of full weight bearing after anterior cruciate ligament reconstruction (ACLR) on functional outcomes at mid-term follow-up. Methods  We performed a retrospective study on 41 patients with ACLR. Patients were divided in two groups: ACLR group, who received isolated ACL reconstruction and ACLR-OI group who received ACL reconstruction and adjunctive surgery. Information about age at surgery, bracing, full or progressive weight bearing permission after surgery were collected for the two groups. Subjective IKDC score was obtained at follow-up. Statistical analysis was performed to compare the two groups for IKDC score. Subgroup analysis was performed to assess the effect of postoperative regimen (knee bracing and weight bearing) on functional outcomes. Results  The mean age of patients was 30.8 ± 10.6 years. Mean IKDC score was 87.4 ± 13.9. The mean follow-up was 3.5 ± 1.8 years. Twenty-two (53.7%) patients underwent ACLR only, while 19 (46.3%) also received other interventions, such as meniscal repair and/or collateral ligament suture. Analysis of overall data showed no differences between the groups for IKDC score. Patients in the ACLR group exhibited a significantly better IKDC score when no brace and full weight bearing after 4 weeks from surgery was prescribed in comparison with patients who worn a brace and had delayed full weight bearing. No differences were found with respect to the use of brace and postoperative weight bearing regimen in the ACLR-OI group. Conclusion  Brace and delayed weight bearing after ACLR have a negative influence on long-term functional outcomes. Further research is required to explore possible differences in the patients operated on ACLR and other intervention with respect to the use of a brace and the timing of full weight bearing to identify optimal recovery strategies. Level of Evidence  Level III, retrospective observational

Devising an indicator to detect mid-term abortions in dairy cattle: a first step towards syndromic surveillance of abortive diseases.

PubMed

Bronner, Anne; Morignat, Eric; Hénaux, Viviane; Madouasse, Aurélien; Gay, Emilie; Calavas, Didier

2015-01-01

Bovine abortion surveillance is essential for human and animal health because it plays an important role in the early warning of several diseases. Due to the limited sensitivity of traditional surveillance systems, there is a growing interest for the development of syndromic surveillance. Our objective was to assess whether, routinely collected, artificial insemination (AI) data could be used, as part of a syndromic surveillance system, to devise an indicator of mid-term abortions in dairy cattle herds in France. A mid-term abortion incidence rate (MAIR) was computed as the ratio of the number of mid-term abortions to the number of female-weeks at risk. A mid-term abortion was defined as a return-to-service (i.e., a new AI) taking place 90 to 180 days after the previous AI. Weekly variations in the MAIR in heifers and parous cows were modeled with a time-dependent Poisson model at the département level (French administrative division) during the period of 2004 to 2010. The usefulness of monitoring this indicator to detect a disease-related increase in mid-term abortions was evaluated using data from the 2007-2008 episode of bluetongue serotype 8 (BT8) in France. An increase in the MAIR was identified in heifers and parous cows in 47% (n = 24) and 71% (n = 39) of the departements. On average, the weekly MAIR among heifers increased by 3.8% (min-max: 0.02-57.9%) when the mean number of BT8 cases that occurred in the previous 8 to 13 weeks increased by one. The weekly MAIR among parous cows increased by 1.4% (0.01-8.5%) when the mean number of BT8 cases occurring in the previous 6 to 12 weeks increased by one. These results underline the potential of the MAIR to identify an increase in mid-term abortions and suggest that it is a good candidate for the implementation of a syndromic surveillance system for bovine abortions.

Devising an Indicator to Detect Mid-Term Abortions in Dairy Cattle: A First Step Towards Syndromic Surveillance of Abortive Diseases

PubMed Central

Bronner, Anne; Morignat, Eric; Hénaux, Viviane; Madouasse, Aurélien; Gay, Emilie; Calavas, Didier

2015-01-01

Bovine abortion surveillance is essential for human and animal health because it plays an important role in the early warning of several diseases. Due to the limited sensitivity of traditional surveillance systems, there is a growing interest for the development of syndromic surveillance. Our objective was to assess whether, routinely collected, artificial insemination (AI) data could be used, as part of a syndromic surveillance system, to devise an indicator of mid-term abortions in dairy cattle herds in France. A mid-term abortion incidence rate (MAIR) was computed as the ratio of the number of mid-term abortions to the number of female-weeks at risk. A mid-term abortion was defined as a return-to-service (i.e. a new AI) taking place 90 to 180 days after the previous AI. Weekly variations in the MAIR in heifers and parous cows were modeled with a time-dependent Poisson model at the département level (French administrative division) during the period of 2004 to 2010. The usefulness of monitoring this indicator to detect a disease-related increase in mid-term abortions was evaluated using data from the 2007–2008 episode of bluetongue serotype 8 (BT8) in France. An increase in the MAIR was identified in heifers and parous cows in 47% (n = 24) and 71% (n = 39) of the départements. On average, the weekly MAIR among heifers increased by 3.8% (min-max: 0.02–57.9%) when the mean number of BT8 cases that occurred in the previous 8 to 13 weeks increased by one. The weekly MAIR among parous cows increased by 1.4% (0.01–8.5%) when the mean number of BT8 cases occurring in the previous 6 to 12 weeks increased by one. These results underline the potential of the MAIR to identify an increase in mid-term abortions and suggest that it is a good candidate for the implementation of a syndromic surveillance system for bovine abortions. PMID:25746469

JNK1 ablation in mice confers long-term metabolic protection from diet-induced obesity at the cost of moderate skin oxidative damage.

PubMed

Becattini, Barbara; Zani, Fabio; Breasson, Ludovic; Sardi, Claudia; D'Agostino, Vito Giuseppe; Choo, Min-Kyung; Provenzani, Alessandro; Park, Jin Mo; Solinas, Giovanni

2016-09-01

Obesity and insulin resistance are associated with oxidative stress, which may be implicated in the progression of obesity-related diseases. The kinase JNK1 has emerged as a promising drug target for the treatment of obesity and type 2 diabetes. JNK1 is also a key mediator of the oxidative stress response, which can promote cell death or survival, depending on the magnitude and context of its activation. In this article, we describe a study in which the long-term effects of JNK1 inactivation on glucose homeostasis and oxidative stress in obese mice were investigated for the first time. Mice lacking JNK1 (JNK1(-/-)) were fed an obesogenic high-fat diet (HFD) for a long period. JNK1(-/-) mice fed an HFD for the long term had reduced expression of antioxidant genes in their skin, more skin oxidative damage, and increased epidermal thickness and inflammation compared with the effects in control wild-type mice. However, we also observed that the protection from obesity, adipose tissue inflammation, steatosis, and insulin resistance, conferred by JNK1 ablation, was sustained over a long period and was paralleled by decreased oxidative damage in fat and liver. We conclude that compounds targeting JNK1 activity in brain and adipose tissue, which do not accumulate in the skin, may be safer and most effective.-Becattini, B., Zani, F., Breasson, L., Sardi, C., D'Agostino, V. G., Choo, M.-K., Provenzani, A., Park, J. M., Solinas, G. JNK1 ablation in mice confers long-term metabolic protection from diet-induced obesity at the cost of moderate skin oxidative damage. © FASEB.

Mid-term cost-effectiveness analysis of open and endovascular repair for ruptured abdominal aortic aneurysm.

PubMed

Rollins, K E; Shak, J; Ambler, G K; Tang, T Y; Hayes, P D; Boyle, J R

2014-02-01

Emergency endovascular repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) may have lower operative mortality rates than open surgical repair. Concerns remain that the early survival benefit after EVAR for rAAA may be offset by late reinterventions. The aim of this study was to compare reintervention rates and cost-effectiveness of EVAR and open repair for rAAA. A retrospective analysis was undertaken of patients with rAAA undergoing EVAR or open repair over 6 years. A health economic model developed for the cost-effectiveness of elective EVAR was used in the emergency setting. Sixty-two patients (mean age 77·9 years) underwent EVAR and 85 (mean age 75·9 years) had open repair of rAAA. Median follow-up was 42 and 39 months respectively. There was no significant difference in 30-day mortality rates after EVAR and open repair (18 and 26 per cent respectively; P = 0·243). Reintervention rates were also similar (32 and 31 per cent; P = 0·701). The mean cost per patient was €26,725 for EVAR and €30,297 for open repair, and the cost per life-year gained was €7906 and €9933 respectively (P = 0·561). Open repair had greater initial costs: longer procedural times (217 versus 178·5 min; P < 0·001) and intensive care stay (5·0 versus 1·0 days; P = 0·015). Conversely, EVAR had greater reintervention (€156,939 versus €35,335; P = 0·001) and surveillance (P < 0·001) costs. There was no significant difference in reintervention rates after EVAR or open repair for rAAA. EVAR was as cost-effective at mid-term follow-up. The increased procedural costs of open repair are not outweighed by greater surveillance and reintervention costs after EVAR. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity.

PubMed

Amenabar, Tomas; Rahman, Wael A; Hetaimish, Bandar M; Kuzyk, Paul R; Safir, Oleg A; Gross, Allan E

2016-02-01

Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cup-cage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges. We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on Merle d'Aubigné-Postel scores; (3) radiological outcomes based primarily on construct migration; and (4) the complication rate for a series of 67 CC procedures performed at our institution. All hip revision procedures between January 2003 and March 2012 where a CC was used (with the exception of tumor cases or acute fracture; four total cases) that had a minimum 2-year followup and that had been seen within the last 2 years were included in this retrospective review. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven CC procedures with an average followup of 74 months (range, 24-135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Postoperative clinical and radiological evaluation was done annually. Merle d'Aubigné-Postel scores were recorded and all radiographs were compared with the 6-week postoperative radiographs to evaluate for radiographic loosening or migration. Failure was defined as revision surgery for any cause, including infection. The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1-97.4), and the 10-year survival rate was 85% (95% CI, 67.2-93.8). The Merle d'Aubigné-Postel score improved significantly from a mean of 6 preoperatively to 13 postoperatively (p < 0.001). Four CC had nonprogressive radiological migration of the ischial flange and they remain stable

Mid-term outcomes of orbital atherectomy combined with drug-coated balloon angioplasty for treatment of femoropopliteal disease.

PubMed

Foley, T Raymond; Cotter, Ryan P; Kokkinidis, Damianos G; Nguyen, Daniel D; Waldo, Stephen W; Armstrong, Ehrin J

2017-05-01

To assess the intraprocedural and mid-term outcomes of orbital atherectomy (OA) combined with drug-coated balloon (DCB) angioplasty for the treatment of calcified femoropopliteal disease. In this single-center cohort, 89 patients (139 lesions) were treated with DCB angioplasty for claudication or critical limb ischemia (CLI). Angiographic characteristics and procedural outcomes were reviewed for patients treated with or without adjunctive OA. Lesion calcification was graded using two previously published scoring systems, the angiographic calcium score (ACS) and the peripheral artery calcification scoring system (PACSS). Among 139 lesions, 40 (29%) were treated with OA + DCB. Mean lesion length was 135 ± 100 mm for lesions treated with OA + DCB and 139 ± 100 mm for DCB alone (P = 0.9). Moderate to severe calcification was present in 83% of patients treated with OA, compared to 42% of patients treated with DCB alone (P < 0.001). Lesions treated with OA + DCB were less likely to require bailout stenting (18% vs. 39%, P =0.01). Rates of embolization (0% in OA + DCB vs. 2% in DCB only, P = 0.4), dissection (13% vs. 14%, P = 0.8), and perforation (0%) did not differ significantly between groups. The freedom from TLR at 1 year was 82% in both groups (P = 0.6) while primary patency was 81% in-patients treated with DCB alone and 77% in-patients treated with DCB with concomitant OA (P = 0.8). In this single-center analysis of patients undergoing DCB angioplasty for claudication or CLI, OA was most often used for the treatment of severely calcified lesions. These lesions were more likely to be treated with scoring balloons and less likely to require bailout stenting. At 1 year, target lesion revascularization and primary patency was similar in patients treated with and without adjunctive OA, despite the higher lesion complexity among those receiving the combination procedure. © 2017 Wiley Periodicals, Inc. © 2017 Wiley

Mid-term results of lateral unicondylar mobile bearing knee arthroplasty: a multicentre study of 363 cases.

PubMed

Walker, T; Zahn, N; Bruckner, T; Streit, M R; Mohr, G; Aldinger, P R; Clarius, M; Gotterbarm, T

2018-01-01

The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint. We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) RESULTS: A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon's learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9). Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: Bone Joint J 2018;100-B:42-9. ©2018

[Mid-Term Clinical Results after Open Rotator Cuff Reconstruction in Double-Row Technique with Titanium Anchor Screws].

PubMed

Geyer, S; Schoch, C; Nelitz, M; Geyer, M

2015-08-01

The double-row rotator cuff repair is discussed controversially. Despite improved biomechanical properties, reduced re-tear rates and higher costs, no significant difference compared to single-row fixation in the clinical results is found. Mid-term results of an open double-row fixation with titanium anchor screws are presented. 237 patients (m = 142, f = 95, median age: 56.3 years) were operated in 2007 with this technique by the senior author (M. G.). Preoperatively, 2 years and 4,5 years postoperatively a subjective shoulder score (SSG) with follow-up rates of 86, 87 and 83 %, was evaluated. 5.1 years postoperatively an objective evaluation of 131 patients using the Constant-Murley scores (CS), the simple shoulder tests (SST), Gerber's shoulder value and the evaluation with school grades followed. The integrity of the cuff was checked with ultrasound. The absolute (re-tears and partial re-tears) and the relative (re-tears, partial re-tears, thinning and thickening of the cuff) re-tear rates were evaluated. In SSG a highly significant improvement from 51 to 83 points was found (p < 0.001). In CS 80 points (min.: 18; max.: 100), and in SST 11 points (min.: 2; max.: 12) were achieved. The shoulder value of Gerber increased significantly from preoperative 28.1 to 84.5 % 5.1 years postoperative (p < 0.001).The absolute re-tear rate, evaluated in ultrasound was 7.6 %, the relative re-tear rate 17.6 %. For primary rotator cuff reconstructions a higher CS with 82 points and a lower relative re-tear rate with 10.5 % were found. The patient's age had no significant influence on the clinical outcome. The rupture size showed a significant impact on the re-tear rate and the scores (p < 0.05). Between the operated and healthy shoulder neither strength nor mobility were found to be significantly different. Men reached a highly significant better strength than women (p < 0.001) which also resulted in a significantly better outcome in the CS

[Distal fixation prosthesis for unstable intertrochanteric fractures in elderly patients: a mid-term follow-up study].

PubMed

Zhang, Zhan-feng; Min, Ji-kang; Zhong, Jian-ming; Wang, Dan

2016-06-01

To explore mid-term follow up results of distal fixation prosthesis in treating unstable intertrochanteric fractures in elderly patients. From May 2008 to March 2014,58 elderly patients with unstable intertrochanteric were treated with distal fixation prosthesis, among them, there were 15 males and 43 females aged from 75 to 87 years old with an average of 83.2 years old. Fracture were classified according to Evans classification, 39 cases were type I c and 19 cases were type I d. Surgical risk was evaluated before operation, 9 patients were performed total hip arthroplasty and 49 patients were performed prosthetic replacement hip joint function of patients with different age period, Evans classificaton, prothesis type, fixation method were evaluated respectively by using Harris score. Fifty-six patients were followed up from 13 to 36 months with an average of 21.6 months. Harris score was 83.51 ± 6.40, 5 cases got excellent results, 38 cases good and 13 cases moderate. Harris score of patients aged from 75 to 80 years old was 88.64 ± 2.35, 81.64 ± 6.40 in patients aged more than 80 years old, and had significant differences between two groups; Harris score in patients with type Evans I c was 83.64 ± 6.53, and 83.11 ± 6.08 in type Evans I d, while there was no significant differences between two groups. There was no obvious meaning in Harris score between patients with tension band (83.63 ± 6.15) and without tension band (82.41 ± 6.57). There was no significant meaning in Harris score between patients with normal distal fixation prosthesis (83.34 ± 6.43) and femoral moment reconstruction distal fixation prosthesis (83.92 ± 6.51). There was 1 patient occurred hip joint dislocation on the operative side and re-dislocation after manual reduction, then received open reduction. Two patients occurred femoral osteolysis without clinical symptoms, and treated conservative treatment. Artificial joint replacement for unstable intertrochanteric fractures in elderly

Mid- and long-term efficacy of the arthroscopic patellar release for treatment of patellar tendinopathy unresponsive to nonoperative management.

PubMed

Maier, Dirk; Bornebusch, Lutz; Salzmann, Gian M; Südkamp, Norbert P; Ogon, Peter

2013-08-01

The purpose of this study was to evaluate the mid- and long-term efficacy of the arthroscopic patellar release (APR) in a representative number of competitive athletes. This prospective study included 35 competitive athletes who underwent APR for treatment of chronic refractory patellar tendinopathy. The minimum follow-up period was 24 months. Preoperatively and at follow-up, we measured the Swedish Victorian Institute of Sport Assessment for Patella (VISA-P) and modified Blazina score for assessment of functional outcome. The patients rated their subjective knee function (0% to 100%) and maximum pain during exercise on a visual analog scale (0 to 10 points). We inquired about time required for full return to sports. Thirty athletes (27 male individuals, 3 female individuals) were available for clinical examination after a mean follow-up period of 4.4 years (σ = 3.0 years). The follow-up rate was 30 of 35 (86%). Mean age at surgery was 27.6 years (σ = 7.4). The mean VISA-P score improved from 57.3 (σ = 11.4) to 95.1 (σ = 8.2) and the mean Blazina score improved from 4.0 (σ = 0.8) to 0.3 (σ = 0.7). Average subjective knee function improved from 48.8% (σ = 18.5%) to 90.5% (σ = 9.8%). The mean pain level decreased from 5.7 (σ = 1.1) to 0.6 (σ = 1.2%). All changes were significant (P < .01). Twenty-three (76.7%) athletes were able to perform sports at previous levels without any symptoms. The mean time required for full return to sports was 4.4 months (1.5 to 12.0 months; σ = 3.3). Less pronounced symptoms recurred in 3 (10%) athletes. After APR, 97% of patients obtained excellent or good functional outcomes with a mean follow-up of 4.4 years. Three of 4 athletes achieved asymptomatic previous sports levels, returning to full sports at an average of 4.4 months. Symptoms partially recurred in 10% of participants. Level IV: prospective therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All

Early and mid-term results of off-pump endarterectomy of the left anterior descending artery

PubMed Central

Takahashi, Mitsuko; Gohil, Sunir; Tong, Bonnie; Lento, Patrick; Filsoufi, Farzan; Reddy, Ramachandra C.

2013-01-01

OBJECTIVES Many patients referred for coronary artery bypass surgery (CABG) today have diffusely diseased coronary vessels, and some of them may require coronary endarterectomy to provide adequate revascularization. Most reports of coronary endarterectomy describe an on-pump procedure. As off-pump coronary artery bypass graft has become safer and more routine, there is renewed interest in off-pump coronary endarterectomy. We report on our series of patients who underwent off-pump coronary endarterectomy of the left anterior descending (LAD) artery using an open endarterectomy technique. METHODS All patients undergoing open heart surgery at The Mount Sinai Medical Center are entered into a state-mandated, audited database. A retrospective review of this database revealed 12 patients between January 2008 and June 2012 who underwent off-pump endarterectomy of the LAD as part of their coronary revascularization. Additional data were collected from a review of the patients' charts. RESULTS There were a total of 12 patients, with a mean age of 72 ± 4 years. Nine (75%) were male and 3 (25%) were female. Comorbidities included hypertension in 11 (92%) patients, dyslipidaemia in 10 (83%), diabetes in 8 (67%), renal failure in 6 (50%) and stroke in 1 (8%). The mean number of diseased coronary territories was 3 ± 0.4 (range 2–3), and the mean number of coronary bypass grafts performed was 4 ± 0.8 (range 2–5). Eight patients required transfusion with packed red blood cells (67%). One (8%) patient was converted from off-pump to on-pump. The mean intensive care unit stay was 3 ± 2.8 (range 1–8 days), and the mean hospital length of stay was 15 ± 13 (range 4–54 days). Postoperative follow-up (mean 24 ± 19 months, range 1–53) is complete, and no ischaemic events have occurred in the early and mid-term follow-up period. CONCLUSIONS We conclude that off-pump endarterectomy of the LAD is a viable option for patients with diffuse LAD disease. PMID:23190620

[Mid-Term to Long-Term Results of Revision Total Hip Arthroplasty Using the Oval-Shaped Acetabular Cup - TC Type].

PubMed

Šťastný, E; Trč, T; Frýdl, J; Kopečný, Z; Philippou, T; Lisý, J

2017-01-01

INTRODUCTION The purpose of our paper is to evaluate the mid-term to long-term results and to confirm the basic criteria of a high-quality revision implant: safe bridging of bone defects, achievement of reliable primary fixation of revision acetabular cup, achievement of good secondary stability with documentable osteointegration of cup and demonstration of remodelling of transplanted bone tissue in the area of defects and in spaces between the implant ribs. MATERIAL AND METHODS Altogether 36 patients (38 cups) were evaluated who had undergone revision hip arthroplasty in the period from 2004 to 2010. The mean follow-up was 8.2 years (5.1-11.6 years after the reimplantation, more than 10 years in 16 patients who underwent surgery). The position and osseointegration of the implant were assessed by digital radiography, the remodelling of transplanted bone tissues in the area of defects and between the implant ribs by computed tomography with reducing artefacts around the metal implant (Aquilion 64 - Toshiba Medical Systems), and for the clinical outcomes the Harris Hip Score was used. RESULTS Preoperatively, the condition of the hip joint based on the Harris Hip Score was in 30 cases evaluated as poor, in 8 patients as satisfactory. At the time of final evaluation, 8 patients achieved excellent results, in 19 patients the condition of the joint was very good (in 2 patients bilaterally), in 6 patients it was considered satisfactory and in 3 patients poor. The mean value for HHS increased from 39.5 to 84.5. Based on the radiography evaluation, in 27 patients (in 2 patients bilaterally) the osseointegration of the revision cup was good, in 8 cases with a radiolucent line of 2-4 mm in width in DeLee zone III, in one case proximal migration of the cup occurred caused by deep infection. The informed consent form for pelvic CT was signed by 25 patients of our cohort. Remodelling of bone tissue in the space between the ribs of the implant was always detected, the presence of

Real-time dominant frequency mapping and ablation of dominant frequency sites in atrial fibrillation with left-to-right frequency gradients predicts long-term maintenance of sinus rhythm.

PubMed

Atienza, Felipe; Almendral, Jesús; Jalife, José; Zlochiver, Sharon; Ploutz-Snyder, Robert; Torrecilla, Esteban G; Arenal, Angel; Kalifa, Jérôme; Fernández-Avilés, Francisco; Berenfeld, Omer

2009-01-01

Spectral analysis identifies localized sites of high-frequency activity during atrial fibrillation (AF). This study sought to determine the effectiveness of using real-time dominant frequency (DF) mapping for radiofrequency ablation of maximal DF (DFmax) sites and elimination of left-to-right frequency gradients in the long-term maintenance of sinus rhythm (SR) in AF patients. DF mapping was performed in 50 patients during ongoing AF (32 paroxysmal, 18 persistent), acquiring a mean of 117 +/- 38 points. Ablation was performed targeting DFmax sites, followed by circumferential pulmonary vein isolation. Ablation significantly reduced DFs (Hz) in the LA (7.9 +/- 1.4 vs. 5.7 +/- 1.3, P <.001), coronary sinus (CS) (5.7 +/- 1.1 vs. 5.3 +/- 1.2, P = .006), and RA (6.3 +/- 1.4 vs. 5.4 +/- 1.3, P <.001) abolishing baseline left-to-right atrial DF gradient (1.7 +/- 1.7 vs. 0.2 +/- 0.9; P <.001). Only a significant reduction in DFs in all chambers with a loss of the left-to-right atrial gradient after ablation was associated with a higher probability of long-term SR maintenance in both paroxysmal and persistent AF patients. After a mean follow-up of 9.3 +/- 5.4 months, 88% of paroxysmal and 56% of persistent AF patients were free of AF (P = .02). Ablation of DFmax sites was associated with a higher probability of remaining both free of arrhythmias (78% vs. 20%; P = .001) and free of AF (88% vs. 30%; P <.001). Radiofrequency ablation leading to elimination of LA-to-RA frequency gradients predicts long-term SR maintenance in AF patients.

Mid term monitoring of heavy metals content in soils of Mediterranean coastal wetlands. La Albufera de Valencia Natural Park, Spain

NASA Astrophysics Data System (ADS)

Pascual-Aguilar, Juan Antonio; Andreu, Vicente; Gimeno-García, Eugenia

2014-05-01

Coastal wetlands, in general, and Mediterranean ones, in particular, suffer from differente anthropogenic pressures that may affect their intrinsic environmental and ecological functions. Most, if not all, Mediterranean wetlands are not natural spaces were preservation of habitat and wildlife is the only management policy achieved, bur rather their terriroty is a combination of land units with different activities and influences, such as farming, environmental protection and connectivities with urban and industrial areas. Therefore, the need of periodical monitoring is required whenever pressures and environmental health of wetlands is assessed, particularly of those processes that affect the interconnection of environmental compartiments involving water, soils and biota. In agro-ecological protected wetlands soils play and important role because they are potential sources of pollutants due to farming practices. In this case, presence of heavy metals in soils is and indicator of both environmental health and anthtopogenic direct (farming activities) and indirect (neighbour urban areas) pressures. In this work a mid term (17 year) monitoring of seven heavy metals (Cd, Co, Cr, Cu, Pb, Ni and Zn) in soils of coastal Mediterranean wetlands (La Albufera Natural Park, Spain) are analyzed. Two monitoring campaings were achieved in 1991 and 2008. In both cases the same 20 points were visited which were distributed in the natural park according two four different sectors of potential anthropogenic pressure and land use. At each point two soil samples were collected at differente depths (0 to 20 cm and 20 to 40 cm). The selected metals were analyzed to determine its total and extractable fractions by treatment with EDTA. Atomic Absorption Spectrometry, using graphite furnace when necessary, was used for the determination of metals. In general, there is a reduction of metal contents in the study area in both dates. The trend of metals according to average concentration (mg

Long-term efficacy of ultrasound-guided low power microwave ablation for the treatment of primary papillary thyroid microcarcinoma: a 3-year follow-up study.

PubMed

Teng, Dengke; Sui, Guoqing; Liu, Caimei; Wang, Yu; Xia, Yongxu; Wang, Hui

2018-04-01

To evaluate the safety and efficacy of ultrasound-guided low-power microwave ablation (MWA) for the treatment of papillary thyroid microcarcinoma (PTMC) with a 3-year follow-up. A total of 21 nodules diagnosed as PTMC from the 15 patients were performed with MWA at a power of 20 W. The images of the nodules were recorded by ultrasound before MWA and 1, 3, 6, 12 months after MWA, and every 6 months thereafter, respectively. The volumes of the nodules were compared before MWA and at each follow-up point after MWA. The volume reduction rate (VRR) of nodules was also calculated. The mean volume of the nodules was 134.3 ± 129.8 mm 3 initially (the range was 7.4-423.8 mm 3 ), which decreased significantly to 2.3 ± 10.5 mm 3 (the range was 0-48.1 mm 3 ) of the ablation area (P = 0.000) at the follow-up point of 36 months with a mean VRR as 98.78 ± 5.61% (the range was 74.28-100%). During the follow-up period (the range was 36-48 months), 20 of the 21 nodules were completely absorbed and no recurrent nodule was found. After a long-term follow-up of 3 years, the low power MWA showed a good safety and efficacy for the treatment of PTMC. In addition to surgery and active surveillance, MWA might be another alternative for patients with PTMC.

[Cryoballon isolation of the pulmonary veins in atrial fibrillation: mid-term results after the first 55 patients].

PubMed

Tóth, Zsuzsanna; Nagy-Baló, Edina; Kertész, Attila; Clemens, Marcell; Herczku, Csaba; Tint, Diana; Kun, Csaba; Edes, István; Csanádi, Zoltán

2010-01-31

Several transcatheter techniques based on radiofrequency energy were elaborated for the treatment of atrial fibrillation through the last decade. Recently, similar success rates with a better safety profile concerning life threatening complications were reported with the novel methode of cryoballon isolation of the pulmonary veins. This paper summarizes our initial experience with cryoballon ablation after the first 55 patients. [corrected] Symptomatic patients refractory to aniarrhythmic medication mostly with paroxysmal atrial fibrillation without significant structural heart disease were enrolled. Cannulation and isolation of all pulmonary veins were attempted using a 28 mm double-wall cryoballon inflated at the ostium of the vein and abolishing eletrical activity of atrial tissue around its perimeter by freezing to -70 C. Intravenous heparin during and oral anticoagulant after the procedure was administered. Conventional ECGs, Holter ECGs and transtelephonic ECG recordings were used through 6 months follow-up for rhythm monitoring. In 55 patients enrolled (18 female; age: 56 + or - 33,64 years) 165 out ot 192 (86%) pulmonary veins were successfully isolated. All pulmonary veins were isolated in 37 patients (67%). Procedure time was 155.67 + or - 100.66 min, while fluoroscopy time was 34.04 + or - 31.89 min. In 34 patients with 6 months follow-up 24 (70%) either remained free of arrhythmia (17 patients) or had a significant decrease in arrhythmia burden (7 patients). Based on our initial experience, cryoballon isolation of pulmonary veins appears to be a more simple procedure with similar efficacy to radiofrequency ablation in the treatment of atrial fibrillation.

Effects of a Long-Term Disturbance on Arthropods and Vegetation in Subalpine Wetlands: Manifestations of Pack Stock Grazing in Early versus Mid-Season

PubMed Central

Holmquist, Jeffrey G.; Schmidt-Gengenbach, Jutta; Haultain, Sylvia A.

2013-01-01

Conclusions regarding disturbance effects in high elevation or high latitude ecosystems based solely on infrequent, long-term sampling may be misleading, because the long winters may erase severe, short-term impacts at the height of the abbreviated growing season. We separated a) long-term effects of pack stock grazing, manifested in early season prior to stock arrival, from b) additional pack stock grazing effects that might become apparent during annual stock grazing, by use of paired grazed and control wet meadows that we sampled at the beginning and end of subalpine growing seasons. Control meadows had been closed to grazing for at least two decades, and meadow pairs were distributed across Sequoia National Park, California, USA. The study was thus effectively a landscape-scale, long-term manipulation of wetland grazing. We sampled arthropods at these remote sites and collected data on associated vegetation structure. Litter cover and depth, percent bare ground, and soil strength had negative responses to grazing. In contrast, fauna showed little response to grazing, and there were overall negative effects for only three arthropod families. Mid-season and long-term results were generally congruent, and the only indications of lower faunal diversity on mid-season grazed wetlands were trends of lower abundance across morphospecies and lower diversity for canopy fauna across assemblage metrics. Treatment x Season interactions almost absent. Thus impacts on vegetation structure only minimally cascaded into the arthropod assemblage and were not greatly intensified during the annual growing season. Differences between years, which were likely a response to divergent snowfall patterns, were more important than differences between early and mid-season. Reliance on either vegetation or faunal metrics exclusively would have yielded different conclusions; using both flora and fauna served to provide a more integrative view of ecosystem response. PMID:23308297

Effects of a long-term disturbance on arthropods and vegetation in subalpine wetlands: manifestations of pack stock grazing in early versus mid-season.

PubMed

Holmquist, Jeffrey G; Schmidt-Gengenbach, Jutta; Haultain, Sylvia A

2013-01-01

Conclusions regarding disturbance effects in high elevation or high latitude ecosystems based solely on infrequent, long-term sampling may be misleading, because the long winters may erase severe, short-term impacts at the height of the abbreviated growing season. We separated a) long-term effects of pack stock grazing, manifested in early season prior to stock arrival, from b) additional pack stock grazing effects that might become apparent during annual stock grazing, by use of paired grazed and control wet meadows that we sampled at the beginning and end of subalpine growing seasons. Control meadows had been closed to grazing for at least two decades, and meadow pairs were distributed across Sequoia National Park, California, USA. The study was thus effectively a landscape-scale, long-term manipulation of wetland grazing. We sampled arthropods at these remote sites and collected data on associated vegetation structure. Litter cover and depth, percent bare ground, and soil strength had negative responses to grazing. In contrast, fauna showed little response to grazing, and there were overall negative effects for only three arthropod families. Mid-season and long-term results were generally congruent, and the only indications of lower faunal diversity on mid-season grazed wetlands were trends of lower abundance across morphospecies and lower diversity for canopy fauna across assemblage metrics. Treatment x Season interactions almost absent. Thus impacts on vegetation structure only minimally cascaded into the arthropod assemblage and were not greatly intensified during the annual growing season. Differences between years, which were likely a response to divergent snowfall patterns, were more important than differences between early and mid-season. Reliance on either vegetation or faunal metrics exclusively would have yielded different conclusions; using both flora and fauna served to provide a more integrative view of ecosystem response.

Brain Emboli After Left Ventricular Endocardial Ablation.

PubMed

Whitman, Isaac R; Gladstone, Rachel A; Badhwar, Nitish; Hsia, Henry H; Lee, Byron K; Josephson, S Andrew; Meisel, Karl M; Dillon, William P; Hess, Christopher P; Gerstenfeld, Edward P; Marcus, Gregory M

2017-02-28

Catheter ablation for ventricular tachycardia and premature ventricular complexes (PVCs) is common. Catheter ablation of atrial fibrillation is associated with a risk of cerebral emboli attributed to cardioversions and numerous ablation lesions in the low-flow left atrium, but cerebral embolic risk in ventricular ablation has not been evaluated. We enrolled 18 consecutive patients meeting study criteria scheduled for ventricular tachycardia or PVC ablation over a 9-month period. Patients undergoing left ventricular (LV) ablation were compared with a control group of those undergoing right ventricular ablation only. Patients were excluded if they had implantable cardioverter defibrillators or permanent pacemakers. Radiofrequency energy was used for ablation in all cases and heparin was administered with goal-activated clotting times of 300 to 400 seconds for all LV procedures. Pre- and postprocedural brain MRI was performed on each patient within a week of the ablation procedure. Embolic infarcts were defined as new foci of reduced diffusion and high signal intensity on fluid-attenuated inversion recovery brain MRI within a vascular distribution. The mean age was 58 years, half of the patients were men, half had a history of hypertension, and the majority had no known vascular disease or heart failure. LV ablation was performed in 12 patients (ventricular tachycardia, n=2; PVC, n=10) and right ventricular ablation was performed exclusively in 6 patients (ventricular tachycardia, n=1; PVC, n=5). Seven patients (58%) undergoing LV ablation experienced a total of 16 cerebral emboli, in comparison with zero patients undergoing right ventricular ablation ( P =0.04). Seven of 11 patients (63%) undergoing a retrograde approach to the LV developed at least 1 new brain lesion. More than half of patients undergoing routine LV ablation procedures (predominately PVC ablations) experienced new brain emboli after the procedure. Future research is critical to understanding the

Is AF Ablation Cost Effective?

PubMed Central

Martin-Doyle, William; Reynolds, Matthew R.

2010-01-01

The use of catheter ablation to treat AF is increasing rapidly, but there is presently an incomplete understanding of its cost-effectiveness. AF ablation procedures involve significant up-front expenditures, but multiple randomized trials have demonstrated that ablation is more effective than antiarrhythmic drugs at maintaining sinus rhythm in a second-line and possibly first-line rhythm control setting. Although truly long-term data are limited, ablation, as compared with antiarrrhythmic drugs, also appears associated with improved symptoms and quality of life and a reduction in downstream hospitalization and other health care resource utilization. Several groups have developed cost effectiveness models comparing AF ablation primarily to antiarrhythmic drugs and the model results suggest that ablation likely falls within the range generally accepted as cost-effective in developed nations. This paper will review available information on the cost-effectiveness of catheter ablation for the treatment of atrial fibrillation, and discuss continued areas of uncertainty where further research is required. PMID:20936083

Renal sympathetic denervation using an externally irrigated radiofrequency ablation catheter for treatment of resistant hypertension - Acute safety and short term efficacy.

PubMed

Yalagudri, Sachin; Raju, Narayana; Das, Bharati; Daware, Ashwin; Maiya, Shreesha; Jothiraj, Kannan; Ravikishore, A G

2015-01-01

This study was conducted to assess the acute safety and short term efficacy of renal sympathetic denervation (RSDN) using solid tip radiofrequency ablation (RFA) catheter and saline irrigation through the renal guiding catheter to achieve effective denervation. RSDN using a specialized solid-tip RFA catheter has recently been demonstrated to safely reduce systemic blood pressure in patients with refractory hypertension, the limitation being inadequate power delivery in renal arteries. So, we used solid-tip RFA catheter along with saline irrigation for RSDN. Nine patients with resistant hypertension underwent CT and conventional renal angiography, followed by bilateral or unilateral RSDN using 5F RFA catheter with saline irrigation through renal guiding catheter. Repeat renal angiography was performed at the end of the procedure. In all patients, pre- and post-procedure serum creatinine was measured. Over 1-month period: 1) the systolic/diastolic blood pressure decreased by -57 ± 20/-25 ± 7.5 mm Hg; 2) all patients experienced a decrease in systolic blood pressure of at least -36 mm Hg (range 36-98 mm Hg); 3) there was no evidence of renal artery injury immediate post-procedure. There was no significant change in serum creatinine level. This data shows the acute procedural safety and short term efficacy of RSDN using modified externally irrigated solid tip RFA catheter. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

COST Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar:" ongoing research activities and mid-term results

NASA Astrophysics Data System (ADS)

Pajewski, Lara; Benedetto, Andrea; Loizos, Andreas; Slob, Evert; Tosti, Fabio

2015-04-01

This work aims at presenting the ongoing activities and mid-term results of the COST (European COoperation in Science and Technology) Action TU1208 'Civil Engineering Applications of Ground Penetrating Radar.' Almost three hundreds experts are participating to the Action, from 28 COST Countries (Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Latvia, Malta, Macedonia, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom), and from Albania, Armenia, Australia, Egypt, Hong Kong, Jordan, Israel, Philippines, Russia, Rwanda, Ukraine, and United States of America. In September 2014, TU1208 has been praised among the running Actions as 'COST Success Story' ('The Cities of Tomorrow: The Challenges of Horizon 2020,' September 17-19, 2014, Torino, IT - A COST strategic workshop on the development and needs of the European cities). The principal goal of the COST Action TU1208 is to exchange and increase scientific-technical knowledge and experience of GPR techniques in civil engineering, whilst simultaneously promoting throughout Europe the effective use of this safe and non-destructive technique in the monitoring of infrastructures and structures. Moreover, the Action is oriented to the following specific objectives and expected deliverables: (i) coordinating European scientists to highlight problems, merits and limits of current GPR systems; (ii) developing innovative protocols and guidelines, which will be published in a handbook and constitute a basis for European standards, for an effective GPR application in civil- engineering tasks; safety, economic and financial criteria will be integrated within the protocols; (iii) integrating competences for the improvement and merging of electromagnetic scattering techniques and of data- processing techniques; this will lead to a novel freeware tool for the localization of buried objects

Mid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative†.

PubMed

Onorati, Francesco; Biancari, Fausto; De Feo, Marisa; Mariscalco, Giovanni; Messina, Antonio; Santarpino, Giuseppe; Santini, Francesco; Beghi, Cesare; Nappi, Giannantonio; Troise, Giovanni; Fischlein, Theodor; Passerone, Giancarlo; Heikkinen, Juni; Faggian, Giuseppe

2015-02-01

Although commonly reported as single-centre experiences, redo aortic valve replacement (RAVR) has overall acceptable results. Nevertheless, trans-catheter aortic valve replacement has recently questioned the efficacy of RAVR. Early-to-mid-term results and determinants of mortality in 711 cases of RAVR from seven European institutions were assessed in the entire population and in selected high-risk subgroups [elderly >75 years, urgent/emergent procedures, preoperative New York Heart Association (NYHA) functional Class IV and endocarditis]. Hospital mortality was 5.1%, major re-entry cardiovascular complications (MRCVCs) 4.9%, low cardiac output syndrome (LCOS) 15.3%, stroke 6.6%, acute respiratory failure (ARF) 10.6%, acute renal insufficiency (ARI) 19.3% and need for continuous renal replacement therapy (CRRT) 7.2%, transfusions 66.9% and for permanent pacemaker (PMK) 12.7%. Mid-term survival, freedom from acute heart failure (AHF), reinterventions, stroke and thrombo-embolisms were 77.2 ± 2.7, 84.4 ± 2.6, 97.2 ± 0.8, 97.2 ± 0.9 and 96.3 ± 1.2%, respectively; 87.5% of patients were in NYHA functional Class I-II. Preoperative left ventricular ejection fraction of <30% [odds ratio (OR) 8.7, 95% confidence interval (CI) 2.1-35.6], MRCVCs (OR 20.9, 95% CI 5.6-78.3), cardiopulmonary bypass time (OR 1.1, 95% CI 1.0-1.1), perioperative LCOS (OR 17.2, 95% CI 5.1-57.4) and ARI (OR 5.1, 95% CI 1.5-18.1) predicted hospital death. Endocarditis (OR 7.5, 95% CI 2.9-19.1), preoperative NYHA functional Class IV (OR 4.7, 95% CI 1.0-24.0), combined RAVR + mitral surgery (OR 5.1, 95% CI 1.5-17.3) and AHF at follow-up (OR 2.8, 95% CI 1.3-6.0) predicted late death at the Cox proportional hazard regression model. Elderly >75 years had similar hospital mortality (P = 0.06) and major morbidity, except for a higher need for PMK (P = 0.03), as well as comparable mid-term survival (P = 0.89), freedom from AHF (P = 0.81), reinterventions (P = 0.63), stroke (P = 0.21) and thrombo

Long-term changes in the personality and psychopathological profile of opiate addicts after nucleus accumbens ablative surgery are associated with treatment outcome.

PubMed

Ge, Shunnan; Chang, Chongwang; Adler, John R; Zhao, Haikang; Chang, Xiaozan; Gao, Li; Wu, Heming; Wang, Jing; Li, Nan; Wang, Xuelian; Gao, Guodong

2013-01-01

To investigate the long-term outcome and changes of the personality and psychopathological profile of opiate addicts after bilateral stereotactic nucleus accumbens (NAc) ablative surgery. 60 patients were followed up for 5 years and abstinent status and adverse events were evaluated. NAc lesion volumes and locations were obtained by postoperative MRI scans. The Chinese version of the Eysenck Personality Questionnaire (EPQ-RSC), the Symptom Checklist-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the World Health Organization's Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were administered to the patients before and 5 years after the stereotactic surgery. The total abstinence rate of all patients in their 5th postoperative year was 47.4%. The abstinent patients had a significantly larger lesion volume than the relapsed ones, but a larger lesion volume also increased the risk of adverse events. 5 years after surgery, the abstinent patients showed significant decreases on the Psychoticism (EPQ-P) and Neuroticism (EPQ-N) scores by EPQ-RSC, a significant decline on the Global Severity Index and the subscores in all 10 dimensions by SCL-90-R, significant decreases on the BDI and Y-BOCS scores, and significant improvements on the scores of all domains by WHOQOL-BREF, while for the relapsed patients, only the subscores of obsessive-compulsive by SCL-90-R and the Y-BOCS scores significantly decreased. Postoperative analysis revealed that the abstinent patients had a significantly better score than the relapsed ones by various instruments, and NAc lesion volumes and locations did not correlate with the outcome of any of these instruments. The bilateral ablation of NAc by stereotactic neurosurgery was a feasible method for alleviating psychological dependence on opiate drugs and preventing a relapse. Long-term follow-up suggested that surgery can improve the personality and psychopathological

Initial Weight Loss after Restrictive Bariatric Procedures May Predict Mid-Term Weight Maintenance: Results From a 12-Month Pilot Trial.

PubMed

Nikolić, Marko; Kruljac, Ivan; Kirigin, Lora; Mirošević, Gorana; Ljubičić, Neven; Nikolić, Borka Pezo; Bekavac-Bešlin, Miroslav; Budimir, Ivan; Vrkljan, Milan

2015-06-01

Background: Bariatric procedures are effective options for weight loss (WL) in the morbidly obese. However, some patients fail to lose any weight after bariatric surgery, and mid-term weight maintenance is variable. The aim of this study was to investigate whether initial WL could predict mid-term weight maintenance. Methods: Eighty patients were enrolled, of whom 44 were treated with the BioEnterics Intragastric Balloon (BIB), 21 with laparoscopic adjustable gastric lap-banding (LAGB), and 15 with laparoscopic sleeve gastrectomy (LSG). Percentage of body WL and percentage of excess weight loss (EWL) were calculated at baseline and after 1, 3, 6, and 12 months. Successful WL was defined as EWL >20% for patients treated with BIB and >50% for patients treated with LAGB and SG. Results: Success in the 6th and 12th month was achieved in 80% and 58% of patients in the BIB group, 33% and 40% in the LAGB group, and 60% and 73% in the LSG group. In the BIB group, WL in the 1st month correlated positively with WL at the 6th and 12th month, and an initial WL >6.5% best predicted success (sensitivity 50%, specificity 80%). A similar association was observed in the LAGB group at the 6th and 12th month and an initial WL >9.4% best predicted success (sensitivity 90.0%, specificity 81.2%). In patients treated with LSG, WL in the 3rd month correlated positively with EWL at the 6th and 12th month, with a cutoff value of 17% (sensitivity 66.7%, specificity 100%). Conclusions: WL in the 1st month in patients treated with BIB and LAGB and WL in the 3rd month in patients treated with LSG could be used as a prognostic factor to predict mid-term weight maintenance.

The assessment of treated wastewater quality and the effects of mid-term irrigation on soil physical and chemical properties (case study: Bandargaz-treated wastewater)

NASA Astrophysics Data System (ADS)

Kaboosi, Kami

2017-09-01

This study was conducted to investigate the characteristics of inflow and outflow wastewater of the Bandargaz wastewater treatment plant on the basis of the data collection of operation period and the samples taken during the study. Also the effects of mid-term use of the wastewater for irrigation (from 2005 to 2013) on soil physical and chemical characteristics were studied. For this purpose, 4 samples were taken from the inflow and outflow wastewater and 25 quality parameters were measured. Also, the four soil samples from a depth of 0-30 cm of two rice field irrigated with wastewater in the beginning and middle of the planting season and two samples from one adjacent rice field irrigated with fresh water were collected and their chemical and physical characteristics were determined. Average of electrical conductivity, total dissolved solids, sodium adsorption ratio, chemical oxygen demand and 5 days biochemical oxygen demand in treated wastewater were 1.35 dS/m, 707 ppm, 0.93, 80 ppm and 40 ppm, respectively. Results showed that although some restrictions exist about chlorine and bicarbonate, the treated wastewater is suitable for irrigation based on national and international standards and criteria. In comparison with fresh water, the mid-term use of wastewater caused a little increase of soil salinity. However, it did not lead to increase of soil salinity beyond rice salinity threshold. Also, there were no restrictions on soil in the aspect of salinity and sodium hazard on the basis of many irrigated soil classifications. In comparison with fresh water, the mid-term use of wastewater caused the increase of total N, absorbable P and absorbable K in soil due to high concentration of those elements in treated wastewater.

Impact of severe left ventricular dysfunction on in-hospital and mid-term outcomes of Chinese patients undergoing first isolated off-pump coronary artery bypass grafting.

PubMed

Ji, Qiang; Xia, Li Min; Shi, Yun Qing; Ma, Run Hua; Shen, Jin Qiang; Ding, Wen Jun; Wang, Chun Sheng

2017-10-10

Few studies focused on evaluating the impacts of preoperative severe left ventricular dysfunction on clinical outcomes of patients undergoing off-pump coronary artery bypass grafting surgery (OPCAB). This single center retrospective study aimed to evaluate the impacts of severe left ventricular dysfunction on in-hospital and mid-term clinical outcomes of Chinese patients undergoing first, scheduled, and isolated OPCAB surgery. From January 2010 to December 2014, 2032 eligible patients were included in this study and were divided into 3 groups: a severe group (patients with preoperative left ventricular ejection fraction (LVEF) of ≤35%, n = 128), an impaired group (patients with preoperative LVEF of 36-50%, n = 680), and a normal group (patients with preoperative LVEF of >50%, n = 1224). In-hospital and follow-up clinical outcomes were investigated and compared. Patients in the severe group compared to the other 2 groups had higher in-hospital mortality and higher incidences of low cardiac output and prolonged ventilation. Kaplan-Meier curves showed a similar cumulative follow-up survival between the severe group and the impaired group (χ 2  = 1.980, Log-rank p = 0.159) and between the severe group and the normal group (χ 2  = 2.701, Log-rank p = 0.102). Multivariate Cox regression indicated that grouping was not a significant variable related to mid-term all-cause mortality. No significant difference was found in the rate of repeat revascularization between the severe group (2.4%) and the other 2 groups. Patients with preoperative LVEF of ≤35% compared to preoperative LVEF of >35% increased the risk of in-hospital death and incidences of postoperative low cardiac output and prolonged ventilation, but shared similar mid-term all-cause mortality and repeat revascularization after OPCAB surgery.

Mid-term haemodynamic and clinical results after aortic valve replacement using the Freedom Solo stentless bioprosthesis versus the Carpentier Edwards Perimount stented bioprosthesis.

PubMed

van der Straaten, Ellen P J; Rademakers, Leonard M; van Straten, Albert H M; Houterman, Saskia; Tan, M Erwin S H; Soliman Hamad, Mohamed A

2016-04-01

The aim of this study was to investigate the mid-term haemodynamic and clinical results after aortic valve replacement (AVR) using the Sorin Freedom Solo (SFS) stentless bioprosthesis, compared with the standard Carpentier Edwards Perimount (CEP) stented bioprosthesis. In this retrospective cohort study of prospectively collected data, 116 patients were included in the SFS group (53 males; median age 74 years, range 56-85 years), and 122 patients in the CEP group (85 males; median age 73 years, range 43-88 years) between July 2007 and January 2013. Echocardiography was performed at 6 weeks after surgery in our centre, and the most recent echocardiography (in our centre or in referring cardiology departments) was requested. Between September 2013 and April 2014, all patients were called by the same researcher to gain clinical follow-up data. Mid-term mortality was 16.4% in the SFS group (19 patients) and 21.3% in the CEP group (26 patients); (P = 0.3). The mean transvalvular gradient was 7.4 ± 3.1 mmHg in the SFS group, and 11.6 ± 3.2 mmHg in the CEP group at 6 weeks postoperatively (P < 0.001). When stratified by labelled valve size, mean gradients were significantly lower in the SFS group for every size (P ≤ 0.03). After 3.3 ± 1.4 years of follow-up, the mean gradient was still significantly lower in the SFS group than that in the CEP group (P < 0.001). Clinical follow-up showed relatively low complication rates. These data suggest that the Sorin Freedom Solo stentless bioprosthesis is as safe as the Carpentier Edwards bioprosthesis, and provides better short- and mid-term haemodynamic performance than the Carpentier Edwards bioprosthesis. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Degeneration of Phrenic Motor Neurons Induces Long-Term Diaphragm Deficits following Mid-Cervical Spinal Contusion in Mice

PubMed Central

Nicaise, Charles; Putatunda, Rajarshi; Hala, Tamara J.; Regan, Kathleen A.; Frank, David M.; Brion, Jean-Pierre; Leroy, Karelle; Pochet, Roland; Wright, Megan C.

2012-01-01

Abstract A primary cause of morbidity and mortality following cervical spinal cord injury (SCI) is respiratory compromise, regardless of the level of trauma. In particular, SCI at mid-cervical regions targets degeneration of both descending bulbospinal respiratory axons and cell bodies of phrenic motor neurons, resulting in deficits in the function of the diaphragm, the primary muscle of inspiration. Contusion-type trauma to the cervical spinal cord is one of the most common forms of human SCI; however, few studies have evaluated mid-cervical contusion in animal models or characterized consequent histopathological and functional effects of degeneration of phrenic motor neuron–diaphragm circuitry. We have generated a mouse model of cervical contusion SCI that unilaterally targets both C4 and C5 levels, the location of the phrenic motor neuron pool, and have examined histological and functional outcomes for up to 6 weeks post-injury. We report that phrenic motor neuron loss in cervical spinal cord, phrenic nerve axonal degeneration, and denervation at diaphragm neuromuscular junctions (NMJ) resulted in compromised ipsilateral diaphragm function, as demonstrated by persistent reduction in diaphragm compound muscle action potential amplitudes following phrenic nerve stimulation and abnormalities in spontaneous diaphragm electromyography (EMG) recordings. This injury paradigm is reproducible, does not require ventilatory assistance, and provides proof-of-principle that generation of unilateral cervical contusion is a feasible strategy for modeling diaphragmatic/respiratory deficits in mice. This study and its accompanying analyses pave the way for using transgenic mouse technology to explore the function of specific genes in the pathophysiology of phrenic motor neuron degeneration and respiratory dysfunction following cervical SCI. PMID:23176637

Contrast-enhanced ultrasound is better than magnetic resonance imaging in evaluating the short-term results of microwave ablation treatment of uterine fibroids.

PubMed

Zhang, Yan; Zhang, Meiwu; Fan, Xiaoxiang; Mao, Dafeng

2017-11-01

Contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) were compared in evaluating the short-term effects of microwave ablation (MWA) on uterine fibroids. A total of 60 patients with uterine fibroids treated by MWA were enrolled in the experimental group during their two-year follow-up period according to the inclusion criteria. Conventional two-dimensional US, MRI and CEUS were performed to determine the volume reduction and the fibroid residue by displaying the size, echo and signal intensity of fibroids prior to and after MWA treatment. As the control group, 60 consecutive patients were recruited on their follow-up visit at least two years after MWA treatment of uterine fibroids. Significant differences were observed in the wash-in rate (WiR) of the fibroid tissue, start time difference, rise time ratio (RTR) and WiR ratio between the experimental and control groups (P<0.05). However, the WiR of fibroid vessel, total area under the curve of fibroid vessel and tissue, and rise time difference (RTD) between fibroid vessel and tissue did not display any significant differences between the two groups. Fibroids were either reduced in volume or cured by MWA therapy in patients with uterine fibroids. The reductions in volume of hypointense, isointense and hyperintense fibroids were 62.42±18.13, 53.27±10.05 and 47.43±9.56%, respectively, on T1-weighted imaging (T1WI). On T2WI, the corresponding reductions were 67.32±32.63, 59.36±19.36 and 42.63±10.37%, respectively. The higher the signal intensity on T1WI and T2WI, the lower the reduction in volume. It is indicative that different blood supply to fibroids results in different ablation. CEUS was proved to be more effective than MRI in evaluating the effects of MWA on uterine fibroids during the first postoperative year.

Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation.

PubMed

Mohanty, Sanghamitra; Mohanty, Prasant; Di Biase, Luigi; Trivedi, Chintan; Morris, Eli Hamilton; Gianni, Carola; Santangeli, Pasquale; Bai, Rong; Sanchez, Javier E; Hranitzky, Patrick; Gallinghouse, G Joseph; Al-Ahmad, Amin; Horton, Rodney P; Hongo, Richard; Beheiry, Salwa; Elayi, Claude S; Lakkireddy, Dhanunjaya; Madhu Reddy, Yaruva; Viles Gonzalez, Juan F; Burkhardt, J David; Natale, Andrea

2017-11-01

Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers. Totally, 177 consecutive patients with PAF and severe LA scarring were included. Patients underwent PVAI only (n = 45, Group 1), PVAI+ scar homogenization (n = 66, Group 2) or PVAI+ ablation of non-PV triggers (n = 66, Group 3) based on operator's choice. Baseline characteristics were similar across the groups. After first procedure, all patients were followed-up for a minimum of 2 years. The success rate at the end of the follow-up was 18% (8 pts), 21% (14 pts), and 61% (40 pts) in Groups 1, 2, and 3, respectively. Cumulative probability of AF-free survival was significantly higher in Group 3 (overall log-rank P <0.01, pairwise comparison 1 vs. 3 and 2 vs. 3 P < 0.01). During repeat procedures, non-PV triggers were ablated in all. After average 1.5 procedures, the success rates were 28 (62%), 41 (62%), and 56 (85%) in Groups 1, 2, and 3, respectively (log-rank P< 0.001). In patients with PAF and severe LA scarring, PVAI+ ablation of non-PV triggers is associated with significantly better long-term outcome than PVAI alone or PVAI+ scar homogenization. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

Mid-Term Outcomes After Open Reduction Internal Fixation of Proximal Interphalangeal Joint Dorsal Fracture-Dislocations Through a Volar, Shotgun Approach and a Review of the Literature

PubMed Central

Giugale, Juan Marcelo; Wang, Juntian; Kaufmann, Robert A.; Fowler, John R.

2017-01-01

Background: Proximal interphalangeal (PIP) fracture dislocations remain a complex injury pattern to treat. There are several treatment methods available aimed to restore stability, preserve range of motion, and reconstitute the articular surface. This study looked at the mid-term clinical and radiographic results of open reduction internal fixation through a shotgun approach of comminuted PIP fracture dislocations. Methods: A retrospective review was conducted of all PIP fracture dislocations treated through a volar, shotgun approach at a single institution over a 15-year period. Patients identified were contacted and asked to return to the office for clinical and radiographic evaluation. Patient reported outcomes were assessed with the Michigan hand questionnaire (MHQ) and visual analog scale (VAS) for pain. Results: 5 patients returned to the office for further evaluation with average follow-up of 69 months (range, 33-133 months). 3 patients were found to have post traumatic arthritis on radiographs. 1 case had recurrent instability and one case had a deep infection, both necessitating further surgical intervention. Average PIP arc of motion was found to be 79°. Average VAS score of 0 and MHQ result of 95 (out of a possible score of 100) indicating no residual pain and excellent functionality of the affected hand. Conclusion: Open reduction internal fixation of comminuted PIP fracture dislocations utilizing the volar, shotgun approach provides excellent mid-term functional results despite the high incidence of post traumatic arthritis. PMID:29151999

Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up.

PubMed

Mehmedagic, Irma; Santén, Stefan; Jörgensen, Sophie; Acosta, Stefan

2016-11-11

Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. Nested case-control study. Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. This study cohort of patients who underwent advanced endovascular aortic repair was rather homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not.

Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results.

PubMed

Chouillard, Elie; Younan, Antoine; Alkandari, Mubarak; Daher, Ronald; Dejonghe, Bernard; Alsabah, Salman; Biagini, Jean

2016-10-01

Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common complication after SG, occurring in more than 3 % of cases, even in specialized centers (Gagner and Buchwald in Surg Obes Relat Dis 10:713-723. doi: 10.1016/j.soard.2014.01.016 , 2014). Its management is not standardized, long, and challenging. We have already reported the short-term results of Roux-en-Y fistulo-jejunostomy (RYFJ) as a salvage procedure in patients with post-SG fistula (Chouillard et al. in Surg Endosc 28:1954-1960 doi: 10.1007/s00464-014-3424-y , 2014). In this study, we analyzed the mid-term results of the RYFJ emphasizing its endoscopic, radiologic, and safety outcome. Between January 2007 and December 2013, we treated 75 patients with post-SG fistula, mainly referred from other centers. Immediate management principles included computerized tomography (CT) scan-guided drainage of collections or surgical peritoneal lavage, nutritional support, and endoscopic stenting. Ultimately, this approach achieved fistula control in nearly two-thirds of the patients. In the remaining third, RYFJ was proposed, eventually leading to fistula control in all cases. The mid-term results (i.e., more than 1 year after surgery) were assessed using anamnesis, clinical evaluation, biology tests, upper digestive tract endoscopy, and IV-enhanced CT scan with contrast upper series. Thirty patients (22 women and 8 men) had RYFJ for post-SG fistula. Mean age was 40 years (range 22-59). Procedures were performed laparoscopically in all but 3 cases (90 %). Three patients (10 %) were lost to follow-up. Mean follow-up period was 22 months (18-90). Mean body mass index (BMI) was 27.4 kg/m(2) (22-41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections. Despite the lack of long-term follow-up, RYFJ could be

Initial Operative Experience and Short-term Hearing Preservation Results With a Mid-scala Cochlear Implant Electrode Array.

PubMed

Svrakic, Maja; Roland, J Thomas; McMenomey, Sean O; Svirsky, Mario A

2016-12-01

To describe our initial operative experience and hearing preservation results with the Advanced Bionics (AB) Mid Scala Electrode (MSE). Retrospective review. Tertiary referral center. Sixty-three MSE implants in pediatric and adult patients were compared with age- and sex-matched 1j electrode implants from the same manufacturer. All patients were severe to profoundly deaf. Cochlear implantation with either the AB 1j electrode or the AB MSE. The MSE and 1j electrodes were compared in their angular depth of insertion and pre to postoperative change in hearing thresholds. Hearing preservation was analyzed as a function of angular depth of insertion. Secondary outcome measures included operative time, incidence of abnormal intraoperative impedance and telemetry values, and incidence of postsurgical complications. Depth of insertion was similar for both electrodes, but was more consistent for the MSE array and more variable for the 1j array. Patients with MSE electrodes had better hearing preservation. Thresholds shifts at four audiometric frequencies ranging from 250 to 2000 Hz were 10, 7, 2, and 6 dB smaller for the MSE electrode than for the 1j (p < 0.05). Hearing preservation at low frequencies was worse with deeper insertion, regardless of array. Secondary outcome measures were similar for both electrodes. The MSE electrode resulted in more consistent insertion depth and somewhat better hearing preservation than the 1j electrode. Differences in other surgical outcome measures were small or unlikely to have a meaningful effect.

Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center.

PubMed

Zaveri, Hinali; Surve, Amit; Cottam, Daniel; Cottam, Austin; Medlin, Walter; Richards, Christina; Belnap, LeGrand; Cottam, Samuel; Horsley, Benjamin

2018-06-16

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. To analyze the outcomes with SADI-S at 4 years. Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m 2 . The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data. SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.

[Long-term Efficacy of Radiofrequency Ablation Combined with Chemotherapy 
in the Treatment of Patients with Advanced Non-small Cell Lung Cancer
--A Retrospective Study].

PubMed

Du, Shuhui; Qin, Da; Pang, Ruiqi; Zhang, Yeqing; Zhao, Siqi; Hu, Mu; Zhi, Xiuyi

2017-10-20

Radiofrequency ablation (RFA) combined with chemotherapy has a certain short-term therapeutic effect for the treatment of advanced non-small cell lung cancer (NSCLC), but whether it can improve the long-term survival rate of patients is still controversy. This study retrospectively analyzed the difference of long-term efficacy between RFA combined with chemotherapy and chemotherapy alone in the treatment of patients with advanced NSCLC. A total of 77 patients with stage IIIb and stage IV NSCLC who underwent radiofrequency ablation and chemotherapy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital University of Medical Sciences from September 2009 to December 2015 were enrolled as the treatment group. Chemotherapy with no radiofrequency ablation was performed in 56 patients with stage IIIb and stage IV NSCLC as the control group. Two groups of patients were followed up by telephone about their living conditions. "Survival" package of R software version 3.4.1 was used for statistical analysis. Two sets of data baseline levels were tested by chi-square test. The bias was processed by Cox regression model and the survival curve was plotted using covariate mean substitution method. The first-year survival rate of the treatment group was 70.74%, the two-year survival rate was 39.31% and the median survival time was 22.1 months. The one-year survival rate was 54.54% in the control group, the two-year survival rate was 19.49%, the median survival for 18.1 months. The long-term survival rate of the treatment group was better than that of the control group (P<0.05, OR=0.571). Radiofrequency ablation of lung cancer combined with chemotherapy can significantly improve the 2-year survival rate of patients with stage IIIb and stage IV NSCLC.

Long-term Sediment Accumulation in Mid-channel Bars of the Upper Reach of the Lower Mississippi River.

NASA Astrophysics Data System (ADS)

Wang, B.; Xu, Y. J.

2016-02-01

A recent study reported that about 44% of the total Mississippi River suspended load reaching the Old River Control Structure (ORCS) was trapped upstream of the Gulf of Mexico by overbank storage and channel bed aggradation. Considering an average annual sediment load of 120 million metric tons passing ORCS to the Mississippi River main channel, the trapped sediment load would be equivalent to annually rebuilding 44-km2 coastal land of 1 meter in depth, assuming a sedimentation bulk density of 1.2 tons m-3. No study has yet demonstrated such a high sediment accumulation rate within the confined river channel or on a floodplain area that surrounds the only unleeved stretch ( 30-km long) of the Lower Mississippi River downstream of ORCS. In this study, we utilized satellite images taken from 1983 to 2013 and analyzed changes in surface area of nine major mid-channel and point bars over a 130-km river reach from ORCS to Baton Rouge. Using river stage records and the estimated surface areas, we developed a stage - surface area rating curve for each of the bars and estimated changes in bar volume over time. We found that more than half of the bars have grown, while the others have shrunken in the past three decades. As a whole, there was a substantial net gain of surface area and volume accretion. Sediment trapping was most prevalent during the spring floods, especially during the period from 2007 to 2011 when two large floods occurred. This paper presents the channel morphological change and sediment accumulation rates under different flow conditions, and discusses their implications for the current understanding and practices of the Mississippi River sediment diversion.

Long-term decline of the mid-infrared emission of normal galaxies: dust echo of tidal disruption flare?

NASA Astrophysics Data System (ADS)

Wang, Tinggui; Yan, Lin; Dou, Liming; Jiang, Ning; Sheng, Zhenfeng; Yang, Chenwei

2018-07-01

We report the discovery of a sample of 19 low-redshift (z < 0.22) spectroscopically non-Seyfert galaxies that show slow declining mid-infrared (MIR) light curves (LCs), similar to those of tidal disruption event (TDE) candidates with extreme coronal lines. Two sources also showed relatively fast-rising MIR LCs. They consist of a 61 per cent sample of Wide-field Infrared Survey Explorer (WISE) MIR variable non-Seyfert galaxies with Sloan Digital Sky Survey (SDSS) spectra. In a comparison sample of optically selected Seyfert galaxies, the fraction of sources with such a LC is only 15 per cent. After rejecting five plausible obscured Seyfert galaxies with red MIR colours, the remaining 14 objects are studied in detail in this article. We fit the declining part of the LC with an exponential law and the decay time is typically one year. The observed peak MIR luminosities (νLν) after subtracting host galaxies are in the range of a few 1042-1044 erg s-1, with a median of 5 × 1043 erg s-1 in the W2 band. The black hole masses are distributed over a wide range, with more than half between 107 and 108 M⊙, but are significantly different from those of optical/UV selected TDEs. Furthermore, MIR luminosities are correlated with the black hole mass, stellar mass or luminosity of their host bulges. Most galaxies in the sample are red and luminous, with an absolute r magnitude between -20 and -23. We estimate the rate of event as about 10-4 galaxy-1 yr-1 among luminous red galaxies. We discuss several possibilities for variable infrared sources and conclude that most likely they are caused by short sporadic fuelling of supermassive black holes via either the instability of accretion flows or tidal disruption of stars.

Initial Operative Experience and Short Term Hearing Preservation Results with a Mid-Scala Cochlear Implant Electrode Array

PubMed Central

Svrakic, Maja; Roland, J. Thomas; McMenomey, Sean O.; Svirsky, Mario A.

2016-01-01

OBJECTIVE To describe our initial operative experience and hearing preservation results with the Advanced Bionics (AB) Mid Scala Electrode (MSE) STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS Sixty-three MSE implants in pediatric and adult patients were compared to age- and gender-matched 1j electrode implants from the same manufacturer. All patients were severe to profoundly deaf. INTERVENTION Cochlear implantation with either the AB 1j electrode or the AB MSE. MAIN OUTCOME MEASURES The MSE and 1j electrode were compared in their angular depth of insertion (aDOI) and pre- to post-operative change in hearing thresholds. Hearing preservation was analyzed as a function of aDOI. Secondary outcome measures included operative time, incidence of abnormal intraoperative impedance and telemetry values, and incidence of postsurgical complications. RESULTS Depth of insertion was similar for both electrodes, but was more consistent for the MSE array and more variable for the 1j array. Patients with MSE electrodes had better hearing preservation. Thresholds shifts at four audiometric frequencies ranging from 250 to 2,000 Hz were 10 dB, 7 dB, 2 dB and 6 dB smaller for the MSE electrode than for the 1j (p<0.05). Hearing preservation at low frequencies was worse with deeper insertion, regardless of array. Secondary outcome measures were similar for both electrodes. CONCLUSIONS The MSE electrode resulted in more consistent insertion depth and somewhat better hearing preservation than the 1j electrode. Differences in other surgical outcome measures were small or unlikely to have a meaningful effect. PMID:27755356

Impaired spatial memory and enhanced long-term potentiation in mice with forebrain-specific ablation of the Stim genes

PubMed Central

Garcia-Alvarez, Gisela; Shetty, Mahesh S.; Lu, Bo; Yap, Kenrick An Fu; Oh-Hora, Masatsugu; Sajikumar, Sreedharan; Bichler, Zoë; Fivaz, Marc

2015-01-01

Recent findings point to a central role of the endoplasmic reticulum-resident STIM (Stromal Interaction Molecule) proteins in shaping the structure and function of excitatory synapses in the mammalian brain. The impact of the Stim genes on cognitive functions remains, however, poorly understood. To explore the function of the Stim genes in learning and memory, we generated three mouse strains with conditional deletion (cKO) of Stim1 and/or Stim2 in the forebrain. Stim1, Stim2, and double Stim1/Stim2 cKO mice show no obvious brain structural defects or locomotor impairment. Analysis of spatial reference memory in the Morris water maze revealed a mild learning delay in Stim1 cKO mice, while learning and memory in Stim2 cKO mice was indistinguishable from their control littermates. Deletion of both Stim genes in the forebrain resulted, however, in a pronounced impairment in spatial learning and memory reflecting a synergistic effect of the Stim genes on the underlying neural circuits. Notably, long-term potentiation (LTP) at CA3-CA1 hippocampal synapses was markedly enhanced in Stim1/Stim2 cKO mice and was associated with increased phosphorylation of the AMPA receptor subunit GluA1, the transcriptional regulator CREB and the L-type Voltage-dependent Ca2+ channel Cav1.2 on protein kinase A (PKA) sites. We conclude that STIM1 and STIM2 are key regulators of PKA signaling and synaptic plasticity in neural circuits encoding spatial memory. Our findings also reveal an inverse correlation between LTP and spatial learning/memory and suggest that abnormal enhancement of cAMP/PKA signaling and synaptic efficacy disrupts the formation of new memories. PMID:26236206

Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair.

PubMed

Huang, C S; Huang, C C; Lien, H H

2005-05-01

Two types of anterior tension-free hernioplasty, prolene hernia system (PHS) repair and mesh plug technique (MPT), were introduced to Taiwan in 2001. This study compared the short- to mid-term outcomes following primary groin hernia repair with PHS and MPT. From January 2001 to December 2003, 393 patients with 426 primary groin hernias were operated on by a single surgeon using MPT (n=192) and PHS (n=234). Baseline perioperative details and follow-up information were compared. Demographic characteristics of both groups were similar. The laterality, types of anesthesia, postoperative stay, postoperative wound pain scores, wound complications and days to return to activities of daily life were equally distributed between the two groups. However, the distribution of Gilbert types in the PHS group was shifted a little to the right compared with that of the MPT group. PHS repair had longer operative time (34+/-17 vs 25+/-9 minutes, p<0.01). No recurrence was noted in both groups during the follow-up from 5 to 41 months. Chronic non-disabling groin pains were noted in 2.8% (6/218) of patients in the PHS group and 8.9% (14/175) in the MPT group (p=0.01). Our results show that both PHS and MPT repairs can be performed with short operation time, minor wound pain and quick return to activities of daily life without short- to mid-term recurrences, but postoperatively the MPT group had higher incidence of chronic non-disabling groin pain. Although the MPT is less invasive, the additional protective patch in the preperitoneal space of the PHS may provide a further safeguard against recurrences, especially for those patients with attenuated inguinal floor. Long-term follow-up is needed.

Simultaneous mobile- and fixed-bearing total knee replacement in the same patients. A prospective comparison of mid-term outcomes using a similar design of prosthesis.

PubMed

Kim, Y-H; Kim, D-Y; Kim, J-S

2007-07-01

We conducted a randomised prospective study to evaluate the clinical and radiological results of a mobile- and fixed-bearing total knee replacement of similar design in 174 patients who had bilateral simultaneous knee replacement. The mean follow-up was for 5.6 years (5.2 to 6.1). The total knee score, pain score, functional score and range of movement were not statistically different (p > 0.05) between the two groups. Osteolysis was not seen in any knee in either group. Two knees (1%) in the mobile-bearing group required revision because of infection; none in the fixed-bearing group needed revision. Excellent results can be achieved with both mobile- and fixed-bearing prostheses of similar design at mid-term follow-up. We could demonstrate no significant clinical advantage for a mobile bearing.

Is the mid-term outcome of free right internal thoracic artery with a proximal anastomosis modification inferior to in situ right internal thoracic artery?

PubMed

Yoshizumi, Tomo; Ito, Toshiaki; Maekawa, Atsuo; Sunada, Masatoshi; Wakai, Kenii; Usui, Akihiko; Ueda, Yuichi

2012-08-01

We investigated the mid-term results of free right internal thoracic artery (RITA) grafts used in an aorto-coronary fashion with a modified proximal anastomosis. The subjects were 214 patients who underwent coronary artery bypass grafting with anastomosis to the left circumflex arteries using the RITA as a free graft (Group A: 158 patients) or an in situ graft (Group B: 56 patients). In Group A, the proximal end of the free RITA was anastomosed onto the ascending aorta interposing free graft tissue or to part of its own tissue as a cuff. The number of RITA anastomoses was 1.38 ± 0.50 in Group A and 1.04 ± 0.19 in Group B (P < 0.001). The relationship between perioperative variables and mid-term outcomes was assessed using Cox proportional hazard models. Survival was not associated with the way the RITA graft was performed (Hazard Ratio 5.26, 95 % CI 0.52-53.1, P = 0.159), however, the number of cardiac events was decreased in Group A (Hazard Ratio 2.55, 95 % CI 1.03-6.33, P = 0.043). The graft patency was evaluated in 187 of 214 patients, and at 1, 3 and 5 years was 97.0, 97.0 and 97.0 % in Group A, and 97.9, 92.5 and 80.5 % in Group B (P = 0.378), respectively. By modifying the proximal anastomosis of the free RITA, cardiac events may be decreased, while survival and graft patency comparable with in situ RITA can be obtained, and a significantly larger number of targets can be revascularized.

Mid- and Long-Term Efficacy of Non-Invasive Ventilation in Obesity Hypoventilation Syndrome: The Pickwick's Study.

PubMed

López-Jiménez, María José; Masa, Juan F; Corral, Jaime; Terán, Joaquín; Ordaz, Estrella; Troncoso, Maria F; González-Mangado, Nicolás; González, Mónica; Lopez-Martínez, Soledad; De Lucas, Pilar; Marín, José M; Martí, Sergi; Díaz-Cambriles, Trinidad; Díaz-de-Atauri, Josefa; Chiner, Eusebi; Aizpuru, Felipe; Egea, Carlos; Romero, Auxiliadora; Benítez, José M; Sánchez-Gómez, Jesús; Golpe, Rafael; Santiago-Recuerda, Ana; Gómez, Silvia; Barbe, Ferrán; Bengoa, Mónica

2016-03-01

The Pickwick project was a prospective, randomized and controlled study, which addressed the issue of obesity hypoventilation syndrome (OHS), a growing problem in developed countries. OHS patients were divided according to apnea-hypopnea index (AHI) ≥30 and <30 determined by polysomnography. The group with AHI≥30 was randomized to intervention with lifestyle changes, noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP); the group with AHI<30 received NIV or lifestyle changes. The aim of the study was to evaluate the efficacy of NIV treatment, CPAP and lifestyle changes (control) in the medium and long-term management of patients with OHS. The primary variables were PaCO2 and days of hospitalization, and operating variables were the percentage of dropouts for medical reasons and mortality. Secondary medium-term objectives were: (i)to evaluate clinical-functional effectiveness on quality of life, echocardiographic and polysomnographic variables; (ii)to investigate the importance of apneic events and leptin in the pathogenesis of daytime alveolar hypoventilation and change according to the different treatments; (ii)to investigate whether metabolic, biochemical and vascular endothelial dysfunction disorders depend on the presence of apneas and hypopneasm and (iv)changes in inflammatory markers and endothelial damage according to treatment. Secondary long-term objectives were to evaluate: (i)clinical and functional effectiveness and quality of life with NIV and CPAP; (ii)changes in leptin, inflammatory markers and endothelial damage according to treatment; (iii)changes in pulmonary hypertension and other echocardiographic variables, as well as blood pressure and incidence of cardiovascular events, and (iv)dropout rate and mortality. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

The mid-sternal length, a practical anatomical landmark for optimal positioning of long-term central venous catheters

PubMed Central

Salimi, Fereshte; Imani, Mohammad Reza; Ghasemi, Navab; Keshavarzian, Amir; Jazi, Amir Hosein Davarpanah

2013-01-01

Background: Long-term tunneled catheters are used for the hemodialysis or chemotherapy in many patients. Proper placement of the catheter tip could reduce early and late catheter related complications. Aim of the present study was to evaluate a new formula for proper placement of tunneled hemodialysis or infusion port device by using an external anatomic landmark. Materials and Methods: A total of 64 adult patients undergoing elective placement of tunneled Central Venous Catheter (CVC) requiring hemodialysis or chemotherapy were enrolled in this prospective study during 2011-2012 in the university hospital. The catheter length to be inserted in the right internal jugular vein (IJV) was calculated by adding two measurements (the shortest straight length between the insertion point of the needle and the suprasternal notch plus and half of sternal length). The catheter position was considered correct if the tip was positioned in the right atrium (RA) or Superior vena cava (SVC)-RA junction. Results: The patients were 55.28 ± 19.85 years of age, weighed 5.78 ± 16.62 kg and were 166.07 ± 10.27 cm tall. Catheters were inserted successfully in 88% of patients (n = 56). Catheter tip positions in the failures were SVC (n = 5), tricuspid valve (n = 2), and right ventricle (n = 1) in our patients. Conclusion: Long-term hemodialysis or port CVC could easily insert in the right IJV by using half of the sternal length as an external land marks among adult patients. PMID:24174941

Radiofrequency Ablation of Hepatocellular Carcinoma with a “Nodule-in-Nodule” Appearance: Long-Term Follow-up and Clinical Implications

SciTech Connect

Kang, Tae Wook; Rhim, Hyunchul, E-mail: rhimhc@skku.edu; Song, Kyoung Doo

PurposeHepatocellular carcinoma (HCC) with a “nodule-in-nodule” (NIN) appearance has unique histological characteristics as an early HCC. We assessed long-term therapeutic outcomes of radiofrequency ablation (RFA) in HCC patients considering this appearance.Materials and MethodsOur Institutional Review Board approved this retrospective study, and the requirement for written informed consent was waived. Between May 2006 and April 2012, a total of 572 patients underwent RFA for single HCC as a first-line treatment. Patients were divided into a NIN HCC group (n = 22) and a non-NIN HCC group (n = 550), according to the NIN feature on pretreatment imaging studies. Local tumor progression (LTP) and disease-free survivalmore » (DFS) were compared. Prognostic factors for LTP and DFS were assessed using a Cox proportional hazards model.ResultsThe cumulative LTP rates were 4.6 and 4.6% at 3 and 5 years, respectively, in the NIN HCC group, and 15.9 and 20.5% in the non-NIN HCC group, with borderline statistical significance (p = 0.085). The corresponding DFS rates were 53.8 and 37.7% in the NIN HCC group and 44.0 and 31.7% in the non-NIN HCC group, with no significant difference (p = 0.318). Although on multivariate analysis only tumor size was a significant prognostic factor for LTP, there was a trend bordering on the significance for the NIN feature [hazard ratio (HR) = 0.19; p = 0.099]. However, it was not a significant factor for DFS (HR = 0.18; p = 0.682).ConclusionsThe NIN appearance, a rare (4%, 22/550) but unique feature of early HCC, may be a favorable prognostic factor for RFA in terms of local tumor control.« less

Long-Term Outcomes of Catheter Ablation of Electrical Storm in Nonischemic Dilated Cardiomyopathy Compared With Ischemic Cardiomyopathy.

PubMed

Muser, Daniele; Liang, Jackson J; Pathak, Rajeev K; Magnani, Silvia; Castro, Simon A; Hayashi, Tatsuya; Garcia, Fermin C; Supple, Gregory E; Riley, Michael P; Lin, David; Dixit, Sanjay; Zado, Erica S; Frankel, David S; Callans, David J; Marchlinski, Francis E; Santangeli, Pasquale

2017-07-01

The goal of this study was to determine the long-term outcomes of catheter ablation (CA) of electrical storm in patients with nonischemic dilated cardiomyopathy (NIDCM) compared with patients with ischemic cardiomyopathy (ICM). CA of ventricular tachycardia (VT) electrical storm has been shown to improve VT-free survival in patients with ICM. Data on the outcomes of CA of electrical storm in patients with NIDCM are insufficient. The study included 267 consecutive patients with NIDCM (n = 71; ejection fraction 32 ± 14%) and ICM (n = 196; ejection fraction 28 ± 12%). Endo-epicardial CA was performed in 59 (22%) patients. CA was guided by activation and entrainment mapping for tolerated VT and pacemapping/targeting of abnormal substrate for unmappable VT. After a median follow-up of 45 (25th to 75th percentile: 9 to 71) months and 1 (25th to 75th percentile: 1 to 8) procedures, 76 (29%) patients died, 25 (9%) underwent heart transplantation, 87 (33%) experienced VT recurrence, and 13 (5%) had recurrence of electrical storm. Overall VT-free survival was 54% at 60 months (48% in NIDCM and 54% in ICM; p = 0.128). Patients with VT recurrence experienced a median of 2 (1 to 10) VT episodes in the 5 (1 to 14) months after the procedure. Death/transplantation-free survival was 62% at 60 months (53% in NIDCM and 64% in ICM; p = 0.067). Persistent inducibility of any VT with cycle length ≥250 ms at programmed stimulation at the end of the procedure was the only independent predictor of VT recurrence. Low ejection fraction, New York Heart Association functional class, and VT recurrence over follow-up independently predicted death/transplantation. CA of electrical storm was similarly effective in patients with NIDCM compared with patients with ICM, with elimination of electrical storm in 95% of cases and achievement of complete VT control at long-term follow-up in most patients. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc

Benign thyroid nodule unresponsive to radiofrequency ablation treated with laser ablation: a case report.

PubMed

Oddo, Silvia; Balestra, Margherita; Vera, Lara; Giusti, Massimo

2018-05-11

Radiofrequency ablation and laser ablation are safe and effective techniques for reducing thyroid nodule volume, neck symptoms, and cosmetic complaints. Therapeutic success is defined as a nodule reduction > 50% between 6 and 12 months after the procedure, but a percentage of nodules inexplicably do not respond to thermal ablation. We describe the case of a young Caucasian woman with a solid benign thyroid nodule who refused surgery and who had undergone radiofrequency ablation in 2013. The nodule did not respond in terms of either volume reduction or improvement in neck symptoms. After 2 years, given the patient's continued refusal of thyroidectomy, we proposed laser ablation. The nodule displayed a significant volume reduction (- 50% from radiofrequency ablation baseline volume, - 57% from laser ablation baseline), and the patient reported a significant improvement in neck symptoms (from 6/10 to 1/10 on a visual analogue scale). We conjecture that some benign thyroid nodules may be intrinsically resistant to necrosis when one specific ablation technique is used, but may respond to another technique. To the best of our knowledge, this is the first description of the effect of performing a different percutaneous ablation technique in a nodule that does not respond to radiofrequency ablation.

Rectal augmentation: short- and mid-term evaluation of a novel procedure for severe fecal urgency with associated incontinence.

PubMed

Murphy, Jamie; Chan, Christopher L H; Scott, S Mark; Vasudevan, Subash P; Lunniss, Peter J; Williams, Norman S

2008-03-01

Rectal augmentation (RA) with or without electrically stimulated gracilis neosphincter (ESGN) was developed to address the physiologic and anatomic abnormalities present in a subset of patients with incapacitating fecal urgency and associated urge fecal incontinence (UFI). This study evaluated the short- and medium-term clinical and physiologic results. Eleven patients with fecal urgency and UFI underwent RA, 6 with concomitant ESGN formation. Patients were evaluated preoperatively, and at a median of 12.5 and 54 months after surgery. At 4.5 years, 7/11 patients had avoided stoma construction. Symptoms recurred leading to permanent stoma formation in 1 patient, whereas one other developed evacuatory difficulty with overflow incontinence. Median ability to defer defecation improved from seconds preoperatively to 10 minutes at 1 year (P = 0.0002), and 15 minutes at 4.5 years (P = 0.002). Median Wexner incontinence scores improved from 15 preoperatively to 3 at 1 year (P = 0.002), and 4 at 4.5 years (P = 0.02). At 1 year, 2 of the rectal sensory thresholds (DDV: P = 0.008; MTV: P = 0.008) and compliance were normalized (P = 0.008), whereas at 4.5 years, all sensation thresholds improved (FCS: P = 0.002; DDV: P = 0.002; MTV: P = 0.002), but changes in compliance were not significant. RA with or without ESGN improved reported symptoms and normalized rectal sensation. Improvements were sustained in the medium term. The procedure had no associated morbidity or mortality, and should be considered in the surgical management of a select group of patients presenting with severe urgency and UFI.

Microwave ablation of hepatocellular carcinoma

PubMed Central

Poggi, Guido; Tosoratti, Nevio; Montagna, Benedetta; Picchi, Chiara

2015-01-01

Although surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma (HCC) in patients with well compensated cirrhosis, thermal ablation techniques provide a valid non-surgical treatment alternative, thanks to their minimal invasiveness, excellent tolerability and safety profile, proven efficacy in local disease control, virtually unlimited repeatability and cost-effectiveness. Different energy sources are currently employed in clinics as physical agents for percutaneous or intra-surgical thermal ablation of HCC nodules. Among them, radiofrequency (RF) currents are the most used, while microwave ablations (MWA) are becoming increasingly popular. Starting from the 90s’, RF ablation (RFA) rapidly became the standard of care in ablation, especially in the treatment of small HCC nodules; however, RFA exhibits substantial performance limitations in the treatment of large lesions and/or tumors located near major heat sinks. MWA, first introduced in the Far Eastern clinical practice in the 80s’, showing promising results but also severe limitations in the controllability of the emitted field and in the high amount of power employed for the ablation of large tumors, resulting in a poor coagulative performance and a relatively high complication rate, nowadays shows better results both in terms of treatment controllability and of overall coagulative performance, thanks to the improvement of technology. In this review we provide an extensive and detailed overview of the key physical and technical aspects of MWA and of the currently available systems, and we want to discuss the most relevant published data on MWA treatments of HCC nodules in regard to clinical results and to the type and rate of complications, both in absolute terms and in comparison with RFA. PMID:26557950

Long-term observation of aerosol-cloud relationships in the Mid-Atlantic of the United States

NASA Astrophysics Data System (ADS)

Li, S.; Joseph, E.; Min, Q.; Yin, B.

2014-07-01

Long-term ground-based observations (2006 to 2010) of aerosol and cloud properties derived from passive radiometric sensors deployed at an atmospheric measurement field station in the Baltimore-Washington corridor operated by Howard University were used to examine aerosol indirect effect on cloud optical depth (COD), liquid water path (LWP), cloud droplets effective radius (Re) and cloud droplets number concentration (Nd). A higher frequency of clouds with large COD (> 20) and small Re (< 7 m) was found during summer of 2006 and 2007 along with higher frequency of abundant aerosol loading. The five-year data are screened for summer months only and are separated into clean and polluted cases based on aerosol particulate matter with aerodynamic diameter ≤ 2.5 m (PM2.5) value. Evidence of aerosol indirect effect is found where for polluted cases the mean and median values of COD and Nd distributions were elevated while the mean and median values of Re were decreased. Further reinforcing this conclusion is the result that the mean and median values of LWP distributions did not show prominent difference between clean and polluted cases, this implies that differences between the two cases of influential factors on cloud properties were relatively controlled. Moreover aerosol indirect effects were found insignificant when LWP was small but significant when LWP was large through the analysis of sensitivity of Nd to LWP under different aerosol loading and the measurements of aerosol size distribution.

Joining of ceramics for high performance energy systems. Mid-term progress report, August 1, 1979-March 31, 1980

SciTech Connect

Smeltzer, C E; Metcalfe, A G

The subject program is primarily an exploratory and demonstration study of the use of silicate glass-based adhesives for bonding silicon-base refractory ceramics (SiC, Si/sub 3/N/sub 4/). The projected application is 1250 to 2050/sup 0/F relaxing joint service in high-performance energy conversion systems. The five program tasks and their current status are as follows. Task 1 - Long-Term Joint Stability. Time-temperature-transformation studies of candidate glass adhesives, out to 2000 hours simulated service exposure, are half complete. Task 2 - Environmental and Service Effects on Joint Reliability. Start up delayed due to late delivery of candidate glass fillers and ceramic specimens. Taskmore » 3 - Viscoelastic Damping of Glass Bonded Ceramics. Promising results obtained over approximately the same range of glass viscosity required for joint relaxation function (10/sup 7.5/ to 10/sup 9.5/ poise). Work is 90% complete. Task 4 - Crack Arrest and Crack Diversion by Joints. No work started due to late arrival of materials. Task 5 - Improved Joining and Fabrication Methods. Significant work has been conducted in the area of refractory pre-glazing and the application and bonding of high-density candidate glass fillers (by both hand-artisan and slip-spray techniques). Work is half complete.« less

[Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching].

PubMed

Hernández-Elena, J; de la Red-Gallego, M Á; Garcés-Zarzalejo, C; Pascual-Carra, M A; Pérez-Aguilar, M D; Rodríguez-López, T; Alfonso-Fernández, A; Pérez-Núñez, M I

2015-01-01

An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Influence of Prior Coronary Stenting on the Immediate and Mid-term Outcome of Isolated Coronary Artery Bypass Surgery.

PubMed

Pliam, Michael B; Zapolanski, Alex; Anastassiou, Peter; Ryan, Colman J; Manila, Louis L; Shaw, Richard E; Pira, Bob-Kenneth

2007-09-01

: There has been little emphasis on the possible consequences of prior stent placement on the outcome of coronary bypass surgery (CABG). We compared the results of isolated CABG patients who had prior stents with those who had not with respect to preoperative status, operative procedure, and postoperative immediate and long-term outcome. : Records of 1471 patients undergoing isolated CABG at our institution between January 1, 2000, and March 31, 2005, were reviewed. Patients were divided into three groups. Group I had no stents (n = 1317). Group II had one to three stents (n = 137). Group III had more than three stents (n = 17). Groups were compared with respect to preoperative risk factors, operative procedures, and postoperative results. Long-term survival data were obtained on 97.6% of patients with a mean follow-up, 4.1 ± 2.3 years. : Stented patients were younger (66.1 ± 10.8 vs. 69.1 ± 10.8 years, P = 0.006), had more unstable angina (68.2% vs. 58.9%, P = 0.02), hypercholesterolemia (83.8% vs. 61.2%, P = 0.00), chronic obstructive pulmonary disease (13.6% vs. 8.4%, P = 0.03), peripheral vascular disease (15.2% vs. 8.4%, P = 0.00), and previous CABG (10.1% vs. 4.2%, P = 0.00), fewer low ejection fractions (1.3% vs. 5.2%, P = 0.02), left main disease (25.3% vs. 32.6%, P = 0.04), diabetes (31.2% vs. 40.8%, P = 0.01), or diffuse disease (19.5 ± 10.5 vs. 22.5 ± 10.9, P = 0.00), had more off pump procedures (53.2% vs. 45.3%, P = 0.03), fewer internal thoracic artery grafts (80.5% vs. 86.6%, P = 0.03), fewer grafts placed (>3: 52.6% vs. 61.8%, P = 0.02), more complications (76.5% vs. 42.6%, P = 0.005), atrial fibrillation (47.1% vs. 19.7%, P = 0.011), longer hospital stays (12.2 vs. 8.3 days, P = 0.019). Percentage survival for groups I, II, and III at 60 months was 82.1%, 84.7%, and 72.6%, respectively. : Stents placed before surgery in isolated CABG patients may be associated with higher preoperative risk, altered operative procedures, more postoperative

Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia

SciTech Connect

Torres-Blanco, Álvaro, E-mail: atorres658@yahoo.es; Edo-Fleta, Gemma; Gómez-Palonés, Francisco

2016-03-15

PurposeThe purpose of the study was to assess the safety and midterm effectiveness of endovascular treatment in Trans-Atlantic Inter-Society Consensus II (TASC-II) D femoropopliteal occlusions in patients with critical limb ischemia (CLI).MethodsPatients with CLI who underwent endovascular treatment for TASC-D de novo femoropopliteal occlusive disease between September 2008 and December 2013 were selected. Data included anatomic features, pre- and postprocedure ankle-brachial index, duplex ultrasound, and periprocedural complications. Sustained clinical improvement, limb salvage rate, freedom from target lesion revascularization (TLR), and freedom from target extremity revascularization (TER) were assessed by Kaplan–Meier estimation and predictors of restenosis/occlusion with Cox analysis.ResultsThirty-two patients underwentmore » treatment of 35 TASC-D occlusions. Mean age was 76 ± 9. Mean lesion length was 23 ± 5 cm. Twenty-eight limbs (80 %) presented tissue loss. Seventeen limbs underwent treatment by stent, 13 by stent-graft, and 5 by angioplasty. Mean follow-up was 29 ± 20 months. Seven patients required major amputation and six patients died during follow-up. Eighteen endovascular and three surgical TLR procedures were performed due to restenosis or occlusion. Estimated freedom from TLR and TER rates at 2 years were 41 and 76 %, whereas estimated primary and secondary patency rates were 41 and 79 %, respectively.ConclusionsEndovascular treatment for TASC II D lesions is safe and offers satisfying outcomes. This patient subset would benefit from a minimally invasive approach. Follow-up is advisable due to a high rate of restenosis. Further follow-up is necessary to know the long-term efficacy of these procedures.« less

Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes.

PubMed

Mohanty, Sanghamitra; Mohanty, Prasant; DI Biase, Luigi; Bai, Rong; Trivedi, Chintan; Santangeli, Pasquale; Santoro, Francesco; Hongo, Richard; Hao, Steven; Beheiry, Salwa; Burkhardt, David; Gallinghouse, Joseph G; Horton, Rodney; Sanchez, Javier E; Bailey, Shane; Hranitzky, Patrick M; Zagrodzky, Jason; Natale, Andrea

2014-09-01

Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for atrial fibrillation (AF) recurrence. This study evaluated ablation outcome in AF patients with coexistent MS and OSA and influence of lifestyle modifications (LSM) on arrhythmia recurrence. We included 1,257 AF patients undergoing first catheter ablation (30% paroxysmal AF). Patients having MS + OSA were classified into Group 1 (n = 126; 64 ± 8 years; 76% male). Group 2 (n = 1,131; 62 ± 11 years; 72% male) included those with either MS (n = 431) or OSA (n = 112; no CPAP users) or neither of these comorbidities (n = 588). Patients experiencing recurrence after first procedure were divided into 2 subgroups; those having sporadic events (frequency < 2 months) remained on previously ineffective antiarrhythmic drugs (AAD) and aggressive LSM, while those with persistent arrhythmia (incessant or ≥2 months) underwent repeat ablation. After 34 ± 8 months of first procedure, 66 (52%) in Group 1 and 386 (34%) in Group 2 had recurrence (P < 0.001). Recurrence rate in only-MS, only-OSA, and without MS/OSA groups were 40%, 38%, and 29%, respectively. Patients with MS + OSA experienced substantially higher recurrence compared to those with lone MS or OSA (52% vs. 40% vs. 38%; P = 0.036). Of the 452 patients having recurrence, 250 underwent redo-ablation and 194 remained on AAD and LSM. At 20 ± 6 months, 76% of the redo group remained arrhythmia-free off AAD whereas 74% of the LSM group were free from recurrence (P = 0.71), 33% of which were off AAD. MS and OSA have additive negative effect on arrhythmia recurrence following single procedure. Repeat ablation or compliant LSM increase freedom from recurrent AF. © 2014 Wiley Periodicals, Inc.

Robotic versus laparoscopic surgery for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of short-term outcomes.

PubMed

Serin, Kursat Rahmi; Gultekin, Fatma Ayca; Batman, Burçin; Ay, Serden; Kapran, Yersu; Saglam, Sezer; Asoglu, Oktar

2015-09-01

The aim of our study was to compare short-term outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision (TME) in male patients with mid-low rectal cancer (RC) after neadjuvant chemoradiotherapy (NCRT). The study was conducted as a retrospective review of a prospectively maintained database, and we analyzed 14 robotic and 65 laparoscopic sphincter saving TME (R-TME and L-TME, respectively) performed by one surgeon between 2005 and 2013. Patient characteristics, perioperative recovery, postoperative complications and and pathology results were compared between the two groups. The patient characteristics did not differ significantly between the two groups. Median operating time was longer in the R-TME than in the L-TME group (182 min versus 140 min). Only two conversions occurred in the L-TME group. No difference was found between groups regarding perioperative recovery and postoperative complication rates. The median number of harvested lymph nodes was higher in the RTME than in the L-TME group (32 versus 23, p = 0.008). The median circumferential margin (CRM) was 10 mm in the R-TME group, 6.5 mm in the L-TME group (p = 0.047. The median distal resection margin (DRM) was 27.5 mm in the R-TME, 15 mm in the L-TME group (p = 0.014). Macroscopic grading of the specimen in the R-TME group was complete in all patients. In the L-TME group, grading was complete in 52 (80%) and incomplete in 13 (20%) cases (p = 0.109). R-TME is a safe and feasible procedure that facilitates performing of TME in male patients with mid-low RC after NCRT.

Mid-term coral-algal dynamics and conservation status of a Gorgona Island (Tropical Eastern Pacific) coral reef.

PubMed

Zapata, Fernando A; Rodríguez-Ramírez, Alberto; Caro-Zambrano, Carlos; Garzón-Ferreira, Jaime

2010-05-01

Colombian coral reefs, as other reefs worldwide, have deteriorated significantly during the last few decades due to both natural and anthropogenic disturbances. The National Monitoring System for Coral Reefs in Colombia (SIMAC) was established in 1998 to provide long-term data bases to assess the changes of Colombian coral reefs against perturbations and to identify the factors responsible for their decline or recovery. On the Pacific coast, data on coral and algal cover have been collected yearly during seven consecutive years (1998-2004) from 20 permanent transects in two sites at La Azufrada reef, Gorgona Island. Overall, coral cover was high (55.1%-65.7%) and algal cover low (28.8%-37.5%) and both exhibited significant changes among years, most notably on shallow areas. Differences between sites in both coral and algal cover were present since the study began and may be explained by differences in sedimentation stress derived from soil runoff. Differences between depths most likely stem from the effects of low tidal sub-aerial exposures. Particularly intense sub-aerial exposures occurred repeatedly during January-March, 2001 and accounted for a decrease in coral and an increase in algal cover on shallow depths observed later that year. Additionally, the shallow area on the Northern site seems to be negatively affected by the combined effect of sedimentation and low tidal exposure. However, a decrease in coral cover and an increase of algal cover since 2001 on deep areas at both sites remain unexplained. Comparisons with previous studies suggest that the reef at La Azufrada has been more resilient than other reefs in the Tropical Eastern Pacific (TEP), recovering pre-disturbance (1979) levels of coral cover within a 10 year period after the 1982-83 El Niño, which caused 85% mortality. Furthermore, the effects of the 1997-98 El Niño, indicated by the difference in overall live coral cover between 1998 and 1999, were minor (< 6% reduction). Despite recurrent

Concomitant coronary artery bypass graft and aortic and mitral valve replacement for rheumatic heart disease: short- and mid-term outcomes.

PubMed

Davarpasand, Tahereh; Hosseinsabet, Ali; Jalali, Arash

2015-09-01

It has been reported that the short-term mortality of concomitant aortic and mitral valve replacement (AVR and MVR) is considerable and concomitant coronary artery bypass graft (CABG) has adverse effects on the survival of patients with valve replacement surgery. We summarize the short- and mid-term outcome after concomitant CABG, AVR and MVR in our centre. Between 2003 and 2013, 103 patients (68 males, 35 females, age: 60.1 ± 10.1 years) underwent CABG, AVR and MVR for rheumatic heart disease (RHD) and coronary artery disease (CAD). The median follow-up was 47.6 months. Most of the patients were asymptomatic at rest. We analysed demographic, clinical and operative data of patients to define independent predictors of overall survival, cardiac event-free survival as well as cardiac death. The rate of 30-day survival was 93% (n = 96). The corresponding rates of overall survival and cardiac event-free survival and the cumulative incidence rate of cardiac death at 1 year were 80.2, 77.3 and 10.9%; the same at 4 years were 73.7, 64.6 and 15.8%. The corresponding freedom rates from anticoagulation-associated major haemorrhage; a composite of major bleeding events, thromboemboli and valvular thrombosis; cardiac rehospitalization; major adverse valve-associated events; and significant malfunction of the prosthetic valve were 96.2, 95.3, 94.7, 81.6 and 97.7% at 1 year. The corresponding freedom rates from anticoagulation-associated major haemorrhage; a composite of major bleeding events, thromboemboli and valvular thrombosis; cardiac rehospitalization; major adverse valve-associated events; and significant malfunction of the prosthetic valve were 93.5, 91.0, 91.4, 73.5 and 95.5% at 4 years. The independent predictors of overall survival were age, cigarette smoking, chronic kidney diseases and balloon pump insertion. The independent predictors of cardiac event-free survival were age and previous myocardial infarction, while age, cigarette smoking, history of cerebrovascular

Resilience of Mediterranean terrestrial ecosystems and fire severity in semiarid areas: Responses of Aleppo pine forests in the short, mid and long term.

PubMed

González-De Vega, S; De Las Heras, J; Moya, D

2016-12-15

In recent decades, the fire regime of the Mediterranean Basin has been disturbed by various factors: climate change; forest management policies; land cover; changed landscape. Size and severity have notably increased, which in turn have increased large fires events with >500ha burned (high severity). In spite of Mediterranean ecosystems' high resilience to fire, these changes have implied more vulnerability and reduced natural recovery with irreparable long-term negative effects. Knowledge of the response of ecosystems to increasing severity, mainly in semiarid areas, is still lacking, which is needed to rehabilitate and restore burned areas. Our approach assessed the resilience concept by focusing on the recovery of ecosystem functions and services, measured as changes in the composition and diversity of plant community vegetation and structure. This will be validated in the long term as a model of ecosystem response. Also, depending on the pre-fire characteristics of vegetation, fire severity and the post-fire management, this approach will lead to tools that can be applied to implement post-fire restoration efforts in order to help decision making in planning activities. Regarding Mediterranean ecosystems' ability to recover after wildfires, this study concludes that pre-fire communities are resilient in these fire-prone areas, but the window for natural recovery in semiarid areas of Aleppo pine forest in SE Iberian Peninsula varied from 3 to 15 post-fire years. Fire severity was also key for effects on the ecosystem: the vegetation types of areas burned with low and medium severity recovered naturally, while those areas with a high-severity burn induced shrublands. We concluded that very strong regeneration activity exists in the short term, and that the negative effects of medium- and high-severity fire are evidenced in the mid and long term, which affect natural recovery. Adaptive forest management to rehabilitate and restore burned Mediterranean ecosystems

Does Previous Hip Surgery Effect the Outcome of Tönnis Triple Periacetabular Osteotomy? Mid-Term Results.

PubMed

Konya, Mehmet Nuri; Aydn, Bahattin Kerem; Yldrm, Timur; Sofu, Hakan; Gürsu, Sarper

2016-03-01

, impingement, TS, VAS, HHS, WOMAC score parameters in clinical outcome and LCE, ACE, Sharp angle, coverage ratio in radiological results were significantly better in PAD group postoperatively but in RAD group; only extension, VAS, HHS, and WOMAC parameters were clinically and LCE and Coverage ratio were significantly different compared with the preoperative measurements. The change of the parameters that used for the evaluation of clinical and radiological results did not show a significant difference between groups.Our data suggest that TPAO can be performed on patients with HD for both groups. Although there were fewer parameters which changed significantly after TPAO in RAD patients; the improvement of radiological and clinical results was similar for groups. Further long-term follow-up studies with large number of patients are needed to determine the proper results of TPAO.

Percutaneous microwave ablation of renal cell carcinoma using a high power microwave system: focus upon safety and efficacy.

PubMed

Filippiadis, D K; Gkizas, C; Chrysofos, M; Siatelis, A; Velonakis, G; Alexopoulou, E; Kelekis, A; Brountzos, E; Kelekis, N

2017-12-04

Percutaneous ablation is an expanding, minimally invasive approach for small- to medium-sized renal masses. The purpose of this study is to review safety, and mid-term efficacy of percutaneous microwave ablation (MWA) for Renal Cell Carcinoma (RCC) treatment using a high power microwave system. Institutional database research identified 50 consecutive patients with a single lesion resembling renal cell carcinoma in CT and MRI who underwent percutaneous microwave ablation using a high power microwave system. All patients underwent biopsy on the same session with ablation using an 18G semi-automatic soft tissue biopsy needle. Contrast-enhanced computed tomography or magnetic resonance imaging was used for post-ablation follow-up. Patient and tumour characteristics, microwave technique, complications and pattern of recurrence were evaluated. Mean patient age was 74 years (male-female: 31-19). Average lesion size was 3.1 cm (range 2.0-4.3 cm). Biopsy results report RCC (n = 48), inflammatory myofibroblastic tumour (n = 1), and non-diagnostic sample (n = 1). The 3-year overall survival was 95.8% (46/48). Two patients died during the 3-year follow-up period due to causes unrelated to the MW ablation and to the RCC. Minor complications including haematomas requiring nothing but observation occurred at 4% (2/50) of the cases. Local recurrence of 6.25% (3/48) was observed with 2/3 cases being re-treated achieving a total clinical success of 97.9% (47/48 lesions). Percutaneous microwave ablation of RCC using a high power microwave system is a safe and efficacious technique for the treatment of small- to medium-sized renal masses.

Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes

PubMed Central

Chew, Nicholas; Hon, Jimmy Kim Fatt; Yip, Wei Luen James; Chan, Siew Pang; Poh, Kian-Keong; Kong, William Kok-Fai; Teoh, Kristine Leok Kheng; Yeo, Tiong Cheng; Tan, Huay Cheem; Tay, Edgar Lik Wui

2017-01-01

INTRODUCTION Transcatheter aortic valve implantation (TAVI) is an effective treatment for high-risk or inoperative patients with severe aortic stenosis. Given the unique characteristics of Asian populations, questions regarding mid-term outcomes in Asians undergoing TAVI have yet to be addressed. We evaluated the two-year clinical outcomes of TAVI in an Asian population using Valve Academic Research Consortium-2 definitions. METHODS This prospective study recruited 59 patients from a major academic medical centre in Singapore. The main outcomes were two-year survival rates, peri-procedural complications, symptom improvement, valvular function and assessment of learning curve. RESULTS Mean age was 76.8 years (61.0% male), mean body surface area 1.6 m2 and mean logistic EuroSCORE 18.7%. Survival was 93.2%, 86.0% and 79.1% at 30 days, one year and two years, respectively. At 30 days post TAVI, the rate of stroke was 1.7%, life-threatening bleeding 5.1%, acute kidney injury 25.0%, major vascular complication 5.1%, and new permanent pacemaker implantation 6.8%. 29.3% of TAVI patients were rehospitalised (47.1% cardiovascular-related) within one year. These composite outcomes were measured: device success (93.2%); early safety (79.7%); clinical efficacy (66.1%); and time-related valve safety (84.7%). Univariate analysis found these predictors of two-year all-cause mortality: logistic EuroSCORE (hazard ratio [HR] 1.07; p < 0.001); baseline estimated glomerular filtration rate (HR 0.97; p = 0.048); and acute kidney injury (HR 5.33; p = 0.022). Multivariate analysis identified non-transfemoral TAVI as a predictor of cardiovascular-related two-year mortality (HR 14.64; p = 0.008). CONCLUSION Despite the unique clinical differences in Asian populations, this registry demonstrated favourable mid-term clinical and safety outcomes in Asians undergoing TAVI. PMID:27516113

Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes.

PubMed

Chew, Nicholas; Hon, Jimmy Kim Fatt; Yip, Wei Luen James; Chan, Siew Pang; Poh, Kian-Keong; Kong, William Kok-Fai; Teoh, Kristine Leok Kheng; Yeo, Tiong Cheng; Tan, Huay Cheem; Tay, Edgar Lik Wui

2017-09-01

Transcatheter aortic valve implantation (TAVI) is an effective treatment for high-risk or inoperative patients with severe aortic stenosis. Given the unique characteristics of Asian populations, questions regarding mid-term outcomes in Asians undergoing TAVI have yet to be addressed. We evaluated the two-year clinical outcomes of TAVI in an Asian population using Valve Academic Research Consortium-2 definitions. This prospective study recruited 59 patients from a major academic medical centre in Singapore. The main outcomes were two-year survival rates, peri-procedural complications, symptom improvement, valvular function and assessment of learning curve. Mean age was 76.8 years (61.0% male), mean body surface area 1.6 m 2 and mean logistic EuroSCORE 18.7%. Survival was 93.2%, 86.0% and 79.1% at 30 days, one year and two years, respectively. At 30 days post TAVI, the rate of stroke was 1.7%, life-threatening bleeding 5.1%, acute kidney injury 25.0%, major vascular complication 5.1%, and new permanent pacemaker implantation 6.8%. 29.3% of TAVI patients were rehospitalised (47.1% cardiovascular-related) within one year. These composite outcomes were measured: device success (93.2%); early safety (79.7%); clinical efficacy (66.1%); and time-related valve safety (84.7%). Univariate analysis found these predictors of two-year all-cause mortality: logistic EuroSCORE (hazard ratio [HR] 1.07; p < 0.001); baseline estimated glomerular filtration rate (HR 0.97; p = 0.048); and acute kidney injury (HR 5.33; p = 0.022). Multivariate analysis identified non-transfemoral TAVI as a predictor of cardiovascular-related two-year mortality (HR 14.64; p = 0.008). Despite the unique clinical differences in Asian populations, this registry demonstrated favourable mid-term clinical and safety outcomes in Asians undergoing TAVI. Copyright: © Singapore Medical Association

Is Previous Cardiac Surgery a Risk Factor for Short and Mid-term Mortality Following Total Aortic Arch Replacement in Patients with Stanford Type A Aortic Dissection?

PubMed

Ge, Yi-Peng; Li, Cheng-Nan; Chen, Lei; Liu, Wei; Cheng, Li-Jian; Liu, Yong-Min; Zheng, Jun; Ma, Wei-Guo; Zhu, Jun-Ming; Sun, Li-Zhong

2015-11-01

The aim of this study was to evaluate if the previous cardiac surgery (PCS) is the risk factor for short- and mid-term mortality following total aortic arch replacement in patients with Stanford type A aortic dissection. Between February 2009 and February 2012, a total of 384 patients who suffered Stanford type A aortic dissection involving aortic arch underwent total aortic arch replacement with frozen elephant trunk. Of these patients, 36 patients had PCS. Logistic regression was used to identify if the previous cardiac surgery was the risk factor for in-hospital mortality. Propensity score-matching (1:1 match) was used to yield patients from the primary surgery group who matched PCS group with respect to pre-operative clinical characteristics and post-operative complications. Survival analysis and differences between the two groups were performed by the Kaplan-Meier estimate and the log-rank test. The overall in-hospital mortality was 8%. Logistic multiple regression identified that cardiopulmonary bypass time≥ 300minutes (OR=12.05, p<0.001) and surgical period from symptom onset shorter than one week (OR=2.43, p=0.04) were final risk factors for in-hospital mortality and PCS was not the final risk factor. Of 36 patients with PCS, three patients died in the hospital and 33 patients were discharged from the hospital. Of these 33 patients, 32 patients matched primary surgery group successfully. During the follow-up period, two patients died in PCS group, one patient died in primary surgery group. The mean follow-up time was 35.38±14.12 months. The five-year survival was 96% for the primary surgery group. Previous cardiac surgery group five-year survival was 73%. Five-year survival was not significantly different between the two groups (p=0.84 log-rank test). PCS is not the risk factor for short- and mid-term mortality following total aortic arch replacement in patients with Stanford type A aortic dissection. Copyright © 2015 Australian and New Zealand

Mid-term survival analysis of closed wedge high tibial osteotomy: A comparative study of computer-assisted and conventional techniques.

PubMed

Bae, Dae Kyung; Song, Sang Jun; Kim, Kang Il; Hur, Dong; Jeong, Ho Yeon

2016-03-01

The purpose of the present study was to compare the clinical and radiographic results and survival rates between computer-assisted and conventional closing wedge high tibial osteotomies (HTOs). Data from a consecutive cohort comprised of 75 computer-assisted HTOs and 75 conventional HTOs were retrospectively reviewed. The Knee Society knee and function scores, Hospital for Special Surgery (HSS) score and femorotibial angle (FTA) were compared between the two groups. Survival rates were also compared with procedure failure. The knee and function scores at one year postoperatively were slightly better in the computer-assisted group than those in conventional group (90.1 vs. 86.1) (82.0 vs. 76.0). The HSS scores at one year postoperatively were slightly better for the computer-assisted HTOs than those of conventional HTOs (89.5 vs. 81.8). The inlier of the postoperative FTA was wider in the computer-assisted group than that in the conventional HTO group (88.0% vs. 58.7%), and mean postoperative FTA was greater in the computer-assisted group that in the conventional HTO group (valgus 9.0° vs. valgus 7.6°, p<0.001). The five- and 10-year survival rates were 97.1% and 89.6%, respectively. No difference was detected in nine-year survival rates (p=0.369) between the two groups, although the clinical and radiographic results were better in the computer-assisted group that those in the conventional HTO group. Mid-term survival rates did not differ between computer-assisted and conventional HTOs. A comparative analysis of longer-term survival rate is required to demonstrate the long-term benefit of computer-assisted HTO. III. Copyright © 2015 Elsevier B.V. All rights reserved.

Mid- and long-term outcomes of carotid-cavernous fistula endovascular management with Onyx and n-BCA: experience of a single tertiary center.

PubMed

Barber, Sean M; Rangel-Castilla, Leonardo; Zhang, Y Jonathan; Klucznik, Richard; Diaz, Orlando

2015-10-01

Endovascular therapy is the preferred treatment for most carotid-cavernous fistulas (CCFs). Early reports have documented excellent initial clinical and radiographic outcomes after embolization of CCFs with Onyx or n-butyl cyanoacrylate (n-BCA), but little evidence is available about the long-term durability of this technique. To characterize the long-term durability of CCF liquid embolization. The authors retrospectively reviewed a database of 24 CCFs in 21 consecutive patients who underwent Onyx or n-BCA embolization of a CCF from 2006 to 2013 at our institution. A total of 25 Onyx or n-BCA embolization procedures were attempted and 24 successfully completed during the study, resulting in complete or near-complete occlusion by the end of the study in all 24 CCFs (obliteration success, 100%). Attempted embolization in a single CCF failed initially, but was performed successfully at a later date by a different approach. None of the 24 CCFs recanalized, regrew, or required any further treatment subsequent to Onyx or n-BCA embolization throughout a mean 12.4 months of angiographic follow-up (range 1-36 months). Clinically significant complications were seen in three embolization procedures, including cranial nerve palsies (n=1), embolic infarct (n=1), and intraperitoneal hemorrhage (n=1). Early evidence has indicated that endovascular embolization with Onyx is relatively safe and effective at achieving an initial angiographic cure for CCFs. Results of our series suggest that angiographic and clinical outcomes of Onyx and n-BCA embolization remain stable at mid- and long-term follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Global ablation techniques.

PubMed

Woods, Sarah; Taylor, Betsy

2013-12-01

Global endometrial ablation techniques are a relatively new surgical technology for the treatment of heavy menstrual bleeding that can now be used even in an outpatient clinic setting. A comparison of global ablation versus earlier ablation technologies notes no significant differences in success rates and some improvement in patient satisfaction. The advantages of the newer global endometrial ablation systems include less operative time, improved recovery time, and decreased anesthetic risk. Ablation procedures performed in an outpatient surgical or clinic setting provide advantages both of potential cost savings for patients and the health care system and improved patient convenience. Copyright © 2013. Published by Elsevier Inc.

From Laser Desorption to Laser Ablation of Biopolymers

NASA Astrophysics Data System (ADS)

Franz, Hillenkamp

1998-03-01

For selected indications laser ablation and cutting of biological tissues is clinical practice. Preferentially lasers with emission wavelengths in the far UV and the mid IR are used, for which tissue absorption is very high. Morphologically the ablation sites look surprisingly similar for the two wavelength ranges, despite of the very different prim y putative interaction mechanisms. Ablation depth as a function of fluence follows a sigmoidal curve. Even factors below the nominal ablation threshold superficial layers of material get removed from the surface. This is the fluence range for Matrix-Assisted Laser Desorption/Ionization (MALDI). Evidence will be presented which suggest that strong similarities exist between the desorption and ablation processes both for UV- as well as for IR-wavelengths.

Direct His bundle pacing post AVN ablation.

PubMed

Lakshmanadoss, Umashankar; Aggarwal, Ashim; Huang, David T; Daubert, James P; Shah, Abrar

2009-08-01

Atrioventricular nodal (AVN) ablation with concomitant pacemaker implantation is one of the strategies that reduce symptoms in patients with atrial fibrillation (AF). However, the long-term adverse effects of right ventricular (RV) apical pacing have led to the search for alternating sites of pacing. Biventricular pacing produces a significant improvement in functional capacity over RV pacing in patients undergoing AVN ablation. Another alternative site for pacing is direct His bundle to reduce the adverse outcome of RV pacing. Here, we present a case of direct His bundle pacing using steerable lead delivery system in a patient with symptomatic paroxysmal AF with concurrent AVN ablation.

Pulmonary vein activity does not predict the outcome of catheter ablation for persistent atrial fibrillation: A long-term multicenter prospective study.

PubMed

Prabhu, Sandeep; Kalla, Manish; Peck, Kah Y; Voskoboinik, Aleksandr; McLellan, Alex J A; Pathik, Bupesh; Nalliah, Chrishan J; Wong, Geoff R; Sugumar, Hariharan; Azzopardi, Sonia M; Lee, Geoffrey; Ling, Liang-Han; Kalman, Jonathan M; Kistler, Peter M

2018-03-02

Pulmonary vein (PV) isolation (PVI) remains the cornerstone of catheter ablation (CA) in persistent atrial fibrillation (AF) (PeAF), although less successful than for paroxysmal AF. Whether rapid or fibrillatory (PV AF) PV firing may identify patients with PeAF more likely to benefit from a PV-based ablation approach is unclear. The purpose of this study was to determine the relationship between the PV cycle length (PVCL) and the PV AF outcome after CA. Before ablation, the multipolar catheter was placed in each PV and the left atrial appendage (LAA) for 100 consecutive cycles. The presence of PV AF, the average PVCL of all 4 veins (PV 4VAverage ), the fastest vein average (PV FVAverage ), the fastest cycle length (PV Fast ) both individually and relative to the average LAA cycle length were calculated. The ablation strategy included PVI and posterior wall isolation with a minimum of 12 months follow-up. A total of 123 patients underwent CA (age 62 ± 9.1 years; CHA 2 DS 2 -VASC score 1.6 ± 1.1; left ventricular ejection fraction 48% ± 13%; left atrial area 31 ± 8.7 cm 2 ; AF duration 16 ± 17 months). PVI was achieved in 100% of patients. Multiprocedure success (MPS; freedom from AF/atrial tachycardia episodes lasting >30 seconds) was achieved in 76% of patients at 24 ± 8.1 months of follow-up after 1.2 ± 0.4 procedures. PV activity was not associated with MPS either absolutely (PV 4VAverage [MPS no vs yes: 178 ± 27 ms vs 177 ± 24 ms; P = .92], PV FVAverage [P = .69], or PV Fast [P = .82]) or as a ratio relative to the LAA cycle length (PV 4VAverage /LAA 1.05 ± 0.11 vs 1.06 ± 0.21; P = .87). The presence of PV AF (31% vs 47%; P = .13) did not predict MPS. The rapidity of PV firing or presence of fibrillation within the PV was not predictive of outcome of CA for PeAF. PV activity does not identify patients most likely to benefit from a PV-based ablation strategy. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Long-term changes in tree-ring – climate relationships at Mt. Patscherkofel (Tyrol, Austria) since the mid 1980s

PubMed Central

Oberhuber, Walter; Kofler, Werner; Pfeifer, Klaus; Seeber, Andrea; Gruber, Andreas; Wieser, Gerhard

2011-01-01

Although growth limitation of trees at Alpine and high-latitude timberlines by prevailing summer temperature is well established, loss of thermal response of radial tree growth during last decades has repeatedly been addressed. We examined long-term variability of climate-growth relationships in ring width chronologies of Stone pine (Pinus cembra L.) by means of moving response functions (MRF). The study area is situated in the timberline ecotone (c. 2000 – 2200 m a.s.l.) on Mt. Patscherkofel (Tyrol, Austria). Five site chronologies were developed within the ecotone with constant sample depth (≥ 19 trees) throughout most of the time period analysed. MRF calculated for the period 1866-1999 and 1901-1999 for c. 200 and c. 100 yr old stands, respectively, revealed that mean July temperature is the major and long-term stable driving force of Pinus cembra radial growth within the timberline ecotone. However, since the mid 1980s, radial growth in timberline and tree line chronologies strikingly diverges from the July temperature trend. This is probably a result of extreme climate events (e.g. low winter precipitation, late frost) and/or increasing drought stress on cambial activity. The latter assumption is supported by a < 10 % increase in annual increments of c. 50 yr old trees at the timberline and at the tree line in 2003 compared to 2002, when extraordinary hot and dry conditions prevailed during summer. Furthermore, especially during the second half of the 20th century, influence of climate variables on radial growth show abrupt fluctuations, which might also be a consequence of climate warming on tree physiology. PMID:21532976

Triple-orifice valve repair in severe Barlow disease with multiple-jet mitral regurgitation: report of mid-term experience.

PubMed

Fucci, Carlo; Faggiano, Pompilio; Nardi, Matilde; D'Aloia, Antonio; Coletti, Giuseppe; De Cicco, Giuseppe; Latini, Leonardo; Vizzardi, Enrico; Lorusso, Roberto

2013-09-10

Barlow disease represents a surgical challenge for mitral valve repair (MR) in the presence of mitral insufficiency (MI) with multiple regurgitant jets. We hereby present our mid-term experience using a modified edge-to-edge technique to address this peculiar MI. From March 2003 till December 2010, 25 consecutive patients (mean age 54 ± 7 years, 14 males) affected by severe Barlow disease with multiple regurgitant jets were submitted to MR. Preoperative transesophageal echo (TEE) in all the cases showed at least 2 regurgitant jets, involving one or both leaflets in more than one segment. In all the patients, a triple orifice valve (TOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the TOV repair. There was no in-hospital death and one late death (non-cardiac related). At intra-operative TEE, the three orifices showed a mean total valve area of 2.9 ± 0.1cm(2) (range 2.5-3.3 cm(2)) with no residual regurgitation (2 cases of trivial MI) and no sign of valve stenosis (mean transvalvular gradient 4.6 ± 1.5 mmHg). At follow up (mean 38 ± 22 months), TTE showed favourable MR and no recurrence of significant MI (6 cases of trivial and 1 of mild MI). Stress TTE was performed in 5 cases showing persistent effective valve function (2 cases of trivial MI at peak exercise). All the patients showed significant NYHA functional class improvement. This report indicates that the TOV technique is effective in correcting complex Barlow mitral valves with multiple jets. Further studies are required to confirm long-term applicability and durability in more numerous clinical cases. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Large scale variability, long-term trends and extreme events in total ozone over the northern mid-latitudes based on satellite time series

NASA Astrophysics Data System (ADS)

Rieder, H. E.; Staehelin, J.; Maeder, J. A.; Ribatet, M.; Davison, A. C.

2009-04-01

Various generations of satellites (e.g. TOMS, GOME, OMI) made spatial datasets of column ozone available to the scientific community. This study has a special focus on column ozone over the northern mid-latitudes. Tools from geostatistics and extreme value theory are applied to analyze variability, long-term trends and frequency distributions of extreme events in total ozone. In a recent case study (Rieder et al., 2009) new tools from extreme value theory (Coles, 2001; Ribatet, 2007) have been applied to the world's longest total ozone record from Arosa, Switzerland (e.g. Staehelin 1998a,b), in order to describe extreme events in low and high total ozone. Within the current study this analysis is extended to satellite datasets for the northern mid-latitudes. Further special emphasis is given on patterns and spatial correlations and the influence of changes in atmospheric dynamics (e.g. tropospheric and lower stratospheric pressure systems) on column ozone. References: Coles, S.: An Introduction to Statistical Modeling of Extreme Values, Springer Series in Statistics, ISBN:1852334592, Springer, Berlin, 2001. Ribatet, M.: POT: Modelling peaks over a threshold, R News, 7, 34-36, 2007. Rieder, H.E., Staehelin, J., Maeder, J.A., Ribatet, M., Stübi, R., Weihs, P., Holawe, F., Peter, T., and Davison, A.C.: From ozone mini holes and mini highs towards extreme value theory: New insights from extreme events and non stationarity, submitted to J. Geophys. Res., 2009. Staehelin, J., Kegel, R., and Harris, N. R.: Trend analysis of the homogenized total ozone series of Arosa (Switzerland), 1929-1996, J. Geophys. Res., 103(D7), 8389-8400, doi:10.1029/97JD03650, 1998a. Staehelin, J., Renaud, A., Bader, J., McPeters, R., Viatte, P., Hoegger, B., Bugnion, V., Giroud, M., and Schill, H.: Total ozone series at Arosa (Switzerland): Homogenization and data comparison, J. Geophys. Res., 103(D5), 5827-5842, doi:10.1029/97JD02402, 1998b.

Mucosal ablation in Barrett's esophagus.

PubMed

Walker, S J; Selvasekar, C R; Birbeck, N

2002-01-01

Barrett's esophagus is a prevalent, premalignant condition affecting the gastroesophageal junction and distal esophagus. Ablation plus antireflux therapy has recently been advocated to prevent the development of adenocarcinoma or to treat those unfit or unwilling to undergo esophagectomy. The present article, based on a search of Medline/ISI databases and cross-referencing of relevant articles, reviews the literature on this subject. A number of techniques have been used to remove the affected mucosa, including laser, electrocoagulation, argon plasma coagulation and photodynamic therapy but, as yet, none has been shown to be superior. Depending on the method used, ablation results in complete removal of Barrett's esophagus in approximately one third of patients and a partial response in nearly two-thirds. The resultant squamous mucosa is apparently 'normal' but may regress. To promote and maintain regeneration, antireflux therapy must be sufficient to reduce repetitive injury to the esophageal mucosa. Whether ablation reduces the cancer risk or delays its occurrence is unknown, though recent data suggests benefit. Complications are infrequent and usually mild. Regular follow-up endoscopy and deep biopsies continue to be necessary. Careful data from much larger populations with long-term follow-up is required before ablation reaches the stage of broad clinical application.

Nonequilibrium Ablation of Phenolic Impregnated Carbon Ablator

NASA Technical Reports Server (NTRS)

Milos, Frank S.; Chen, Yih K.; Gokcen, Tahir

2012-01-01

In previous work, an equilibrium ablation and thermal response model for Phenolic Impregnated Carbon Ablator was developed. In general, over a wide range of test conditions, model predictions compared well with arcjet data for surface recession, surface temperature, in-depth temperature at multiple thermocouples, and char depth. In this work, additional arcjet tests were conducted at stagnation conditions down to 40 W/sq cm and 1.6 kPa. The new data suggest that nonequilibrium effects become important for ablation predictions at heat flux or pressure below about 80 W/sq cm or 10 kPa, respectively. Modifications to the ablation model to account for nonequilibrium effects are investigated. Predictions of the equilibrium and nonequilibrium models are compared with the arcjet data.

Endovascular treatment of intracranial aneurysms with the p64 flow diverter stent: mid-term results in 35 patients with 41 intracranial aneurysms.

PubMed

Morais, Ricardo; Mine, Benjamin; Bruyère, Pierre Julien; Naeije, Gilles; Lubicz, Boris

2017-03-01

The p64 flow diverter (FD) device is a fully resheathable and detachable stent dedicated for endovascular treatment (EVT) of intracranial aneurysms (IAs). We report our mid-term experience with this device. Between January 2015 and February 2016, we retrospectively identified, in our prospectively maintained database, all patients treated with p64 FDs in two institutions. Independent clinical follow-up was performed by a vascular neurologist. Imaging follow-up included a digitalized subtraction angiography (DSA) at 3, 6, and 12 months and a magnetic resonance angiography (MRA) at 12 months. Thirty-nine patients (22 women/17 men; median age 54 years) with 48 IAs (median aneurysm size 6.2 mm; mean neck size 3.4 mm) were identified. All IAs were saccular and unruptured. Failure of safe stent delivery occurred in 15% of cases (7/48 IAs) which were excluded. Transient neurological morbidity occurred in 2/35 patients (5.7%) including one delayed thromboembolic complication. No permanent morbidity or mortality was encountered. Complete aneurysmal occlusion at 3, 6, and 12 months was 20/30 (66.6%), 18/27 (66.6%), and 24/28 (85.7%), respectively. Intra-stent stenosis was observed in 9/29 patients (31%) and classified as moderate in 4/29 (13.7%) and mild in 5/29 patients (17.2%). These stenoses gradually improved over time, with only mild stenoses being identified at 6 months and at 12 months. In our small case series, the p64 FD stent appears safe and effective for EVT of IAs. A high occlusion rate and a low morbidity rate were observed.

Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot.

PubMed

Chraim, M; Krenn, S; Alrabai, H M; Trnka, H-J; Bock, P

2018-02-01

Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up. We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail. Patients were ten men and eight women with a mean age of 63.43 years (38.5 to 79.8). We report the rate of limb salvage, complications requiring additional surgery, and fusion rate in both groups. The mean duration of follow-up was 46.36 months (37 to 70). The limb salvage rate was 16 of 19 limbs. Three patients had to undergo below-knee amputation due to persistent infection followed by osteomyelitis resistant to parenteral antibiotic therapy and repeated debridement. Complications including infection, hardware removal, nonunion, and persistent ulcers requiring further intervention were also observed. Postoperative functional scores revealed significant improvement compared with preoperative scores on American Orthopaedic Foot and Ankle Society (AOFAS) - Hindfoot scale, Foot Function Index (FFI), visual analogue scale (VAS), and Foot and Ankle Outcome Score (FAOS). The use of retrograde intramedullary compression nail results in good rates of limb salvage when used for hindfoot reconstruction in patients with Charcot arthropathy. Cite this article: Bone Joint J 2018;100-B:190-6. ©2018 The British Editorial Society of Bone & Joint Surgery.

Early and mid-term results of autograft rescue by Ross reversal: A one-valve disease need not become a two-valve disease.

PubMed

Hussain, Syed T; Majdalany, David S; Dunn, Aaron; Stewart, Robert D; Najm, Hani K; Svensson, Lars G; Houghtaling, Penny L; Blackstone, Eugene H; Pettersson, Gösta B

2018-02-01

Risk of reoperation and loss of a second native valve are major drawbacks of the Ross operation. Rather than discarding the failed autograft, it can be placed back into the native pulmonary position by "Ross reversal." We review our early and mid-term results with this operation. From 2006 to 2017, 39 patients underwent reoperation for autograft dysfunction. The autograft was successfully rescued in 35 patients: by Ross reversal in 30, David procedure in 4, and autograft repair in 1. Medical records were reviewed for patient characteristics (mean age was 46 ± 13 years, range 18-67 years, and 23 were male), previous operations, indications for reoperation, hospital outcomes, and echocardiographic findings for the 30 patients undergoing successful Ross reversal. Follow-up was 4.1 ± 3.5 years (range 7 months-11 years). Median interval between the original Ross procedure and Ross reversal was 12 years (range 5-19 years). Eight patients also had absolute indications for replacement of the pulmonary allograft. There was no operative mortality. One patient required reoperation for bleeding. Another had an abdominal aorta injury from use of an endoballoon clamp. There was no other major postoperative morbidity, and median postoperative hospital stay was 7.2 days (range 4-41 days). No patient required reoperation during follow-up. Twenty-four patients had acceptable pulmonary valve function, and 6 had clinically well-tolerated moderate or severe pulmonary regurgitation. Ross reversal can be performed with low morbidity and acceptable pulmonary valve function, reducing patient risk of losing 2 native valves when the autograft fails in the aortic position. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Long-Term Effects of Safinamide on Dyskinesia in Mid- to Late-Stage Parkinson's Disease: A Post-Hoc Analysis.

PubMed

Cattaneo, Carlo; Ferla, R La; Bonizzoni, Erminio; Sardina, Marco

2015-01-01

Safinamide is a novel α-aminoamide with dopaminergic and non-dopaminergic properties developed as adjunctive therapy for patients with PD. Results from a 24-month double-blind controlled study suggested that as add-on to levodopa (and other PD medications) the benefits of safinamide on dyskinesia may be related to severity of dyskinesia at baseline. This post-hoc analysis further characterized the effects of safinamide on dyskinesia in mid- to late-stage PD patients. Patients were stratified by the presence or absence of dyskinesia at baseline, and by whether or not the dose of levodopa had been changed during the 24-month treatment period. Differences between safinamide and placebo were evaluated using the Wilcoxon rank-sum test. For the overall treated population (with or without baseline dyskinesia), safinamide 100 mg/day significantly improved the dyskinesia rating scale score, compared with placebo, in the subgroup of patients with no change in levodopa dose (p = 0.0488). For patients with baseline dyskinesia, improvements over placebo were also significant (p = 0.0153) in patients with or without changes in levodopa dose, and nearly significant (p = 0.0546) in patients with no change in levodopa dose, suggesting that these improvements were not due to levodopa dose reductions. While no statistically significant difference in mean DRS scores was seen between safinamide and placebo in the original study population, the present post-hoc analysis helps to provide a meaningful interpretation of the long-term effects of safinamide on dyskinesia. These results may be related to safinamide state- and use-dependent inhibition of sodium channels and stimulated glutamate release, and are unlikely due to reduced dopaminergic stimulation.

Long-Term Effects of Safinamide on Dyskinesia in Mid- to Late-Stage Parkinson’s Disease: A Post-Hoc Analysis

PubMed Central

Cattaneo, Carlo; Ferla, R. La; Bonizzoni, Erminio; Sardina, Marco

2015-01-01

Abstract Background: Safinamide is a novel α-aminoamide with dopaminergic and non-dopaminergic properties developed as adjunctive therapy for patients with PD. Results from a 24-month double-blind controlled study suggested that as add-on to levodopa (and other PD medications) the benefits of safinamide on dyskinesia may be related to severity of dyskinesia at baseline. Objective: This post-hoc analysis further characterized the effects of safinamide on dyskinesia in mid- to late-stage PD patients. Methods: Patients were stratified by the presence or absence of dyskinesia at baseline, and by whether or not the dose of levodopa had been changed during the 24-month treatment period. Differences between safinamide and placebo were evaluated using the Wilcoxon rank-sum test. Results: For the overall treated population (with or without baseline dyskinesia), safinamide 100 mg/day significantly improved the dyskinesia rating scale score, compared with placebo, in the subgroup of patients with no change in levodopa dose (p = 0.0488). For patients with baseline dyskinesia, improvements over placebo were also significant (p = 0.0153) in patients with or without changes in levodopa dose, and nearly significant (p = 0.0546) in patients with no change in levodopa dose, suggesting that these improvements were not due to levodopa dose reductions. Conclusions: While no statistically significant difference in mean DRS scores was seen between safinamide and placebo in the original study population, the present post-hoc analysis helps to provide a meaningful interpretation of the long-term effects of safinamide on dyskinesia. These results may be related to safinamide state- and use-dependent inhibition of sodium channels and stimulated glutamate release, and are unlikely due to reduced dopaminergic stimulation. PMID:26406127

Mid-term development of hamstring tendon length and velocity after distal femoral extension osteotomy in children with bilateral cerebral palsy: a retrospective cohort study.

PubMed

Salami, Firooz; Wagner, Julia; van Drongelen, Stefan; Klotz, Matthias C M; Dreher, Thomas; Wolf, Sebastian I; Niklasch, Mirjam

2018-03-14

Flexed knee gait can be treated with distal femoral extension osteotomy (DFEO) and additional patellar tendon advancement (PTA) in children with cerebral palsy (CP). This study assesses changes in hamstring muscle tendon length (MTL) and velocity after DFEO (+PTA). Nineteen children (mean age 13y [standard deviation 3y] at surgery) with CP and flexed knee gait who were treated with DFEO (15 limbs) or DFEO+PTA (10 limbs) were retrospectively included in this study. Gait analyses were performed preoperatively (E0), 1 year postoperatively (E1), and for 10 limbs additionally 2 to 5 years postoperatively (E2). Hamstring MTL and velocities were assessed at all examination dates using OpenSim. Hamstring MTL and velocity did not change significantly over time. From E0 to E1, knee flexion in stance improved for both DFEO and DFEO+PTA (p<0.05), knee flexion in swing only improved after DFEO+PTA (p<0.05). The improved knee flexion in stance and swing was maintained at E2. DFEO led to a significant improvement in knee kinematics at E1 which was maintained at E2. DFEO seems to prevent recurrent hamstring tightness but does not lead to lengthened or fastened hamstrings. Distal femoral extension osteotomy (DFEO) does not change hamstring muscle tendon length. DFEO does not change hamstring lengthening velocity. DFEO leads to a significant improvement in knee kinematics. Changes in knee kinematics after DFEO can be maintained at mid-term. DFEO seems to prevent recurrent hamstring tightness. © 2018 Mac Keith Press.

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

PubMed Central

Alamanni, Francesco; Veglia, Fabrizio; Galli, Claudia; Parolari, Alessandro; Zanobini, Marco

2015-01-01

The radiofrequency maze procedure achieves sinus rhythm in 45%–95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze—performed concomitant to elective cardiac surgery—to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables. From 2003 through 2011, 247 patients (mean age, 64 ± 9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12, and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors of maze failure were identified. The in-hospital mortality rate was 1.2%. During a median follow-up of 39.4 months, the late mortality rate was 3.6%, and pacemaker insertion was necessary in 26 patients (9.4%). Sinus rhythm was present in 63% of patients at the latest follow-up. Predictive factors for atrial fibrillation recurrence were arrhythmia duration (hazard ratio [HR]=1.296, P=0.045) and atrial fibrillation at hospital discharge (HR=2.03, P=0.019). The monopolar device favored maze success (HR=0.191, P <0.0001). Left atrial area and indexed left ventricular end-diastolic volume showed significant decrease both in sinus rhythm and atrial fibrillation patients. Early sinus rhythm conversion was associated with improved left ventricular ejection fraction. Concomitant radiofrequency maze procedure provided remarkable outcomes. Shorter preoperative atrial fibrillation duration, monopolar device use, and prompt treatment of arrhythmia recurrences increase the midterm success rate. Early sinus rhythm restoration seems to result in better left ventricular ejection fraction recovery. PMID:26413016

Long-term tilt and acceleration data from the Logatchev Hydrothermal Vent Field, Mid-Atlantic Ridge, measured by the Bremen Ocean Bottom Tiltmeter

NASA Astrophysics Data System (ADS)

Fabian, Marcus; Villinger, Heinrich

2008-07-01

Long-term seafloor deformations in the Logatchev Hydrothermal Vent Field (LHF) at the Mid-Atlantic Ridge are largely unexplored and unknown, even though the LHF has been the focus of international research for many years. As seafloor tilt and vertical acceleration provide key information about seafloor deformations, the Bremen Ocean Bottom Tiltmeter (OBT) was deployed in May 2005 at position 14°45'11.7″N, 44°58'47.0″W, 3035 m water depth in the LHF. The OBT recorded 384 days and was recovered in January 2007. Strong tilt steps and strong gradual tilt changes over less than a minute to days in the range of some 10 mrad and aligned mostly with the topography possibly indicate nearby mass movements like avalanches of bulk material due to local uplift or subsidence or may show tectonic activity. A vertically aligned high-resolution microelectromechanical systems (MEMS) accelerometer of type Servo K-Beam in the sensor package seems to be helpful to distinguish between tilt signals caused by a true rotation and fake tilt related to a transient translational motion of the OBT in a horizontal direction. Hodographs show elliptic motion patterns with about 1 mrad total tilt amplitude and distinct orientations of tilt toward hydrothermal vents. It is up to speculation whether the latter signals are related to hydrothermal fluid circulation. The amplitude spectra of these tilt signals and acceleration show discrete lines mostly between 0.1 and 50 mHz. The spectra show the periodic character of those signals and also proof that tides or bottom currents, which are known to show lower signal frequencies, or tremor, which generally has higher frequencies, are most likely not the reason. Compared with studies onshore and offshore, the LHF is most likely an area of strong and highly variable seafloor deformations.

Transgenic Reproductive Cell Ablation.

PubMed

Lawit, Shai J; Chamberlin, Mark A

2017-01-01

Numerous cell ablation technologies are available and have been used in reproductive tissues, particularly for male tissues and cells. The importance of ablation of reproductive tissues is toward a fundamental understanding reproductive tissue development and fertilization, as well as, in developing sterility lines important to breeding strategies. Here, we describe techniques for developing ablation lines for both male and female reproductive cells. Also discussed are techniques for analysis, quality control, maintenance, and the lessening of pleiotropism in such lines.

A simple technique to strengthen the initial and mid-term to long-term stability of the cup during total hip arthroplasty in developmental dysplasia of the hip.

PubMed

Guan, Mingqiang; Zhou, Guanming; Li, Xue

2018-04-01

To assess the effects of a technique of cup blocking screws combined with impaction bone grafting during total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH). From August 2011 to July 2015, 53 patients (59 hips) with DDH in our hospital were treated with THA using the technique of cup blocking screws combined with impaction particulate bone grafting. These patients were prospectively followed, and the clinical and imaging results were collected. Harris hip score (HHS) was raised from 41.24 before surgery to 91.49 at the latest follow-up (p less than 0.001). Length discrepancy (LLD) was reduced from 28.97 mm before surgery to 6.08 mm after surgery (p less than 0.001). No loosening of the cup was detected at the last follow-up. The differences were insignificant in cup inclination and rate of cup coverage among the 3 groups of Crowe type II, type III, and type IV DDH (p greater than 0.05). The technique of cup blocking screws combined with impaction particulate bone grafting is simple and reliable, and it not only simplifies the attainment of initial stability, but also strengthens the mid-term to long-term stability during THA in DDH.

The Present, Mid-Term, and Long-Term Supply Curves for Tellurium; and Updates in the Results from NREL's CdTe PV Module Manufacturing Cost Model (Presentation)

SciTech Connect

Woodhouse, M.; Goodrich, A.; Redlinger, M.

2013-09-01

For those PV technologies that rely upon Te, In, and Ga, first-order observations and calculations hint that there may be resource constraints that could inhibit their successful deployment at a SunShot level. These are only first-order approximations, however, and the possibility for an expansion in global Te, In, and Ga supplies needs to be considered in the event that there are upward revisions in their demand and prices.In this study, we examine the current, mid-term, and long-term prospects of Tellurium (Te) for use in PV. We find that the current global supply base of Te would support <10 GW ofmore » annual traditional CdTe PV manufacturing production. But as for the possibility that the supply base for Te might be expanded, after compiling several preliminary cumulative availability curves we find that there may be significant upside potential in the supply base for this element - principally vis a vis increasing demand and higher prices. Primarily by reducing the Tellurium intensity in manufacturing and by increasing the recovery efficiency of Te in Cu refining processes, we calculate that it may prove affordable to PV manufacturers to expand the supply base for Te such that 100 GW, or greater, of annual CdTe PV production is possible in the 2030 - 2050 timeframe.« less

Ablative Thermal Protection System Fundamentals

NASA Technical Reports Server (NTRS)

Beck, Robin A. S.

2013-01-01

This is the presentation for a short course on the fundamentals of ablative thermal protection systems. It covers the definition of ablation, description of ablative materials, how they work, how to analyze them and how to model them.

Flexible Ablators: Applications and Arcjet Testing

NASA Technical Reports Server (NTRS)

Arnold, James O.; Venkatapathy, Ethiraj; Beck, Robin A S.; Mcguire, Kathy; Prabhu, Dinesh K.; Gorbunov, Sergey

2011-01-01

Flexible ablators were conceived in 2009 to meet the technology pull for large, human Mars Exploration Class, 23 m diameter hypersonic inflatable aerodynamic decelerators. As described elsewhere, they have been recently undergoing initial technical readiness (TRL) advancement by NASA. The performance limits of flexible ablators in terms of maximum heat rates, pressure and shear remain to be defined. Further, it is hoped that this emerging technology will vastly expand the capability of future NASA missions involving atmospheric entry systems. This paper considers four topics of relevance to flexible ablators: (1) Their potential applications to near/far term human and robotic missions (2) Brief consideration of the balance between heat shield diameter, flexible ablator performance limits, entry vehicle controllability and aft-body shear layer impingement of interest to designers of very large entry vehicles, (3) The approach for developing bonding processes of flexible ablators for use on rigid entry bodies and (4) Design of large arcjet test articles that will enable the testing of flexible ablators in flight-like, combined environments (heat flux, pressure, shear and structural tensile loading). Based on a review of thermal protection system performance requirements for future entry vehicles, it is concluded that flexible ablators have broad applications to conventional, rigid entry body systems and are enabling to large deployable (both inflatable and mechanical) heat shields. Because of the game-changing nature of flexible ablators, it appears that NASA's Office of the Chief Technologist (OCT) will fund a focused, 3-year TRL advancement of the new materials capable of performance in heat fluxes in the range of 200-600 W/sq. cm. This support will enable the manufacture and use of the large-scale arcjet test designs that will be a key element of this OCT funded activity.

Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation

PubMed Central

Gasparini, Maurizio; Auricchio, Angelo; Metra, Marco; Regoli, François; Fantoni, Cecilia; Lamp, Barbara; Curnis, Antonio; Vogt, Juergen; Klersy, Catherine

2008-01-01

Aims To investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failure (HF) patients with permanent atrial fibrillation (AF) and the role of atrio-ventricular junction (AVJ) ablation in these patients. Methods and results Data from 1285 consecutive patients implanted with CRT devices are presented: 1042 patients were in sinus rhythm (SR) and 243 (19%) in AF. Rate control in AF was achieved by either ablating the AVJ in 118 patients (AVJ-abl) or prescribing negative chronotropic drugs (AF-Drugs). Compared with SR, patients with AF were significantly older, more likely to be non-ischaemic, with higher ejection fraction, shorter QRS duration, and less often received ICD back-up. During a median follow-up of 34 months, 170/1042 patients in SR and 39/243 in AF died (mortality: 8.4 and 8.9 per 100 person-year, respectively). Adjusted hazard ratios were similar for all-cause and cardiac mortality [0.9 (0.57–1.42), P = 0.64 and 1.00 (0.60–1.66) P = 0.99, respectively]. Among AF patients, only 11/118 AVJ-abl patients died vs. 28/125 AF-Drugs patients (mortality: 4.3 and 15.2 per 100 person-year, respectively, P < 0.001). Adjusted hazard ratios of AVJ-abl vs. AF-Drugs was 0.26 [95% confidence interval (CI) 0.09–0.73, P = 0.010] for all-cause mortality, 0.31 (95% CI 0.10–0.99, P = 0.048) for cardiac mortality, and 0.15 (95% CI 0.03–0.70, P = 0.016) for HF mortality. Conclusion Patients with HF and AF treated with CRT have similar mortality compared with patients in SR. In AF, AVJ ablation in addition to CRT significantly improves overall survival compared with CRT alone, primarily by reducing HF death. PMID:18390869

Extreme events in total ozone over the northern mid-latitudes: A case study based on long-term data sets from 5 ground-based stations

NASA Astrophysics Data System (ADS)

Rieder, Harald E.; Jancso, Leonhardt M.; Staehelin, Johannes; Maeder, Jörg A.; Ribatet, Mathieu; Peter, Thomas; Davison, Anthony C.

2010-05-01

In this study we analyze the frequency distribution of extreme events in low and high total ozone (termed ELOs and EHOs) for 5 long-term stations in the northern mid-latitudes in Europe (Belsk, Poland; Hradec Kralove, Czech Republic; Hohenpeissenberg and Potsdam, Germany; and Uccle, Belgium). Further, the influence of these extreme events on annual and seasonal mean values and trends is analysed. The applied method follows the new "ozone extreme concept", which is based on tools from extreme value theory [Coles, 2001; Ribatet, 2007], recently developed by Rieder et al. [2010a, b]. Mathematically seen the decisive feature within the extreme concept is the Generalized Pareto Distribution (GPD). In this analysis, the long-term trends needed to be removed first, differently to the treatment of Rieder et al. [2010a, b], in which the time series of Arosa was analysed, covering many decades of measurements in the anthropogenically undisturbed stratosphere. In contrast to previous studies only focusing on so called ozone mini-holes and mini-highs the "ozone extreme concept" provides a statistical description of the tails in total ozone distributions (i.e. extreme low and high values). It is shown that this concept is not only an appropriate method to describe the frequency and distribution of extreme events, it also provides new information on time series properties and internal variability. Furthermore it allows detection of fingerprints of physical (e.g. El Niño, NAO) and chemical (e.g. polar vortex ozone loss) features in the Earth's atmosphere as well as major volcanic eruptions (e.g. El Chichón, Mt. Pinatubo). It is shown that mean values and trends in total ozone are strongly influenced by extreme events. Trend calculations (for the period 1970-1990) are performed for the entire as well as the extremes-removed time series. The results after excluding extremes show that annual trends are most reduced at Hradec Kralove (about a factor of 3), followed by Potsdam

A meta-analysis of long-term survival outcomes between surgical resection and radiofrequency ablation in patients with single hepatocellular carcinoma ≤ 2 cm (BCLC very early stage).

PubMed

Yin, Zi; Jin, Haosheng; Ma, Tingting; Zhou, Yu; Yu, Min; Jian, Zhixiang

2018-04-30

The optimal management choice in consideration of long-term overall survival (OS) and disease-free survival (DFS) for patients with BLCL very early stage is a matter of debate. A systematic review and meta-analysis was conducted to evaluate the efficacy of liver resection (RES) and radiofrequency ablation (RFA) for single HCC 2 cm or less. The primary sources of the reviewed studies through December 2017, without restriction on the languages or regions, were Pubmed and Embase. The hazard ratio (HR) was used as a summary statistic for long-term outcomes. A total of 5 studies qualified for inclusion in this quantified meta-analysis with a total of 729 HCC patients of BCLC very early stage. Only postoperative 1-year OS was comparable in both RES and RFA groups. As for long-term outcomes of 3-year and 5-year OSs, RES was significantly better than RFA, the HRs were 0.64 (95%CI: 0.41, 1.00; P = 0.05) and 0.63 (95%CI: 0.42, 0.95; P = 0.03) respectively. In terms of postoperative DFS, reduced tumor recurrence was observed in RES, and all the short- and long-terms outcomes were favored RES. RES offers better long-term oncologic outcomes compared with RFA in current clinical evidences. Copyright © 2018. Published by Elsevier Ltd.

[Percutaneous lung thermo-ablation].

PubMed

Palussière, Jean; Catena, Vittorio; Gaubert, Jean-Yves; Buy, Xavier; de Baere, Thierry

2017-05-01

Percutaneous lung thermo-ablation has steadily been developed over the past 15years. Main indications are early stage non-small cell lung carcinoma (NSCLC) for non-surgical patients and slow evolving localized metastatic disease, either spontaneous or following a general treatment. Radiofrequency, being the most evaluated technique, offers a local control rate of about 80-90% for tumors <3 cm in diameter. With excellent tolerance and very few complications, radiofrequency may be proposed for patients with a chronic disease. Other ablation techniques under investigation such as microwaves and cryotherapy could allow overcoming radiofrequency limits. Furthermore, stereotactic radiotherapy proposed for the same indications is efficient. Comparative studies are warranted to differentiate these techniques in terms of efficacy, tolerance and cost-effectiveness. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Long-term response to combination therapy with estramustine and somatostatin analogue in a patient with androgen ablation-refractory prostate cancer.

PubMed

Cerulli, Costantino; Sciarra, Alessandro; Salvatori, Gianfilippo; Di Silverio, Franco

2004-12-01

We report on a patient with androgen ablation-refractory prostate adenocarcinoma who had an objective response for longer than 24 months using a combination of estramustine and lanreotide. At baseline from our combination therapy, his prostate-specific antigen level was 21.30 ng/mL and serum chromogranin A level was 816 ng/mL. The patient discontinued complete androgen deprivation therapy and underwent combination therapy with oral estramustine 420 mg/day plus lanreotide acetate 73.9 mg intramuscularly every 4 weeks. After 33 months of follow-up, the patient was alive without clinical disease progression, and his prostate-specific antigen and chromogranin A level was 0.10 and 12 ng/mL, respectively.

Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study.

PubMed

Huang, Bing-Yang; Li, Xin-Min; Song, Xiao-Yong; Zhou, Jun-Jun; Shao, Zhuang; Yu, Zhi-Qi; Lin, Yi; Guo, Xin-Yu; Liu, Da-Jiang; Li, Lu

2018-05-01

This study was performed to retrospectively evaluate the 10-year overall survival (OS), progression-free survival (PFS), and local control rates of patients with inoperable stage Ia non-small cell lung cancer (NSCLC) who underwent computed tomography (CT)-guided radiofrequency ablation (RFA) in a single center. Fifty patients with inoperable NSCLC underwent RFA between 2004 and 2016. Thoracic surgeons evaluated the patients and performed RFA under CT guidance. Follow-up CT and positron emission tomography/CT scans were obtained. Local control rates and recurrence patterns were analyzed. Seventy-three lesions in 50 patients (M:F = 22:28; median age: 73 years; range: 52-82 years) were treated with CT-guided RFA. The mean lesion size was 2.2 cm (range: 1-3 cm). No procedure-related deaths occurred. Low-grade fever was the most common post-ablation complication, with an incidence rate of 36%. The 1-, 2-, 3-, 5-, and 10-year OS rates of patients with Ia NSCLC were 96.0%, 86.5%, 67.1%, 36.3%, and 1%, respectively, and the 1-, 2-, 3-, and 5-year PFS rates were 94.0%, 77.5%, 43.5%, and 10.8%, respectively. The most common pattern of recurrence was local, and 15 patients with recurrence were treated with repeat RFA. Tumor size <2.0 cm was associated with a significantly improved 3-year survival rate of 78.9%. CT-guided RFA is feasible and well tolerated by inoperable patients with inoperable stage Ia NSCLC. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Sprayable lightweight ablative coating

NASA Technical Reports Server (NTRS)

Simpson, William G. (Inventor); Sharpe, Max H. (Inventor); Hill, William E. (Inventor)

1991-01-01

An improved lightweight, ablative coating is disclosed that may be spray applied and cured without the development of appreciable shrinkage cracks. The ablative mixture consists essentially of phenolic microballoons, hollow glass spheres, glass fibers, ground cork, a flexibilized resin binder, and an activated colloidal clay.

Diagnosis and ablation of multiform fascicular tachycardia.

PubMed

Sung, Raphael K; Kim, Albert M; Tseng, Zian H; Han, Frederick; Inada, Keiichi; Tedrow, Usha B; Viswanathan, Mohan N; Badhwar, Nitish; Varosy, Paul D; Tanel, Ronn; Olgin, Jeffrey E; Stephenson, William G; Scheinman, Melvin

2013-03-01

Fascicular tachycardia (FT) is an uncommon cause of monomorphic sustained ventricular tachycardia (VT). We describe 6 cases of FT with multiform QRS morphologies. Six of 823 consecutive VT cases were retrospectively analyzed and found attributable to FT with multiform QRS patterns, with 3 cases exhibiting narrow QRS VT as well. All underwent electrophysiology study including fascicular potential mapping, entrainment pacing, and electroanatomic mapping. The first 3 cases describe similar multiform VT patterns with successful ablation in the upper mid septum. Initially, a right bundle branch block (RBBB) VT with superior axis was induced. Radiofrequency catheter ablation (RFCA) targeting the left posterior fascicle (LPF) resulted in a second VT with RBBB inferior axis. RFCA in the upper septum just apical to the LBB potential abolished VT in all cases. Cases 4 and 5 showed RBBB VT with alternating fascicular block compatible with upper septal dependent VT, resulting in bundle branch reentrant VT (BBRT) after ablation of LPF and left anterior fascicle (LAF). Finally, Cases 5 and 6 demonstrated spontaneous shift in QRS morphology during VT, implicating participation of a third fascicle. In Case 6, successful ablation was achieved over the proximal LAF, likely representing insertion of the auxiliary fascicle near the proximal LAF. Multiform FTs show a reentrant mechanism using multiple fascicular branches. We hypothesize that retrograde conduction over the septal fascicle produces alternate fascicular patterns as well as narrow VT forms. Ablation of the respective fascicle was successful in abolishing FT but does not preclude development of BBRT unless septal fascicle is targeted and ablated. © 2012 Wiley Periodicals, Inc.

Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients.

PubMed

Pecoraro, Felice; Lachat, Mario; Hofmann, Michael; Cayne, Neal S; Chaykovska, Lyubov; Rancic, Zoran; Puippe, Gilbert; Pfammatter, Thomas; Mangialardi, Nicola; Veith, Frank J; Bettex, Dominique; Maisano, Francesco; Neff, Thomas A

2017-06-01

with complex thoracic aorta disease is safe and shows promising mid-term results at 3 years. The combination of these techniques could represent an alternative to the standard open surgical repair, especially in older patients or in patients unfit for cardiopulmonary bypass. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Patellofemoral Osteoarthritis Progression and Alignment Changes after Open-Wedge High Tibial Osteotomy Do Not Affect Clinical Outcomes at Mid-term Follow-up.

PubMed

Goshima, Kenichi; Sawaguchi, Takeshi; Shigemoto, Kenji; Iwai, Shintaro; Nakanishi, Akira; Ueoka, Ken

2017-10-01

patellofemoral OA progression did not affect the clinical outcomes of OWHTO at mid-term follow-up. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis.

PubMed

Crippa, Stefano; Bassi, Claudio; Salvia, Roberto; Malleo, Giuseppe; Marchegiani, Giovanni; Rebours, Vinciane; Levy, Philippe; Partelli, Stefano; Suleiman, Shadeah L; Banks, Peter A; Ahmed, Nazir; Chari, Suresh T; Fernández-Del Castillo, Carlos; Falconi, Massimo

2017-03-01

To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians' recommendation, patient personal choice or comorbidities precluding surgery. In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained. Of 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2% vs 60.2%, p<0.0001). In elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96%, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40% risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Approaches to quantifying long-term continental shelf sediment transport with an example from the Northern California STRESS mid-shelf site

NASA Astrophysics Data System (ADS)

Harris, Courtney K.; Wiberg, Patricia L.

1997-09-01

Modeling shelf sediment transport rates and bed reworking depths is problematic when the wave and current forcing conditions are not precisely known, as is usually the case when long-term sedimentation patterns are of interest. Two approaches to modeling sediment transport under such circumstances are considered. The first relies on measured or simulated time series of flow conditions to drive model calculations. The second approach uses as model input probability distribution functions of bottom boundary layer flow conditions developed from wave and current measurements. Sediment transport rates, frequency of bed resuspension by waves and currents, and bed reworking calculated using the two methods are compared at the mid-shelf STRESS (Sediment TRansport on Shelves and Slopes) site on the northern California continental shelf. Current, wave and resuspension measurements at the site are used to generate model inputs and test model results. An 11-year record of bottom wave orbital velocity, calculated from surface wave spectra measured by the National Data Buoy Center (NDBC) Buoy 46013 and verified against bottom tripod measurements, is used to characterize the frequency and duration of wave-driven transport events and to estimate the joint probability distribution of wave orbital velocity and period. A 109-day record of hourly current measurements 10 m above bottom is used to estimate the probability distribution of bottom boundary layer current velocity at this site and to develop an auto-regressive model to simulate current velocities for times when direct measurements of currents are not available. Frequency of transport, the maximum volume of suspended sediment, and average flux calculated using measured wave and simulated current time series agree well with values calculated using measured time series. A probabilistic approach is more amenable to calculations over time scales longer than existing wave records, but it tends to underestimate net transport

Mechanically-Deployed Hypersonic Decelerator and Conformal Ablator Technologies for Mars Missions

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj; Wercinski, Paul F.; Beck, Robin A. S.; Hamm, Kenneth R.; Yount, Bryan C.; Makino, A.; Smith, B.; Gage, P.; Prabhu, D.

2012-01-01

The concept of a mechanically deployable hypersonic decelerator, developed initially for high mass (40 MT) human Mars missions, is currently funded by OCT for technology maturation. The ADEPT (Adaptive, Deployable Entry and Placement Technology) project has broad, game-changing applicability to in situ science missions to Venus, Mars, and the Outer Planets. Combined with maturation of conformal ablator technology (another current OCT investment), the two technologies provide unique low mass mission enabling capabilities otherwise not achievable by current rigid aeroshell or by inflatables. If this abstract is accepted, we will present results that illustrate the mission enabling capabilities of the mechanically deployable architecture for: (1) robotic Mars (Discovery or New Frontiers class) in the near term; (2) alternate approaches to landing MSL-class payloads, without the need for supersonic parachute or lifting entry, in the mid-term; and (3) Heavy mass and human missions to Mars in the long term.

Mechanically-Deployed Hypersonic Decelerator and Conformal Ablator Technologies for Mars Missions

NASA Technical Reports Server (NTRS)

Venkatapathy, E.; Wercinski, P.; Prabhu, D.

2012-01-01

The concept of a mechanically deployable hypersonic decelerator, developed initially for high mass (approximately 40 MT) human Mars missions, is currently funded by OCT for technology maturation. The ADEPT (Adaptive, Deployable Entry and Placement Technology) project has broad, game-changing applicability to in situ science missions to Venus, Mars, and the Outer Planets. Combined with maturation of conformal ablator technology (another current OCT investment), the two technologies provide unique low-mass mission enabling capabilities otherwise not achievable by current rigid aeroshell or by inflatables. If this abstract is accepted, we will present results that illustrate the mission enabling capabilities of the mechanically deployable architecture for: (1) robotic Mars (Discovery or New Frontiers class) in the near term (2) alternate approaches to landing MSL-class payloads, without the need for supersonic parachute or lifting entry, in the mid-term and (3) Heavy mass and human missions to Mars in the long term.

Long-term outcome of patients with triphasic mitral flow with a mid-diastolic L wave: prognostic role of left atrial volume and N-terminal pro-brain natriuretic peptide.

PubMed

Kim, Sung-Ai; Son, Jungwoo; Shim, Chi-Young; Choi, Eui-Young; Ha, Jong-Won

2017-09-01

A mid-diastolic L wave has been recognized as a marker of advanced left ventricular (LV) diastolic dysfunction. However, its prognostic implication is unclear. This study assessed long-term prognosis and independent predictors of adverse outcomes in patients with a mid-diastolic L wave. A total of 144 consecutive patients (mean age 63 ± 12 years, 88 female) with a mid-diastolic L wave of ≥0.2 m/s and in sinus rhythm were identified. Patients with significant valvular heart disease, low LV ejection fraction and arrhythmias were excluded. Subjects were followed up for cardiovascular (CV) mortality and hospitalization for heart failure (HF). During follow-up for a median of 44 months (1-76), CV deaths and hospitalization for HF occurred in 41 (28%) patients. In multivariate Cox analysis, age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02-1.11; p = 0.001), log N-terminal pro-brain natriuretic peptide (NT-proBNP)(HR 3.81; 95% CI 1.78-8.15; p = 0.001), and left atrial volume index (HR 1.02; 95% CI 1.01-1.04; p = 0.019) were independent predictors of adverse outcomes in patients with a mid-diastolic L wave. In a stepwise model, NT-proBNP showed an incremental prognostic value for prediction of adverse outcomes when added to the clinical and echocardiographic parameters (Chi square from 30.1 to 41.1, p < 0.001). Patients with a mid-diastolic L wave and clinical, biochemical, and echocardiographic evidence of advanced diastolic dysfunction showed poor long-term clinical outcome.

Glue septal ablation: A promising alternative to alcohol septal ablation

PubMed Central

Aytemir, Kudret; Oto, Ali

2016-01-01

Hypertrophic cardiomyopathy (HCM) is defined as myocardial hypertrophy in the absence of another cardiac or systemic disease capable of producing the magnitude of present hypertrophy. In about 70% of patients with HCM, there is left ventricular outflow tract (LVOT) obstruction (LVOTO) and this is known as obstructive type of hypertrophic cardiomyopathy (HOCM). Cases refractory to medical treatment have had two options either surgical septal myectomy or alcohol septal ablation (ASA) to alleviate LVOT gradient. ASA may cause some life-threatening complications including conduction disturbances and complete heart block, hemodynamic compromise, ventricular arrhythmias, distant and massive myocardial necrosis. Glue septal ablation (GSA) is a promising technique for the treatment of HOCM. Glue seems to be superior to alcohol due to some intrinsic advantageous properties of glue such as immediate polymerization which prevents the leak into the left anterior descending coronary artery and it is particularly useful in patients with collaterals to the right coronary artery in whom alcohol ablation is contraindicated. In our experience, GSA is effective and also a safe technique without significant complications. GSA decreases LVOT gradient immediately after the procedure and this reduction persists during 12 months of follow-up. It improves New York Heart Association functional capacity and decrease interventricular septal wall thickness. Further studies are needed in order to assess the long-term efficacy and safety of this technique. PMID:27011786

Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair: a comparison of AneuRx and Zenith endografts.

PubMed

Tonnessen, Britt H; Sternbergh, W Charles; Money, Samuel R

2005-09-01

Freedom from migration is key to the durability of endovascular aneurysm repair (EVAR). This study evaluates the mid- and long-term incidence of migration with two different endografts. Between September 1997 and June 2004, 235 patients were scheduled for EVAR with an AneuRx (Medtronic/AVE Inc.) or Zenith (Cook) endograft. Patients with fusiform, infrarenal aneurysms and a minimum 12 months of follow-up were analyzed, for a final cohort of 130 patients. Migration was assessed on axial computed tomography (CT) (2.5 to 3 mm cuts) as the distance from the most caudal renal artery to the first slice containing endograft (AneuRx) or to the top of the bare suprarenal stent (Zenith). Aortic neck diameters were measured at the most caudal renal artery. The initial postoperative CT scan was the baseline. Migration was defined by caudal movement of the endograft at two thresholds, > or =5 mm and > or =10 mm, or any migration with a related clinical event. Life-table analysis demonstrated AneuRx freedom from migration (> or =10 mm or clinical event) was 96.1%, 89.5%, 78.0%, and 72.0% at 1, 2, 3, and 4 years, respectively. Zenith freedom from migration was 100%, 97.6%, 97.6%, and 97.6% at 1, 2, 3, and 4 years, respectively (P = .01, log-rank test). The stricter 5-mm migration threshold found 67.4% of AneuRx and 90.1% of Zenith patients free from migration at 4 years of follow-up. Twelve out of 14 (85.7%) AneuRx patients (12/14) with migration (> or =10 mm or clinical event) underwent 14 related secondary procedures (13 endovascular, 1 open conversion). The single Zenith patient with migration (> or =10 mm) has not required adjuvant treatment. Mean follow-up was 39.0 +/- 2.3 months (AneuRx) and 30.8 +/- 1.9 months (Zenith, P = .01). Patients with and without migration did not differ in age, gender ratio, aneurysm diameter, and neck diameter. However, initial neck length was shorter in patients with migration (22.1 +/- 2.1 mm vs 31.2 +/- 1.2 mm, P = .02). A subset of patients

Interatrial block and interatrial septal thickness in patients with paroxysmal atrial fibrillation undergoing catheter ablation: Long-term follow-up study.

PubMed

Gul, Enes E; Pal, Raveen; Caldwell, Jane; Boles, Usama; Hopman, Wilma; Glover, Benedict; Michael, Kevin A; Redfearn, Damian; Simpson, Chris; Abdollah, Hoshiar; Baranchuk, Adrian

2017-07-01

Interatrial block (IAB) is a strong predictor of recurrence of atrial fibrillation (AF). IAB is a conduction delay through the Bachman region, which is located in the upper region of the interatrial space. During IAB, the impulse travels from the right atrium to the interatrial septum (IAS) and coronary sinus to finally reach the left atrium in a caudocranial direction. No relation between the presence of IAB and IAS thickness has been established yet. To determine whether a correlation exists between the degree of IAB and the thickness of the IAS and to determine whether IAS thickness predicts AF recurrence. Sixty-two patients with diagnosis of paroxysmal AF undergoing catheter ablation were enrolled. IAB was defined as P-wave duration ≥120 ms. IAS thickness was measured by cardiac computed tomography. Among 62 patients with paroxysmal AF, 45 patients (72%) were diagnosed with IAB. Advanced IAB was diagnosed in 24 patients (39%). Forty-seven patients were male. During a mean follow-up period of 49.8 ± 22 months (range 12-60 months), 32 patients (51%) developed AF recurrence. IAS thickness was similar in patients with and without IAB (4.5 ± 2.0 mm vs. 4.0 ± 1.4 mm; p = .45) and did not predict AF. Left atrial size was significantly enlarged in patients with IAB (40.9 ± 5.7 mm vs. 37.2 ± 4.0 mm; p = .03). Advanced IAB predicted AF recurrence after the ablation (OR: 3.34, CI: 1.12-9.93; p = .03). IAS thickness was not significantly correlated to IAB and did not predict AF recurrence. IAB as previously demonstrated was an independent predictor of AF recurrence. © 2016 Wiley Periodicals, Inc.

Robotic navigation and ablation.

PubMed

Malcolme-Lawes, L; Kanagaratnam, P

2010-12-01

Robotic technologies have been developed to allow optimal catheter stability and reproducible catheter movements with the aim of achieving contiguous and transmural lesion delivery. Two systems for remote navigation of catheters within the heart have been developed; the first is based on a magnetic navigation system (MNS) Niobe, Stereotaxis, Saint-Louis, Missouri, USA, the second is based on a steerable sheath system (Sensei, Hansen Medical, Mountain View, CA, USA). Both robotic and magnetic navigation systems have proven to be feasible for performing ablation of both simple and complex arrhythmias, particularly atrial fibrillation. Studies to date have shown similar success rates for AF ablation compared to that of manual ablation, with many groups finding a reduction in fluoroscopy times. However, the early learning curve of cases demonstrated longer procedure times, mainly due to additional setup times. With centres performing increasing numbers of robotic ablations and the introduction of a pressure monitoring system, lower power settings and instinctive driving software, complication rates are reducing, and fluoroscopy times have been lower than manual ablation in many studies. As the demand for catheter ablation for arrhythmias such as atrial fibrillation increases and the number of centres performing these ablations increases, the demand for systems which reduce the hand skill requirement and improve the comfort of the operator will also increase.

[A Long-Term Disease-Free Survival Case of Synchronous Pulmonary and Liver Metastasis of Rectal Cancer with Systemic Chemotherapy and Radiofrequency Ablation Therapy for Liver Metastasis].

PubMed

Enomoto, Masaya; Katsumata, Kenji; Kasahara, Kenta; Kuwabara, Hiroshi; Matsudo, Takaaki; Shigoka, Masatoshi; Enomoto, Masanobu; Ishizaki, Tetsuo; Tsuchida, Akihiko

2017-11-01

A 55-year-old woman underwent laparoscopic anterior resection and D2 lymph node dissection for recto-sigmoid colon cancer in November 2014, which was diagnosed as T3N1M1(H3, PUL2), stage IV , for the purpose of preserving the ileus. FOLFOX therapy with panitumumab(Pmab)was started in January 2015.A t the end of 11 courses, pulmonary metastasis changed to CR, and liver metastasis was down-graded to H2 on the CT.Because of the risk of hepatic dysfunction with advanced fatty liver due to chemotherapy and extrahepatic lesions, we chose radiofrequency ablation(RFA)therapy for liver metastasis.Pmab combined FOLFIRI therapy was administered, and maintenance therapy was initiated.This patient is alive 2 years and 7 months after surgery and 10 months after RFA without relapse.It is suggested that RFA therapy for liver metastasis of colon cancer with pulmonary metastasis combined with chemotherapy could be an effective treatment strategy.

Early-term and mid-term histologic events during single-level posterolateral intertransverse process fusion with rhBMP-2/collagen carrier and a ceramic bulking agent in a nonhuman primate model: implications for bone graft preparation.

PubMed

Khan, Safdar N; Toth, Jeffrey M; Gupta, Kavita; Glassman, Steven D; Gupta, Munish C

2014-06-01

We used a nonhuman primate lumbar intertransverse process arthrodesis model to evaluate biological cascade of bone formation using different carrier preparation methods with a single dose of recombinant human bone morphogenetic protein-2 (rhBMP-2) at early time points. To examine early-term/mid-term descriptive histologic and computerized tomographic events in single-level uninstrumented posterolateral nonhuman primate spinal fusions using rhBMP-2/absorbable collagen sponge (ACS) combined with ceramic bulking agents in 3 different configurations. rhBMP-2 on an ACS carrier alone leads to consistent posterolateral lumbar spine fusions in lower-order animals; however, these results have been difficult to replicate in nonhuman primates. Twelve skeletally mature, rhesus macaque monkeys underwent single-level posterolateral arthrodesis at L4-L5. A hydroxyapatite/β-tricalcium phosphate ceramic bulking agent in 3 formulations was used in the treatment groups (n=3). When used, rhBMP-2/ACS at 1.5 mg/cm (3.0 mg rhBMP-2) was combined with 2.5 cm of ceramic bulking agent per side. Animals were euthanized at 4 and 12 weeks postoperative. Computerized tomography scans were performed immediately postoperatively and every 4 weeks until they were euthanized. Sagittal histologic sections were evaluated for bone histogenesis and location, cellular infiltration of the graft/substitute, and bone remodeling activity. Significant histologic differences in the developing fusion appeared between the 3 rhBMP-2/ACS treatment groups at 4 and 12 weeks. At 4 weeks, bone formation appeared to originate at the transverse process and the intertransverse membrane. Cellular infiltration was greatest in granular ceramic groups compared with matrix ceramic group. Minimal to no residual ACS was identified at the early time point. At 12 weeks, marked ceramic remodeling was observed with continued bone formation noted in all carrier groups. At the early time period, histology showed that bone formation

MID TERM RESULTS AFTER OPEN HEART SURGERY IN HEMODIALYSIS PATIENTS AWAITING KIDNEY TRANSPLANT: DOES CARDIOVASCULAR SURGICAL INTERVENTION PRIOR TO TRANSPLANTATION PROLONG SURVIVAL?

PubMed

Ozbek, C; Sever, K; Demirhan, O; Mansuroglu, D; Kurtoglu, N; Ugurlucan, M; Sevmis, S; Karakayali, H

2015-12-01

The aim of this study was to compare the mid and long term postoperative outcomes between the hemodialysis-dependent patients awaiting kidney transplantat who underwent open heart surgery in our department during the last five years, and those who did not receive a renal transplant, to determine the predictors of mortality, and assess the possible contribution of post heart surgery kidney transplantation to survival. The patients were separated into two groups: those who underwent a transplantation after open heart surgery were included in the Tp+ group, and those who did not in the Tp- group Between June 2008 and December 2012, 127 dialysis dependent patients awaiting kidney transplant and who underwent open heart surgery were separated into two groups. Those who underwent transplantation after open heart surgery were determined as Tp+ (n=33), and those who did not as Tp- (n=94). Both groups were compared with respect to preoperative paramaters including age, sex, diabetes mellitus (DM), hypertension (HT), hyperlipidemia (HL), obesity, smoking, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), left ventricle ejection fraction (EF), Euroscore; operative parameters including cross clamp time, perfusion time, number of grafts, use of internal mammary artery (IMA); postoperative parameters including revision, blood transfusion, ventilation time, use of inotropic agents, length of stay in the intensive care unit and hospital, and follow up findings. Problems encountered during follow up were recorded. Predictors of mortality were determined and the survival was calculated. Among the preoperative parameters, when compared with the Tp- group, the Tp+ group had significantly lower values in mean age, presence of DM, obesity, PVD, and Euroscore levels, and higher EF values. Assessment of postoperative values showed that blood transfusion requirement and length of hospital stay were significantly lower in the Tp+ group compared to the Tp

Moldable cork ablation material

NASA Technical Reports Server (NTRS)

1977-01-01

A successful thermal ablative material was manufactured. Moldable cork sheets were tested for density, tensile strength, tensile elongation, thermal conductivity, compression set, and specific heat. A moldable cork sheet, therefore, was established as a realistic product.

Ablative skin resurfacing.

PubMed

Agrawal, Nidhi; Smith, Greg; Heffelfinger, Ryan

2014-02-01

Ablative laser resurfacing has evolved as a safe and effective treatment for skin rejuvenation. Although traditional lasers were associated with significant thermal damage and lengthy recovery, advances in laser technology have improved safety profiles and reduced social downtime. CO2 lasers remain the gold standard of treatment, and fractional ablative devices capable of achieving remarkable clinical improvement with fewer side effects and shorter recovery times have made it a more practical option for patients. Although ablative resurfacing has become safer, careful patient selection and choice of suitable laser parameters are essential to minimize complications and optimize outcomes. This article describes the current modalities used in ablative laser skin resurfacing and examines their efficacy, indications, and possible side effects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Long-term surveillance of papillary thyroid cancer patients who do not undergo postoperative radioiodine remnant ablation: is there a role for serum thyroglobulin measurement?

PubMed

Durante, Cosimo; Montesano, Teresa; Attard, Marco; Torlontano, Massimo; Monzani, Fabio; Costante, Giuseppe; Meringolo, Domenico; Ferdeghini, Marco; Tumino, Salvatore; Lamartina, Livia; Paciaroni, Alessandra; Massa, Michela; Giacomelli, Laura; Ronga, Giuseppe; Filetti, Sebastiano

2012-08-01

Serum thyroglobulin (Tg) assays are considered fundamental in postoperative surveillance of differentiated thyroid cancer (DTC) patients. However, the postsurgical profile of Tg levels has never been specifically investigated in patients who do not undergo radioiodine remnant ablation (RRA). Our objective was to explore the evolution of Tg levels over time in DTC patients treated with total or near-total thyroidectomy without RRA. We retrospectively analyzed 290 consecutively diagnosed cases of low-risk (American Thyroid Association criteria) DTC treated with thyroidectomy alone and followed yearly with neck ultrasonography and serum Tg assays. We compared final Tg values in this group and a matched group of 495 RRA-positive patients. Temporal trends of serial Tg levels were also analyzed in 78 of the RRA-negative patients monitored with a high-sensitivity immunoradiometric assay. After follow-up of 2.5-22 yr (median 5 yr), final Tg levels were undetectable (<1 ng/ml) in 274 of 290 RRA-negative patients (95%) and 492 of 495 RRA-positive controls (99%). In the subset of 78 RRA-negative patients, undetectable Tg levels (<0.2 ng/ml) were recorded in 60% at the first postoperative evaluation (3-12 months) and in 79% after 5 yr. Tg levels increased in the single patient who experienced disease recurrence during the observation period. In most RRA-negative patients, postoperative serum Tg values spontaneously drop to undetectable levels within 5-7 yr after thyroidectomy. Thus, in later phases, Tg assays may be a valuable tool for follow-up even in patients who do not undergo RRA.

Ablative fractional CO2 laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort.

PubMed

Issler-Fisher, Andrea C; Fisher, Oliver M; Smialkowski, Ania O; Li, Frank; van Schalkwyk, Constant P; Haertsch, Peter; Maitz, Peter K M

2017-05-01

The introduction of ablative fractional CO 2 lasers (CO 2 -AFL) for burn scar management shows promising results. Whilst recent studies have focused on objective scar outcomes following CO 2 -AFL treatment, to date no data on patient subjective factors such as quality of life are available. A prospective study was initiated to analyze the safety and efficacy of the CO 2 -AFL. Various objective and subjective outcome parameters were prospectively collected from the date of first consultation and follow-up following treatment. Objective factors include the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and ultrasound measurements of the thickness of the scar. Subjective parameters included the assessment of neuropathic pain and pruritus, as well as the evaluation of improvement of quality of life following CO 2 -AFL with the Burns Specific Health Scale (BSHS-B). For treatment effect analysis, patients were stratified according to scar maturation status (> or <2 years after injury). 47 patients with 118 burn scars completed at least one treatment cycle. At a median of 55 days (IQR 32-74) after CO 2 -AFL treatment all analyzed objective parameters decreased significantly: intra-patient normalized scar thickness decreased from a median of 2.4mm to 1.9mm (p<0.001) with a concomitant VSS-drop from a median of 7 to 6 (p<0.001). The overall POSAS patient scale decreased from a median of 9 to 5 (p<0.001) with similar effects documented in POSAS observer scales. Both pain and pruritus showed significant reduction. Quality of life increased significantly by 15 points (median 120 to 135; p<0.001). All of the identified changes following CO 2 -AFL were equally significant irrespective of scar maturation status. Our preliminary results confirm significant improvement in thickness, texture, colour, and symptoms following treatment with CO 2 -AFL. Foremost, quality of life of patients with both immature and mature scars (up to 23 years after

Effects of Laser Wavelength on Ablator Testing

NASA Technical Reports Server (NTRS)

White, Susan M.

2014-01-01

Wavelength-dependent or spectral radiation effects are potentially significant for thermal protection materials. NASA atmospheric entry simulations include trajectories with significant levels of shock layer radiation which is concentrated in narrow spectral lines. Tests using two different high powered lasers, the 10.6 micron LHMEL I CO2 laser and the near-infrared 1.07 micron fiber laser, on low density ablative thermal protection materials offer a unique opportunity to evaluate spectral effects. Test results indicated that the laser wavelength can impact the thermal response of an ablative material, in terms of bond-line temperatures, penetration times, mass losses, and char layer thicknesses.

Specific Impulse Definition for Ablative Laser Propulsion

NASA Technical Reports Server (NTRS)

Herren, Kenneth A.; Gregory, Don A.

2004-01-01

The term "specific impulse" is so ingrained in the field of rocket propulsion that it is unlikely that any fundamental argument would be taken seriously for its removal. It is not an ideal measure but it does give an indication of the amount of mass flow (mass loss/time), as in fuel rate, required to produce a measured thrust over some time period This investigation explores the implications of being able to accurately measure the ablation rate and how the language used to describe the specific impulse results may have to change slightly, and recasts the specific impulse as something that is not a time average. It is not currently possible to measure the ablation rate accurately in real time so it is generally just assumed that a constant amount of material will be removed for each laser pulse delivered The specific impulse dependence on the ablation rate is determined here as a correction to the classical textbook definition.

HYDRA: Macroscopic 3D Approach of Light Weight Ablator

NASA Astrophysics Data System (ADS)

Pinaud, G.; Barcena, J.; Bouilly, J.-M.; Leroy, V.; Fischer, Wpp.; Massuti, T.

2014-06-01

The HYDRA project is an European funded program that aims at developing novel solution in term of TPS associated to a demonstration of Technology Readiness Level (TRL) 4. We describe modelling activities (radiation/ablation) compared to plasma test.

CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma: specific technical aspects and clinical results.

PubMed

Sommer, C M; Lemm, G; Hohenstein, E; Bellemann, N; Stampfl, U; Goezen, A S; Rassweiler, J; Kauczor, H U; Radeleff, B A; Pereira, P L

2013-06-01

This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. We included 22 consecutive patients (3 women; age 74.2 ± 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 ± 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, and technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 ± 13.6 min and 43.7 ± 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 ± 8.8 months, local recurrence-free survival was 14.4 ± 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 ± 16.6 ml/min/1.73 m(2) before RF ablation vs. 47.2 ± 11.9 ml/min/1.73 m(2) after RF ablation; not significant). CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.

Theoretical analyses of the refractive implications of transepithelial PRK ablations.

PubMed

Arba Mosquera, Samuel; Awwad, Shady T

2013-07-01

To analyse the refractive implications of single-step, transepithelial photorefractive keratectomy (TransPRK) ablations. A simulation for quantifying the refractive implications of TransPRK ablations has been developed. The simulation includes a simple modelling of corneal epithelial profiles, epithelial ablation profiles as well as refractive ablation profiles, and allows the analytical quantification of the refractive implications of TransPRK in terms of wasted tissue, achieved optical zone (OZ) and induced refractive error. Wasted tissue occurs whenever the actual corneal epithelial profile is thinner than the applied epithelial ablation profile, achieved OZ is reduced whenever the actual corneal epithelial profile is thicker than the applied epithelial ablation profile and additional refractive errors are induced whenever the actual difference centre-to-periphery in the corneal epithelial profile deviates from the difference in the applied epithelial ablation profile. The refractive implications of TransPRK ablations can be quantified using simple theoretical simulations. These implications can be wasted tissue (∼14 µm, if the corneal epithelial profile is thinner than the ablated one), reduced OZ (if the corneal epithelial profile is thicker than ablated one, very severe for low corrections) and additional refractive errors (∼0.66 D, if the centre-to-periphery progression of the corneal epithelial profile deviates from the progression of the ablated one). When TransPRK profiles are applied to normal, not previously treated, non-pathologic corneas, no specific refractive implications associated to the transepithelial profile can be anticipated; TransPRK would provide refractive outcomes equal to those of standard PRK. Adjustments for the planned OZ and, in the event of retreatments, for the target sphere can be easily derived.

Cooled radiofrequency ablation for bilateral greater occipital neuralgia.

PubMed

Vu, Tiffany; Chhatre, Akhil

2014-01-01

This report describes a case of bilateral greater occipital neuralgia treated with cooled radiofrequency ablation. The case is considered in relation to a review of greater occipital neuralgia, continuous thermal and pulsed radiofrequency ablation, and current medical literature on cooled radiofrequency ablation. In this case, a 35-year-old female with a 2.5-year history of chronic suboccipital bilateral headaches, described as constant, burning, and pulsating pain that started at the suboccipital region and radiated into her vertex. She was diagnosed with bilateral greater occipital neuralgia. She underwent cooled radiofrequency ablation of bilateral greater occipital nerves with minimal side effects and 75% pain reduction. Cooled radiofrequency ablation of the greater occipital nerve in challenging cases is an alternative to pulsed and continuous RFA to alleviate pain with less side effects and potential for long-term efficacy.

Cooled Radiofrequency Ablation for Bilateral Greater Occipital Neuralgia

PubMed Central

Chhatre, Akhil

2014-01-01

This report describes a case of bilateral greater occipital neuralgia treated with cooled radiofrequency ablation. The case is considered in relation to a review of greater occipital neuralgia, continuous thermal and pulsed radiofrequency ablation, and current medical literature on cooled radiofrequency ablation. In this case, a 35-year-old female with a 2.5-year history of chronic suboccipital bilateral headaches, described as constant, burning, and pulsating pain that started at the suboccipital region and radiated into her vertex. She was diagnosed with bilateral greater occipital neuralgia. She underwent cooled radiofrequency ablation of bilateral greater occipital nerves with minimal side effects and 75% pain reduction. Cooled radiofrequency ablation of the greater occipital nerve in challenging cases is an alternative to pulsed and continuous RFA to alleviate pain with less side effects and potential for long-term efficacy. PMID:24716017

VIRAL LOAD AND SHORT-TERM NATURAL HISTORY OF TYPE-SPECIFIC ONCOGENIC HUMAN PAPILLOMAVIRUS INFECTIONS IN A HIGH-RISK COHORT OF MID-ADULT WOMEN

PubMed Central

Winer, Rachel L.; Xi, Long Fu; Shen, Zhenping; Stern, Joshua E.; Newman, Laura; Feng, Qinghua; Hughes, James P.; Koutsky, Laura A.

2013-01-01

Oncogenic human papillomavirus (HPV) viral load may inform the origin of newly detected infections and characterize oncogenic HPV natural history in mid-adult women. From 2007–2011, we enrolled 521 25–65 year old female online daters and followed them triannually with mailed health and sexual behavior questionnaires and kits for self-sampling for PCR-based HPV DNA testing. Samples from oncogenic HPV positive women were selected for type-specific DNA load testing by real-time PCR with adjustment for cellularity. Linear or logistic regression models were used to evaluate relationships between viral levels, health and sexual behavior, and longitudinal oncogenic HPV detection. Type-specific viral levels were borderline significantly higher in oncogenic HPV infections that were prevalent versus newly detected (p=0.092), but levels in newly detected infections were higher than in infections re-detected after intercurrent negativity (p<.001). Recent sex partners were not significantly associated with viral levels. Compared to prevalent infections detected intermittently, the likelihood of persistent (OR=4.31,95%CI:2.20–8.45) or single-time (OR=1.32,95%CI:1.03–1.71) detection increased per 1-unit increase in baseline log10 viral load. Viral load differences between re-detected and newly detected infections suggest a portion of new detections were due to new acquisition, although report of recent new sex partners (a potential marker of new infection) was not predictive of viral load; oncogenic HPV infections in mid-adult women with new partners likely represent a mix of new acquisition and reactivation or intermittent detection of previous infection. Intermittent detection was characterized by low viral levels, suggesting that intermittent detection of persisting oncogenic HPV infection may be of limited clinical significance PMID:24136492

Ablative Thermal Protection Systems Fundamentals

NASA Technical Reports Server (NTRS)

Beck, Robin A. S.

2017-01-01

This is a presentation of the fundamentals of ablative TPS materials for a short course at TFAWS 2017. It gives an overall description of what an ablator is, the equations that define it, and how to model it.

Advanced Ablative TPS

NASA Technical Reports Server (NTRS)

Gasch, Matthew J.

2011-01-01

Early NASA missions (Gemini, Apollo, Mars Viking) employed new ablative TPS that were tailored for the entry environment. After 40 years, heritage ablative TPS materials using Viking or Pathfinder era materials are at or near their performance limits and will be inadequate for future exploration missions. Significant advances in TPS materials technology are needed in order to enable any subsequent human exploration missions beyond Low Earth Orbit. This poster summarizes some recent progress at NASA in developing families of advanced rigid/conformable and flexible ablators that could potentially be used for thermal protection in planetary entry missions. In particular the effort focuses technologies required to land heavy (approx.40 metric ton) masses on Mars to facilitate future exploration plans.

[Thoracoscopic, epicardial ablation of atrial fibrillation using the COBRA Fusion system as the first part of hybrid ablation].

PubMed

Budera, P; Osmančík, P; Talavera, D; Fojt, R; Kraupnerová, A; Žďárská, J; Vaněk, T; Straka, Z

2017-01-01

Treatment of persistent and long-standing persistent atrial fibrillation is not successfully managed by methods of catheter ablation or pharmacotherapy. Hybrid ablation (i.e. combination of minimally invasive surgical ablation, followed by electrophysiological assessment and subsequent endocardial catheter ablation to complete the entire intended procedure) presents an ever more used and very promising treatment method. Patients underwent thoracoscopic ablation of pulmonary veins and posterior wall of the left atrium (the box-lesion) with use of the COBRA Fusion catheter; thoracoscopic occlusion of the left atrial appendage using the AtriClip system was also done in later patients. After 23 months, electrophysiological assessment and catheter ablation followed. In this article we summarize a strategy of the surgical part of the hybrid procedure performed in our centre. We describe the surgery itself (including possible periprocedural complications) and we also present our short-term results, especially with respect to subsequent electrophysiological findings. Data of the first 51 patients were analyzed. The first 25 patients underwent unilateral ablation; the mean time of surgery was 102 min. Subsequent 26 patients underwent the bilateral procedure with the mean surgery time of 160 min. Serious complications included 1 stroke, 1 phrenic nerve palsy and 2 surgical re-explorations for bleeding. After 1 month, 65% of patients showed sinus rhythm. The box-lesion was found complete during electrophysiological assessment in 38% of patients and after catheter ablation, 96% of patients were discharged in sinus rhythm. The surgical part of the hybrid procedure with use of the minimally invasive approach and the COBRA Fusion catheter is a well-feasible method with a low number of periprocedural complications. For electrophysiologists, it provides a very good basis for successful completion of the hybrid ablation.Key words: atrial fibrillation hybrid ablation - thoracoscopy

Meta-analysis of bipolar radiofrequency endometrial ablation versus thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding.

PubMed

Zhai, Yan; Zhang, Zihan; Wang, Wei; Zheng, Tingping; Zhang, Huili

2018-01-01

Heavy menstrual bleeding is a common problem that can severely affect quality of life. To compare bipolar radiofrequency endometrial ablation and thermal balloon ablation for heavy menstrual bleeding in terms of efficacy and health-related quality of life (HRQoL). Online registries were systematically searched using relevant terms without language restriction from inception to November 24, 2016. Randomized control trials or cohort studies of women with heavy menstrual bleeding comparing the efficacy of two treatments were eligible. Data were extracted. Results were expressed as risk ratios (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs). Six studies involving 901 patients were included. Amenorrhea rate at 12 months was significantly higher after bipolar radiofrequency endometrial ablation than after thermal balloon ablation (RR 2.73, 95% CI 2.00-3.73). However, no difference at 12 months was noted for dysmenorrhea (RR 1.04, 95% CI 0.68-1.58) or treatment failure (RR 0.78, 95% CI 0.38-1.60). The only significant difference for HRQoL outcomes was for change in SAQ pleasure score (12 months: WMD -3.51, 95% CI -5.42 to -1.60). Bipolar radiofrequency endometrial ablation and thermal balloon ablation reduce menstrual loss and improve quality of life. However, bipolar radiofrequency endometrial ablation is more effective in terms of amenorrhea rate and SAQ pleasure. © 2017 International Federation of Gynecology and Obstetrics.

An emerging view of the crust and mantle of tectonic North America from EMScope: a mid- term progress review of Earthscope's magnetotelluric program

NASA Astrophysics Data System (ADS)

Schultz, A.; Bedrosian, P.; Evans, R.; Egbert, G.; Kelbert, A.; Mickus, K.; Livelybrooks, D.; Park, S.; Patro, P.; Peery, T.; Wannamaker, P.; Unsworth, M.; Weiss, C.; Woodward, B.

2008-12-01

EMScope, the MT component of the Earthscope project has completed its final year of infrastructure construction, and its third annual campaign of regional magnetotelluric array operations in the western USA. Seven semi-permanent "backbone" MT observatories have been installed in California, Oregon, Montana, New Mexico, Minnesota, Missouri and Virginia, designed through installation in 2 m deep, insulated underground vaults and with long, buried electric dipole detectors using stable electrodes, to provide extremely long-period magnetotelluric data meant to provide a set of regional, deep structural "anchor points" penetrating into the mid-mantle, in which a series of denser and more uniform regional, transportable MT networks can be tied. A total of 160 "transportable array" MT stations have been occupied in Oregon, Washington, Idaho, northernmost-California, and Montana. These were located on a 70 km quasi-regular grid, with coverage of Cascadia, parts of the Basin and Range, the Rockies and the Snake River Plain, the zone above a putative mantle plume that is hypothesized to serve as the magma source for both the Yellowstone supervolcano and a chain of volcanic features extending westward into Oregon. It is anticipated that in 2009 the transportable array will sweep eastward through the Yellowstone region, following which a set of regional transects at sites of special geodynamic interest will be staged. The transportable array stations are typically occupied for three weeks, providing MT response functions extending from 2-10,000 s or in cases as great as 20,000 s period. These stations are anchored at longer periods (extending as close to 100,000 s periods as possible) by the network of 7 backbone stations, to be operated continuously for up to five years. We present an initial set of 3-d inverse models from the EMScope data sets There is substantial coherence between the resulting 3-d conductivity model and the known boundaries of major physiographic provinces

Long-term evolution of a propagating non-transform offset on the Mid-Atlantic Ridge over the last 26 m.y.

NASA Astrophysics Data System (ADS)

Zheng, T.; Tucholke, B. E.; Lin, J.

2017-12-01

By making plate reconstructions from Chron 8n ( 26.54 Ma) to present and analyzing multibeam bathymetry, long-range HMR1 sidescan sonar images, residual mantle Bouguer gravity anomaly (RMBA) and gravity-derived crust thickness, we investigated the structure and evolution of a propagating non-transform discontinuity (NTD) and adjacent ridge segments that now intersect the Mid-Atlantic Ridge (MAR) axis at 25°37'N. The NTD has propagated consistently northward since Chron 8n at a rate of 4.76 km/m.y. Offset across the NTD since Chron 6an (22 Ma) has been right lateral and has ranged from 8-52 km. Key features are: 1) Inside-corner (IC) crust consistently has higher values of RMBA than the adjacent ridge segments, implying thinner crust. 2) IC crust typically exhibits elevated, irregular edifices. Slopes of the NTD walls are steeper at ICs than at outside corners (OCs). Steep (up to 40°), abrupt slopes are particularly pronounced at the IC on the north side of the NTD. 3) OC crust is deeper and normally exhibits long linear ridges that curve toward the MAR axis at the southern edge of the NTD but show little curvature at the northern edge. 4) Width of the NTD between its northern and southern walls (at mid-depth) has ranged from 2 to 22 km, averaging 15 km. 5) The NTD valley was intermittently crossed by individual ridges or blocks every 5-60 km (average 20 km) along the run of the NTD. The ridges curve along the transtensional plate boundary within the NTD but are often discontinuous. HMR1 data show lumpy small-scale topography and occasional volcanic cones on the ridges and blocks. Their intermittency indicates that melt intruded sporadically into the NTD. Propagation of the NTD occurred as the transtensional plate boundary within the NTD jumped northward from a volcanic ridge axis or block, apparently as magmatism waned. The jumps captured crust and transferred it to the east flank only within the NTD, not from the northern IC edifices. We propose two possible

Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths.

PubMed

Ando, Tomo; Takagi, Hisato; Grines, Cindy L

2017-09-01

Clinical outcomes of transfemoral-transcatheter aortic valve implantation (TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical (TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because previous meta-analyses only included a limited number of adjusted studies or several non-adjusted studies, our goal was to compare and summarize the outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the RCT and propensity-matched cohort studies with direct and adjusted indirect comparisons to reach more precise conclusions. We hypothesized that TF-TAVI would offer surgical candidates a better outcome compared with SAVR and TA-TAVI because of its potential for fewer myocardial injuries. A literature search was conducted through PUBMED and EMBASE through June 2016. Only RCTs and propensity-matched cohort studies were included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect meta-analysis was calculated from the direct meta-analysis. The effect sizes of direct and indirect meta-analyses were then combined. A random-effects model was used to calculate the hazards ratio and the odds ratio with 95% confidence intervals. Early (in-hospital or 30 days) and mid-term (≥1 year) all-cause mortality rates were assessed. Our search resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217) studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and SAVR, respectively. Direct meta-analyses and combined direct and indirect meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct meta-analyses (odds ratio 0.64, P = 0.35) and direct and indirect meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with TF-TAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct meta-analysis and became significant

Stellar Ablation of Planetary Atmospheres

NASA Technical Reports Server (NTRS)

Moore, Thomas E.; Horwitz, J. L.

2007-01-01

We review observations and theories of the solar ablation of planetary atmospheres, focusing on the terrestrial case where a large magnetosphere holds off the solar wind, so that there is little direct atmospheric impact, but also couples the solar wind electromagnetically to the auroral zones. We consider the photothermal escape flows known as the polar wind or refilling flows, the enhanced mass flux escape flows that result from localized solar wind energy dissipation in the auroral zones, and the resultant enhanced neutral atom escape flows. We term these latter two escape flows the "auroral wind." We review observations and theories of the heating and acceleration of auroral winds, including energy inputs from precipitating particles, electromagnetic energy flux at magnetohydrodynamic and plasma wave frequencies, and acceleration by parallel electric fields and by convection pickup processes also known as "centrifugal acceleration." We consider also the global circulation of ionospheric plasmas within the magnetosphere, their participation in magnetospheric disturbances as absorbers of momentum and energy, and their ultimate loss from the magnetosphere into the downstream solar wind, loading reconnection processes that occur at high altitudes near the magnetospheric boundaries. We consider the role of planetary magnetization and the accumulating evidence of stellar ablation of extrasolar planetary atmospheres. Finally, we suggest and discuss future needs for both the theory and observation of the planetary ionospheres and their role in solar wind interactions, to achieve the generality required for a predictive science of the coupling of stellar and planetary atmospheres over the full range of possible conditions.

Advanced Rigid Ablative TPS

NASA Technical Reports Server (NTRS)

Gasch, Matthew J.

2011-01-01

NASA Exploration Systems Mission Directorate s (ESMD) Entry, Descent, and Landing (EDL) Technology Development Project (TDP) and the NASA Aeronautics Research Mission Directorate s (ARMD) Hypersonics Project are developing new advanced rigid ablators in an effort to substantially increase reliability, decrease mass, and reduce life cycle cost of rigid aeroshell-based entry systems for multiple missions. Advanced Rigid Ablators combine ablation resistant top layers capable of high heat flux entry and enable high-speed EDL with insulating mass-efficient bottom that, insulate the structure and lower the areal weight. These materials may benefit Commercial Orbital Transportation Services (COTS) vendors and may potentially enable new NASA missions for higher velocity returns (e.g. asteroid, Mars). The materials have been thermally tested to 400-450 W/sq cm at the Laser Hardened Materials Evaluation Lab (LHMEL), Hypersonics Materials Evaluation Test System (HyMETS) and in arcjet facilities. Tested materials exhibit much lower backface temperatures and reduced recession over the baseline materials (PICA). Although the EDL project is ending in FY11, NASA in-house development of advanced ablators will continue with a focus on varying resin systems and fiber/resin interactions.

Modelling ultrafast laser ablation

NASA Astrophysics Data System (ADS)

Rethfeld, Baerbel; Ivanov, Dmitriy S.; E Garcia, Martin; Anisimov, Sergei I.

2017-05-01

This review is devoted to the study of ultrafast laser ablation of solids and liquids. The ablation of condensed matter under exposure to subpicosecond laser pulses has a number of peculiar properties which distinguish this process from ablation induced by nanosecond and longer laser pulses. The process of ultrafast ablation includes light absorption by electrons in the skin layer, energy transfer from the skin layer to target interior by nonlinear electronic heat conduction, relaxation of the electron and ion temperatures, ultrafast melting, hydrodynamic expansion of heated matter accompanied by the formation of metastable states and subsequent formation of breaks in condensed matter. In case of ultrashort laser excitation, these processes are temporally separated and can thus be studied separately. As for energy absorption, we consider peculiarities of the case of metal irradiation in contrast to dielectrics and semiconductors. We discuss the energy dissipation processes of electronic thermal wave and lattice heating. Different types of phase transitions after ultrashort laser pulse irradiation as melting, vaporization or transitions to warm dense matter are discussed. Also nonthermal phase transitions, directly caused by the electronic excitation before considerable lattice heating, are considered. The final material removal occurs from the physical point of view as expansion of heated matter; here we discuss approaches of hydrodynamics, as well as molecular dynamic simulations directly following the atomic movements. Hybrid approaches tracing the dynamics of excited electrons, energy dissipation and structural dynamics in a combined simulation are reviewed as well.

The long-term outcome of displaced mid-third clavicle fractures on scapular and shoulder function: variations between immediate surgery, delayed surgery, and nonsurgical management.

PubMed

George, Daniel M; McKay, Bartholomew P; Jaarsma, Ruurd L

2015-05-01

Conservative management for uncomplicated displaced clavicle fractures is common practice. Delay of surgical fixation may result in less favorable outcomes. A retrospective cohort study was conducted of 60 patients with a closed mid-third clavicle fracture that did not meet current operative or nonoperative guidelines; 20 primary (plate fixation <6 weeks), 20 delayed (plate fixation >6 weeks), and 20 matched conservative patients were included. Each patient completed 2 questionnaires, the Disabilities of the Arm, Shoulder, and Hand and the American Shoulder and Elbow Surgeons, as well as visual analog scales for pain, cosmetic satisfaction, and overall satisfaction. In addition, 10 patients from each group underwent clinical review of scapular rotation by the lateral scapular slide test, clinical impingement, range of motion assessment, and radiologic review of clavicle union and length. The American Shoulder and Elbow Surgeons patient self-reported questionnaire demonstrated a median score of 5.5 for the delayed group, 2 for the primary group, and 1 for the conservative group (P = .032). The median Disabilities of the Arm, Shoulder, and Hand score was 7.92 for the delayed group, 3.32 for the primary group, and 1.67 for the conservative group (P = .212). Six patients in the delayed group had scapular malrotation compared with 2 in the primary group and none in the conservative group (P = .008). Flexion and external rotation in 90° abduction were decreased in the conservative group (P = .049 and .041, respectively). We support the conservative management of uncomplicated displaced clavicle fractures but recognize that a lower threshold for early surgery should be considered where optimal shoulder function is required. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Extreme events in total ozone over the Northern mid-latitudes: an analysis based on long-term data sets from five European ground-based stations

NASA Astrophysics Data System (ADS)

Rieder, Harald E.; Jancso, Leonhardt M.; Rocco, Stefania Di; Staehelin, Johannes; Maeder, Joerg A.; Peter, Thomas; Ribatet, Mathieu; Davison, Anthony C.; de Backer, Hugo; Koehler, Ulf; Krzyścin, Janusz; Vaníček, Karel

2011-11-01

We apply methods from extreme value theory to identify extreme events in high (termed EHOs) and low (termed ELOs) total ozone and to describe the distribution tails (i.e. very high and very low values) of five long-term European ground-based total ozone time series. The influence of these extreme events on observed mean values, long-term trends and changes is analysed. The results show a decrease in EHOs and an increase in ELOs during the last decades, and establish that the observed downward trend in column ozone during the 1970-1990s is strongly dominated by changes in the frequency of extreme events. Furthermore, it is shown that clear ‘fingerprints’ of atmospheric dynamics (NAO, ENSO) and chemistry [ozone depleting substances (ODSs), polar vortex ozone loss] can be found in the frequency distribution of ozone extremes, even if no attribution is possible from standard metrics (e.g. annual mean values). The analysis complements earlier analysis for the world's longest total ozone record at Arosa, Switzerland, confirming and revealing the strong influence of atmospheric dynamics on observed ozone changes. The results provide clear evidence that in addition to ODS, volcanic eruptions and strong/moderate ENSO and NAO events had significant influence on column ozone in the European sector.

Mid- to long-term outcome comparison of the Medtronic Hancock II and bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis.

PubMed

Wang, Yin; Chen, Si; Shi, Jiawei; Li, Geng; Dong, Nianguo

2016-03-01

This study aims to compare mid-long-term clinical outcomes between patients younger than 60 years of age undergoing bioprosthetic and mechanical aortic valve replacement. From January 2002 to December 2009, patients younger than 60 years of age who received Medtronic Hancock II porcine bioprostheses were selected and compared with those who received mechanical bi-leaflet valves in the aortic position. A stepwise logistic regression propensity score identified a subset of 112 evenly matched patient-pairs. Mid-long-term outcomes of survival, valve-related reoperations, thromboembolic events and bleeding events were assessed. The follow-up was only 95.1% complete. Fourteen measurable variables were statistically similar for the matched cohort. Postoperative in-hospital mortality was 3.6% (bioprosthetic valves) and 2.7% (mechanical valves) (P = 0.700). Survival at 5 and 10 years was 96.3 and 88.7% for patients receiving bioprosthetic valve replacement versus 96.3 and 87.9% for patients receiving mechanical valve replacement (P = 0.860), respectively. At 5 and 10 years after operations, freedom from valve-related reoperation was 97.2 and 94.8% for patients receiving mechanical valve replacement, and 96.3 and 90.2% for patients receiving bioprosthetic valve replacement (P = 0.296), respectively. There was no difference between freedom from thromboembolic events (P = 0.528) and bleeding events (P = 0.128) between the matched groups during the postoperative 10 years. In patients younger than 60 years of age undergoing aortic valve replacement, mid-long-term survival rate was similar for patients receiving bioprosthetic versus mechanical valve replacement. Bioprosthetic valves were associated with a trend for a lower risk of anticoagulation treatment and did not have significantly greater likelihood of a reoperation. These findings suggest that a bioprosthetic valve may be a reasonable choice for AVR in patients younger than 60 years of age. © The Author 2015. Published by

Radiofrequency ablation versus cryoablation for atrioventricular nodal re-entrant tachycardia in children: a value comparison.

PubMed

Oster, Matthew E; Yang, Zhou; Stewart-Huey, Kay; Glanville, Michelle; Porter, Arlene; Campbell, Robert; Webb, Brad; Strieper, Margaret

2017-03-01

It is unclear whether cryoablation or radiofrequency ablation offers better value for treating atrioventricular nodal re-entrant tachycardia in children. We aimed to compare the value of these procedures for treating atrioventricular nodal re-entrant tachycardia in children, with value being outcomes relative to costs. We performed a retrospective cohort study of all atrioventricular nodal re-entrant tachycardia ablations for children (age⩽18 years) from July, 2009 to June, 2011 at our institution. Costs included fixed costs, miscellaneous hospital costs, and labour costs, and key outcomes were acute and long-term success (6 months) of the ablations. We conducted T-tests and regression analyses to investigate the associations between the ablation procedure type and the cost and success of the ablations. Of 96 unique cases performed by three paediatric electrophysiologists, 48 were cryoablation only, 42 radiofrequency ablation only, and six were a combination. Acute success was 100% for the cryoablation only and radiofrequency ablation only cases and 83% for the combination cases. There were no notable adverse events. The average total cost was $9636 for cryoablation cases, $9708 for radiofrequency ablation cases, and $10,967 for combination cases (p=0.51 for cryoablation only versus radiofrequency ablation only). The long-term success rate was 79.1% for cryoablation only, 92.8% for radiofrequency ablation only, and 66.7% for the combination (p=0.01 for cryoablation only versus radiofrequency ablation only), but long-term success varied notably by provider. Cryoablation and radiofrequency ablation offer similar value in the short term for the treatment of atrioventricular nodal re-entrant tachycardia in children. Differences in long-term success may vary substantially by physician, and thus may lead to differences in long-term value.

Six-month follow-up of isthmus-dependent right atrial flutter ablation using a remote magnetic catheter navigation system: a case-control study.

PubMed

Huo, Yan; Hindricks, Gerhard; Piorkowski, Christopher; Bollmann, Andreas; Wetzel, Ulrike; Sommer, Phillip; Gaspar, Thomas; Kottkamp, Hans; Arya, Arash

2010-06-01

The objective of this study was to compare results between the magnetic navigation system (MNS) and conventional catheter ablation of cavo-tricuspid isthmus (CTI)-dependent right atrial flutter (AFL) in a case control study. A remote MNS has been used for ablation of various arrhythmias including CTI-dependent AFL but comparative results between MNS and conventional ablation are not available. Between May and September 2007, a total of 51 consecutive patients (45 men, mean age 65.4 +/- 9.4 years) had undergone catheter ablation for CTI-dependent AFL. The catheter ablation (70 degrees C, 70 W, 90 s) was performed with either an 8-mm-tip magnetic catheter using MNS (case group, n = 26, 23 men, mean age 64.6 +/- 9.6 y) or a conventional 8-mm catheter (case group, n = 25, 22 men, mean age 65.4 +/- 9.1 y). Acute procedural success was defined as complete bidirectional isthmus block and success at six months was defined as absence of AFL during the six months follow-up. With respect to baseline characteristics there were no differences between the two groups. The procedure time in MNS and conventional group was [median (range)] 53 (30-130) min and 45 (30-100) min, respectively (P = 0.12). Acute success was achieved by MNS and conventional ablation in 25/26 (96.2%) and 25/25 (100%) of patients, respectively (P = 0.53). During the six months of follow-up 4 patients, 2 in each group, experienced recurrence (P = 0.90). No major complication occurred during the procedure. Charring on the catheter tip occurred in 5 patients (19.2%) in MNS and none of the patients in the control group (P <0.05). This case-control study demonstrated the acute and mid-term efficacy and safety of catheter ablation by MNS for CTI-dependent AFL, similar to rates achieved by conventional radiofrequency catheter ablation.

Percutaneous laser ablation of benign and malignant thyroid nodules.

PubMed

Papini, Enrico; Bizzarri, Giancarlo; Pacella, Claudio M

2008-10-01

Percutaneous image-guided procedures, largely based on thermal ablation, are at present under investigation for achieving a nonsurgical targeted cytoreduction in benign and malignant thyroid lesions. In several uncontrolled clinical trials and in two randomized clinical trials, laser ablation has demonstrated a good efficacy and safety for the shrinkage of benign cold thyroid nodules. In hyperfunctioning nodules, laser ablation induced a nearly 50% volume reduction with a variable frequency of normalization of thyroid-stimulating hormone levels. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences or distant metastases. Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.

Initiation of long-term coupled microbiological, geochemical, and hydrological experimentation within the seafloor at North Pond, western flank of the Mid-Atlantic Ridge

USGS Publications Warehouse

Edwards, K.J.; Backert, N.; Bach, W.; Becker, K.; Klaus, A.; Griffin, Dale W.; Anderson, L.; Haddad, A.G.; Harigane, Y.; Campion, P.L.; Hirayama, H.; Mills, H.J.; Hulme, S.M.; Nakamura, K.; Jorgensen, S.L.; Orcutt, B.; Insua, T.L.; Park, Y.-S.; Rennie, V.; Salas, E.C.; Rouxel, O.; Wang, F.; Russel, J.A.; Wheat, C.G.; Sakata, K.; Brown, M.; Magnusson, J.L.; Ettlinger, Z.

2012-01-01

Integrated Ocean Drilling Program (IODP) Expedition 336 successfully initiated subseafloor observatory science at a young mid-ocean-ridge flank setting. All of the drilled sites are located in the North Pond region of the Atlantic Ocean (22??45'N, 46??05'W) in 4414-4483 m water depth. This area is known from previous ocean drilling and site survey investigations as a site of particularly vigorous circulation of seawater in permeable 8 Ma basaltic basement underlying a <300 m thick sedimentary pile. Understanding how this seawater circulation affects microbial and geochemical processes in the uppermost basement was the primary science objective of Expedition 336. Basement was cored and wireline-logged in Holes U1382A and U1383C. Upper oceanic crust in Hole U1382A, which is only 50 m west of Deep Sea Drilling Project (DSDP) Hole 395A, recovered 32 m of core between 110 and 210 meters below seafloor (mbsf). Core recovery in basement was 32%, yielding a number of volcanic flow units with distinct geochemical and petrographic characteristics. A unit of sedimentary breccia containing clasts of basalt, gabbroic rocks, and mantle peridotite was found intercalated between two volcanic flow units and was interpreted as a rock slide deposit. From Hole U1383C we recovered 50.3 m of core between 69.5 and 331.5 mbsf (19%). The basalts are aphyric to highly plagioclase-olivine-phyric tholeiites that fall on a liquid line of descent controlled by olivine fractionation. They are fresh to moderately altered, with clay minerals (saponite, nontronite, and celadonite), Fe oxyhydroxide, carbonate, and zeolite as secondary phases replacing glass and olivine to variable extents. In addition to traditional downhole logs, we also used a new logging tool for detecting in situ microbial life in ocean floor boreholes-the Deep Exploration Biosphere Investigative tool (DEBI-t). Sediment thickness was ???90 m at Sites U1382 and U1384 and varied between 38 and 53 m at Site U1383. The sediments are

OCDR guided laser ablation device

DOEpatents

Dasilva, Luiz B.; Colston, Jr., Bill W.; James, Dale L.

2002-01-01

A guided laser ablation device. The device includes a mulitmode laser ablation fiber that is surrounded by one or more single mode optical fibers that are used to image in the vicinity of the laser ablation area to prevent tissue damage. The laser ablation device is combined with an optical coherence domain reflectometry (OCDR) unit and with a control unit which initializes the OCDR unit and a high power laser of the ablation device. Data from the OCDR unit is analyzed by the control unit and used to control the high power laser. The OCDR images up to about 3 mm ahead of the ablation surface to enable a user to see sensitive tissue such as a nerve or artery before damaging it by the laser.

Multiple target laser ablation system

DOEpatents

Mashburn, D.N.

1996-01-09

A laser ablation apparatus and method are provided in which multiple targets consisting of material to be ablated are mounted on a movable support. The material transfer rate is determined for each target material, and these rates are stored in a controller. A position detector determines which target material is in a position to be ablated, and then the controller controls the beam trigger timing and energy level to achieve a desired proportion of each constituent material in the resulting film. 3 figs.

Multiple target laser ablation system

DOEpatents

Mashburn, Douglas N.

1996-01-01

A laser ablation apparatus and method are provided in which multiple targets consisting of material to be ablated are mounted on a movable support. The material transfer rate is determined for each target material, and these rates are stored in a controller. A position detector determines which target material is in a position to be ablated, and then the controller controls the beam trigger timing and energy level to achieve a desired proportion of each constituent material in the resulting film.

Long-Term Changes in Lower Tropospheric Baseline Ozone Concentrations:. [Comparing Chemistry-Climate Models and Observations at Northern Mid-Latitudes

NASA Technical Reports Server (NTRS)

Parrish, D. D.; Lamarque, J.-F.; Naik, V.; Horowitz, L.; Shindell, D. T.; Staehelin, J.; Derwent, R.; Cooper, O. R.; Tanimoto, H.; Volz-Thomas, A.;

Project 5322 Mid-Term Report: Key Eco-Hydrological Parameters Retrieval And Land Data Assimilation System Development In A Typical Inland River Basin Of Chinas Arid Region

NASA Astrophysics Data System (ADS)

Faivre, R.; Colin, J.; Menenti, M.; Lindenbergh, R.; Van Den Bergh, L.; Yu, H.; Jia, L.; Xin, L.

2010-10-01

Improving the understanding and the monitoring of high elevation regions hydrology is of major relevance from both societal and environmental points of view for many Asian countries, in particular in terms of flood and drought, but also in terms of food security in a chang- ing environment. Satellite and airborne remote sensing technologies are of utmost for such a challenge. Exist- ing imaging spectro-radiometers, radars, microwave ra- diometers and backscatter LIDAR provide a very com- prehensive suite of measurements over a wide rage of wavelengths, time frequencies and spatial resolu- tions. It is however needed to devise new algorithms to convert these radiometric measurements into useful eco-hydrological quantitative parameters for hydrologi- cal modeling and water management. The DRAGON II project entitled Key Eco-Hydrological Parameters Re- trieval and Land Data Assimilation System Development in a Typical Inland River Basin of Chinas Arid Region (ID 5322) aims at improving the monitoring, understand- ing, and predictability of hydrological and ecological pro- cesses at catchment scale, and promote the applicability of quantitative remote sensing in watershed science. Ex- isting Earth Observation platforms provided by the Euro- pean Space Agency as well as prototype airborne systems developed in China - ENVISAT/AATSR, ALOS/PRISM and PALSAR, Airborne LIDAR - are used and combined to retrieve advanced land surface physical properties over high elevation arid regions of China. The existing syn- ergies between this project, the CEOP-AEGIS project (FP7) and the WATER project (CAS) provide incentives for innovative studies. The investigations presented in the following report focus on the development of advanced and innovative methodologies and algorithms to monitor both the state and the trend of key eco-hydrological vari- ables: 3D vegetation properties, land surface evaporation, glacier mass balance and drought indicators.

A cost-utility analysis of ablative therapy for Barrett’s esophagus

PubMed Central

Inadomi, John M.; Somsouk, Ma; Madanick, Ryan D.; Thomas, Jennifer P.; Shaheen, Nicholas J.

2009-01-01

Background & Aims Recommendations for patients with Barrett’s esophagus (BE) include endoscopic surveillance with esophagectomy for early-stage cancer, although new technologies to ablate dysplasia and metaplasia are available. This study compares the cost-utility of ablation with that of endoscopic surveillance strategies. Methods A decision analysis model was created to examine a population of patients with BE (mean age 50), with separate analyses for patients with no dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). Strategies compared were: no endoscopic surveillance; endoscopic surveillance with ablation for incident dysplasia; immediate ablation followed by endoscopic surveillance in all patients or limited to patients in whom metaplasia persisted, and esophagectomy. Ablation modalities modeled included radiofrequency, argon plasma coagulation, multipolar electrocoagulation and photodynamic therapy. Results Endoscopic ablation for patients with HGD could increase life expectancy by 3 quality-adjusted years at an incremental cost of < $6,000, compared with no intervention. Patients with LGD or no dysplasia can also be optimally managed with ablation, but continued surveillance after eradication of metaplasia is expensive. If ablation permanently eradicates at least 28% of LGD or 40% of non-dysplastic metaplasias, ablation would be preferred to surveillance. Conclusions Endoscopic ablation could be the preferred strategy for managing patients with BE with HGD. Ablation might also be preferred in subjects with LGD or no dysplasia, but the cost-effectiveness depends on the long-term effectiveness of ablation and whether surveillance endoscopy can be discontinued following successful ablation. As further post-ablation data become available, the optimal management strategy will be clarified. PMID:19272389

Performance of Er:YAG laser ablation of hard bone under different irrigation water cooling conditions

NASA Astrophysics Data System (ADS)

Beltrán Bernal, Lina M.; Shayeganrad, Gholamreza; Kosa, Gabor; Zelechowski, Marek; Rauter, Georg; Friederich, Niklaus; Cattin, Philippe C.; Zam, Azhar

2018-02-01

The biological applicability of the Erbium-doped Yttrium Aluminum Garnet (Er:YAG) laser in surgical processes is so far limited to hard dental tissues. Using the Er:YAG laser for bone ablation is being studied since it has shown good performance for ablating dental hard tissues at the wavelength 2.94 μm, which coincides with the absorption peak of water, one of the main components of hard tissue, like teeth and bone. To obtain a decent performance of the laser in the cutting process, we aim at examining the influence of sequenced water jet irrigation on both, the ablation rate and the prevention of carbonization while performing laser ablation of bone with fixed laser parameters. An Er:YAG laser at 2.94 μm wavelength, 940 mJ energy per pulse, 400 μs pulse width, and 10 Hz repetition rate is used for the ablation of a porcine femur bone under different pulsed water jet irrigation conditions. We used micro-computed tomography (micro-CT) scans to determine the geometry of the ablated areas. In addition, scanning electron microscopy (SEM) is used for qualitative observations for the presence of carbonization and micro-fractures on the ablated surfaces. We evaluate the performance of the laser ablation process for the different water jet conditions in terms of the ablation rate, quantified by the ablated volume per second and the ablation efficiency, calculated as the ablated volume per pulse energy. We provide an optimized system for laser ablation which delivers the appropriate amount of water to the bone and consequently, the bone is ablated in the most efficient way possible without carbonization.

Improvements In AF Ablation Outcome Will Be Based More On Technological Advancement Versus Mechanistic Understanding.

PubMed

Jiang Md, Chen-Yang; Jiang Ms, Ru-Hong

2014-01-01

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. Catheter ablation has proven more effective than antiarrhythmic drugs in preventing clinical recurrence of AF, however long-term outcome remains unsatisfactory. Ablation strategies have evolved based on progress in mechanistic understanding, and technologies have advanced continuously. This article reviews current mechanistic concepts and technological advancements in AF treatment, and summarizes their impact on improvement of AF ablation outcome.

Mid-Term Assessment of the EU Drugs Strategy 2013-2020 and Final Evaluation of the Action Plan on Drugs 2013-2016: Final report.

PubMed

Emilie, Balbirnie; Matthew, Davies; Emma, Disley; Cristina Gonzalez, Monsalve; Stephen, Hartka; Stijn, Hoorens; Kristy, Kruithof; Martin, Sacher; Jirka, Taylor

2018-01-01

The aim of the EU Drugs Strategy 2013-2020 is to contribute to a reduction in drug demand and drug supply within the EU. The Strategy has so far been implemented by an Action Plan covering the period 2013-2016. This article sets out the findings of an evaluation that assesses the degree of implementation of the Strategy and the Action Plan in terms of outputs and, where possible, impacts. It looks at the extent to which the objectives of the Strategy have been achieved. The evaluation aims to provide evidence to support the European Commission's decision about whether to propose a new Action Plan for the period 2017-2020 and, if so, what changes would be needed compared to the current plan. Through applying a mixed-methods approach, the evaluation examined the effectiveness, efficiency, relevance and coherence of the actions undertaken on the basis of the EU Drugs Strategy and the Action Plan, as well as their EU added value. The evaluation makes 20 recommendations, addressed to the European Commission, Member States, the European Council and other stakeholders. The key recommendation for the Commission is that a new Action Plan should be implemented for the period 2017-2020. This should be an updated version of the current Action Plan, rather than taking a new approach or introducing more new actions.

Arcjet Testing of Advanced Conformal Ablative TPS

NASA Technical Reports Server (NTRS)

Gasch, Matthew; Beck, Robin; Agrawal, Parul

2014-01-01

A conformable TPS over a rigid aeroshell has the potential to solve a number of challenges faced by traditional rigid TPS materials (such as tiled Phenolic Impregnated Carbon Ablator (PICA) system on MSL. The compliant (high strain to failure) nature of the conformable ablative materials will allow integration of the TPS with the underlying aeroshell structure much easier and enable monolithic-like configuration and larger segments (or parts) to be used. In May of 2013 the CA250 project executed an arcjet test series in the Ames IHF facility to evaluate a phenolic-based conformal system (named Conformal-PICA) over a range of test conditions from 40-400Wcm2. The test series consisted of four runs in the 13-inch diameter nozzle. Test models were based on SPRITE configuration (a 55-deg sphere cone), as it was able to provide a combination of required heat flux, pressure and shear within a single entry. The preliminary in-depth TC data acquired during that test series allowed a mid-fidelity thermal response model for conformal-PICA to be created while testing of seam models began to address TPS attachment and joining of multiple segments for future fabrication of large-scale aeroshells. Discussed in this paper are the results.

Impact of socioeconomic status and rurality on early outcomes and mid-term survival after CABG: insights from a multicentre registry.

PubMed

Shi, William Y; Yap, Cheng-Hon; Newcomb, Andrew E; Hayward, Philip A; Tran, Lavinia; Reid, Christopher M; Smith, Julian A

2014-08-01

We examined whether socioeconomic status and rurality influenced outcomes after coronary surgery. We identified 14,150 patients undergoing isolated coronary surgery. Socioeconomic and rurality data was obtained from the Australian Bureau of Statistics and linked to patients' postcodes. Outcomes were compared between categories of socioeconomic disadvantage (highest versus lowest quintiles, n= 3150 vs. 2469) and rurality (major cities vs. remote, n=9598 vs. 839). Patients from socioeconomically-disadvantaged areas experienced a greater burden of cardiovascular risk factors including diabetes, obesity and current smoking. Thirty-day mortality (disadvantaged 1.6% vs. advantaged 1.6%, p>0.99) was similar between groups as was late survival (7 years: 83±0.9% vs. 84±1.0%, p=0.79). Those from major cities were less likely to undergo urgent surgery. There was similar 30-day mortality (major cities: 1.6% vs. remote: 1.5%, p=0.89). Patients from major cities experienced improved survival at seven years (84±0.5% vs. 79±2.0%, p=0.010). Propensity-analysis did not show socioeconomic status or rurality to be associated with late outcomes. Patients presenting for coronary artery surgery from different socioeconomic and geographic backgrounds exhibit differences in their clinical profile. Patients from more rural and remote areas appear to experience poorer long-term survival, though this may be partially driven by the population's clinical profile. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Low Educational Status and Childhood Obesity Associated with Insufficient Mid-Term Weight Loss After Sleeve Gastrectomy: a Retrospective Observational Cohort Study.

PubMed

Dilektasli, Evren; Erol, Mehmet Fatih; Cayci, Haci Murat; Ozkaya, Guven; Bayam, Mehmet Emrah; Duman, Ugur; Tihan, Necdet D; Erdogdu, Umut; Kisakol, Gurcan

2017-01-01

Successful weight loss after bariatric surgery has been associated with a variety of factors. The aim of this study was to determine the effects of educational status on surgical weight loss for patients undergoing sleeve gastrectomy (SG). This retrospective cohort study was carried out on patients undergoing SG between September 2013 and July 2015. Six months after surgery, the patients were classified into two groups according to their success in the percentage of excess weight loss (%EWL). Group 1: <%50EWL (insufficient WL) and group 2: ≥%50EWL (successful WL) in the sixth month. The independent predictors for insufficient weight loss six months after SG were analyzed. In the sixth post-operative month, their mean %EWL and percentage of excess body mass index loss (%EBMIL) were 50 ± 15.4 and 58.2 ± 19.3, respectively. In univariate analysis, group 1 patients were found to be significantly older when compared to group 2 patients while the education level of group 2 patients was significantly higher when compared to group 1. A tertiary educational level at a university or higher was associated with a nearly fourfold increased success in weight loss (AOR 3.772, p = 0.03) 6 months after SG. Multivariate analysis showed that patients with a history of childhood obesity were more likely to have insufficient weight loss (AOR 0.390, p = 0.045). Childhood obesity and a lower level of education are associated with insufficient weight loss 6 months after SG. However, prospective external validation is warranted, with a long-term follow-up of a large bariatric surgery population.

The Incidence and Predictors of Early- and Mid-Term Clinically Relevant Neurological Events After Transcatheter Aortic Valve Replacement in Real-World Patients.

PubMed

Bosmans, Johan; Bleiziffer, Sabine; Gerckens, Ulrich; Wenaweser, Peter; Brecker, Stephen; Tamburino, Corrado; Linke, Axel

2015-07-21

Transcatheter aortic valve replacement (TAVR) enables treatment of high-risk patients with symptomatic aortic stenosis without open-heart surgery; however, the benefits are mitigated by the potential for neurological events. This study sought to determine the timing and causes of clinically relevant neurological events after self-expandable TAVR. We enrolled 1,015 patients, of whom 996 underwent TAVR with a self-expandable system at 44 TAVR-experienced centers in Europe, Colombia, and Israel. Neurological events were evaluated for 3 distinct time periods: periprocedural (0 to 1 days post TAVR); early (2 to 30 days); and late (31 to 730 days). In this real-world study, neurological events were first referred to the site neurologist and then reviewed by an independent neurologist. The overall stroke rate was 1.4% through the first day post-procedure, 3.0% at 30 days, and 5.6% at 2 years. There were no significant predictors of periprocedural stroke or stroke/transient ischemic attack (TIA) combined. Significant predictors of early stroke were acute kidney injury (p = 0.03), major vascular complication (p = 0.04), and female sex (p = 0.04). For stroke/TIA combined, prior atrial fibrillation (p = 0.03) and major vascular complication (p = 0.009) were predictive. Coronary artery bypass graft surgery was the only significant predictor of late stroke (p = 0.007) or late stroke/TIA (p = 0.06). Treatment of high-risk patients with aortic stenosis using a self-expandable system was associated with a low stroke rate at short- and long-term follow-up. Multivariable predictors of clinically relevant neurological events differed on the basis of the timing after TAVR. (CoreValve Advance International Post Market Study; NCT01074658). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Anaortic off-pump versus clampless off-pump using the PAS-Port device versus conventional coronary artery bypass grafting: mid-term results from a matched propensity score analysis of 5422 unselected patients.

PubMed

Furukawa, Nobuyuki; Kuss, Oliver; Preindl, Konstantin; Renner, André; Aboud, Anas; Hakim-Meibodi, Kavous; Benzinger, Michael; Pühler, Thomas; Ensminger, Stephan; Fujita, Buntaro; Becker, Tobias; Gummert, Jan F; Börgermann, Jochen

2017-10-01

Meta-analyses from observational and randomized studies have demonstrated benefits of off-pump surgery for hard and surrogate endpoints. In some of them, increased re-revascularization was noted in the off-pump groups, which could impact their long-term survival. Therefore, we analyzed the course of all patients undergoing isolated coronary surgery regarding the major cardiac and cerebrovascular event (MACCE) criteria. A prospective register was taken from a high-volume off-pump center recording all anaortic off-pump (ANA), clampless off-pump (PAS-Port) and conventional (CONV) coronary artery bypass operations between July 2009 and June 2015. Propensity Score Matching was performed based on 28 preoperative risk variables. We identified 935 triplets (N = 2805). Compared with CONV, in-hospital mortality of both the ANA group (OR for ANA [95% CI] 0.25 [0.06; 0.83], P = 0.021), and the PAS-Port group was lower (OR for PAS-Port [95% CI] 0.50 [0.17; 1.32], P = 0.17). In the mid-term follow-up there were no significant differences between the groups regarding mortality (HR for ANA [95%-CI] 0.83 [0.55-1.26], P = 0.38; HR for PAS-Port [95%-CI] 1.06 [0.70-1.59], P = 0.79), incidence of stroke (HR for ANA 0.81 [0.43-1.53], P = 0.52; HR for PAS-Port 0.78 [0.41-1.50], P = 0.46), myocardial infarction (HR for ANA 0.53 [0.22-1.31], P = 0.17; HR for PAS-Port 0.78 [0.37-1.66], P = 0.52) or re-revascularization rate (HR for ANA 0.99 [0.67-1.44], P = 0.94; HR for PAS-Port 0.95 [0.65-1.38], P = 0.77). Both off-pump clampless techniques were associated with lower in-hospital mortality compared with conventional CABG. The mid-term course showed no difference with regard to the MACCE criteria between anaortic off-pump, clampless off-pump using PAS-Port and conventional CABG. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Improved Ablative Materials

DTIC Science & Technology

1967-12-01

Equipment 62 2. Gas Analysis 62 3. Chemical Analysis for Titanium and Boron 63 4. Tensile Strength Determinations 64 5. Density Determinations 64 6. X-ray...mils, and its density was about 4. 45 g/cm 3. Elastic modulus values averaged about 71 x 106 psi for the filament. -X- I. INTRODUCTION Ablative liner...20 4 /50 percent N 2H 4 -50 percent UDMH or L0 2 /LH. The more-energetic propellant systems, using fluorine or FLOX, demand more-effective abla- tive

High temperature ablative foam

NASA Technical Reports Server (NTRS)

Liu, Matthew T. (Inventor)

1992-01-01

An ablative foam composition is formed of approximately 150 to 250 parts by weight polymeric isocyanate having an isocyanate functionality of 2.6 to 3.2; approximately 15 to 30 parts by weight reactive flame retardant having a hydroxyl number range from 200-260; approximately 10 to 40 parts by weight non-reactive flame retardant; approximately 10 to 40 parts by weight nonhydrolyzable silicone copolymer having a hydroxyl number range from 75-205; and approximately 3 to 16 parts by weight amine initiated polyether resin having an isocyanate functionality greater than or equal to 3.0 and a hydroxyl number range from 400-800.

Benefits of Moderate-Z Ablators for Direct-Drive Inertial Confinement Fusion

NASA Astrophysics Data System (ADS)

Lafon, M.; Betti, R.; Anderson, K. S.; Collins, T. J. B.; Skupsky, S.; McKenty, P. W.

2014-10-01

Control of hydrodynamic instabilities and DT-fuel preheating by hot electrons produced by laser-plasma interaction is crucial in inertial confinement fusion. Moderate- Z ablators have been shown to reduce the laser imprinting on target and suppress the generation of hot electrons from the two-plasmon-decay instability. These results have motivated the use of ablators of higher- Z than pure plastic in direct-drive-ignition target designs for the National Ignition Facility (NIF). Two-dimensional radiation-hydrodynamic simulations assess the robustness of these ignition designs to laser imprint and capsule nonuniformities. The complex behavior of the hydrodynamic stability of mid- Z ablators is investigated through single and multimode simulations. A polar-drive configuration is developed within the NIF Laser System specifications for each ablator material. The use of multilayer ablators is also investigated to enhance the hydrodynamic stability. Results indicate that ignition target designs using mid- Z ablators exhibit good hydrodynamic properties, leading to high target gain for direct-drive implosions on the NIF. This material is based upon work supported by the Department of Energy National Nuclear Security Administration under Award Number DE-NA0001944 and the Office of Fusion Energy Sciences Number DE-FG02-04ER54786.

[Radiofrequency ablation of hepatocellular carcinoma].

PubMed

Widmann, Gerlig; Schullian, Peter; Bale, Reto

2013-03-01

Percutaneous radiofrequency ablation (RFA) is well established in the treatment of hepatocellular carcinoma (HCC). Due to its curative potential, it is the method of choice for non resectable BCLC (Barcelona Liver Clinic) 0 and A. RFA challenges surgical resection for small HCC and is the method of choice in bridging for transplantation and recurrence after resection or transplantation. The technical feasibility of RFA depends on the size and location of the HCC and the availability of ablation techniques (one needle techniques, multi-needle techniques). More recently, stereotactic multi-needle techniques with 3D trajectory planning and guided needle placement substantially improve the spectrum of treatable lesions including large volume tumors. Treatment success depends on the realization of ablations with large intentional margins of tumor free tissue (A0 ablation in analogy to R0 resection), which has to be documented by fusion of post- with pre-ablation images, and confirmed during follow-up imaging.

Simulation of Pellet Ablation

NASA Astrophysics Data System (ADS)

Parks, P. B.; Ishizaki, Ryuichi

2000-10-01

In order to clarify the structure of the ablation flow, 2D simulation is carried out with a fluid code solving temporal evolution of MHD equations. The code includes electrostatic sheath effect at the cloud interface.(P.B. Parks et al.), Plasma Phys. Contr. Fusion 38, 571 (1996). An Eulerian cylindrical coordinate system (r,z) is used with z in a spherical pellet. The code uses the Cubic-Interpolated Psudoparticle (CIP) method(H. Takewaki and T. Yabe, J. Comput. Phys. 70), 355 (1987). that divides the fluid equations into non-advection and advection phases. The most essential element of the CIP method is in calculation of the advection phase. In this phase, a cubic interpolated spatial profile is shifted in space according to the total derivative equations, similarly to a particle scheme. Since the profile is interpolated by using the value and the spatial derivative value at each grid point, there is no numerical oscillation in space, that often appears in conventional spline interpolation. A free boundary condition is used in the code. The possibility of a stationary shock will also be shown in the presentation because the supersonic ablation flow across the magnetic field is impeded.

Laboratory Simulations of Micrometeoroid Ablation

NASA Astrophysics Data System (ADS)

Thomas, Evan Williamson

Each day, several tons of meteoric material enters Earth's atmosphere, the majority of which consist of small dust particles (micrometeoroids) that completely ablate at high altitudes. The dust input has been suggested to play a role in a variety of phenomena including: layers of metal atoms and ions, nucleation of noctilucent clouds, effects on stratospheric aerosols and ozone chemistry, and the fertilization of the ocean with bio-available iron. Furthermore, a correct understanding of the dust input to the Earth provides constraints on inner solar system dust models. Various methods are used to measure the dust input to the Earth including satellite detectors, radar, lidar, rocket-borne detectors, ice core and deep-sea sediment analysis. However, the best way to interpret each of these measurements is uncertain, which leads to large uncertainties in the total dust input. To better understand the ablation process, and thereby reduce uncertainties in micrometeoroid ablation measurements, a facility has been developed to simulate the ablation of micrometeoroids in laboratory conditions. An electrostatic dust accelerator is used to accelerate iron particles to relevant meteoric velocities (10-70 km/s). The particles are then introduced into a chamber pressurized with a target gas, and they partially or completely ablate over a short distance. An array of diagnostics then measure, with timing and spatial resolution, the charge and light that is generated in the ablation process. In this thesis, we present results from the newly developed ablation facility. The ionization coefficient, an important parameter for interpreting meteor radar measurements, is measured for various target gases. Furthermore, experimental ablation measurements are compared to predictions from commonly used ablation models. In light of these measurements, implications to the broader context of meteor ablation are discussed.

Ultrafast properties of femtosecond-laser-ablated GaAs and its application to terahertz optoelectronics.

PubMed

Madéo, Julien; Margiolakis, Athanasios; Zhao, Zhen-Yu; Hale, Peter J; Man, Michael K L; Zhao, Quan-Zhong; Peng, Wei; Shi, Wang-Zhou; Dani, Keshav M

2015-07-15

We report on the first terahertz (THz) emitter based on femtosecond-laser-ablated gallium arsenide (GaAs), demonstrating a 65% enhancement in THz emission at high optical power compared to the nonablated device. Counter-intuitively, the ablated device shows significantly lower photocurrent and carrier mobility. We understand this behavior in terms of n-doping, shorter carrier lifetime, and enhanced photoabsorption arising from the ablation process. Our results show that laser ablation allows for efficient and cost-effective optoelectronic THz devices via the manipulation of fundamental properties of materials.

Use of radiofrequency ablation in benign thyroid nodules: a literature review and updates.

PubMed

Wong, Kai-Pun; Lang, Brian Hung-Hin

2013-01-01

Successful thermal ablation using radiofrequency has been reported in various tumors including liver or kidney tumors. Nonsurgical minimally invasive ablative therapy such as radiofrequency ablation (RFA) has been reported to be a safe and efficient treatment option in managing symptomatic cold thyroid nodules or hyperfunctioning thyroid nodules. Pressure and cosmetic symptoms have been shown to be significantly improved both in the short and long terms after RFA. For hyperfunctioning thyroid nodules, RFA is indicated for whom surgery or radioiodine are not indicated or ineffective or for those who refuse surgery or radio-iodine. Improvement of thyroid function with decreased need for antithyroid medications has been reported. Complication rate is relatively low. By reviewing the current literature, we reported its efficacy and complications and compared the efficacy of RFA relative to other ablative options such as ethanol ablation and laser ablation.

Use of Radiofrequency Ablation in Benign Thyroid Nodules: A Literature Review and Updates

PubMed Central

Wong, Kai-Pun; Lang, Brian Hung-Hin

2013-01-01

Successful thermal ablation using radiofrequency has been reported in various tumors including liver or kidney tumors. Nonsurgical minimally invasive ablative therapy such as radiofrequency ablation (RFA) has been reported to be a safe and efficient treatment option in managing symptomatic cold thyroid nodules or hyperfunctioning thyroid nodules. Pressure and cosmetic symptoms have been shown to be significantly improved both in the short and long terms after RFA. For hyperfunctioning thyroid nodules, RFA is indicated for whom surgery or radioiodine are not indicated or ineffective or for those who refuse surgery or radio-iodine. Improvement of thyroid function with decreased need for antithyroid medications has been reported. Complication rate is relatively low. By reviewing the current literature, we reported its efficacy and complications and compared the efficacy of RFA relative to other ablative options such as ethanol ablation and laser ablation. PMID:24298282

[Ablative treatments in localized renal cancer: literature review for 2014].

PubMed

Chodez, M; Fiard, G; Arnoux, V; Descotes, J-L; Long, J-A

2015-07-01

To focus on indications and results of ablative treatments (cyoablation, radiofrequency) for small renal masses, a bibliographic research was conducted in MedLine database using terms of "ablative treatment", "cryotherapy", "radiofrequency", "kidney cancer", "renal cell carcinoma". Sixty-four articles were selected. Carcinologic outcomes seem to be better with cryoablation than with radiofrequency. Available results have to be balanced according to surgical approach, teams' experience and duration of follow-up. Tumour's size and central localization are the main factors of failure. The size of 3cm is the most generally validated. Hospital stay and complications seem to be better with ablative therapies than with surgical approach, especially with percutaneous approach. The renal function preservation appears to be better with ablative therapies. It could be an interesting alternative to partial nephrectomy for small masses, in particular for fragile patients or in particular indications (multifocal tumors, in case of solitary kidney or transplanted kidney). The indications in elderly people must be proposed with care after the comorbidities have been evaluated. Indications of ablative treatment for small renal masses improve, but the gold standard treatment remains partial nephrectomy and indications must be individually discussed. Other ablative treatments are under-development, needing further studies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The effect of asteroid topography on surface ablation deflection

NASA Astrophysics Data System (ADS)

McMahon, Jay W.; Scheeres, Daniel J.

2017-02-01

Ablation techniques for deflecting hazardous asteroids deposit energy into the asteroid's surface, causing an effective thrust on the asteroid as the ablating material leaves normal to the surface. Although it has long been recognized that surface topography plays an important role in determining the deflection capabilities, most studies to date have ignored this aspect of the model. This paper focuses on understanding the topography for real asteroid shapes, and how this topography can change the deflection performance of an ablation technique. The near Earth asteroids Golevka, Bennu, and Itokawa are used as the basis for this study, as all three have high-resolution shape models available. This paper shows that naive targeting of an ablation method without accounting for the surface topography can lower the deflection performance by up to 20% in the cases studied in terms of the amount of acceleration applied in the desired direction. If the ablation thrust level is assumed to be 100 N, as used elsewhere in the literature, this misapplication of thrust translates to tens of kilometers per year in decreased semimajor axis change. However, if the ablation method can freely target any visible point on the surface of the asteroid, almost all of this performance can be recovered.

Regional Pericarditis Status Post Cardiac Ablation: A Case Report

PubMed Central

Orme, Joseph; Eddin, Moneer; Loli, Akil

2014-01-01

Context: Regional pericarditis is elusive and difficult to diagnosis. Healthcare providers should be familiar with post-cardiac ablation complications as this procedure is now widespread and frequently performed. The management of regional pericarditis differs greatly from that of acute myocardial infarction. Case report: A 52 year-old male underwent atrial fibrillation ablation and developed severe mid-sternal chest pain the following day with electrocardiographic findings suggestive of acute myocardial infarction, and underwent coronary angiography, a left ventriculogram, and 2D transthoracic echocardiogram, all of which were unremarkable without evidence of obstructive coronary disease, wall motion abnormalities, or pericardial effusions. Ultimately, the patient was diagnosed with regional pericarditis. After diagnosis, the patient's presenting symptoms resolved with treatment including nonsteroidal anti-inflammatory agents and colchicine. Conclusion: This is the first reported case study of regional pericarditis status post cardiac ablation. Electrocardiographic findings were classic for an acute myocardial infarction; however, coronary angiography and left ventriculogram demonstrated no acute coronary occlusion or ventricular wall motion abnormalities. Healthcare professionals must remember that the electrocardiographic findings in pericarditis are not always classic and that pericarditis can occur status post cardiac ablation. PMID:25317395

Regional pericarditis status post cardiac ablation: a case report.

PubMed

Orme, Joseph; Eddin, Moneer; Loli, Akil

2014-09-01

Regional pericarditis is elusive and difficult to diagnosis. Healthcare providers should be familiar with post-cardiac ablation complications as this procedure is now widespread and frequently performed. The management of regional pericarditis differs greatly from that of acute myocardial infarction. A 52 year-old male underwent atrial fibrillation ablation and developed severe mid-sternal chest pain the following day with electrocardiographic findings suggestive of acute myocardial infarction, and underwent coronary angiography, a left ventriculogram, and 2D transthoracic echocardiogram, all of which were unremarkable without evidence of obstructive coronary disease, wall motion abnormalities, or pericardial effusions. Ultimately, the patient was diagnosed with regional pericarditis. After diagnosis, the patient's presenting symptoms resolved with treatment including nonsteroidal anti-inflammatory agents and colchicine. This is the first reported case study of regional pericarditis status post cardiac ablation. Electrocardiographic findings were classic for an acute myocardial infarction; however, coronary angiography and left ventriculogram demonstrated no acute coronary occlusion or ventricular wall motion abnormalities. Healthcare professionals must remember that the electrocardiographic findings in pericarditis are not always classic and that pericarditis can occur status post cardiac ablation.

Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected "recurrent" neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy.

PubMed

Hay, Ian D; Lee, Robert A; Davidge-Pitts, Caroline; Reading, Carl C; Charboneau, J William

2013-12-01

Ultrasound-guided percutaneous ethanol ablation (UPEA) of neck nodal metastases (NNM) has rarely been reported in papillary thyroid carcinoma (PTC) patients with advanced localized disease. We ablated 25 PTC patients with stage III or IVA disease (mean age 58 years) who had "recurrent" NNM after surgery and 131I therapy. Diagnosis of 37 selected NNM was proven by ultrasound-guided biopsy. UPEA was usually performed in 2 outpatient sessions. After UPEA, 35 of 37 NNM (95%) decreased in size. None had significant Doppler flow. Seventeen (46%) disappeared on rescanning. Serum thyroglobulin fell in 19 of 22 (86%) without thyroglobulin autoantibodies. None of the UPEA-treated NNM, followed on average for 5.4 years, required further intervention. Six patients (24%) subsequently developed 18 "new" recurrences. Of the 18, 15 (83%) were managed successfully by UPEA rather than operation. None of the 25 patients developed permanent hoarseness or have died from PTC. At our institution, where patients undergoing nodal dissections are charged $35-45,000, each outpatient UPEA procedure saves health providers approximately $38,400. Our 25 ablated patients, by avoiding 40 further neck reexplorations, on average, saved $61,440 in charges. UPEA for NNM in advanced localized PTC has proved safe and effective. It is also considerably less expensive than the conventional operative alternative of nodal dissection. Copyright © 2013 Mosby, Inc. All rights reserved.

Mid-space-independent deformable image registration.

PubMed

Aganj, Iman; Iglesias, Juan Eugenio; Reuter, Martin; Sabuncu, Mert Rory; Fischl, Bruce

2017-05-15

Aligning images in a mid-space is a common approach to ensuring that deformable image registration is symmetric - that it does not depend on the arbitrary ordering of the input images. The results are, however, generally dependent on the mathematical definition of the mid-space. In particular, the set of possible solutions is typically restricted by the constraints that are enforced on the transformations to prevent the mid-space from drifting too far from the native image spaces. The use of an implicit atlas has been proposed as an approach to mid-space image registration. In this work, we show that when the atlas is aligned to each image in the native image space, the data term of implicit-atlas-based deformable registration is inherently independent of the mid-space. In addition, we show that the regularization term can be reformulated independently of the mid-space as well. We derive a new symmetric cost function that only depends on the transformation morphing the images to each other, rather than to the atlas. This eliminates the need for anti-drift constraints, thereby expanding the space of allowable deformations. We provide an implementation scheme for the proposed framework, and validate it through diffeomorphic registration experiments on brain magnetic resonance images. Copyright © 2017 Elsevier Inc. All rights reserved.

Mid-Space-Independent Deformable Image Registration

PubMed Central

Aganj, Iman; Iglesias, Juan Eugenio; Reuter, Martin; Sabuncu, Mert Rory; Fischl, Bruce

2017-01-01

Aligning images in a mid-space is a common approach to ensuring that deformable image registration is symmetric – that it does not depend on the arbitrary ordering of the input images. The results are, however, generally dependent on the mathematical definition of the mid-space. In particular, the set of possible solutions is typically restricted by the constraints that are enforced on the transformations to prevent the mid-space from drifting too far from the native image spaces. The use of an implicit atlas has been proposed as an approach to mid-space image registration. In this work, we show that when the atlas is aligned to each image in the native image space, the data term of implicit-atlas-based deformable registration is inherently independent of the mid-space. In addition, we show that the regularization term can be reformulated independently of the mid-space as well. We derive a new symmetric cost function that only depends on the transformation morphing the images to each other, rather than to the atlas. This eliminates the need for anti-drift constraints, thereby expanding the space of allowable deformations. We provide an implementation scheme for the proposed framework, and validate it through diffeomorphic registration experiments on brain magnetic resonance images. PMID:28242316

Ablative heat shield design for space shuttle

NASA Technical Reports Server (NTRS)

Seiferth, R. W.

1973-01-01

Ablator heat shield configuration optimization studies were conducted for the orbiter. Ablator and reusable surface insulation (RSI) trajectories for design studies were shaped to take advantage of the low conductance of ceramic RSI and high temperature capability of ablators. Comparative weights were established for the RSI system and for direct bond and mechanically attached ablator systems. Ablator system costs were determined for fabrication, installation and refurbishment. Cost penalties were assigned for payload weight penalties, if any. The direct bond ablator is lowest in weight and cost. A mechanically attached ablator using a magnesium subpanel is highly competitive for both weight and cost.

Mid-Term Quasi-Periodicities and Solar Cycle Variation of the White-Light Corona from 18.5 Years (1996.0 - 2014.5) of LASCO Observations

NASA Astrophysics Data System (ADS)

Barlyaeva, T.; Lamy, P.; Llebaria, A.

2015-07-01

We report on the analysis of the temporal evolution of the solar corona based on 18.5 years (1996.0 - 2014.5) of white-light observations with the SOHO/LASCO-C2 coronagraph. This evolution is quantified by generating spatially integrated values of the K-corona radiance, first globally, then in latitudinal sectors. The analysis considers time series of monthly values and 13-month running means of the radiance as well as several indices and proxies of solar activity. We study correlation, wavelet time-frequency spectra, and cross-coherence and phase spectra between these quantities. Our results give a detailed insight on how the corona responds to solar activity over timescales ranging from mid-term quasi-periodicities (also known as quasi-biennial oscillations or QBOs) to the long-term 11 year solar cycle. The amplitude of the variation between successive solar maxima and minima (modulation factor) very much depends upon the strength of the cycle and upon the heliographic latitude. An asymmetry is observed during the ascending phase of Solar Cycle 24, prominently in the royal and polar sectors, with north leading. Most prominent QBOs are a quasi-annual period during the maximum phase of Solar Cycle 23 and a shorter period, seven to eight months, in the ascending and maximum phases of Solar Cycle 24. They share the same properties as the solar QBOs: variable periodicity, intermittency, asymmetric development in the northern and southern solar hemispheres, and largest amplitudes during the maximum phase of solar cycles. The strongest correlation of the temporal variations of the coronal radiance - and consequently the coronal electron density - is found with the total magnetic flux. Considering that the morphology of the solar corona is also directly controlled by the topology of the magnetic field, this correlation reinforces the view that they are intimately connected, including their variability at all timescales.

Impact of anti-HCV direct antiviral agents on graft function and immunosuppressive drug levels in kidney transplant recipients: a call to attention in the mid-term follow-up in a single-center cohort study.

PubMed

Fernández-Ruiz, Mario; Polanco, Natalia; García-Santiago, Ana; Muñoz, Raquel; Hernández, Ana M; González, Esther; Mercado, Verónica R; Fernández, Inmaculada; Aguado, José María; Praga, Manuel; Andrés, Amado

2018-01-22

The medium-term impact on graft function and immunosuppressive drug pharmacokinetics of direct antiviral agents (DAAs) among hepatitis C virus (HCV)-infected kidney transplant (KT) recipients remain unclear. We compared pre- and post-treatment 12-month trajectories of estimated glomerular filtration rate (ΔeGFR) and 24-h proteinuria (Δ24-h proteinuria) in 49 recipients treated with DAAs (mostly sofosbuvir plus ledipasvir). Among evaluable patients, 66.7% and 100.0% had undetectable viral load by week 4 and end of therapy (EoT). The sustained virologic response rate at 12 weeks was 95.8%. Overall, 80.6% of patients receiving tacrolimus required dose escalation while on DAA-based therapy (median increase of 66.7%) to maintain target levels. Tacrolimus levels resulted to be higher at 12 months compared to EoT (7.8 ± 2.1 vs. 6.7 ± 2.0 ng/ml; P-value = 0.002). No changes in graft function during the course of therapy were observed. However, eGFR significantly decreased (P-value <0.001) throughout the first 12 months after EoT. Median ΔeGFR and Δ24-h over pre- and post-treatment periods were 3.9% and -6.1% (P-value = 0.002) and -5.3% and 26.2% (P-value = 0.057). Caution should be exercised when adjusting immunosuppression in HCV-infected KT recipients upon initiation of DAAs, followed by mid-term monitoring of immunosuppressive drug levels and graft function. © 2018 Steunstichting ESOT.

Glacial reduction of AMOC strength and long-term transition in weathering inputs into the Southern Ocean since the mid-Miocene: Evidence from radiogenic Nd and Hf isotopes

NASA Astrophysics Data System (ADS)

Dausmann, Veit; Frank, Martin; Gutjahr, Marcus; Rickli, Jörg

2017-03-01

Combined seawater radiogenic hafnium (Hf) and neodymium (Nd) isotope compositions were extracted from bulk sediment leachates and foraminifera of Site 1088, Ocean Drilling Program Leg 177, 2082 m water depth on the Agulhas Ridge. The new data provide a continuous reconstruction of long- and short-term changes in ocean circulation and continental weathering inputs since the mid-Miocene. Due to its intermediate water depth, the sediments of this core sensitively recorded changes in admixture of North Atlantic Deep Water to the Antarctic Circumpolar Current as a function of the strength of the Atlantic Meridional Overturning Circulation (AMOC). Nd isotope compositions (ɛNd) range from -7 to -11 with glacial values generally 1 to 3 units more radiogenic than during the interglacials of the Quaternary. The data reveal episodes of significantly increased AMOC strength during late Miocene and Pliocene warm periods, whereas peak radiogenic ɛNd values mark a strongly diminished AMOC during the major intensification of Northern Hemisphere Glaciation near 2.8 Ma and in the Pleistocene after 1.5 Ma. In contrast, the Hf isotope compositions (ɛHf) show an essentially continuous evolution from highly radiogenic values of up to +11 during the Miocene to less radiogenic present-day values (+2 to +4) during the late Quaternary. The data document a long-term transition in dominant weathering inputs, where inputs from South America are replaced by those from Southern Africa. Moreover, radiogenic peaks provide evidence for the supply of radiogenic Hf originating from Patagonian rocks to the Atlantic sector of the Southern Ocean via dust inputs.

TPS Ablator Technologies for Interplanetary Spacecraft

NASA Technical Reports Server (NTRS)

Curry, Donald M.

2004-01-01

This slide presentation reviews the status of Thermal Protection System (TPS) Ablator technologies and the preparation for use in interplanetary spacecraft. NASA does not have adequate TPS ablatives and sufficient selection for planned missions. It includes a comparison of shuttle and interplanetary TPS requirements, the status of mainline TPS charring ablator materials, a summary of JSC SBIR accomplishments in developing advanced charring ablators and the benefits of SBIR Ablator/fabrication technology.

Ion acceleration enhanced by target ablation

SciTech Connect

Zhao, S.; State Key Laboratory of Nuclear Physics and Technology, and Key Lab of HEDPS, CAPT, Peking University, Beijing 100871; Institute of Radiation, Helmholtz-Zentrum Dresden-Rossendorf, 01314 Dresden

2015-07-15

Laser proton acceleration can be enhanced by using target ablation, due to the energetic electrons generated in the ablation preplasma. When the ablation pulse matches main pulse, the enhancement gets optimized because the electrons' energy density is highest. A scaling law between the ablation pulse and main pulse is confirmed by the simulation, showing that for given CPA pulse and target, proton energy improvement can be achieved several times by adjusting the target ablation.

Ablating Atrial Fibrillation: Customizing Lesion Sets Guided by Rotor Mapping

PubMed Central

Zaman, Junaid A. B.; Narayan, Sanjiv M.

2015-01-01

Ablation occupies an increasing role in the contemporary management of atrial fibrillation (AF), but results are suboptimal, particularly for persistent AF. While an anatomic approach to ablation is a highly efficacious and safe method to isolate pulmonary vein (PV) triggers, recurrence of AF is not always associated with PV reconnection, and there is compelling evidence that non-PV sites sustain AF after it is triggered. Recent developments in wide-area mapping and signal processing now identify rotors in the vast majority of AF patients that sustain AF and whose elimination improves long-term freedom from AF in multicenter studies. Investigators have now demonstrated rotor and focal sources for AF that show many analogous properties between approaches: they lie in spatially reproducible regions temporally over hours to days, and they are amenable to targeted ablation. This review outlines the rationale and technical developments supporting this mechanistic paradigm for human AF, and discusses how rotor mapping may be implemented for individual patient customization of lesion sets. Mechanistic studies are required to explain why rotor elimination (or other ablation approaches) producing long-term elimination of AF may not always terminate AF acutely, how AF correlates with structural changes on magnetic resonance imaging, and how these findings can be integrated clinically with current ablation strategies to improve patient outcomes. PMID:26306123

Ablating Atrial Fibrillation: Customizing Lesion Sets Guided by Rotor Mapping.

PubMed

Zaman, Junaid A B; Narayan, Sanjiv M

2015-01-01

Ablation occupies an increasing role in the contemporary management of atrial fibrillation (AF), but results are suboptimal, particularly for persistent AF. While an anatomic approach to ablation is a highly efficacious and safe method to isolate pulmonary vein (PV) triggers, recurrence of AF is not always associated with PV reconnection, and there is compelling evidence that non-PV sites sustain AF after it is triggered. Recent developments in wide-area mapping and signal processing now identify rotors in the vast majority of AF patients that sustain AF and whose elimination improves long-term freedom from AF in multicenter studies. Investigators have now demonstrated rotor and focal sources for AF that show many analogous properties between approaches: they lie in spatially reproducible regions temporally over hours to days, and they are amenable to targeted ablation. This review outlines the rationale and technical developments supporting this mechanistic paradigm for human AF, and discusses how rotor mapping may be implemented for individual patient customization of lesion sets. Mechanistic studies are required to explain why rotor elimination (or other ablation approaches) producing long-term elimination of AF may not always terminate AF acutely, how AF correlates with structural changes on magnetic resonance imaging, and how these findings can be integrated clinically with current ablation strategies to improve patient outcomes.

Thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism.

PubMed

Duan, Ya-Qi; Liang, Ping

2013-05-01

Many studies have been conducted on splenic thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In this article, we review the evolution and current status of radiofrequency and microwave ablation in the treatment of spleen diseases. All publications from 1990 to 2011 on radiofrequency and microwave ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism were retrieved by searching PubMed. Thermal ablation in the spleen for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism can preserve part of the spleen and maintain splenic immunologic function. Thermal ablation for assisting hemostasis in partial splenectomy minimizes blood loss during operation. Thermal ablation for spleen trauma reduces the number of splenectomy and the amount of blood transfusion. Thermal ablation for splenic metastasis is minimally invasive and can be done under the guidance of an ultrasound, which helps shorten the recovery time. Thermal ablation for hypersplenism increases platelet (PLT) and white blood cell (WBC) counts and improves liver function. It also helps to maintain splenic immunologic function and even improves splenic immunologic function in the short-term. In conclusion, thermal ablative approaches are promising for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In order to improve therapeutic effects, directions for future studies may include standardized therapeutic indications, prolonged observation periods and enlarged sample sizes.

Radiofrequency ablation for benign thyroid nodules.

PubMed

Bernardi, S; Stacul, F; Zecchin, M; Dobrinja, C; Zanconati, F; Fabris, B

2016-09-01

Benign thyroid nodules are an extremely common occurrence. Radiofrequency ablation (RFA) is gaining ground as an effective technique for their treatment, in case they become symptomatic. Here we review what are the current indications to RFA, its outcomes in terms of efficacy, tolerability, and cost, and also how it compares to the other conventional and experimental treatment modalities for benign thyroid nodules. Moreover, we will also address the issue of treating with this technique patients with cardiac pacemakers (PM) or implantable cardioverter-defibrillators (ICD), as it is a rather frequent occurrence that has never been addressed in detail in the literature.

Magnetic Resonance Mediated Radiofrequency Ablation.

PubMed

Hue, Yik-Kiong; Guimaraes, Alexander R; Cohen, Ouri; Nevo, Erez; Roth, Abraham; Ackerman, Jerome L

2018-02-01

To introduce magnetic resonance mediated radiofrequency ablation (MR-RFA), in which the MRI scanner uniquely serves both diagnostic and therapeutic roles. In MR-RFA scanner-induced RF heating is channeled to the ablation site via a Larmor frequency RF pickup device and needle system, and controlled via the pulse sequence. MR-RFA was evaluated with simulation of electric and magnetic fields to predict the increase in local specific-absorption-rate (SAR). Temperature-time profiles were measured for different configurations of the device in agar phantoms and ex vivo bovine liver in a 1.5 T scanner. Temperature rise in MR-RFA was imaged using the proton resonance frequency method validated with fiber-optic thermometry. MR-RFA was performed on the livers of two healthy live pigs. Simulations indicated a near tenfold increase in SAR at the RFA needle tip. Temperature-time profiles depended significantly on the physical parameters of the device although both configurations tested yielded temperature increases sufficient for ablation. Resected livers from live ablations exhibited clear thermal lesions. MR-RFA holds potential for integrating RF ablation tumor therapy with MRI scanning. MR-RFA may add value to MRI with the addition of a potentially disposable ablation device, while retaining MRI's ability to provide real time procedure guidance and measurement of tissue temperature, perfusion, and coagulation.

Laser ablation mechanism of transparent layers on semiconductors with ultrashort laser pulses

NASA Astrophysics Data System (ADS)

Rublack, Tino; Hartnauer, Stefan; Mergner, Michael; Muchow, Markus; Seifert, Gerhard

2011-12-01

Transparent dielectric layers on semiconductors are used as anti-reflection coatings both for photovoltaic applications and for mid-infrared optical elements. We have shown recently that selective ablation of such layers is possible using ultrashort laser pulses at wavelengths being absorbed by the semiconductor. To get a deeper understanding of the ablation mechanism, we have done ablation experiments for different transparent materials, in particular SiO2 and SixNy on silicon, using a broad range of wavelengths ranging from UV to IR, and pulse durations between 50 and 2000 fs. The characterization of the ablated regions was done by light microscopy and atomic force microscopy (AFM). Utilizing laser wavelengths above the silicon band gap, selective ablation of the dielectric layer without noticeable damage of the opened silicon surface is possible. In contrast, ultrashort pulses (1-2 ps) at mid-infrared wavelengths already cause damage in the silicon at lower intensities than in the dielectric layer, even when a vibrational resonance (e.g. at λ = 9.26 μm for SiO2) is addressed. The physical processes behind this, on the first glance counterintuitive, observation will be discussed.

Atrial fibrillation ablation using a closed irrigation radiofrequency ablation catheter.

PubMed

Golden, Keith; Mounsey, John Paul; Chung, Eugene; Roomiani, Pahresah; Morse, Michael Andew; Patel, Ankit; Gehi, Anil

2012-05-01

Catheter ablation is an effective therapy for symptomatic, medically refractory atrial fibrillation (AF). Open-irrigated radiofrequency (RF) ablation catheters produce transmural lesions at the cost of increased fluid delivery. In vivo models suggest closed-irrigated RF catheters create equivalent lesions, but clinical outcomes are limited. A cohort of 195 sequential patients with symptomatic AF underwent stepwise AF ablation (AFA) using a closed-irrigation ablation catheter. Recurrence of AF was monitored and outcomes were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models. Mean age was 59.0 years, 74.9% were male, 56.4% of patients were paroxysmal and mean duration of AF was 5.4 years. Patients had multiple comorbidities including hypertension (76.4%), tobacco abuse (42.1%), diabetes (17.4%), and obesity (mean body mass index 30.8). The median follow-up was 55.8 weeks. Overall event-free survival was 73.6% with one ablation and 77.4% after reablation (reablation rate was 8.7%). Median time to recurrence was 26.9 weeks. AF was more likely to recur in patients being treated with antiarrhythmic therapy at the time of last follow-up (recurrence rate 30.3% with antiarrhythmic drugs, 13.2% without antiarrhythmic drugs; hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.1-4.4, P = 0.024) and in those with a history of AF greater than 2 years duration (HR 2.7, 95% CI 1.1-6.9, P = 0.038). Our study represents the largest cohort of patients receiving AFA with closed-irrigation ablation catheters. We demonstrate comparable outcomes to those previously reported in studies of open-irrigation ablation catheters. Given the theoretical benefits of a closed-irrigation system, a large head-to-head comparison using this catheter is warranted. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

Multiscale Mathematical Modeling in Dental Tissue Engineering: Toward Computer-Aided Design of a Regenerative System Based on Hydroxyapatite Granules, Focussing on Early and Mid-Term Stiffness Recovery

PubMed Central

Scheiner, Stefan; Komlev, Vladimir S.; Gurin, Alexey N.; Hellmich, Christian

2016-01-01

We here explore for the very first time how an advanced multiscale mathematical modeling approach may support the design of a provenly successful tissue engineering concept for mandibular bone. The latter employs double-porous, potentially cracked, single millimeter-sized granules packed into an overall conglomerate-type scaffold material, which is then gradually penetrated and partially replaced by newly grown bone tissue. During this process, the newly developing scaffold-bone compound needs to attain the stiffness of mandibular bone under normal physiological conditions. In this context, the question arises how the compound stiffness is driven by the key design parameters of the tissue engineering system: macroporosity, crack density, as well as scaffold resorption/bone formation rates. We here tackle this question by combining the latest state-of-the-art mathematical modeling techniques in the field of multiscale micromechanics, into an unprecedented suite of highly efficient, semi-analytically defined computation steps resolving several levels of hierarchical organization, from the millimeter- down to the nanometer-scale. This includes several types of homogenization schemes, namely such for porous polycrystals with elongated solid elements, for cracked matrix-inclusion composites, as well as for assemblies of coated spherical compounds. Together with the experimentally known stiffnesses of hydroxyapatite crystals and mandibular bone tissue, the new mathematical model suggests that early stiffness recovery (i.e., within several weeks) requires total avoidance of microcracks in the hydroxyapatite scaffolds, while mid-term stiffness recovery (i.e., within several months) is additionally promoted by provision of small granule sizes, in combination with high bone formation and low scaffold resorption rates. PMID:27708584

Age-dependent impact of new ESC-Guideline recommended door-to-balloon times on mid-term survival in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

PubMed

Wang, Yu-Chen; Huang, Ying-Ying; Lo, Ping-Hang; Chang, Kuan-Cheng; Chen, Chu-Huang; Chen, Ming-Fong

2016-11-01

To investigate the age-dependent impact of the superfast door-to-balloon (D2B) times of ≤60min as recommended by the new ESC Guideline for patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) on mid-term survival rates based on a single center registry dataset. This study enrolled consecutive STEMI patients who underwent PPCI from Jan 1, 2009 through Sep 30, 2013. We compared demographics, clinical characteristics and the D2B-survival relationships between patients aged ≥65 and <65. The younger group comprised 242 patients (68%) aged <65 and the elder group consisted of 115 patients (32%) aged ≥65. In patients aged <65, the mortality rate decreased linearly with D2B time shortening (>90min vs. 61-90min vs. ≤60min=14.9% vs. 13.3% vs. 1.2%, P=0.001). Contrarily, shortening of D2B time was not associated with reduced mortality rate in patients aged ≥65 (>90min vs. 61-90min vs. ≤60min=23.5% vs. 19% vs. 18.9%, P=0.99). In younger patients but not the elderly, a D2B time of <60min has sufficient power to predict mortality with a sensitivity of 0.83, specificity of 0.74, and Youden index of 0.57. Our results show that the new ESC Guideline recommendation of D2B time ≤60min is associated with better survival rates in younger STEMI patients undergoing PPCI. Our findings stress the importance of guideline adherence to minimize reperfusion delay to improve survival in these patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Biomarker analysis of hemoglobin adducts of acrylamide and glycidamide enantiomers for mid-term internal exposure assessment by isotope dilution ultra-high performance liquid chromatography tandem mass spectrometry.

PubMed

Zhang, Yu; Wang, Qiao; Zhang, Gong; Jia, Wei; Ren, Yiping; Wu, Yongning

2018-02-01

Hemoglobin (Hb) adducts of acrylamide (AA) and its oxidative metabolite glycidamide (GA) are important biomarkers for evaluating the mid-term exposure of acrylamide toxicity in vivo. Taking pentafluoro-2-methylphenyl isothiocyanates of N-(2-carbamoylethyl)valine (AAVal-PFPTH) and N-(2-carbamoyl-2-hydroxyethy)valine (GAVal-PFPTH) as target analytes, we developed an isotope dilution ultra-high performance liquid chromatograph tandem mass spectrometry (UHPLC-MS/MS) method for the simultaneous determination of AA and GA hemoglobin (Hb) adducts under the electroscopy ionization negative (ESI‾) mode in the present work. Among them, the enantiomer pair of GA-Hb adducts was firstly identified and successfully separated at baseline level. The method achieved high sensitivity with the LOD and LOQ ranging 1.43-5.05pmol/g Hb and 4.78-16.82pmol/g Hb, respectively. The recovery rates with low, intermediate and high spiking levels were calculated as 97.0-105.2%, 97.4-106.4% and 100.3-111.2%, respectively. Acceptable within-laboratory reproducibility (RSD < 13.7%) substantially supported the robustness of current UHPLC-MS/MS method, which was successfully applied to measure the hemoglobin adducts of acrylamide and glycidamide enantiomers in blood of both rats and humans. A linear exposure assessment model was developed for estimating the daily exposure to acrylamide in humans via considering acrylamide hemoglobin adducts as variables, indicating a novel connect between biomarker-based internal exposure and dietary-based external exposure. Overall, the present instrumental analysis and related internal exposure assessment model provide a substantially methodological support for profiling the internal biological exposure and estimating the external dietary exposure to acrylamide. Copyright © 2017 Elsevier B.V. All rights reserved.

Persistent Atrial Fibrillation Ablation using the Tip-Versatile Ablation Catheter.

PubMed

Davies, Edward J; Clayton, Ben; Lines, Ian; Haywood, Guy A

2016-07-01

The mechanisms by which persistent atrial fibrillation (PsAF) develops are incompletely understood. Consequently, the optimal strategy for the ablative management of PsAF remains debated. Current methods are often time consuming, complex and non-reproducible. We assessed the Tip-Versatile Ablation Catheter (T-VAC) technique, a rapidly delivered, empirical technique based on the box-set concept using duty-cycled linear catheter ablation technology. Forty-four procedures in 40 patients undergoing PsAF ablation with the novel technique were prospectively entered onto a database: 27 de novo. Primary endpoint was freedom from arrhythmia at over two-year follow-up. Secondary endpoints were time to first arrhythmia recurrence, freedom from atrial fibrillation (AF) on and off antiarrhythmic drugs (AAD), procedural and fluoroscopy duration and complication rate. At mean follow-up of 33 months, absolute freedom from arrhythmia recurrence was 45% in the de novo group. Overall, at 33 (IQR 24-63) months, 60% of de novo patients were in sustained normal sinus rhythm and a further 15% reported only occasional paroxysms of AF at long-term follow-up. Procedure time was 192±25 mins, total energy delivered 2239±883s and fluoroscopy time was 60±10mins. In selected patients with persistent AF, a long-term rate of 60% arrhythmia free survival off AAD can be achieved using this novel T-VAC technique. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Comparison of remote magnetic navigation ablation and manual ablation of idiopathic ventricular arrhythmia after failed manual ablation.

PubMed

Kawamura, Mitsuharu; Scheinman, Melvin M; Tseng, Zian H; Lee, Byron K; Marcus, Gregory M; Badhwar, Nitish

2017-01-01

Catheter ablation for idiopathic ventricular arrhythmia (VA) is effective and safe, but efficacy is frequently limited due to an epicardial origin and difficult anatomy. The remote magnetic navigation (RMN) catheter has a flexible catheter design allowing access to difficult anatomy. We describe the efficacy of the RMN for ablation of idiopathic VA after failed manual ablation. Among 235 patients with idiopathic VA referred for catheter ablation, we identified 51 patients who were referred for repeat ablation after a failed manual ablation. We analyzed the clinical characteristics, including the successful ablation site and findings at electrophysiology study, in repeat procedures conducted using RMN as compared with manual ablation. Among these patients, 22 (43 %) underwent repeat ablation with the RMN and 29 (57 %) underwent repeat ablation with a manual ablation. Overall, successful ablation rate was significantly higher using RMN as compared with manual ablation (91 vs. 69 %, P = 0.02). Fluoroscopy time in the RMN was 17 ± 12 min as compared with 43 ± 18 min in the manual ablation (P = 0.009). Successful ablation rate in the posterior right ventricular outflow tract (RVOT) plus posterior-tricuspid annulus was higher with RMN as compared with manual ablation (92 vs. 50 %, P = 0.03). Neither groups exhibited any major complications. The RMN is more effective in selected patients with recurrent idiopathic VA after failed manual ablation and is associated with less fluoroscopy time. The RMN catheters have a flexible design enabling them to access otherwise difficult anatomy including the posterior tricuspid annulus and posterior RVOT.

School restrictions on outdoor activities and weight status in adolescent children after Japan’s 2011 Fukushima Nuclear Power Plant disaster: a mid-term to long-term retrospective analysis

PubMed Central

Nomura, Shuhei; Blangiardo, Marta; Hodgson, Susan

2016-01-01

Objective Radiation fears following Japan's 2011 Fukushima nuclear disaster affected levels of physical activity in local children. We assessed the postdisaster versus predisaster weight status in school children and evaluated to what extent school restrictions on outdoor activities that were intended to reduce radiation exposure risk affected child weight. Participants We considered children aged 13–15 years from 4 of the 5 secondary schools in Soma City (n=1030, 99.1% of all children in the city), located in 35–50 km from the Fukushima nuclear plant, postdisaster (2012 and 2015) and predisaster (2010). Methods Weight status, in terms of body mass index (BMI), percentage of overweight (POW) and incidence of obesity and underweight (defined as a POW ≥20% and ≤−20%, respectively) were examined and compared predisaster and postdisaster using regression models. We also constructed models to assess the impact of school restrictions on outdoor activity on weight status. Results After adjustment for covariates, a slight decrease in mean BMI and POW was detected in females in 2012 (−0.37, 95% CI −0.68 to −0.06; and −1.97, 95% CI −3.57 to −0.36, respectively). For male children, obesity incidence increased in 2012 (OR for obesity: 1.45, 95% CI 1.02 to 2.08). Compared with predisaster weight status, no significant weight change was identified in 2015 in either males or females. School restrictions on outdoor activities were not significantly associated with weight status. Conclusions 4 years following the disaster, weight status has recovered to the predisaster levels for males and females; however, a slight decrease in weight in females and a slight increase in risk of obesity were observed in males 1 year following the disaster. Our findings could be used to guide actions taken during the early phase of a radiological disaster to manage the postdisaster health risks in adolescent children. PMID:27683520

Surgical Ablation of Atrial Fibrillation Using Energy Sources.

PubMed

Brick, Alexandre Visconti; Braile, Domingo Marcolino

2015-01-01

Surgical ablation, concomitant with other operations, is an option for treatment in patients with chronic atrial fibrillation. The aim of this study is to present a literature review on surgical ablation of atrial fibrillation in patients undergoing cardiac surgery, considering energy sources and return to sinus rhythm. A comprehensive survey was performed in the literature on surgical ablation of atrial fibrillation considering energy sources, sample size, study type, outcome (early and late), and return to sinus rhythm. Analyzing studies with immediate results (n=5), the percentage of return to sinus rhythm ranged from 73% to 96%, while those with long-term results (n=20) (from 12 months on) ranged from 62% to 97.7%. In both of them, there was subsequent clinical improvement of patients who underwent ablation, regardless of the energy source used. Surgical ablation of atrial fibrillation is essential for the treatment of this arrhythmia. With current technology, it may be minimally invasive, making it mandatory to perform a procedure in an attempt to revert to sinus rhythm in patients requiring heart surgery.

Radiofrequency ablation of osteoid osteomas: five years experience.

PubMed

Papathanassiou, Zafiria G; Petsas, Theodore; Papachristou, Dionysios; Megas, Panagiotis

2011-12-01

The purpose of this study is to retrospectively evaluate the efficacy of radiofrequency ablation as a curative treatment method for benign bone tumours. Twenty-nine osteoid osteomas were treated with radiofrequency ablation. Primary success rate was 89.6% and total secondary success rate was 93.1%. Mean clinical follow-up period was 26.7 months (range: 6-63 months). Statistical analysis of 25 cases of osteoid osteomas with CT follow-up revealed that post-treatment re-ossification does not correlate with clinical outcome (p = 0.14) but is strongly correlated with long-term (> or = 12 months) CT follow-up (p = 0.014). Percutaneous radiofrequency ablation was found to be an effective and safe treatment for osteoid osteomas. CT findings cannot solely differentiate between treatment successes and failures.

Femtosecond laser ablation of enamel

NASA Astrophysics Data System (ADS)

Le, Quang-Tri; Bertrand, Caroline; Vilar, Rui

2016-06-01

The surface topographical, compositional, and structural modifications induced in human enamel by femtosecond laser ablation is studied. The laser treatments were performed using a Yb:KYW chirped-pulse-regenerative amplification laser system (560 fs and 1030 nm) and fluences up to 14 J/cm2. The ablation surfaces were studied by scanning electron microscopy, grazing incidence x-ray diffraction, and micro-Raman spectroscopy. Regardless of the fluence, the ablation surfaces were covered by a layer of resolidified material, indicating that ablation is accompanied by melting of hydroxyapatite. This layer presented pores and exploded gas bubbles, created by the release of gaseous decomposition products of hydroxyapatite (CO2 and H2O) within the liquid phase. In the specimen treated with 1-kHz repetition frequency and 14 J/cm2, thickness of the resolidified material is in the range of 300 to 900 nm. The micro-Raman analysis revealed that the resolidified material contains amorphous calcium phosphate, while grazing incidence x-ray diffraction analysis allowed detecting traces of a calcium phosphate other than hydroxyapatite, probably β-tricalcium phosphate Ca3), at the surface of this specimen. The present results show that the ablation of enamel involves melting of enamel's hydroxyapatite, but the thickness of the altered layer is very small and thermal damage of the remaining material is negligible.

Mugshot Identification Database (MID)

National Institute of Standards and Technology Data Gateway

NIST Mugshot Identification Database (MID) (Web, free access)   NIST Special Database 18 is being distributed for use in development and testing of automated mugshot identification systems. The database consists of three CD-ROMs, containing a total of 3248 images of variable size using lossless compression. A newer version of the compression/decompression software on the CDROM can be found at the website http://www.nist.gov/itl/iad/ig/nigos.cfm as part of the NBIS package.

Image-Guided Ablation of Adrenal Lesions

PubMed Central

Yamakado, Koichiro

2014-01-01

Although laparoscopic adrenalectomy has remained the standard of care for the treatment for adrenal tumors, percutaneous image-guided ablation therapy, such as chemical ablation, radiofrequency ablation, cryoablation, and microwave ablation, has been shown to be clinically useful in many nonsurgical candidates. Ablation therapy has been used to treat both functioning adenomas and malignant tumors, including primary adrenal carcinoma and metastasis. For patients with functioning adenomas, biochemical and symptomatic improvement is achieved in 96 to 100% after ablation; for patients with malignant adrenal neoplasms, however, the survival benefit from ablation therapy remains unclear, though good initial results have been reported. This article outlines the current role of ablation therapy for adrenal lesions, as well as identifying some of the technical considerations for this procedure. PMID:25049444

Mid-Life Career Influence

ERIC Educational Resources Information Center

Heald, James E.

1977-01-01

Events common to all people, although in differing degrees, such as physiological and technological changes at mid-life, constitute important influences on career change and development in the mid-life period. (Author)

Multifunctional Information Distribution System (MIDS)

DTIC Science & Technology

2013-12-01

Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to...Estimate DoD - Department of Defense DSN - Defense Switched Network Econ - Economic Eng - Engineering Est - Estimating FMS - Foreign Military Sales FY...fighter aircraft, bombers, helicopters, ships, and ground sites . The MIDS Program consists of the MIDS Low Volume Terminal (MIDS-LVT) and the MIDS

Atrio-ventricular junction ablation and pacemaker treatment: a comparison between men and women.

PubMed

Carnlöf, Carina; Insulander, Per; Jensen-Urstad, Mats; Iwarzon, Marie; Gadler, Fredrik

2018-06-01

To explore sex differences regarding indication for atrio-ventricular junction ablation (AVJ), choice of pacing system, complications to pacemaker treatment, long-term outcome, and cause of death after AVJ ablation. 700 patients who had undergone AVJ ablation between January 1990 and December 2010 were included. Data were retrieved from the patients´ medical records and the Swedish Pacemaker and Implantable Cardioverter-Defibrillator Registry. Information about admission to hospital and cause of death was retrieved from the National Board of Health and Welfare. Mean follow-up was 90 ± 64 months. Indication for AVJ ablation, choice of pacing system, and outcome after AVJ ablation differed between the sexes. The men had more often permanent atrial fibrillation, p = .0001, and a VVIR pacemaker or cardiac resynchronization therapy (CRT) implanted prior to ablation, p = .0001. Heart failure was present in 44% of the men vs. 28% of the women, p = .0001. LVEF decreased slightly in the whole cohort after the AVJ ablation. There were no sex differences in complication rates due to the pacemaker/ICD treatment, p = .3 or mortality due to AVJ ablation. In this long-term follow-up in patients with atrial fibrillation treated with AVJ ablation and pacing, indication, choice of pacing system, and morbidity differed but there were no sex differences regarding survival or primary cause of death found. The main factor influencing survival was age at the time of ablation. Women less often received treatment with ICD and/or CRT when indication was present compared with men.

Idiopathic ventricular outflow tract arrhythmias from the great cardiac vein: challenges and risks of catheter ablation.

PubMed

Steven, D; Pott, C; Bittner, A; Sultan, A; Wasmer, K; Hoffmann, B A; Köbe, J; Drewitz, I; Milberg, P; Lueker, J; Mönnig, G; Servatius, H; Willems, S; Eckardt, L

2013-11-20

Catheter ablation for idiopathic ventricular arrhythmia is well established but epicardial origin, proximity to coronary arteries, and limited accessibility may complicate ablation from the venous system in particular from the great cardiac vein (GCV). Between April 2009 and October 2010 14 patients (56 ± 15 years; 9 male) out of a total group of 117 patients with idiopathic outflow tract tachycardias were included undergoing ablation for idiopathic VT or premature ventricular contractions (PVC) originating from GCV. All patients in whom the PVC arose from the GCV were subject to the study. In these patients angiography of the left coronary system was performed with the ablation catheter at the site of earliest activation. Successful ablation was performed in 6/14 (43%) and long-term success was achieved in 5/14 (36%) patients. In 4/14 patients (28.6%) ablation was not performed. In another 4 patients (26.7%), ablation did not abolish the PVC/VT. In the majority, the anatomical proximity to the left coronary system prohibited effective RF application. In 3 patients RF application resulted in a coronary spasm with complete regression as revealed in repeat coronary angiography. A relevant proportion idiopathic VT/PVC can safely be ablated from the GCV without significant permanent coronary artery stenosis after RF application. Our data furthermore demonstrate that damage to the coronary artery system is likely to be transient. © 2013.

State-of-the-art and emerging technologies for atrial fibrillation ablation.

PubMed

Dewire, Jane; Calkins, Hugh

2010-03-01

Catheter ablation is an important treatment modality for patients with atrial fibrillation (AF). Although the superiority of catheter ablation over antiarrhythmic drug therapy has been demonstrated in middle-aged patients with paroxysmal AF, the role the procedure in other patient subgroups-particularly those with long-standing persistent AF-has not been well defined. Furthermore, although AF ablation can be performed with reasonable efficacy and safety by experienced operators, long-term success rates for single procedures are suboptimal. Fortunately, extensive ongoing research will improve our understanding of the mechanisms of AF, and considerable funds are being invested in developing new ablation technologies to improve patient outcomes. These technologies include ablation catheters designed to electrically isolate the pulmonary veins with improved safety, efficacy, and speed, catheters designed to deliver radiofrequency energy with improved precision, robotic systems to address the technological demands of the procedure, improved imaging and electrical mapping systems, and MRI-guided ablation strategies. The tools, technologies, and techniques that will ultimately stand the test of time and become the standard approach to AF ablation in the future remain unclear. However, technological advances are sure to result in the necessary improvements in the safety and efficacy of AF ablation procedures.

Accessory atrioventricular pathways refractory to catheter ablation: role of percutaneous epicardial approach.

PubMed

Scanavacca, Maurício Ibrahim; Sternick, Eduardo Back; Pisani, Cristiano; Lara, Sissy; Hardy, Carina; d'Ávila, André; Correa, Frederico Soares; Darrieux, Francisco; Hachul, Denise; Marcial, Miguel Barbero; Sosa, Eduardo A

2015-02-01

Epicardial mapping and ablation of accessory pathways through a subxiphoid approach can be an alternative when endocardial or epicardial transvenous mapping has failed. We reviewed acute and long-term follow-up of 21 patients (14 males) referred for percutaneous epicardial accessory pathway ablation. There was a median of 2 previous failed procedures. All patients were highly symptomatic, 8 had atrial fibrillation (3 with cardiac arrest) and 13 had frequent symptomatic episodes of atrioventricular reentrant tachycardia. Six patients (28.5%) had a successful epicardial ablation. Five patients (23.8%) underwent a successful repeated endocardial mapping, and ablation after epicardial mapping yielded no early activation site. Epicardial mapping was helpful in guiding endocardial ablation in 2 patients (9.5%), showing that the earliest activation was simultaneous at the epicardium and endocardium. Four patients (19%) underwent successful open-chest surgery after failing epicardial/endocardial ablation. Two patients (9.5%) remained controlled under antiarrhythmic drugs after unsuccessful endocardial/epicardial ablation. Two patients had a coronary sinus diverticulum and one a right atrium to right ventricle diverticulum. Three patients acquired postablation coronary sinus stenosis. There was no major complication related to pericardial access. Percutaneous epicardial approach is an alternative when conventional endocardial or transvenous epicardial ablation fails in the elimination of the accessory pathway. A new attempt by endocardial approach was successful in a significant number of patients. Open-chest surgery may be required in symptomatic cases refractory to endocardial-epicardial approach. © 2014 American Heart Association, Inc.

Characteristics of Cavotricuspid Isthmus Ablation for Atrial Flutter Guided by Novel Parameters Using a Contact Force Catheter.

PubMed

Gould, Paul A; Booth, Cameron; Dauber, Kieran; Ng, Kevin; Claughton, Andrew; Kaye, Gerald C

2016-12-01

This study sought to investigate specific contact force (CF) parameters to guide cavotricuspid isthmus (CTI) ablation and compare the outcome with a historical control cohort. Patients (30) undergoing CTI ablation were enrolled prospectively in the Study cohort and compared with a retrospective Control cohort of 30 patients. Ablation in the Study cohort was performed using CF parameters >10 g and <40 g and a Force Time Integral (FTI) of 800 ± 10 g. The Control cohort underwent traditionally guided CTI ablation. Traditional parameters (electrogram and impedance change) were assessed in both cohorts. All ablations regardless of achieving targets were included in data analysis. Bidirectional CTI block was achieved in all of the Study and 27 of the Control cohort. Atrial flutter recurred in 3 (10%) patients (follow-up 564 ± 212 days) in the study cohort and in 3 (10%) patients (follow-up 804 ± 540 days) in the Control cohort. There were no major complications in either cohort. Traditional parameters correlated poorly with CF parameters. In the Study cohort, flutter recurrence was associated with significantly lower FTI and ablation duration, but was not associated with total average CF. CTI ablation can be safely performed using CF parameters guiding ablation, with similar long-term results to a historical ablation control group. Potentially CF parameters may provide adjunctive information to enable a more efficient CTI ablation. Further research is required to confirm this. © 2016 Wiley Periodicals, Inc.

Laser ablation based fuel ignition

DOEpatents

Early, J.W.; Lester, C.S.

1998-06-23

There is provided a method of fuel/oxidizer ignition comprising: (a) application of laser light to a material surface which is absorptive to the laser radiation; (b) heating of the material surface with the laser light to produce a high temperature ablation plume which emanates from the heated surface as an intensely hot cloud of vaporized surface material; and (c) contacting the fuel/oxidizer mixture with the hot ablation cloud at or near the surface of the material in order to heat the fuel to a temperature sufficient to initiate fuel ignition. 3 figs.

Laser ablation based fuel ignition

DOEpatents

Early, James W.; Lester, Charles S.

1998-01-01

There is provided a method of fuel/oxidizer ignition comprising: (a) application of laser light to a material surface which is absorptive to the laser radiation; (b) heating of the material surface with the laser light to produce a high temperature ablation plume which emanates from the heated surface as an intensely hot cloud of vaporized surface material; and (c) contacting the fuel/oxidizer mixture with the hot ablation cloud at or near the surface of the material in order to heat the fuel to a temperature sufficient to initiate fuel ignition.

Ablative Therapies for Barrett's Esophagus

PubMed Central

Garman, Katherine S.; Shaheen, Nicholas J.

2011-01-01

Barrett's esophagus has gained increased clinical attention because of its association with esophageal adenocarcinoma, a cancer with increasing incidence and poor survival rates. The goals of ablating Barrett's esophagus are to decrease esophageal cancer rates and to improve overall survival and quality of life. Different techniques have been developed and tested for their effectiveness eradicating Barrett's epithelium. This review assesses the literature associated with different ablative techniques. The safety and efficacy of different techniques are discussed. This review concludes with recommendations for the clinician, including specific strategies for patient care decisions for patients with Barrett's esophagus with varying degrees of dysplasia. PMID:21373836

Tektite ablation - Some confirming calculations.

NASA Technical Reports Server (NTRS)

O'Keefe, J. A., III; Silver, A. D.; Cameron, W. S.; Adams , E. W.; Warmbrod, J. D.

1973-01-01

The calculation of tektite ablation has been redone, taking into account transient effects, internal radiation, melting and nonequilibrium vaporization of the glass, and the drag effect of the flanges. It is found that the results confirm the earlier calculations of Chapman and his group and of Adams and his co-workers. The general trend of the results is not sensitive to reasonable changes of the physical parameters. The ablation is predominantly by melting rather than by vaporization at all velocities up to 11 km/sec; this is surprising in view of the lack of detectable melt flow in most tektites. Chemical effects have not been considered.

Ablative therapy for liver tumours

PubMed Central

Dick, E A; Taylor-Robinson, S D; Thomas, H C; Gedroyc, W M W

2002-01-01

Established ablative therapies for the treatment of primary and secondary liver tumours, including percutaneous ethanol injection, cryotherapy, and radiofrequency ablation, are discussed. Newer techniques such as magnetic resonance imaging guided laser interstitial thermal therapy of liver tumours has produced a median survival rate of 40.8 months after treatment. The merits of this newly emerging technique are discussed, together with future developments, such as focused ultrasound therapy, which holds the promise of non-invasive thermoablation treatment on an outpatient basis. PMID:11950826

Fractional ablative laser skin resurfacing: a review.

PubMed

Tajirian, Ani L; Tarijian, Ani L; Goldberg, David J

2011-12-01

Ablative laser technology has been in use for many years now. The large side effect profile however has limited its use. Fractional ablative technology is a newer development which combines a lesser side effect profile along with similar efficacy. In this paper we review fractional ablative laser skin resurfacing.

Pulmonary vein stenosis following catheter ablation of atrial fibrillation.

PubMed

Pürerfellner, Helmut; Martinek, Martin

2005-11-01

This review provides an update on the mechanisms, incidence, and current management of significant pulmonary vein stenosis following catheter ablation of atrial fibrillation. Catheter ablation involving the pulmonary veins and the surrounding left atrial tissue is increasingly used to treat atrial fibrillation. In parallel with the fact that these procedures may cure a substantial proportion of patients, severe complications have been observed. Pulmonary vein stenosis is a new clinical entity produced by radiofrequency energy delivery mainly within or at the orifice of the pulmonary veins. The exact incidence is currently unknown because the diagnosis is dependent on the imaging modality and on the rigor with which patients are followed up. The optimal method for screening patients has not been determined. Stenosis of a pulmonary vein may be assessed by combining anatomic and functional imaging using computed tomographic or magnetic resonance imaging, transesophageal echocardiography, and lung scanning. Symptoms vary considerably and may be misdiagnosed, leading to severe clinical consequences. Current treatment strategies involve pulmonary vein dilatation or stenting; however, the restenosis rate remains high. The long-term outcome in patients with pulmonary vein stenosis is unclear. Strategies under development to prevent pulmonary vein stenosis include alternate energy sources and modified ablation techniques. Pulmonary vein stenosis following catheter ablation is a new clinical entity that has been described in various reports recently. There is much uncertainty with respect to causative factors, incidence, diagnosis, and treatment, and long-term sequelae are unclear.

Radiofrequency ablation during continuous saline infusion can extend ablation margins

PubMed Central

Ishikawa, Toru; Kubota, Tomoyuki; Horigome, Ryoko; Kimura, Naruhiro; Honda, Hiroki; Iwanaga, Akito; Seki, Keiichi; Honma, Terasu; Yoshida, Toshiaki

2013-01-01

AIM: To determine whether fluid injection during radiofrequency ablation (RFA) can increase the coagulation area. METHODS: Bovine liver (1-2 kg) was placed on an aluminum tray with a return electrode affixed to the base, and the liver was punctured by an expandable electrode. During RFA, 5% glucose; 50% glucose; or saline fluid was infused continuously at a rate of 1.0 mL/min through the infusion line connected to the infusion port. The area and volume of the thermocoagulated region of bovine liver were determined after RFA. The Joule heat generated was determined from the temporal change in output during the RFA experiment. RESULTS: No liquid infusion was 17.3 ± 1.6 mL, similar to the volume of a 3-cm diameter sphere (14.1 mL). Mean thermocoagulated volume was significantly larger with continuous infusion of saline (29.3 ± 3.3 mL) than with 5% glucose (21.4 ± 2.2 mL), 50% glucose (16.5 ± 0.9 mL) or no liquid infusion (17.3 ± 1.6 mL). The ablated volume for RFA with saline was approximately 1.7-times greater than for RFA with no liquid infusion, representing a significant difference between these two conditions. Total Joule heat generated during RFA was highest with saline, and lowest with 50% glucose. CONCLUSION: RFA with continuous saline infusion achieves a large ablation zone, and may help inhibit local recurrence by obtaining sufficient ablation margins. RFA during continuous saline infusion can extend ablation margins, and may be prevent local recurrence. PMID:23483097

Analysis of Ablative Performance of C/C Composite Throat Containing Defects Based on X-ray 3D Reconstruction in a Solid Rocket Motor

NASA Astrophysics Data System (ADS)

Hui, Wei-Hua; Bao, Fu-Ting; Wei, Xiang-Geng; Liu, Yang

2015-12-01

In this paper, a new measuring method of ablation rate was proposed based on X-ray three-dimensional (3D) reconstruction. The ablation of 4-direction carbon/carbon composite nozzles was investigated in the combustion environment of a solid rocket motor, and the macroscopic ablation and linear recession rate were studied through the X-ray 3D reconstruction method. The results showed that the maximum relative error of the X-ray 3D reconstruction was 0.0576%, which met the minimum accuracy of the ablation analysis; along the nozzle axial direction, from convergence segment, throat to expansion segment, the ablation gradually weakened; in terms of defect ablation, the middle ablation was weak, while the ablation in both sides was more serious. In a word, the proposed reconstruction method based on X-ray about C/C nozzle ablation can construct a clear model of ablative nozzle which characterizes the details about micro-cracks, deposition, pores and surface to analyze ablation, so that this method can create the ablation curve in any surface clearly.

Consensus for the Treatment of Varicose Vein with Radiofrequency Ablation

PubMed Central

Joh, Jin Hyun; Kim, Woo-Shik; Jung, In Mok; Park, Ki-Hyuk; Lee, Taeseung; Kang, Jin Mo

2014-01-01

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2–20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis ≥class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles’ ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks. PMID:26217628

Animal Studies of Epicardial Atrial Ablation

PubMed Central

Schuessler, Richard B.; Lee, Anson M.; Melby, Spencer J.; Voeller, Rochus K.; Gaynor, Sydney L.; Sakamoto, Shun-Ichiro; Damiano, Ralph J.

2009-01-01

The Cox-Maze procedure is an effective treatment for atrial fibrillation with a long-term freedom from recurrence of >90%. The original procedure was highly invasive and required cardiopulmonary bypass (CPB). Modifications of the procedure have been proposed so that the procedure can be done without CPB. These approaches proposed to use alternative energy sources, to replace cut and sew lesions with lines of ablation, made from the epicardium on the beating heart. This has been challenging because the atrial wall muscle thickness is extremely variable and can be covered with an epicardial layer of fat. Moreover, the circulating intracavitary blood acts as a potential heat sink, making transmural lesions difficult to obtain. In this report, we summarize the use of nine different unidirectional devices to create continuous transmural lines of ablation from the atrial epicardium in a porcine model. We define a unidirectional device as one in which all the energy is applied by a single transducer on a single heart surface. These include four radiofrequency, two microwave, two lasers, and one cryothermic device. The maximum penetration of any device was 8.3 mm. All devices except one, the Atricure IsolatorT pen, failed to penetrate 2.0 mm in some non-transmural sections. Future development of unidirectional energy sources should be directed at increasing the maximum depth and the consistency of penetration. PMID:19959142

Early and mid-term outcomes of 1904 patients undergoing transcatheter balloon-expandable valve implantation in Italy: results from the Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER).

PubMed

Salizzoni, Stefano; D'Onofrio, Augusto; Agrifoglio, Marco; Colombo, Antonio; Chieffo, Alaide; Cioni, Micaela; Besola, Laura; Regesta, Tommaso; Rapetto, Filippo; Tarantini, Giuseppe; Napodano, Massimo; Gabbieri, Davide; Saia, Francesco; Tamburino, Corrado; Ribichini, Flavio; Cugola, Diego; Aiello, Marco; Sanna, Francesco; Iadanza, Alessandro; Pompei, Esmeralda; Stefàno, Pierluigi; Cappai, Antioco; Minati, Alessandro; Cassese, Mauro; Martinelli, Gian Luca; Agostinelli, Andrea; Fiorilli, Rosario; Casilli, Francesco; Reale, Maurizio; Bedogni, Francesco; Petronio, Anna Sonia; Mozzillo, Rosa Alba; Bonmassari, Roberto; Briguori, Carlo; Liso, Armando; Sardella, Gennaro; Bruschi, Giuseppe; Fiorina, Claudia; Filippini, Claudia; Moretti, Claudio; D'Amico, Maurizio; La Torre, Michele; Conrotto, Federico; Di Bartolomeo, Roberto; Gerosa, Gino; Rinaldi, Mauro

2016-12-01

: 0.905; 95% CI:0.833-0.984); critical preoperative state (HR: 2.282; 95% CI: 1.384-3.761); neurological dysfunction (HR: 1.552; 95% CI:1.060-2.272); atrial fibrillation (HR: 1.556; 95% CI:1.213-1.995); pacemaker rhythm (HR: 1.948; 95% CI:1.310-2.896); NYHA Class III or IV (HR: 1.800; 95% CI:1.205-2.689 or HR: 2.331; 95% CI:1.392-3.903, respectively). TAVI with a balloon-expandable device in the 'real world' shows good mid-term outcomes in terms of survival, technical success, valve-related adverse events and haemodynamic performance. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Modern Advances in Ablative TPS

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj

2013-01-01

Topics covered include: Physics of Hypersonic Flow and TPS Considerations. Destinations, Missions and Requirements. State of the Art Thermal Protection Systems Capabilities. Modern Advances in Ablative TPS. Entry Systems Concepts. Flexible TPS for Hypersonic Inflatable Aerodynamic Decelerators. Conformal TPS for Rigid Aeroshell. 3-D Woven TPS for Extreme Entry Environment. Multi-functional Carbon Fabric for Mechanically Deployable.

Radiofrequency Ablation versus Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation: A Meta-Analysis

PubMed Central

Hachem, Ali H.; Marine, Joseph E.; Tahboub, Housam A.; Kamdar, Sana; Kanjwal, Shaffi; Soni, Ronak

2018-01-01

Background Pulmonary vein isolation is commonly performed using radiofrequency energy with cryoablation gaining acceptance. We performed a meta-analysis of randomized controlled trials which compared radiofrequency versus cryoablation for patients with atrial fibrillation. Methods A systematic search strategy identified both published and unpublished articles from inception to November 10, 2016, in multiple databases. The primary outcomes for this meta-analysis were long-term freedom from atrial fibrillation at 12-month follow-up and overall postoperative complication rates. For all included studies, the methodological quality was assessed through the Cochrane Collaboration's tool for risk of bias. Results A total of 247 articles were identified with eight being included in this review as they satisfied the prespecified inclusion criteria. Overall, there was no significant difference in freedom from atrial fibrillation at ≥12-month follow-up between those receiving cryoballoon and radiofrequency ablation, respectively (OR = 0.98, CI = 0.67–1.43, I2 = 56%, p=0.90). Additionally, the secondary outcomes of duration of ablation, fluoroscopy time, and ablation time failed to reach significance. Cryoballoon ablation had significantly greater odds of postoperative phrenic nerve injury at 12-month follow-up. Conclusions Our meta-analysis suggests that cryoballoon ablation provides comparable benefits with regard to freedom from atrial fibrillation at medium-term follow-up, fluoroscopy time, ablation time, operative duration, and overall complication rate in comparison to radiofrequency ablation. PMID:29805800

Mid-trimester induced abortion: a review.

PubMed

Lalitkumar, S; Bygdeman, M; Gemzell-Danielsson, K

2007-01-01

Mid-trimester abortion constitutes 10-15% of all induced abortion. The aim of this article is to provide a review of the current literature of mid-trimester methods of abortion with respect to efficacy, side effects and acceptability. There have been continuing efforts to improve the abortion technology in terms of effectiveness, technical ease of performance, acceptability and reduction of side effects and complications. During the last decade, medical methods for mid-trimester induced abortion have shown a considerable development and have become safe and more accessible. The combination of mifepristone and misoprostol is now an established and highly effective method for termination of pregnancy (TOP). Advantages and disadvantages of medical versus surgical methods are discussed. Randomized studies are lacking, and more studies on pain treatment and the safety of any method used in patients with a previous uterine scar are debated, and data are scarce. Pain management in abortion requires special attention. This review highlights the need for randomized studies to set guidelines for mid-trimester abortion methods in terms of safety and acceptability as well as for better analgesic regimens.

Corneal tissue ablation using 6.1 μm quantum cascade laser

NASA Astrophysics Data System (ADS)

Huang, Yong; Kang, Jin U.

2012-03-01

High absorption property of tissues in the IR range (λ> 2 μm) results in effective tissue ablation, especially near 3 μm. In the mid-infrared range, wavelengths of 6.1 μm and 6.45 μm fall into the absorption bands of the amide protein groups Amide-I and Amide-II, respectively. They also coincide with the deformation mode of water, which has an absorption peak at 6.1 μm. This coincidence makes 6.1 μm laser a better ablation tool that has promising effectiveness and minimum collateral damages than 3 μm lasers. In this work, we performed bovine corneal ablation test in-vitro using high-power 6.1μm quantum cascade laser (QCL) operated at pulse mode. Quantum cascade laser has the advantages of low cost, compact size and tunable wavelength, which makes it great alternative Mid-IR light source to conventional tunable free-electron lasers (FEL) for medical applications. Preliminary results show that effective corneal stroma craters were achieved with much less collateral damage in corneal tissue that contains less water. Future study will focus on optimizing the control parameters of QCL to attain neat and precise ablation of corneal tissue and development of high peak power QCL.

Atrial Tachycardias Following Atrial Fibrillation Ablation

PubMed Central

Sághy, László; Tutuianu, Cristina; Szilágyi, Judith

2015-01-01

One of the most important proarrhythmic complications after left atrial (LA) ablation is regular atrial tachycardia (AT) or flutter. Those tachycardias that occur after atrial fibrillation (AF) ablation can cause even more severe symptoms than those from the original arrhythmia prior to the index ablation procedure since they are often incessant and associated with rapid ventricular response. Depending on the method and extent of LA ablation and on the electrophysiological properties of underlying LA substrate, the reported incidence of late ATs is variable. To establish the exact mechanism of these tachycardias can be difficult and controversial but correlates with the ablation technique and in the vast majority of cases the mechanism is reentry related to gaps in prior ablation lines. When tachycardias occur, conservative therapy usually is not effective, radiofrequency ablation procedure is mostly successful, but can be challenging, and requires a complex approach. PMID:25308808

Deviation from threshold model in ultrafast laser ablation of graphene at sub-micron scale

SciTech Connect

Gil-Villalba, A.; Xie, C.; Salut, R.

We investigate a method to measure ultrafast laser ablation threshold with respect to spot size. We use structured complex beams to generate a pattern of craters in CVD graphene with a single laser pulse. A direct comparison between beam profile and SEM characterization allows us to determine the dependence of ablation probability on spot-size, for crater diameters ranging between 700 nm and 2.5 μm. We report a drastic decrease of ablation probability when the crater diameter is below 1 μm which we interpret in terms of free-carrier diffusion.

Clinical Implications of Ablation of Drivers for Atrial Fibrillation: A Systematic Review and Meta-Analysis.

PubMed

Baykaner, Tina; Rogers, Albert J; Meckler, Gabriela L; Zaman, Junaid; Navara, Rachita; Rodrigo, Miguel; Alhusseini, Mahmood; Kowalewski, Christopher A B; Viswanathan, Mohan N; Narayan, Sanjiv M; Clopton, Paul; Wang, Paul J; Heidenreich, Paul A

2018-05-01

The outcomes from pulmonary vein isolation (PVI) for atrial fibrillation (AF) are suboptimal, but the benefits of additional lesion sets remain unproven. Recent studies propose ablation of AF drivers improves outcomes over PVI, yet with conflicting reports in the literature. We undertook a systematic literature review and meta-analysis to determine outcomes from ablation of AF drivers in addition to PVI or as a stand-alone procedure. Database search was done using the terms atrial fibrillation and ablation or catheter ablation and driver or rotor or focal impulse or FIRM (Focal Impulse and Rotor Modulation). We pooled data using random effects model and assessed heterogeneity with I 2 statistic. Seventeen studies met inclusion criteria, in a cohort size of 3294 patients. Adding AF driver ablation to PVI reported freedom from AF of 72.5% (confidence interval [CI], 62.1%-81.8%; P <0.01) and from all arrhythmias of 57.8% (CI, 47.5%-67.7%; P <0.01). AF driver ablation when added to PVI or as stand-alone procedure compared with controls produced an odds ratio of 3.1 (CI, 1.3-7.7; P =0.02) for freedom from AF and an odds ratio of 1.8 (CI, 1.2-2.7; P <0.01) for freedom from all arrhythmias in 4 controlled studies. AF termination rate was 40.5% (CI, 30.6%-50.9%) and predicted favorable outcome from ablation( P <0.05). In controlled studies, the addition of AF driver ablation to PVI supports the possible benefit of a combined approach of AF driver ablation and PVI in improving single-procedure freedom from all arrhythmias. However, most studies are uncontrolled and are limited by substantial heterogeneity in outcomes. Large multicenter randomized trials are needed to precisely define the benefits of adding driver ablation to PVI. © 2018 American Heart Association, Inc.

Impact of steerable sheaths on contact forces and reconnection sites in ablation for persistent atrial fibrillation.

PubMed

Ullah, Waqas; Hunter, Ross J; McLean, Ailsa; Dhinoja, Mehul; Earley, Mark J; Sporton, Simon; Schilling, Richard J

2015-03-01

In preclinical studies, catheter contact force (CF) during radiofrequency ablation correlates with the subsequent lesion size. We investigated the impact of steerable sheaths on ablation CF, its consistency, and wide area circumferential ablation (WACA) line reconnection sites. Five thousand and sixty-four ablations were analyzed across 60 patients undergoing first-time ablation for persistent AF using a CF-sensing catheter: 19 manual nonsteerable sheath (Manual-NSS), 11 manual steerable sheath, and 30 robotic steerable sheath (Sensei, Hansen Medical Inc.) procedures were studied. Ablation CFs were higher in the steerable sheath groups for all left atrial ablations and also WACA ablations specifically (P < 0.006), but less consistent per WACA segment (P < 0.005). There were significant differences in the CFs around both WACAs by group: in the left WACA CFs were lower with Manual-NSS, other than at the anterior-inferior and posterior-superior regions, and lower in the right WACA, other than the anterior-superior region. There was a difference in the proportion of segments chronically reconnecting across groups: Manual-NSS 26.5%, manual steerable sheath 4.6%, robotic 12% (P < 0.0005). The left atrial appendage/PV ridge and right posterior wall were common sites of reconnection in all groups. Steerable sheaths increased ablation CF; however, there were region-specific heterogeneities in the extent of increment, with some segments where they failed to increase CF. Steerable sheath use was associated with reduced WACA-segment reconnection. It may be that the benefits of steerable sheath use in terms of higher CFs could be translated to improved clinical outcomes if regional weaknesses of this technology are taken into account during ablation procedures. © 2014 Wiley Periodicals, Inc.

Microwave Ablation Compared with Radiofrequency Ablation for Breast Tissue in an Ex Vivo Bovine Udder Model

SciTech Connect

Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp; Westphal, Saskia, E-mail: swestphal@ukaachen.de; Isfort, Peter, E-mail: isfort@hia.rwth-aachen.de

2012-08-15

Purpose: To compare the effectiveness of microwave (MW) ablation with radiofrequency (RF) ablation for treating breast tissue in a nonperfused ex vivo model of healthy bovine udder tissue. Materials and Methods: MW ablations were performed at power outputs of 25W, 35W, and 45W using a 915-MHz frequency generator and a 2-cm active tip antenna. RF ablations were performed with a bipolar RF system with 2- and 3-cm active tip electrodes. Tissue temperatures were continuously monitored during ablation. Results: The mean short-axis diameters of the coagulation zones were 1.34 {+-} 0.14, 1.45 {+-} 0.13, and 1.74 {+-} 0.11 cm for MWmore » ablation at outputs of 25W, 35W, and 45W. For RF ablation, the corresponding values were 1.16 {+-} 0.09 and 1.26 {+-} 0.14 cm with electrodes having 2- and 3-cm active tips, respectively. The mean coagulation volumes were 2.27 {+-} 0.65, 2.85 {+-} 0.72, and 4.45 {+-} 0.47 cm{sup 3} for MW ablation at outputs of 25W, 35W, and 45W and 1.18 {+-} 0.30 and 2.29 {+-} 0.55 cm{sup 3} got RF ablation with 2- and 3-cm electrodes, respectively. MW ablations at 35W and 45W achieved significantly longer short-axis diameters than RF ablations (P < 0.05). The highest tissue temperature was achieved with MW ablation at 45W (P < 0.05). On histological examination, the extent of the ablation zone in MW ablations was less affected by tissue heterogeneity than that in RF ablations. Conclusion: MW ablation appears to be advantageous with respect to the volume of ablation and the shape of the margin of necrosis compared with RF ablation in an ex vivo bovine udder.« less

Sustaining Phenolic Impregnated Carbon Ablator (PICA) TPS for Future NASA Robotic Science Missions Including NF-4 and Discovery

NASA Technical Reports Server (NTRS)

Venkatapathy, E.; Stackpoole, M.; Violette, S.

2018-01-01

Phenolic Impregnated Carbon Ablator (PICA), invented in the mid 1990s, is a low-density ablative thermal protection material proven capable of meeting sample return mission needs from the moon, asteroids, comets and other unrestricted class V destinations as well as for Mars. Its low density and efficient performance characteristics have proven effective for use from Discovery to Flagship class missions. It is important that NASA maintain this TPS material capability and ensure its availability for future NASA use. The rayon based carbon precursor raw material used in PICA preform manufacturing required replacement and requalification at least twice in the past 25 years and a third substitution is now needed. The carbon precursor replacement challenge is twofold the first involves finding a long-term replacement for the current rayon and the second is to assess its future availability periodically to ensure it is sustainable and be alerted if additional replacement efforts need to be initiated. Rayon is no longer a viable process in the US and Europe due to environmental concerns. In the early 80s rayon producers began investigating a new method of producing a cellulosic fiber through a more environmentally responsible process. This cellulosic fiber, lyocell, is a viable replacement precursor for PICA fiberform. This presentation reviews current SMD-PSD funded PICA sustainability activities in ensuring a rayon replacement for the long term is identified and in establishing that the capability of the new PICA derived from an alternative precursor is in family with previous versions of the so called heritage PICA.

Miniaturization of Microwave Ablation Antennas

NASA Astrophysics Data System (ADS)

Luyen, Hung

Microwave ablation (MWA) is a promising minimally invasive technique for the treatment of various types of cancers as well as non-oncological diseases. In MWA, an interstitial antenna is typically used to deliver microwave energy to the diseased tissue and heat it up to lethal temperature levels that induce cell death. The desired characteristics of the interstitial antenna include a narrow diameter to minimize invasiveness of the treatment, a low input reflection coefficient at the operating frequency, and a localized heating zone. Most interstitial MWA antennas are fed by coaxial cables and designed for operation at either 915 MHz or 2.45 GHz. Coax-fed MWA antennas are commonly equipped with coaxial baluns to achieve localized heating. However, the conventional implementation of coaxial baluns increases the overall diameters of the antennas and therefore make them more invasive. It is highly desirable to develop less invasive antennas with shorter active lengths and smaller diameters for MWA applications. In this work, we demonstrate the feasibility of using higher frequency microwaves for tissue ablation and present several techniques for decreasing diameters of MWA antennas. First, we investigated MWA at higher frequencies by conducting numerical and experimental studies to compare ablation performance at 10 GHz and 1.9 GHz. Simulation and ex vivo ablation experiment results demonstrate comparable ablation zone dimensions achieved at these two frequencies. Operating at higher frequencies enables interstitial antennas with shorter active lengths. This can be combined with smaller-diameter antenna designs to create less invasive applicators or allow integration of multiple radiating elements on a single applicator to have better control and customization of the heating patterns. Additionally, we present three different coax-fed antenna designs and a non-coaxial-based balanced antenna that have smaller-diameter configurations than conventional coax-fed balun

[Percutaneous radiofrequency ablation of osteoid osteomas: technique and results].

PubMed

Bruners, P; Penzkofer, T; Günther, R W; Mahnken, A

2009-08-01

Osteoid osteoma is a benign primary bone tumor that typically occurs in children and young adults. Besides local pain, which is often worse at night, prompt relief due to medication with acetylsalicylic acid (ASS) is characteristic for this bone lesion. Because long-term medication with ASS does not represent an alternative treatment strategy due to its potentially severe side effects, different minimally invasive image-guided techniques for the therapy of osteoid osteoma have been developed. In this context radiofrequency (RF) ablation in particular has become part of the clinical routine. The technique and results of image-guided RF ablation are compared to alternative treatment strategies. Using this technique, an often needle-shaped RF applicator is percutaneously placed into the tumor under image guidance. Then a high-frequency alternating current is applied by the tip of the applicator which leads to ionic motion within the tissue resulting in local heat development and thus in thermal destruction of the surrounding tissue including the tumor. The published primary and secondary success rates of this technique are 87 and 83 %, respectively. Surgical resection and open curettage show comparable success rates but are associated with higher complication rates. In addition image-guided RF ablation of osteoid osteomas is associated with low costs. In conclusion image-guided RF ablation can be considered the gold standard for the treatment of osteoid osteoma.

Radiofrequency ablation of hepatocellular carcinoma: pros and cons.

PubMed

Rhim, Hyunchul; Lim, Hyo K

2010-09-01

Among locoregional treatments for hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) has been accepted as the most popular alternative to curative transplantation or resection, and it shows an excellent local tumor control rate and acceptable morbidity. The benefits of RFA have been universally validated by the practice guidelines of international societies of hepatology. The main advantages of RFA include 1) it is minimally invasive with acceptable morbidity, 2) it enables excellent local tumor control, 3) it has promising long-term survival, and 4) it is a multimodal approach. Based on these pros, RFA will play an important role in managing the patient with early HCC (smaller than 3 cm with fewer than four tumors). The main limitations of current RFA technology in hepatic ablation include 1) limitation of ablation volume, 2) technically infeasible in some tumors due to conspicuity and dangerous location, and 3) the heat-sink effect. Many technical approaches have been introduced to overcome those limitations, including a novel guiding modality, use of artificial fluid or air, and combined treatment strategies. RFA will continue to play a role as a representative ablative modality in the management of HCC, even in the era of targeted agents.

Radiofrequency Ablation of Hepatocellular Carcinoma: Pros and Cons

PubMed Central

Lim, Hyo K.

2010-01-01

Among locoregional treatments for hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) has been accepted as the most popular alternative to curative transplantation or resection, and it shows an excellent local tumor control rate and acceptable morbidity. The benefits of RFA have been universally validated by the practice guidelines of international societies of hepatology. The main advantages of RFA include 1) it is minimally invasive with acceptable morbidity, 2) it enables excellent local tumor control, 3) it has promising long-term survival, and 4) it is a multimodal approach. Based on these pros, RFA will play an important role in managing the patient with early HCC (smaller than 3 cm with fewer than four tumors). The main limitations of current RFA technology in hepatic ablation include 1) limitation of ablation volume, 2) technically infeasible in some tumors due to conspicuity and dangerous location, and 3) the heat-sink effect. Many technical approaches have been introduced to overcome those limitations, including a novel guiding modality, use of artificial fluid or air, and combined treatment strategies. RFA will continue to play a role as a representative ablative modality in the management of HCC, even in the era of targeted agents. PMID:21103289

Efficacy and predictability of soft tissue ablation using a prototype Raman-shifted alexandrite laser

NASA Astrophysics Data System (ADS)

Kozub, John A.; Shen, Jin-H.; Joos, Karen M.; Prasad, Ratna; Shane Hutson, M.

2015-10-01

Previous research showed that mid-infrared free-electron lasers could reproducibly ablate soft tissue with little collateral damage. The potential for surgical applications motivated searches for alternative tabletop lasers providing thermally confined pulses in the 6- to-7-μm wavelength range with sufficient pulse energy, stability, and reliability. Here, we evaluate a prototype Raman-shifted alexandrite laser. We measure ablation thresholds, etch rates, and collateral damage in gelatin and cornea as a function of laser wavelength (6.09, 6.27, or 6.43 μm), pulse energy (up to 3 mJ/pulse), and spot diameter (100 to 600 μm). We find modest wavelength dependence for ablation thresholds and collateral damage, with the lowest thresholds and least damage for 6.09 μm. We find a strong spot-size dependence for all metrics. When the beam is tightly focused (˜100-μm diameter), ablation requires more energy, is highly variable and less efficient, and can yield large zones of mechanical damage (for pulse energies >1 mJ). When the beam is softly focused (˜300-μm diameter), ablation proceeded at surgically relevant etch rates, with reasonable reproducibility (5% to 12% within a single sample), and little collateral damage. With improvements in pulse-energy stability, this prototype laser may have significant potential for soft-tissue surgical applications.

Efficacy and predictability of soft tissue ablation using a prototype Raman-shifted alexandrite laser

PubMed Central

Kozub, John A.; Shen, Jin-H.; Joos, Karen M.; Prasad, Ratna; Shane Hutson, M.

2015-01-01

Abstract. Previous research showed that mid-infrared free-electron lasers could reproducibly ablate soft tissue with little collateral damage. The potential for surgical applications motivated searches for alternative tabletop lasers providing thermally confined pulses in the 6- to-7-μm wavelength range with sufficient pulse energy, stability, and reliability. Here, we evaluate a prototype Raman-shifted alexandrite laser. We measure ablation thresholds, etch rates, and collateral damage in gelatin and cornea as a function of laser wavelength (6.09, 6.27, or 6.43  μm), pulse energy (up to 3  mJ/pulse), and spot diameter (100 to 600  μm). We find modest wavelength dependence for ablation thresholds and collateral damage, with the lowest thresholds and least damage for 6.09  μm. We find a strong spot-size dependence for all metrics. When the beam is tightly focused (∼100-μm diameter), ablation requires more energy, is highly variable and less efficient, and can yield large zones of mechanical damage (for pulse energies >1  mJ). When the beam is softly focused (∼300-μm diameter), ablation proceeded at surgically relevant etch rates, with reasonable reproducibility (5% to 12% within a single sample), and little collateral damage. With improvements in pulse-energy stability, this prototype laser may have significant potential for soft-tissue surgical applications. PMID:26456553

Emerging indications of endoscopic radiofrequency ablation

PubMed Central

Becq, Aymeric; Camus, Marine; Rahmi, Gabriel; de Parades, Vincent; Marteau, Philippe

2015-01-01

Introduction Radiofrequency ablation (RFA) is a well-validated treatment of dysplastic Barrett's esophagus. Other indications of endoscopic RFA are under evaluation. Results Four prospective studies (total 69 patients) have shown that RFA achieved complete remission of early esophageal squamous intra-epithelial neoplasia at a rate of 80%, but with a substantial risk of stricture. In the setting of gastric antral vascular ectasia, two prospective monocenter studies, and a retrospective multicenter study, (total 51 patients), suggest that RFA is efficacious in terms of reducing transfusion dependency. In the setting of chronic hemorrhagic radiation proctopathy, a prospective monocenter study and a retrospective multicenter study (total 56 patients) suggest that RFA is an efficient treatment. A retrospective comparative study (64 patients) suggests that RFA improves stents patency in malignant biliary strictures. Conclusions Endoscopic RFA is an upcoming treatment modality in early esophageal squamous intra-epithelial neoplasia, as well as in gastric, rectal, and biliary diseases. PMID:26279839

Ablation of hypertrophic septum using radiofrequency energy: an alternative for gradient reduction in patient with hypertrophic obstructive cardiomyopathy?

PubMed

Riedlbauchová, Lucie; Janoušek, Jan; Veselka, Josef

2013-06-01

Alcohol septal ablation and surgical myectomy represent accepted therapeutic options for treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy. Long-term experience with radiofrequency ablation of arrhythmogenic substrates raised a question if this technique might be effective for left ventricular outflow tract (LVOT) gradient reduction. We report on a 63-year-old patient with recurrence of symptoms 1 year after alcohol septal ablation (ASA) leading originally to a significant reduction of both symptoms and gradient. Due to a new increase of gradient in the LVOT up to 200 mm Hg with corresponding worsening of symptoms and due to refusal of surgical myectomy by the patient, endocardial radiofrequency ablation of the septal hypertrophy (ERASH) was indicated. Radiofrequency ablation was performed in the LVOT using irrigated-tip ablation catheter; the target site was identified using intracardiac echocardiography and electroanatomical CARTO mapping. ERASH caused an immediate gradient reduction due to hypokinesis of the ablated septum. At 2-month follow-up exam, significant clinical improvement was observed, together with persistent gradient reduction assessed with Doppler echocardiography. Echocardiography and magnetic resonance revealed persistent septal hypokinesis and slight thinning of the ablated region. Septal ablation using radiofrequency energy may be a promising alternative or adjunct to the treatment of hypertrophic obstructive cardiomyopathy. Intracardiac echocardiography and electroanatomical CARTO mapping enable exact lesion placement and preservation of atrioventricular conduction.

Picosecond laser ablation of poly-L-lactide: Effect of crystallinity on the material response

NASA Astrophysics Data System (ADS)

Ortiz, Rocío; Quintana, Iban; Etxarri, Jon; Lejardi, Ainhoa; Sarasua, Jose-Ramon

2011-11-01

The picosecond laser ablation of poly-L-lactide (PLLA) as a function of laser fluence and degree of crystallinity was examined. The ablation parameters and the surface modifications were analyzed under various irradiation conditions using laser wavelengths ranging from the ultraviolet through the visible. When processing the amorphous PLLA, both energy threshold and topography varied considerably depending on laser wavelength. Laser irradiation showed a reduction in the energy ablation threshold as the degree of crystallinity increased, probably related to photomechanical effects involved in laser ablation with ultra-short pulses and the lower stress accommodation behavior of semicrystalline polymers. In particular, cooperative chain motions are impeded by the higher degree of crystallinity, showing fragile mechanical behavior and lower energy dissipation. The experimental results on ablation rate versus laser energy showed that UV laser ablation on semicrystalline PLLA was more efficient than the visible ablation, i.e., it exhibits higher etch rates over a wide range of pulse energy conditions. These results were interpreted in terms of photo-thermal and photo-chemical response of polymers as a function of material micro-structure and incident laser wavelength. High quality micro-grooves were produced in amorphous PLLA, reveling the potential of ultra-fast laser processing technique in the field of micro-structuring biocompatible and biodegradable polymers for biomedical applications.

Artificial meteor ablation studies: Olivine

NASA Technical Reports Server (NTRS)

Blanchard, M. B.; Cunningham, G. G.

1973-01-01

Artificial meteor ablation was performed on a Mg-rich olivine sample using an arc-heated plasma of ionized air. Experimental conditions simulated a meteor traveling about 12 km/sec at an altitude of 70 km. The mineral content of the original olivine sample was 98% olivine (including traces of olivine alteration products) and 2% chromite. Forsterite content of the original olivine was Fo-89. After ablation, the forsterite content had increased to Fo-94 in the recrystallized olivine. In addition, lamella-like intergrowths of magnetite were prevalent constituents. Wherever magnetite occurred, there was an increase in Mg and a corresponding decrease in Fe for the recrystallized olivine. The Allende fusion crust consisted of a recrystallized olivine, which was more Mg-rich and Fe-deficient than the original meteorite's olivine, and abundant magnetite grains. Although troilite and pentlandite were the common opaque mineral constituents in this meteorite, magnetite was the principal opaque mineral found in the fusion crust.

Percutaneous ablation of pancreatic cancer

PubMed Central

D’Onofrio, Mirko; Ciaravino, Valentina; De Robertis, Riccardo; Barbi, Emilio; Salvia, Roberto; Girelli, Roberto; Paiella, Salvatore; Gasparini, Camilla; Cardobi, Nicolò; Bassi, Claudio

2016-01-01

Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review. PMID:27956791

Mid-IR super-continuum generation

NASA Astrophysics Data System (ADS)

Islam, Mohammed N.; Xia, Chenan; Freeman, Mike J.; Mauricio, Jeremiah; Zakel, Andy; Ke, Kevin; Xu, Zhao; Terry, Fred L., Jr.

2009-02-01

A Mid-InfraRed FIber Laser (MIRFIL) has been developed that generates super-continuum covering the spectral range from 0.8 to 4.5 microns with a time-averaged power as high as 10.5W. The MIRFIL is an all-fiber integrated laser with no moving parts and no mode-locked lasers that uses commercial off-the-shelf parts and leverages the mature telecom/fiber optics platform. The MIRFIL power can be easily scaled by changing the repetition rate and modifying the erbium-doped fiber amplifier. Some of the applications using the super-continuum laser will be described in defense, homeland security and healthcare. For example, the MIRFIL is being applied to a catheter-based medical diagnostic system to detect vulnerable plaque, which is responsible for most heart attacks resulting from hardening-of-the-arteries or atherosclerosis. More generally, the MIRFIL can be a platform for selective ablation of lipids without damaging normal protein or smooth muscle tissue.

Keratocyte density 3 months, 15 months, and 3 years after corneal surface ablation with mitomycin C.

PubMed

de Benito-Llopis, Laura; Cañadas, Pilar; Drake, Pilar; Hernández-Verdejo, José Luis; Teus, Miguel A

2012-01-01

To study the effects of surface ablation with mitomycin C (MMC) on keratocyte population. Prospective, nonrandomized, interventional, comparative case series. Thirty two eyes treated with surface ablation with 0.02% MMC were compared with nontreated eyes at Vissum Santa Hortensia, Madrid, Spain. Keratocyte density was measured with the Heidelberg Retina Tomograph II (Rostock Cornea Module) 3, 15, and 36 to 42 months after the surgery in the anterior, mid, and posterior stroma, and compared with control eyes. Three months postoperatively, we found a lower stromal bed density compared to controls (16 993 ± 8001 vs 29 660 ± 5904 cells/mm(3), P = .0001), while there was a significantly higher cell density in the mid (30 783 ± 9300 vs 18 505 ± 1996 cells/mm(3), P = .0001) and deep stroma (30 268 ± 8321 vs 18 438 ± 2139 cells/mm(3), P = .0001). Three years after the surgery, the cellularity in the stromal bed had not significantly changed from the 3-month follow-up, but the density in the mid (18 889 ± 3474 cells/mm(3)) and posterior stroma (18 992 ± 3402 cells/mm(3)) had decreased to show no difference from controls. The mean cell density between the anterior, mid, and posterior stroma was not significantly different from controls 15 months and 3 years after the surgery. Our study suggests that there is a reorganization of the stromal cell population soon after surface ablation with MMC, with a decrease in the stromal bed compensated initially with an increase in the mid and posterior stroma. Corneal cellularity tends to normalize over time, and 3 years postoperatively the mean cell density throughout the cornea seems to maintain normal values. Copyright © 2012 Elsevier Inc. All rights reserved.

Effects of pulsed mid-IR lasers on bovine knee joint tissues

NASA Astrophysics Data System (ADS)

Vari, Sandor G.; Shi, Wei-Qiang; Pergadia, Vani R.; Duffy, J. T.; Miller, J. M.; van der Veen, Maurits J.; Weiss, Andrew B.; Fishbein, Michael C.; Grundfest, Warren S.

1993-07-01

We investigated the effect of varying Tm:YAG (2.014 micrometers ) and Ho:YAG (2.130 micrometers ) laser parameters on ablation rate and consequent thermal damage. Mid-infrared wavelengths are strongly absorbed by most biological tissues due to the tissue's high water content. The ablation rate of fresh bovine knee joint tissues (fibrous cartilage, hyaline cartilage, and bone) in saline was assessed as a function of radiant exposure (160 - 950 J/cm2), at pulse widths of 200 microsecond(s) ec for Tm:YAG and 250 microsecond(s) ec for Ho:YAG and a repetition rate of 2 Hz. All tissues used in this study could be efficiently ablated using two micron lasers. The mechanism of action is likely related to the formation and collapse of cavitation bubbles, associated with mid-infrared lasers. We concluded that the Tm:YAG and Ho:YAG lasers are capable of effective knee joint tissue ablation.

Caries selective ablation: the handpiece

NASA Astrophysics Data System (ADS)

Hennig, Thomas; Rechmann, Peter; Holtermann, Andreas

1995-05-01

Caries selective ablation is fixed to a window of fluences predicted by the ablation thresholds of carious and healthy dentin, respectively. The aim of the study was to develop a dental handpiece which guarantees homogeneous fluence at the irradiated tooth surface. Furthermore the point of treatment should be cooled down without energy losses due to the cooling system. We suggest the direct coupling of the laser radiation into a laminar stream of liquid, which acts in turn as a lengthened beam guide. The impacts of the laser radiation and of the cooling medium fall exactly into the same point. Hot ablation debris is removed out of the crater by the flush of the water jet. Fluences are constant if the handpiece is used in contact mode or at a distance. Normally the surface of a bare fiber working in contact mode is destroyed after a few shots. Coupling the laser radiation into a stream of liquid prevents this destruction. Putting together the benefits of this special handpiece short overall treatment times seem to be possible. High average power can be applied to the tooth without the threat of thermal damage. Furthermore no time consuming cutting of the fiber prolongs the treatment time.

The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation.

PubMed

Klatte, Tobias; Kroeger, Nils; Zimmermann, Uwe; Burchardt, Martin; Belldegrun, Arie S; Pantuck, Allan J

2014-06-01

Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. A PubMed wide the literature search of was conducted. International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. Ablative techniques pose a valid treatment option in selected patients.

Impact of radiofrequency ablation geometry on electrical conduction

NASA Astrophysics Data System (ADS)

Rivas, Rhiana N.; Lye, Theresa H.; Hendon, Christine P.

2018-02-01

The gold standard of current treatment for atrial fibrillation is radiofrequency ablation (RFA). Single RFA procedures have low long-term, single-procedure success rates, which can be attributed to factors including inability to measure and visualize lesion depth in real time and incomplete knowledge of how atrial fibrillation manifests and persists. One way to address this problem is to develop a heart model that accurately fits lesion dimensions and depth using OCT to extract structural information. Twenty-three lesions of varying transmurality in left and right swine atrial tissue have been imaged with a Thorlabs OCT system with 6.5-micron axial resolution and a custom Ultra High Resolution system with 2.5-micron axial resolution. The boundaries of the ablation lesions were identified by the appearance of the birefringence artifact to identify areas of un-ablated tissue, as well as by changes to depth penetration and structural features, including decreased contrast between the endocardium and myocardium and disappearance of collagen fibers within the ablation lesion. Using these features, the lateral positions of the lesion boundaries were identified. An algorithm that fit ellipses to the lesion contours modeled the ablation geometry in depth. Lesion dimensions and shape were confirmed by comparison with trichrome histological processing. Finite-element models were fitted with these parameters and electrophysiological simulations were run with the Continuity 6 package. Next steps include correlating lesion geometry to conduction velocity, and including further tissue complexity such as varying tissue composition and fiber orientation. Additional models of linear lesions with gaps and adjacent lesions created with non-perpendicular contact will be created. This work will provide insight into how lesion geometry, tissue composition, and fiber organization impact electrophysiological propagation.

Endometrial ablation in the management of abnormal uterine bleeding.

PubMed

Laberge, Philippe; Leyland, Nicholas; Murji, Ally; Fortin, Claude; Martyn, Paul; Vilos, George; Leyland, Nicholas; Wolfman, Wendy; Allaire, Catherine; Awadalla, Alaa; Dunn, Sheila; Heywood, Mark; Lemyre, Madeleine; Marcoux, Violaine; Potestio, Frank; Rittenberg, David; Singh, Sukhbir; Yeung, Grace

2015-04-01

Abnormal uterine bleeding (AUB) is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for the problem during their reproductive years. To provide current evidence-based guidelines on the techniques and technologies used in endometrial ablation (EA), a minimally invasive technique for the management of AUB of benign origin. Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of both location in Canada and type of practice, as well as subspecialty expertise and general background in gynaecology. The committee reviewed all available evidence in the English medical literature, including published guidelines, and evaluated surgical and patient outcomes for the various EA techniques. Recommendations were established by consensus. Published literature was retrieved through searches of MEDLINE and The Cochrane Library in 2013 and 2014 using appropriate controlled vocabulary and key words (endometrial ablation, hysteroscopy, menorrhagia, heavy menstrual bleeding, AUB, hysterectomy). RESULTS were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English from January 2000 to November 2014. Searches were updated on a regular basis and incorporated in the guideline to December 2014. Grey (unpublished) literature was identifies through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). This document reviews the evidence regarding the available techniques and technologies for EA

Alternate energy sources for catheter ablation.

PubMed

Wang, P J; Homoud, M K; Link, M S; Estes III, N A

1999-07-01

Because of the limitations of conventional radiofrequency ablation in creating large or linear lesions, alternative energy sources have been used as possible methods of catheter ablation. Modified radiofrequency energy, cryoablation, and microwave, laser, and ultrasound technologies may be able to create longer, deeper, and more controlled lesions and may be particularly suited for the treatment of ventricular tachycardias and for linear atrial ablation. Future studies will establish the efficacy of these new and promising technologies.

Emergency catheter ablation in critical patients

PubMed Central

Tebbenjohanns, Jürgen; Rühmkorf, Klaus

2010-01-01

Emergency catheter ablation is justified in critical patients with drug-refractory life-threatening arrhythmias. The procedure can be used for ablation of an accessory pathway in preexcitation syndrome with high risk of ventricular fibrillation and in patients with shock due to ischemic cardiomyopathy and incessant ventricular tachycardia. Emergency catheter ablation can also be justified in patients with an electrical storm of the implanted cardioverter-defibrillator or in patients with idiopathic ventricular fibrillation. PMID:20606793

Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation.

PubMed

Che, Y; Jin, S; Shi, C; Wang, L; Zhang, X; Li, Y; Baek, J H

2015-07-01

Nodular goiter is one of the most common benign lesions in thyroid nodule. The main treatment of the disease is still the traditional surgical resection, however there are many problems such as general anesthesia, surgical scar, postoperative thyroid or parathyroid function abnormalities, and high nodules recurrence rate in residual gland. The purpose of this study was to compare the efficacy, safety, and cost-effectiveness of 2 treatment methods, surgery and radiofrequency ablation, for the treatment of benign thyroid nodules. From May 2012 to September 2013, 200 patients with nodular goiters who underwent surgery (group A) and 200 patients treated by radiofrequency ablation (group B) were enrolled in this study. Inclusion criteria were the following: 1) cosmetic problem, 2) nodule-related symptoms, 3) hyperfunctioning nodules related to thyrotoxicosis, and 4) refusal of surgery (for group B). An internally cooled radiofrequency ablation system and an 18-ga internally cooled electrode were used. We compared the 2 groups in terms of efficacy, safety, and cost-effectiveness during a 1-year follow-up. After radiofrequency ablation, the nodule volume decreased significantly from 5.4 to 0.4 mL (P = .002) at the 12-month follow-up. The incidence of complications was significantly higher from surgery than from radiofrequency ablation (6.0% versus 1.0%, P = .002). Hypothyroidism was detected in 71.5% of patients after surgery but in none following radiofrequency ablation. The rate of residual nodules (11.9% versus 2.9%, P = .004) and hospitalization days was significantly greater after surgery (6.6 versus 2.1 days, P < .001), but the cost difference was not significant. Surgical resection and radiofrequency ablation are both effective treatments of nodular goiter. Compared with surgery, the advantages of radiofrequency ablation include fewer complications, preservation of thyroid function, and fewer hospitalization days. Therefore, radiofrequency ablation should be

ABLATIVE COMPOSITES FOR LIFTING REENTRY THERMAL PROTECTION.

DTIC Science & Technology

MECHANICAL PROPERTIES, THERMAL CONDUCTIVITY, ABLATION, DENSITY, TABLES(DATA), SPECIFIC HEAT, THERMOGRAVIMETRIC ANALYSIS, CORROSION RESISTANCE, COLORIMETRY , HEAT RESISTANT MATERIALS, ATMOSPHERE ENTRY.

Ablation driven by hot electrons generated during the ignitor laser pulse in shock ignition

SciTech Connect

Piriz, A. R.; Rodriguez Prieto, G.; Tahir, N. A.

2012-12-15

An analytical model for the ablation driven by hot electrons is presented. The hot electrons are assumed to be generated during the high intensity laser spike used to produce the ignitor shock wave in the shock ignition driven inertial fusion concept, and to carry on the absorbed laser energy in its totality. Efficient energy coupling requires to keep the critical surface sufficiently close to the ablation front and this goal can be achieved for high laser intensities provided that the laser wavelength is short enough. Scaling laws for the ablation pressure and the other relevant magnitudes of the ablation cloudmore » are found in terms of the laser and target parameters. The effect of the preformed plasma assembled by the compression pulse, previous to the ignitor, is also discussed. It is found that a minimum ratio between the compression and the ignitor pulses would be necessary for the adequate matching of the corresponding scale lengths.« less

Three dimensional characterization of laser ablation craters using high resolution X-ray computed tomography

NASA Astrophysics Data System (ADS)

Galmed, A. H.; du Plessis, A.; le Roux, S. G.; Hartnick, E.; Von Bergmann, H.; Maaza, M.

2018-01-01

Laboratory X-ray computed tomography is an emerging technology for the 3D characterization and dimensional analysis of many types of materials. In this work we demonstrate the usefulness of this characterization method for the full three dimensional analysis of laser ablation craters, in the context of a laser induced breakdown spectroscopy setup. Laser induced breakdown spectroscopy relies on laser ablation for sampling the material of interest. We demonstrate here qualitatively (in images) and quantitatively (in terms of crater cone angles, depths, diameters and volume) laser ablation crater analysis in 3D for metal (aluminum) and rock (false gold ore). We show the effect of a Gaussian beam profile on the resulting crater geometry, as well as the first visual evidence of undercutting in the rock sample, most likely due to ejection of relatively large grains. The method holds promise for optimization of laser ablation setups especially for laser induced breakdown spectroscopy.

Effects of insulator ablation on the operation of a quasi-steady MPD arc

NASA Technical Reports Server (NTRS)

Boyle, M. J.; Jahn, R. G.

1973-01-01

Multimegawatt operation of quasi-steady MPD arcjets can involve serious ablation of the insulator surfaces within the arc discharge chamber. Various degrees of insulator ablation manifest themselves by significantly perturbing the voltage-current characteristics and the exhaust velocity profiles. Voltage-current characteristics for two different insulator materials, Plexiglas and boron nitride, are interpreted in terms of an empirical Ohm's law. Use of the refractory insulator material eliminates the ablation-dominated nature of the terminal voltage, but the exhaust stream is still disturbed by insulator material. An Alfven critical velocity model can be applied to this influence of insulator ablation on exhaust velocity. Appropriate changes in the propellant injection geometry eliminate this influence and result in arcjet operation which is independent of insulator material. A particular combination of propellant injection geometries reduces the terminal voltage for a given current and mass flow while maintaining insulator-independent operation, thus implying an improvement in the overall efficiency of the device.

Analysis of iodinated contrast delivered during thermal ablation: is material trapped in the ablation zone?

PubMed

Wu, Po-Hung; Brace, Chris L

2016-08-21

Intra-procedural contrast-enhanced CT (CECT) has been proposed to evaluate treatment efficacy of thermal ablation. We hypothesized that contrast material delivered concurrently with thermal ablation may become trapped in the ablation zone, and set out to determine whether such an effect would impact ablation visualization. CECT images were acquired during microwave ablation in normal porcine liver with: (A) normal blood perfusion and no iodinated contrast, (B) normal perfusion and iodinated contrast infusion or (C) no blood perfusion and residual iodinated contrast. Changes in CT attenuation were analyzed from before, during and after ablation to evaluate whether contrast was trapped inside of the ablation zone. Visualization was compared between groups using post-ablation contrast-to-noise ratio (CNR). Attenuation gradients were calculated at the ablation boundary and background to quantitate ablation conspicuity. In Group A, attenuation decreased during ablation due to thermal expansion of tissue water and water vaporization. The ablation zone was difficult to visualize (CNR  =  1.57  ±  0.73, boundary gradient  =  0.7  ±  0.4 HU mm(-1)), leading to ablation diameter underestimation compared to gross pathology. Group B ablations saw attenuation increase, suggesting that iodine was trapped inside the ablation zone. However, because the normally perfused liver increased even more, Group B ablations were more visible than Group A (CNR  =  2.04  ±  0.84, boundary gradient  =  6.3  ±  1.1 HU mm(-1)) and allowed accurate estimation of the ablation zone dimensions compared to gross pathology. Substantial water vaporization led to substantial attenuation changes in Group C, though the ablation zone boundary was not highly visible (boundary gradient  =  3.9  ±  1.1 HU mm(-1)). Our results demonstrate that despite iodinated contrast being trapped in the ablation zone, ablation visibility

Survival analysis of high-intensity focused ultrasound ablation in patients with small hepatocellular carcinoma.

PubMed

Cheung, Tan To; Fan, Sheung Tat; Chu, Ferdinand S K; Jenkins, Caroline R; Chok, Kenneth S H; Tsang, Simon H Y; Dai, Wing Chiu; Chan, Albert C Y; Chan, See Ching; Yau, Thomas C C; Poon, Ronnie T P; Lo, Chung Mau

2013-08-01

High-intensity focused ultrasound (HIFU) ablation is a non-invasive treatment for hepatocellular carcinoma (HCC). At present, data on the treatment's long-term outcome are limited. This study analysed the survival outcome of HIFU ablation for HCCs smaller than 3 cm. Forty-seven patients with HCCs smaller than 3 cm received HIFU treatment between October 2006 and September 2010. Fifty-nine patients who received percutaneous radiofrequency ablation (RFA) were selected for comparison. The two groups of patients were compared in terms of pre-operative variables and survival. More patients in the HIFU group patients had Child-Pugh B cirrhosis (34% versus 8.5%; P = 0.001). The 1- and 3-year overall survival rates of patients whose tumours were completely ablated in the HIFU group compared with the RFA group were 97.4% versus 94.6% and 81.2% versus 79.8%, respectively (P = 0.530). The corresponding 1- and 3-year disease-free survival rates were 63.6% versus 62.4% and 25.9% versus 34.1% (P = 0.683). HIFU ablation is a safe and effective method for small HCCs. It can achieve survival outcomes comparable to those of percutaneous RFA and thus serves as a good alternative ablation treatment for patients with cirrhosis. © 2012 International Hepato-Pancreato-Biliary Association.

Optical feedback-induced light modulation for fiber-based laser ablation.

PubMed

Kang, Hyun Wook

2014-11-01

Optical fibers have been used as a minimally invasive tool in various medical fields. However, due to excessive heat accumulation, the distal end of a fiber often suffers from severe melting or devitrification, leading to the eventual fiber failure during laser treatment. In order to minimize thermal damage at the fiber tip, an optical feedback sensor was developed and tested ex vivo. Porcine kidney tissue was used to evaluate the feasibility of optical feedback in terms of signal activation, ablation performance, and light transmission. Testing various signal thresholds demonstrated that 3 V was relatively appropriate to trigger the feedback sensor and to prevent the fiber deterioration during kidney tissue ablation. Based upon the development of temporal signal signatures, full contact mode rapidly activated the optical feedback sensor possibly due to heat accumulation. Modulated light delivery induced by optical feedback diminished ablation efficiency by 30% in comparison with no feedback case. However, long-term transmission results validated that laser ablation assisted with optical feedback was able to almost consistently sustain light delivery to the tissue as well as ablation efficiency. Therefore, an optical feedback sensor can be a feasible tool to protect optical fiber tips by minimizing debris contamination and delaying thermal damage process and to ensure more efficient and safer laser-induced tissue ablation.

Recolonization of laser-ablated bacterial biofilm.

PubMed

Nandakumar, Kanavillil; Obika, Hideki; Utsumi, Akihiro; Toshihiko, Ooie; Yano, Tetsuo

2004-01-20

The recolonization of laser-ablated bacterial monoculture biofilm was studied in the laboratory by using a flow-cytometer system. The marine biofilm-forming bacterium Pseudoalteromonas carrageenovora was used to develop biofilms on titanium coupons. Upon exposure to a low-power pulsed irradiation from an Nd:YAG laser, the coupons with biofilm were significantly reduced both in terms of total viable count (TVC) and area cover. The energy density used for a pulse of 5 ns was 0.1 J/cm(2) and the durations of irradiation exposure were 5 and 10 min. When placed in a flow of dilute ZoBell marine broth medium (10%) the laser-destructed bacterial film in a flow-cytometer showed significant recovery over a period of time. The flow of medium was regulated at 3.2 ml/min. The increase in area cover and TVC, however, was significantly less than that observed for nonirradiated control (t-test, P< 0.05). The coupons were observed for biofilm area cover and TVC at different intervals (3, 6, and 9 h) after irradiation. While the biofilm in the control coupon at the end of 9 h of exposure showed 95.6 +/- 4.1% cover, the 5- and 10-min irradiated samples after 9 h showed 60.3 +/- 6.5 and 37.4 +/- 12.1% area cover, respectively. The reduced rate of recolonization compared to control was thought be due to the lethal and sublethal impacts of laser irradiation on bacteria. This observation thus provided data on the online recolonization speed of biofilm, which is important when considering pulsed laser irradiation as an ablating technique of biofilm formation and removal in natural systems. Copyright 2003 Wiley Periodicals, Inc.

Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation--initial observations.

PubMed

Allaf, Mohamad E; Varkarakis, Ioannis M; Bhayani, Sam B; Inagaki, Takeshi; Kavoussi, Louis R; Solomon, Stephen B

2005-10-01

To retrospectively compare the pain control requirements of patients undergoing computed tomography (CT)-guided percutaneous radiofrequency (RF) ablation with those of patients undergoing CT-guided percutaneous cryoablation of small (< or = 4-cm) renal tumors. The study was HIPAA compliant and received institutional review board exemption; informed consent was not required. Medical and procedure records of patients who underwent RF ablation and cryoablation of renal tumors from June 19, 2003, to February 28, 2004, were retrospectively reviewed for clinical data, tumor characteristics, and anesthesia information. During the study period, 10 men (mean age, 66.5 years) underwent cryoablation of 11 renal lesions, and 14 patients (11 men, four women; mean age, 68.1 years) underwent RF ablation of 15 renal tumors. Analgesic and sedative requirements during the procedure were compared. Standard anesthesia consisted of 5 mL of 1% lidocaine injected locally, and conscious sedation consisted of 50 microg of fentanyl and 1 mg of midazolam administered intravenously. The Fisher exact test and Student t test were used to compare clinical factors and drug requirements between the two groups. There was no difference in terms of patient demographics, tumor diameter, or distribution of central versus noncentral lesions between the two groups. Cryoablation was associated with a significantly lower dose of fentanyl (165.0 microg [RF group] vs 75.0 microg [cryoablation group]; P < .001) and midazolam (2.9 mg [RF group] vs 1.6 mg [cryoablation group]; P = .026). In the RF group, one patient required general anesthesia, one patient required supplemental narcotics (5 mg of oxycodone) and sedatives (1 mg lorezapam), and one patient became apneic for a brief interval after receiving additional narcotics for pain during the procedure. An additional RF session was terminated early in one patient because of pain, and further medication could not be administered owing to bradycardia. No

Bone Ablation at 2.94 mm Using the Free-Electron Laser and Er:YAG Laser

NASA Astrophysics Data System (ADS)

Ivanov, Borislav; Hakimian, Arman; Peavy, G. M.; Haglund, Richard

2002-03-01

Bone Ablation at 2.94 microns Using the Free-Electron Laser and Er:YAG Laser in Perfluorocarbon Compounds B. Ivanov^1, A. M. Hakimian^1, G. M. Peavy^2, R. F. Haglund, Jr.1 1Department of Physics and Astronomy, W. M. Keck Foundation Free-Electron Laser Center, Vanderbilt University, Nashville, TN 37235 2Beckman Laser Institute and Medical Clinic, College of Medicine, University of California, Irvine, CA 92612 We report studies on the efficiency of mid-IR laser ablation of cow cortical bone using the Vanderbilt free-electron laser (FEL), when irrigating the ablation zone with an inert and biocompatible perfluorocarbon compounds (PFC). At 2.94 microns, the bone matrix (mainly by water) absorbs the radiation while the PFCs transmit this wavelength, dissipate heat and acoustical stress, and prevent carbonization of the bone sample. The ablation rate, as a function of laser fluence, scanning speed and the type of PFC, was investigated. The laser fluence was estimated to be 5 J/cm^2 - 100 J/cm^2 with a laser focal spot diameter of 160 microns 500 microns and a scanning speed of 40 microns/s 2960 microns/s. The ablation rate was estimated from scanning electron microscopy to be 0.5 mm/s 2.4 mm/s. Comparisons of ablation rates with the FEL and a Er:YAG laser at 2.94 microns are being evaluated.

Mid-IR laser ultrasonic testing for fiber reinforced plastics

NASA Astrophysics Data System (ADS)

Kusano, Masahiro; Hatano, Hideki; Oguchi, Kanae; Yamawaki, Hisashi; Watanabe, Makoto; Enoki, Manabu

2018-04-01

Ultrasonic testing is the most common method to detect defects in materials and evaluate their sizes and locations. Since piezo-electric transducers are manually handled from point to point, it takes more costs for huge products such as airplanes. Laser ultrasonic testing (LUT) is a breakthrough technique. A pulsed laser generates ultrasonic waves on a material surface due to thermoelastic effect or ablation. The ultrasonic waves can be detected by another laser with an interferometer. Thus, LUT can realize instantaneous inspection without contacting a sample. A pulse laser with around 3.2 μm wavelength (in the mid-IR range) is more suitable to generate ultrasonic waves for fiber reinforced plastics (FRPs) because the light is well absorbed by the polymeric matrix. On the other hand, such a laser is not available in the market. In order to emit the mid-IR laser pulse, we came up with the application of an optical parametric oscillator and developed an efficient wavelength conversion device by pumping a compact Nd:YAG solid-state laser. Our mid-IR LUT system is most suitable for inspection of FRPs. The signal-to-noise ratio of ultrasonic waves generated by the mid-IR laser is higher than that by the Nd:YAG laser. The purpose of the present study is to evaluate the performance of the mid-IR LUT system in reflection mode. We investigated the effects of the material properties and the laser properties on the generated ultrasonic waves. In addition, C-scan images by the system were also presented.

Ablative skin resurfacing with a novel microablative CO2 laser.

PubMed

Gotkin, Robert H; Sarnoff, Deborah S; Cannarozzo, Giovanni; Sadick, Neil S; Alexiades-Armenakas, Macrene

2009-02-01

Carbon dioxide (CO2) laser skin resurfacing has been a mainstay of facial rejuvenation since its introduction in the mid 1990s. Recently, a new generation of fractional or microablative CO2 lasers has been introduced to the marketplace. According to the concept of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area. An array of microscopic thermal wounds is created that ablates the epidermis and dermis within very tiny zones; adjacent to these areas, the epidermis and dermis are spared. This microablative process of laser skin resurfacing has proven safe and effective not only for facial rejuvenation, but elsewhere on the body as well. It is capable of improving wrinkles, acne scars, and other types of atrophic scars and benign pigmented lesions associated with elastotic, sun-damaged skin. Because of the areas of spared epidermis and dermis inherent in a procedure that employs fractional photothermolysis, healing is more rapid compared to fully ablative CO2 laser skin resurfacing and downtime is proportionately reduced. A series of 32 consecutive patients underwent a single laser resurfacing procedure with the a new microablative CO2 laser. All patients were followed for a minimum of 6 months and were asked to complete patient satisfaction questionnaires; a 6 month postoperative photographic evaluation by an independent physician, not involved in the treatment, was also performed. Both sets of data were graded and reported on a quartile scale. Results demonstrated greater than 50% improvement in almost all patients with those undergoing treatment for wrinkles, epidermal pigment or solar elastosis deriving the greatest change for the better (>75%).

Contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease.

PubMed

Krause, Ulrich; Backhoff, David; Klehs, Sophia; Schneider, Heike E; Paul, Thomas

2016-08-01

Monitoring of catheter contact force during catheter ablation of atrial fibrillation has been shown to increase efficacy and safety. However, almost no data exists on the use of this technology in catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. The aim of the present study was to evaluate the impact of contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in those patients. Catheter ablation of intraatrial reentrant tachycardia using monitoring of catheter contact force was performed in 28 patients with congenital heart disease (CHD). Thirty-two patients matched according to gender, age, and body weight with congenital heart disease undergoing catheter ablation without contact force monitoring served as control group. Parameters reflecting acute procedural success, long-term efficacy, and safety were compared. Acute procedural success was statistically not different in both groups (contact force 93 % vs. control 84 %, p = 0.3). Likewise the recurrence rate 1 year after ablation as shown by Kaplan-Meier analysis did not differ (contact force 28 % vs. control 37 %, p = 0.63). Major complications were restricted to groin vessel injuries and occurred in 3 out of 60 patients (contact force n = 1; control n = 2). Complications related to excessive catheter contact force were not observed. The present study did not show superiority of catheter contact force monitoring during ablation of intraatrial reentrant tachycardia in patients with CHD in terms of efficacy and safety. Higher contact force compared to pulmonary vein isolation might therefore be required to increase the efficacy of catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease.

Carbon Nanotube-enhanced Carbon-phenolic Ablator Material

NASA Technical Reports Server (NTRS)

Nikolaev, P.; Stackpoole, M.; Fan, W.; Cruden, B.; Waid, M.; Maloney, P.; Arepalli, S.; Arnold, J.; Partridge, H.; Yowell, L.

2006-01-01

Phenolic impregnated carbon ablator (PICA) is a thermal protection system (TPS) material developed at NASA Ames Research Center in the mid-90 s for Discovery missions. It was used on the Stardust return capsule heat shield which successfully executed the highest speed Earth entry to date on January 15, 2006. PICA is a porous fibrous carbon insulation infiltrated with phenolic resin, and is an excellent ablator that is effective for heating rates up to 1000 W/sq cm. It is one of several candidate TPS materials for the next generation of crewed spacecraft for Lunar and Mars missions. We will describe an ongoing research effort at NASA to improve mechanical properties of the phenolic matrix with carbon nanotubes. The aim is two-fold: to increase overall TPS strength during reentry and to improve Micrometeoroid/Orbital Debris (MMOD) protection in space. The former requires at least a good dispersion of nanotubes in phenolic, while the latter also requires covalent bonding between them to couple and transfer impact energy effectively from matrix to nanotubes. We will discuss the required chemical functionalization of nanotubes, processing issues and test results.

Perioral Rejuvenation With Ablative Erbium Resurfacing.

PubMed

Cohen, Joel L

2015-11-01

Since the introduction of the scanning full-field erbium laser, misconceptions regarding ablative erbium resurfacing have resulted in its being largely overshadowed by ablative fractional resurfacing. This case report illustrates the appropriateness of full-field erbium ablation for perioral resurfacing. A patient with profoundly severe perioral photodamage etched-in lines underwent full-field ablative perioral resurfacing with an erbium laser (Contour TRL, Sciton Inc., Palo Alto, CA) that allows separate control of ablation and coagulation. The pre-procedure consultations included evaluation of the severity of etched-in lines, and discussion of patient goals, expectations, and appropriate treatment options, as well as a review of patient photos and post-treatment care required. The author generally avoids full-field erbium ablation in patients with Fitzpatrick type IV and above. For each of 2 treatment sessions (separated by approximately 4 months), the patient received (12 cc plain 2% lidodaine) sulcus blocks before undergoing 4 passes with the erbium laser at 150 μ ablation, no coagulation, and then some very focal 30 μ ablation to areas of residual lines still visualized through the pinpoint bleeding. Similarly, full-field ablative resurfacing can be very reliable for significant wrinkles and creping in the lower eyelid skin--where often a single treatment of 80 μ ablation, 50 μ coagulation can lead to a nice improvement. Standardized digital imaging revealed significant improvement in deeply etched rhytides without significant adverse events. For appropriately selected patients requiring perioral (or periorbital) rejuvenation, full-field ablative erbium resurfacing is safe, efficacious and merits consideration.

One-Dimensional Ablation with Pyrolysis Gas Flow Using a Full Newton's Method and Finite Control Volume Procedure

NASA Technical Reports Server (NTRS)

Amar, Adam J.; Blackwell, Ben F.; Edwards, Jack R.

2007-01-01

The development and verification of a one-dimensional material thermal response code with ablation is presented. The implicit time integrator, control volume finite element spatial discretization, and Newton's method for nonlinear iteration on the entire system of residual equations have been implemented and verified for the thermochemical ablation of internally decomposing materials. This study is a continuation of the work presented in "One-Dimensional Ablation with Pyrolysis Gas Flow Using a Full Newton's Method and Finite Control Volume Procedure" (AIAA-2006-2910), which described the derivation, implementation, and verification of the constant density solid energy equation terms and boundary conditions. The present study extends the model to decomposing materials including decomposition kinetics, pyrolysis gas flow through the porous char layer, and a mixture (solid and gas) energy equation. Verification results are presented for the thermochemical ablation of a carbon-phenolic ablator which involves the solution of the entire system of governing equations.

Mid-infrared tunable metamaterials

DOEpatents

Brener, Igal; Miao, Xiaoyu; Shaner, Eric A.; Passmore, Brandon Scott

2017-07-11

A mid-infrared tunable metamaterial comprises an array of resonators on a semiconductor substrate having a large dependence of dielectric function on carrier concentration and a semiconductor plasma resonance that lies below the operating range, such as indium antimonide. Voltage biasing of the substrate generates a resonance shift in the metamaterial response that is tunable over a broad operating range. The mid-infrared tunable metamaterials have the potential to become the building blocks of chip based active optical devices in mid-infrared ranges, which can be used for many applications, such as thermal imaging, remote sensing, and environmental monitoring.

Mid-infrared tunable metamaterials

DOEpatents

Brener, Igal; Miao, Xiaoyu; Shaner, Eric A; Passmore, Brandon Scott; Jun, Young Chul

2015-04-28

A mid-infrared tunable metamaterial comprises an array of resonators on a semiconductor substrate having a large dependence of dielectric function on carrier concentration and a semiconductor plasma resonance that lies below the operating range, such as indium antimonide. Voltage biasing of the substrate generates a resonance shift in the metamaterial response that is tunable over a broad operating range. The mid-infrared tunable metamaterials have the potential to become the building blocks of chip based active optical devices in mid-infrared ranges, which can be used for many applications, such as thermal imaging, remote sensing, and environmental monitoring.

Possible role for cryoballoon ablation of right atrial appendage tachycardia when conventional ablation fails.

PubMed

Amasyali, Basri; Kilic, Ayhan

2015-06-01

Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial tachycardia originates from the right atrial appendage.

Ablation of "Background Tachycardia" in Long Standing Atrial Fibrillation: Improving the Outcomes by Unmasking a Residual Atrial Fibrillation Perpetuator.

PubMed

Pachón-M, José Carlos; Pachón-M, Enrique I; Santillana P, Tomas G; Lobo, Tasso Julio; Pachón, Carlos Thiene C; Pachón-M, Juán Carlos; Albornoz V, Remy Nelson; Zerpa A, Juán Carlos; Ortencio, Felipe; Arruda, Mauricio

2017-01-01

Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)+AFN ablation one or more BT may arise or be induced in 30-40% of patients, which could be the culprit forAF maintenance and ablation recurrences. We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation.After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p<0.01. Following BT ablation, AF could not be induced. During FU of 13→60 months(22.8±12m), AF freedom for BT RF(+) vs. BT RF(-) groups were 77.9% vs. 56.4% (p=0.009), respectively. There was no significant complication. BT ablation following PVI and AFN ablation improved long-term outcomes ofLSAF ablation. BT is likely due to sustained microreentry, protected during AF by entry block. BT can be suspected by spectral analysis of the pre-ablation ECG and is likely one important AF perpetuator by causing electrical resonance of the AFN. This ablation strategy warrants randomized, multicenter investigation.

Multiple-electrode radiofrequency ablation: simultaneous production of separate zones of coagulation in an in vivo porcine liver model.

PubMed

Laeseke, Paul F; Sampson, Lisa A; Haemmerich, Dieter; Brace, Chris L; Fine, Jason P; Frey, Tina M; Winter, Thomas C; Lee, Fred T

2005-12-01

A multiple-electrode radiofrequency (RF) system was developed based on switching between electrodes that allows for the simultaneous use of as many as three electrically independent electrodes. The purpose of this study was to determine if each multiple-electrode ablation zone is identical to an ablation zone created with conventional single-electrode mode. Nine female domestic pigs (mean weight, 90 kg) were used for this study. A prototype monopolar multiple-electrode RF ablation system was created with use of an RF generator and an electronic switching algorithm. A maximum of three electrodes can be used simultaneously by switching between electrodes at each impedance spike (30 omega greater than baseline levels). A total of 39 zones of ablation were created at open laparotomy in pig livers with use of a conventional single electrode (n = 9), two single electrodes simultaneously (n = 6 ablations; 12 ablation zones), or three single electrodes simultaneously (n = 6 ablations; 18 ablation zones). RF electrodes were spaced in separate lobes of the liver when multiple zones of coagulation were created simultaneously. Animals were euthanized after RF ablation, livers were removed, and ablation zones were sectioned and measured. Zones of coagulation created simultaneously with two or three electrodes were equivalent to ablation zones created with use of conventional single-electrode ablation. No significant differences were observed among control animals treated with a single electrode, those with two separate zones of ablation created simultaneously, and those with three simultaneously created ablation zones in terms of mean (+/-SD) minimum diameter (1.6 cm +/- 0.6, 1.6 cm +/- 0.5, and 1.7 cm +/- 0.4, respectively), maximum diameter (2.0 cm +/- 0.5, 2.3 cm +/- 0.5, 2.2 cm +/- 0.5, respectively), and volume (6.7 cm3 +/- 3.7, 7.4 cm3 +/- 3.8, and 7.8 cm3 +/- 3.9; P > .30, analysis of variance, pairwise t-test comparisons). A rapid-switching multiple-electrode RF system

Applications of laser ablation to microengineering

NASA Astrophysics Data System (ADS)

Gower, Malcolm C.; Rizvi, Nadeem H.

2000-08-01

Applications of pulsed laser ablation to the manufacture of micro- electro-mechanical systems (MEMS) and micro-opto-electro-mechanical systems (MOEMS) devices are presented. Laser ablative processes used to manufacture a variety of microsystems technology (MST) components in the computer peripheral, sensing and biomedical industries are described together with a view of some future developments.

Testing and evaluation of light ablation decontamination

SciTech Connect

Demmer, R.L.; Ferguson, R.L.

1994-10-01

This report details the testing and evaluation of light ablation decontamination. It details WINCO contracted research and application of light ablation efforts by Ames Laboratory. Tests were conducted with SIMCON (simulated contamination) coupons and REALCON (actual radioactive metal coupons) under controlled conditions to compare cleaning effectiveness, speed and application to plant process type equipment.

Evaluation of the cavity margins after Er:YAG laser ablation of the enamel and dentin

NASA Astrophysics Data System (ADS)

Dostalova, Tatjana; Krejsa, Otakar; Jelinkova, Helena; Hamal, Karel

1994-12-01

This study investigates the checks of cavity margin after enamel and dentin ablation. The Er:YAG laser enamel and dentin ablation can be directly connected with the danger of cracks originating in the enamel near the cavity. This study evaluates the quality of the enamel edges after Er:YAG laser preparation. The enamel and dentin of buccal surfaces were ablated by the Er:YAG laser radiation. An Erbium:YAG laser system with the energy of 200 mJ was used to generate 200 microsecond(s) long pulses of mid-infrared 2.94 micrometers light in multimode configuration. The laser was operating in a free running mode, the repetition rate being 0.5 Hz with average laser power of 100 mW. Laser radiation was focused on the tooth tissue. Water cooling was used during the procedure in order to prevent tooth tissue destruction. The time of laser preparation was 5 minutes. A cavity of class V was prepared. The teeth were immersed into 0.5% basic fuchsin and then centrifuged at 6000 rev/min for 20 minutes. The microphotographs of the margins stained with 0.5% basic fuchsin were made and then the longitudinal section of the teeth were evaluated. The micrographs of the longitudinal section were checked and measured afterwards. The effect of the investigated laser irradiation on the origin of cracks was analyzed in the scanning electron microscope. Micrographs of each tooth before and after the laser ablation were compared. Micrographs of the intact teeth after extraction present the cracks of the enamel. They depend on the pressure exerted during extraction. The influence of the laser ablation proper is it bears no signs of new cracks. The conclusions of this study demonstrate the non-invasive nature of the Er:YAG laser ablation of the hard dental tissues.

Endovascular Radiofrequency Ablation for Varicose Veins

PubMed Central

2011-01-01

cohort studies was 2.9% (105⁄3,664). Imaging defined treatment effectiveness of vein closure rates were variable ranging from 68% to 96% at post-operative follow-up. Vein ablation rate at 6-month follow-up was reported in four studies with rates close to 90%. Only one study reported vein closure rates at 2 years but only for a minority of the eligible cases. The two studies reporting on RFA ablation with the more efficient second generation catheters involved better follow-up and reported higher ablation rates close to 100% at 6-month follow-up with no major adverse events. A large prospective registry trial that recruited over 1,000 patients at thirty-four largely European centers reported on treatment success in six overlapping reports on selected patient subgroups at various follow-up points up to 5 year. However, the follow-up for eligible recruited patients at all time points was low resulting in inadequate estimates of longer term treatment efficacy. The overall level of evidence of randomized trials comparing RFA with surgical ligation and vein stripping (n = 5) was graded as low to moderate. In all trials RFA ablation was performed with first generation catheters in the setting of the operating theatre under general anaesthesia, usually without tumescent anaesthesia. Procedure times were significantly longer after RFA than surgery. Recovery after treatment was significantly quicker after RFA both with return to usual activity and return to work with on average a one week less of work loss. Major adverse events occurring after surgery were higher [(1.8% (n=4) vs. 0.4% (n = 1) than after RFA but not significantly. Treatment effectiveness measured by imaging defined vein absence or vein closure was comparable in the two treatment groups. Significant improvements in vein symptoms and quality of life over baseline were reported for both treatment groups. Improvements in these outcomes were significantly greater in the RFA group than the surgery group in the peri

Laser ablated hydantoin: A high resolution rotational study.

PubMed

Alonso, Elena R; Kolesniková, Lucie; Alonso, José L

2017-09-28

Laser ablation techniques coupled with broadband and narrowband Fourier transform microwave spectroscopies have allowed the high resolution rotational study of solid hydantoin, an important target in astrochemistry as a possible precursor of glycine. The complicated hyperfine structure arising from the presence of two 14 N nuclei in non-equivalent positions has been resolved and interpreted in terms of the nuclear quadrupole coupling interactions. The results reported in this work provide a solid base for the interstellar searches of hydantoin in the astrophysical surveys. The values of the nuclear quadrupole coupling constants have been also discussed in terms of the electronic environment around the respective nitrogen atom.

Radiofrequency ablation versus electrocautery in tonsillectomy.

PubMed

Hall, Daniel J; Littlefield, Philip D; Birkmire-Peters, Deborah P; Holtel, Michael R

2004-03-01

The objective of this study was to compare the safety, difficulty of removal, and postoperative pain profile of radiofrequency ablation versus standard electrocautery removal of tonsils. A prospective, blinded study was designed to remove 1 tonsil with each of the 2 methods. Time of operation, estimated blood loss, difficulty of operation, postoperative pain, rate of postoperative hemorrhage, and the patient's preferred technique were evaluated. The operating time was significantly longer (P < 0.007) and the patients reported significantly less pain (P < 0.001) with radiofrequency ablation. There were no differences in blood loss, difficulty of operation, or postoperative hemorrhage rates. The patients preferred the radiofrequency ablation technique (P < 0.001). Radiofrequency ablation is a viable method to remove tonsillar tissue. Operating time for this procedure will likely decrease with experience. There was significantly less pain reported with radiofrequency ablation compared with standard electrocautery.

Artificial meteor ablation studies - Iron oxides.

NASA Technical Reports Server (NTRS)

Blanchard, M. B.

1972-01-01

Artificial meteor ablation was performed on natural minerals composed predominantly of magnetite and hematite by using an arc-heated plasma stream of air. Analysis indicates that most of the ablated debris was composed of two or more minerals. Wustite, a metastable mineral, was found to occur as a common product. The 'magnetite' sample, which was 80% magnetite, 14% hematite, 4% apatite, and 2% quartz, yielded ablated products consisting of more than 12 different minerals. Magnetite occurred in 91% of the specimens examined, hematite in 16%, and wustite in 30%. The 'hematite' sample, which was 96% hematite and 3% quartz, yielded ablated products consisting of more than 13 different minerals. Hematite occurred in 47% of the specimens examined, magnetite in 60%, and wustite in 28%. The more volatile elements (Si, P, and Cl) were depleted by about 50%. This study has shown that artificially created ablation products from iron oxides exhibit unique properties that can be used for identification.

The Mid-Ocean Ridge.

ERIC Educational Resources Information Center

Macdonald, Kenneth C.; Fox, Paul J.

1990-01-01

Described are concepts involved with the formation and actions of the Mid-Ocean Ridge. Sea-floor spreading, the magma supply model, discontinuities, off-axis structures, overlaps and deviation, and aquatic life are discussed. (CW)

Femtosecond ablation of ultrahard materials

NASA Astrophysics Data System (ADS)

Dumitru, G.; Romano, V.; Weber, H. P.; Sentis, M.; Marine, W.

Several ultrahard materials and coatings of definite interest for tribological applications were tested with respect to their response when irradiated with fs laser pulses. Results on cemented tungsten carbide and on titanium carbonitride are reported for the first time and compared with outcomes of investigations on diamond and titanium nitride. The experiments were carried out in air, in a regime of 5-8 J/cm2 fluences, using the beam of a commercial Ti:sapphire laser. The changes induced in the surface morphology were analysed with a Nomarski optical microscope, and with SEM and AFM techniques. From the experimental data and from the calculated incident energy density distributions, the damage and ablation threshold values were determined. As expected, the diamond showed the highest threshold, while the cemented tungsten carbide exhibited typical values for metallic surfaces. The ablation rates determined (under the above-mentioned experimental conditions) were in the range 0.1-0.2 μm per pulse for all the materials investigated.

Ablative shielding for hypervelocity projectiles

NASA Technical Reports Server (NTRS)

Rucker, Michelle A. (Inventor)

1993-01-01

A hypervelocity projectile shield which includes a hollow semi-flexible housing fabricated from a plastic like, or otherwise transparent membrane which is filled with a fluid (gas or liquid) is presented. The housing has a inlet valve, similar to that on a tire or basketball, to introduce an ablating fluid into the housing. The housing is attached by a Velcro mount or double-sided adhesive tape to the outside surface of a structure to be protected. The housings are arrayed in a side-by-side relationship for complete coverage of the surface to be protected. In use, when a hypervelocity projectile penetrates the outer wall of a housing it is broken up and then the projectile is ablated as it travels through the fluid, much like a meteorite 'burns up' as it enters the earth's atmosphere, and the housing is deflated. The deflated housing can be easily spotted for replacement, even from a distance. Replacement is then accomplished by simply pulling a deflated housing off the structure and installing a new housing.

Percutaneous Microwave Ablation of Renal Angiomyolipomas.

PubMed

Cristescu, Mircea; Abel, E Jason; Wells, Shane; Ziemlewicz, Timothy J; Hedican, Sean P; Lubner, Megan G; Hinshaw, J Louis; Brace, Christopher L; Lee, Fred T

2016-03-01

To evaluate the safety and efficacy of US-guided percutaneous microwave (MW) ablation in the treatment of renal angiomyolipoma (AML). From January 2011 to April 2014, seven patients (5 females and 2 males; mean age 51.4) with 11 renal AMLs (9 sporadic type and 2 tuberous sclerosis associated) with a mean size of 3.4 ± 0.7 cm (range 2.4-4.9 cm) were treated with high-powered, gas-cooled percutaneous MW ablation under US guidance. Tumoral diameter, volume, and CT/MR enhancement were measured on pre-treatment, immediate post-ablation, and delayed post-ablation imaging. Clinical symptoms and creatinine were assessed on follow-up visits. All ablations were technically successful and no major complications were encountered. Mean ablation parameters were ablation power of 65 W (range 60-70 W), using 456 mL of hydrodissection fluid per patient, over 4.7 min (range 3-8 min). Immediate post-ablation imaging demonstrated mean tumor diameter and volume decreases of 1.8% (3.4-3.3 cm) and 1.7% (27.5-26.3 cm(3)), respectively. Delayed imaging follow-up obtained at a mean interval of 23.1 months (median 17.6; range 9-47) demonstrated mean tumor diameter and volume decreases of 29% (3.4-2.4 cm) and 47% (27.5-12.1 cm(3)), respectively. Tumoral enhancement decreased on immediate post-procedure and delayed imaging by CT/MR parameters, indicating decreased tumor vascularity. No patients required additional intervention and no patients experienced spontaneous bleeding post-ablation. Our early experience with high-powered, gas-cooled percutaneous MW ablation demonstrates it to be a safe and effective modality to devascularize and decrease the size of renal AMLs.

Long-Term Seismicity of Northern (15° N-60° N) Mid-Atlantic Ridge (MAR) Recorded by two Regional Hydrophone Arrays: a Widespread Along-Ridge Influence of the Azores and Iceland Hotspots

NASA Astrophysics Data System (ADS)

Goslin, J.; Bazin, S.; Dziak, R. P.; Fox, C.; Fowler, M.; Haxel, J.; Lourenco, N.; Luis, J.; Martin, C.; Matsumoto, H.; Perrot, J.; Royer, J.

2004-12-01

The seismicity of the North Atlantic was recorded by two networks of hydrophones moored in the SOFAR channel, north and south of the Azores Plateau. The interpretation of the hydro-acoustic signals recorded during the first six-month common period of operation of the two networks (June 2002 to Nov. 2002) provides a unique data set on the spatial and time distributions of the numerous low-magnitude earthquakes which occurred along the Mid-Atlantic Ridge. Close to 2000 events were localized during this six-month period between latitudes 15° N and 63° N, 501 of which are localized within the SIRENA network (40° N-51° N) and 692 within the wider South Azores network (17° N-33° N). Using hydrophones to locate seafloor earthquakes by interpreting T-wave signals lowers the detection threshold of Mid-Atlantic Ridge events to 3.0 mb from the 4.7 mb of global seismic networks. This represents an average thirty-fold increase in the number of events: 62 events were detected by global seismological networks within the same area during the same period. An along-ridge spatial distribution of the seismicity is obtained by computing the cumulated numbers of events in 1° -wide latitudinal bins. When plotted vs. latitude, this first-order distribution shows remarkable long-wavelength patterns: the seismicity rate is low when approaching the Azores and Iceland (reaching values as low as 10 events/d° ), while it peaks to 70 events/d° in the vicinity of the Gibbs FZ. Moreover, the latitudinal distribution of the seismicity hints at an asymmetric influence of the Azores hotpot on the MAR. Finally, the spatial distribution of the seismicity anti-correlates well at long wavelengths with the zero-age depths along the MAR and correlates with the zero-age Mantle Bouguer (MBA) anomaly values and the Vs velocity anomalies at 100 km in the upper mantle. It is thus proposed that the seismicity level would be partly tied to the rheology and thickness of the brittle layer and be thus

Laser ablation of persistent twist cells in Drosophila: muscle precursor fate is not segmentally restricted

NASA Technical Reports Server (NTRS)

Farrell, E. R.; Keshishian, H.

1999-01-01

In Drosophila the precursors of the adult musculature arise during embryogenesis. These precursor cells have been termed Persistent Twist Cells (PTCs), as they continue to express the transcription factor Twist after that gene ceases expression elsewhere in the mesoderm. In the larval abdomen, the PTCs are associated with peripheral nerves in stereotypic ventral, dorsal, and lateral clusters, which give rise, respectively, to the ventral, dorsal, and lateral muscle fiber groups of the adult. We tested the developmental potential of the PTCs by using a microbeam laser to ablate specific clusters in larvae. We found that the ablation of a single segmental PTC cluster does not usually result in the deletion of the corresponding adult fibers of that segment. Instead, normal or near normal numbers of adult fibers can form after the ablation. Examination of pupae following ablation showed that migrating PTCs from adjacent segments are able to invade the affected segment, replenishing the ablated cells. However, the ablation of homologous PTCs in multiple segments does result in the deletion of the corresponding adult muscle fibers. These data indicate that the PTCs in an abdominal segment can contribute to the formation of muscle fibers in adjacent abdominal segments, and thus are not inherently restricted to the formation of muscle fibers within their segment of origin.

Laparoscopic microwave thermosphere ablation of malignant liver tumors: An analysis of 53 cases.

PubMed

Zaidi, Nisar; Okoh, Alexis; Yigitbas, Hakan; Yazici, Pinar; Ali, Noaman; Berber, Eren

2016-02-01

Microwave thermosphere ablation (MTA) is a new technology that is designed to create spherical zones of ablation using a single antenna. The aim of this study is to assess the results of MTA in a large series of patients. This was a prospective study assessing the use of MTA in patients with malignant liver tumors. The procedures were done mostly laparoscopically and ablation zones created were assessed for completeness of tumor response, spherical geometry and recurrence on tri-phasic CT scans done on follow-up. There were a total of 53 patients with an average of 3 tumors measuring 1.5 cm. Ablations were performed laparoscopically in all but eight patients. Morbidity was 11.3% (n = 6), and mortality zero. On postoperative scans, there was 99.3% tumor destruction. Roundness indices A, B, and transverse were 1.1, 1.0, and 0.9, respectively. At a median follow-up of 4.5 months, incomplete ablation was seen in 1 of 149 lesions treated (0.7%) and local tumor recurrence in 1 lesion (0.7%). The results of this series confirm the safety and feasibility of MTA technology. The 99.3% rate of complete tumor ablation and low rate of local recurrence at short-term follow up are promising. © 2015 Wiley Periodicals, Inc.

Remote magnetic navigation for mapping and ablating right ventricular outflow tract tachycardia.

PubMed

Thornton, Andrew S; Jordaens, Luc J

2006-06-01

Navigation, mapping, and ablation in the right ventricular outflow tract (RVOT) can be difficult. Catheter navigation using external magnetic fields may allow more accurate mapping and ablation. The purpose of this study was to assess the feasibility of RVOT tachycardia ablation using remote magnetic navigation. Mapping and ablation were performed in eight patients with outflow tract ventricular arrhythmias. Tachycardia mapping was undertaken with a 64-polar basket catheter, followed by remote activation and pace-mapping using a magnetically enabled catheter. The area of interest was localized on the basket catheter in seven patients in whom an RVOT arrhythmia was identified. Remote navigation of the magnetic catheter to this area was followed by pace-mapping. Ablation was performed at the site of perfect pace-mapping, with earliest activation if possible. Acute success was achieved in all patients (median four applications). Median procedural time was 144 minutes, with 13.4 minutes of patient fluoroscopy time and 3.8 minutes of physician fluoroscopy time. No complications occurred. One recurrence occurred during follow-up (mean 366 days). RVOT tachycardias can be mapped and ablated using remote magnetic navigation, initially guided by a basket catheter. Precise activation and pace-mapping are possible. Remote magnetic navigation permitted low fluoroscopy exposure for the physician. Long-term results are promising.

Recovery of the vomiting reflex following area postrema ablation in squirrel monkeys

NASA Technical Reports Server (NTRS)

Elfar, S.; Brizzee, Kenneth R.; Fox, Robert A.; Corcoran, Meryl Lee; Daunton, Nancy G.; Coleman, J.

1991-01-01

The role of the area postrema (AP) in motion-induced emesis was re-assessed recently in several different species. In a few of these studies, the role of the AP in motion-induced conditioned taste aversion (CTA) was also addressed. The purpose was to extend this comparative study to the squirrel monkey, to evaluate further the role of AP in vomiting, and to investigate the dynamics of the recovery process. The AP was ablated bilaterally in 7 motion-susceptible squirrel monkeys which previously had been characterized in terms of their responses to various motion sickness-inducing stimuli. After recovery from surgery all animals were tested at 30-day intervals for a period of 11 months to determine the effects of AP ablations on susceptibility to the same sickness-inducing conditions. In addition, the effectiveness of motion in preducing CTA was evaluated. All pre-ablation motion tests involved stimulation for 30 min., while post-lesion tests were 60 min., in duration. All animals showed significant increases in latencies to vomiting after AP ablations. However, the latencies tended to decrease with time after ablation. All but one animal vomited on at least one of the 10 motion tests occurring after ablation of AP. In addition, CTA was produced by motion used in the conditioning sessions. These results suggest that structures other than AP, and processes other that those mediated through AP, may play an important role in motion-induced emesis.

Microwave ablation at 10.0 GHz achieves comparable ablation zones to 1.9 GHz in ex vivo bovine liver.

PubMed

Luyen, Hung; Gao, Fuqiang; Hagness, Susan C; Behdad, Nader

2014-06-01

We demonstrate the feasibility of using high-frequency microwaves for tissue ablation by comparing the performance of a 10 GHz microwave ablation system with that of a 1.9 GHz system. Two sets of floating sleeve dipole antennas operating at these frequencies were designed and fabricated for use in ex vivo experiments with bovine livers. Combined electromagnetic and transient thermal simulations were conducted to analyze the performance of these antennas. Subsequently, a total of 16 ablation experiments (eight at 1.9 GHz and eight at 10.0 GHz) were conducted at a power level of 42 W for either 5 or 10 min. In all cases, the 1.9 and 10 GHz experiments resulted in comparable ablation zone dimensions. Temperature monitoring probes revealed faster heating rates in the immediate vicinity of the 10.0 GHz antenna compared to the 1.9 GHz antenna, along with a slightly delayed onset of heating farther from the 10 GHz antenna, suggesting that heat conduction plays a greater role at higher microwave frequencies in achieving a comparably sized ablation zone. The results obtained from these experiments agree very well with the combined electromagnetic/thermal simulation results. These simulations and experiments show that using lower frequency microwaves does not offer any significant advantages, in terms of the achievable ablation zones, over using higher frequency microwaves. Indeed, it is demonstrated that high-frequency microwave antennas may be used to create reasonably large ablation zones. Higher frequencies offer the advantage of smaller antenna size, which is expected to lead to less invasive interstitial devices and may possibly lead to the development of more compact multielement arrays with heating properties not available from single-element antennas.

Evaluation of Finite-Rate Gas/Surface Interaction Models for a Carbon Based Ablator

NASA Technical Reports Server (NTRS)

Chen, Yih-Kanq; Goekcen, Tahir

2015-01-01

Two sets of finite-rate gas-surface interaction model between air and the carbon surface are studied. The first set is an engineering model with one-way chemical reactions, and the second set is a more detailed model with two-way chemical reactions. These two proposed models intend to cover the carbon surface ablation conditions including the low temperature rate-controlled oxidation, the mid-temperature diffusion-controlled oxidation, and the high temperature sublimation. The prediction of carbon surface recession is achieved by coupling a material thermal response code and a Navier-Stokes flow code. The material thermal response code used in this study is the Two-dimensional Implicit Thermal-response and Ablation Program, which predicts charring material thermal response and shape change on hypersonic space vehicles. The flow code solves the reacting full Navier-Stokes equations using Data Parallel Line Relaxation method. Recession analyses of stagnation tests conducted in NASA Ames Research Center arc-jet facilities with heat fluxes ranging from 45 to 1100 wcm2 are performed and compared with data for model validation. The ablating material used in these arc-jet tests is Phenolic Impregnated Carbon Ablator. Additionally, computational predictions of surface recession and shape change are in good agreement with measurement for arc-jet conditions of Small Probe Reentry Investigation for Thermal Protection System Engineering.

Interest of waiting time for spontaneous early reconnection after cavotricuspid isthmus ablation: A monocentric randomized trial.

PubMed

Marchandise, Sébastien; Scavée, Christophe; Barbraud, Cynthia; de Meester de Ravenstein, Christophe; Balola Bagalwa, Mittérand; Goesaert, Cédric; Reis-Pinheiro, Ivone; le Polain de Waroux, Jean-Benoit

2017-12-01

The aim of this study was to determine the rate of recurrent atrial flutter (AFl) after isolated cavotricuspid isthmus (CTI) ablation and to evaluate the impact of a waiting period with the search for early resumption of the CTI block on the long-term outcome. Three hundred and nineteen consecutive patients referred for typical AFl ablation were randomly assigned to CTI ablation with continuous reevaluation of the CTI block during 30 minutes and early reablation if needed (waiting time [WT] + group, n  =  155) or to CTI ablation with no waiting period after proven bidirectional CTI block (WT - group, n  =  164). All patients were regularly followed-up. In the WT+ group, 10 patients (6%) presented a recovery across the CTI (time to recovery: 17 ± 7') and were reablated at the end of the waiting period. After a median follow-up of 21 months, the rate of recurrent AFl was significantly higher in the WT - group as compared to the WT+ group (11.6% [19/164] vs 2.5% [4/155], respectively; P  =  0.007). However, no significant differences in the subsequent rate of AF were observed between the two groups (29% [WT -] vs 32% [WT+], P  =  0.66). During the follow-up, 28 patients from the WT - group underwent a second ablation procedure (16 AFl redo and 12 AF ablation) versus 10 patients form the WT+ group (three AFl redo and seven AF ablation). Waiting 30 minutes after CTI ablation to check for early resumption and early reablation allows for decreasing significantly the rate of recurrent atrial flutter. © 2017 Wiley Periodicals, Inc.

Single-ring ablation compared with standard circumferential pulmonary vein isolation using remote magnetic catheter navigation.

PubMed

Sohns, Christian; Bergau, Leonard; Seegers, Joachim; Lüthje, Lars; Vollmann, Dirk; Zabel, Markus

2014-10-01

In ablation of atrial fibrillation, the single-ring method aims for isolation of the posterior wall of the left atrium (LA) including the pulmonary veins (PVs) but avoiding posterior LA lesions. The aim of this randomized prospective study was to evaluate safety and efficacy of remote magnetic navigation (RMN)-guided single-ring ablation strategy as compared to standard RMN-guided circumferential PV ablation (PVA). Eighty consecutive patients undergoing PVA were enrolled prospectively and randomized equally into two study groups. RMN using the Stereotaxis system and open-irrigated 3.5-mm ablation catheters were used with a 3D mapping system in all procedures. Forty patients underwent RMN-guided single-ring ablation, and 40 patients received RMN-guided circumferential PVA. In the circumferential group, 3.3 ± 1.1 PVs were successfully isolated at the end of the procedure as compared to 3.1 ± 1.3 in the single-ring (box) group (p=0.38). All patients in the box group required additional posterior lesions in order to achieve electrical isolation of the PVs. Single-ring ablation was associated with longer procedure duration (p=0.01) and ablation time (p=0.001). After a single procedure, the proportion of patients free of any atrial tachycardia (AT)/atrial fibrillation (AF) episode at 12-month follow-up was 57 % in the box group and 58 % in the circ group. Using RMN, only minor complications have been observed. RMN-guided single-ring PVA provides comparable acute and long-term success rates as compared to RMN-guided circumferential PVA but requires additional posterior lesions to achieve PV isolation and increased procedure and ablation time. Procedural complication rates are low when using RMN.

Therapy of Pancreatic Neuroendocrine Tumors: Fine Needle Intervention including Ethanol and Radiofrequency Ablation

PubMed Central

Lakhtakia, Sundeep

2017-01-01

Pancreatic neuroendocrine tumors (PNETs) are increasingly being detected, though usually as incidental findings. Majority of the PNETs are non-functional and surgical resection is the standard of care for most of them. However, in patients with small PNETs localized within the pancreas, who are unfit or unwilling for surgery, alternate methods of treatment are needed. Direct methods of ablation of PNETs, using either ethanol injection or radiofrequency ablation (RFA), are emerging as effective methods. The limited literature available as case reports or case series on endoscopic ultrasound (EUS)-guided local ablation using either ethanol or RFA has demonstrated safety and efficacy along with short- to medium-term sustained relief. Long-term benefits with these local ablative therapies are awaited. Comparative studies are needed to show which of these two competing technologies is superior. Finally, comparative trials of EUS-guided ablation with surgical resection in terms of efficacy and safety will ensure their place in the management algorithm. PMID:29207860

Addition of topical pimecrolimus to once-daily mid-potent steroid confers no short-term therapeutic benefit in the treatment of severe atopic dermatitis; a randomized controlled trial.

PubMed

Spergel, J M; Boguniewicz, M; Paller, A S; Hebert, A A; Gallagher, P R; McCormick, C; Parneix-Spake, A; Hultsch, T

2007-08-01

Combination therapy with pimecrolimus cream 1%, a topical calcineurin inhibitor (TCI), and fluticasone propionate cream 0.05% (FP), a mid-potency topical corticosteroid, may have a synergistic effect for treatment of atopic dermatitis (AD) because their mechanism of action differs. To assess the efficacy of concomitant pimecrolimus twice daily/FP once daily vs. vehicle twice daily/FP once daily in patients with severe AD. An exploratory, 2-week, double-blind, randomized, within-patient study was conducted (n = 45). Two target areas of similar severity, size and location were assessed. Assessments included the modified Eczema Area and Severity Index (0-12 scale) (primary variable), localized investigator global assessment (0-4 scale) and Patients' Self-Assessment of Disease Severity (0-4 scale). Data for all variables were similar for the TCI/FP and vehicle/FP treatments. The efficacy observed for treatment of severe AD flares with this TCI/FP combination regimen was equivalent to that of vehicle/FP.

Radiofrequency ablation of fast ventricular tachycardia causing an ICD storm in an infant with hypertrophic cardiomyopathy.

PubMed

Ergul, Yakup; Ozyilmaz, Isa; Bilici, Meki; Ozturk, Erkut; Haydin, Sertaç; Guzeltas, Alper

2018-04-01

An implantable cardioverter defibrillator (ICD) storm involves very frequent arrhythmia episodes and ICD shocks, and it is associated with poor short-term and long-term prognosis. Radiofrequency catheter ablation can be used as an effective rescue treatment for patients with an ICD storm. To our knowledge, this is the first report of an infant with hypertrophic cardiomyopathy presenting with an ICD storm and undergoing successful radiofrequency catheter ablation salvage treatment for the fast left posterior fascicular ventricular tachycardia. © 2017 Wiley Periodicals, Inc.

Robotically assisted ablation produces more rapid and greater signal attenuation than manual ablation.

PubMed

Koa-Wing, Michael; Kojodjojo, Pipin; Malcolme-Lawes, Louisa C; Salukhe, Tushar V; Linton, Nick W F; Grogan, Aaron P; Bergman, Dale; Lim, Phang Boon; Whinnett, Zachary I; McCarthy, Karen; Ho, Siew Yen; O'Neill, Mark D; Peters, Nicholas S; Davies, D Wyn; Kanagaratnam, Prapa

2009-12-01

Robotic remote catheter ablation potentially provides improved catheter-tip stability, which should improve the efficiency of radiofrequency energy delivery. Percentage reduction in electrogram peak-to-peak voltage has been used as a measure of effectiveness of ablation. We tested the hypothesis that improved catheter-tip stability of robotic ablation can diminish signals to a greater degree than manual ablation. In vivo NavX maps of 7 pig atria were constructed. Separate lines of ablation were performed robotically and manually, recording pre- and postablation peak-to-peak voltages at 10, 20, 30, and 60 seconds and calculating signal amplitude reduction. Catheter ablation settings were constant (25W, 50 degrees , 17 mL/min, 20-30 g catheter tip pressure). The pigs were sacrificed and ablation lesions correlated with NavX maps. Robotic ablation reduced signal amplitude to a greater degree than manual ablation (49 +/- 2.6% vs 29 +/- 4.5% signal reduction after 1 minute [P = 0.0002]). The mean energy delivered (223 +/- 184 J vs 231 +/- 190 J, P = 0.42), power (19 +/- 3.5 W vs 19 +/- 4 W, P = 0.84), and duration of ablation (15 +/- 9 seconds vs 15 +/- 9 seconds, P = 0.89) was the same for manual and robotic. The mean peak catheter-tip temperature was higher for robotic (45 +/- 5 degrees C vs 42 +/- 3 degrees C [P < 0.0001]). The incidence of >50% signal reduction was greater for robotic (37%) than manual (21%) ablation (P = 0.0001). Robotically assisted ablation appears to be more effective than manual ablation at signal amplitude reduction, therefore may be expected to produce improved clinical outcomes.

Laser-induced breakdown spectroscopy using mid-infrared femtosecond pulses

DOE PAGES

Hartig, K. C.; Colgan, J.; Kilcrease, D. P.; ...

2015-07-30

Here, we report on a laser-induced breakdown spectroscopy (LIBS) experiment driven by mid-infrared (2.05-μm) fs pulses, in which time-resolved emission spectra of copper were studied. Ab-initio modeling is consistent with the results of new fs measurements at 2.05 μm and traditional 800-nm fs-LIBS. Ablation by mid-infrared fs pulses results in a plasma with a lower plasma density and temperature compared to fs-LIBS performed at shorter laser wavelength. LIBS driven by mid-infrared fs pulses results in a signal-to-background ratio ~50% greater and a signal-to-noise ratio ~40% lower than fs-LIBS at near-infrared laser wavelength.

Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis

NASA Astrophysics Data System (ADS)

Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Zhang, Xiao-Ting; Li, Yi-Gang

2015-06-01

We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: -2.83 P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: -2.36 P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time.

Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis

PubMed Central

Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Zhang, Xiao-Ting; Li, Yi-Gang

2015-01-01

We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time. PMID:26039980

Atrial fibrillation ablation using very short duration 50 W ablations and contact force sensing catheters.

PubMed

Winkle, Roger A; Moskovitz, Ryan; Hardwin Mead, R; Engel, Gregory; Kong, Melissa H; Fleming, William; Salcedo, Jonathan; Patrawala, Rob A; Tranter, John H; Shai, Isaac

2018-06-01

The optimal radiofrequency (RF) power and lesion duration using contact force (CF) sensing catheters for atrial fibrillation (AF) ablation are unknown. We evaluate 50 W RF power for very short durations using CF sensing catheters during AF ablation. We evaluated 51 patients with paroxysmal (n = 20) or persistent (n = 31) AF undergoing initial RF ablation. A total of 3961 50 W RF lesions were given (average 77.6 ± 19.1/patient) for an average duration of only 11.2 ± 3.7 s. As CF increased from < 10 to > 40 g, the RF application duration decreased from 13.7 ± 4.4 to 8.6 ± 2.5 s (p < 0.0005). Impedance drops occurred in all ablations, and for patients in sinus rhythm, there was loss of pacing capture during RF delivery suggesting lesion creation. Only 3% of the ablation lesions were at < 5 g and 1% at > 40 g of force. As CF increased, the force time integral (FTI) increased from 47 ± 24 to 376 ± 102 gs (p < 0.0005) and the lesion index (LSI) increased from 4.10 ± 0.51 to 7.63 ± 0.50 (p < 0.0005). Both procedure time (101 ± 19.7 min) and total RF energy time (895 ± 258 s) were very short. For paroxysmal AF, the single procedure freedom from AF was 86% at 1 and 2 years. For persistent AF, it was 83% at 1 year and 72% at 2 years. There were no complications. Short duration 50 W ablations using CF sensing catheters are safe and result in excellent long-term freedom from AF for both paroxysmal and persistent AF with short procedure times and small amounts of total RF energy delivery.

Stabilized gold nanoparticles by laser ablation in ferric chloride solutions

NASA Astrophysics Data System (ADS)

Nouraddini, M. I.; Ranjbar, M.; Dobson, P. J.; Farrokhpour, H.; Johnston, C.; Jurkschat, K.

2017-12-01

In this study, laser ablation of gold was performed in different ferric chloride solutions and water as a reference. The ferric chloride solutions included hexachloro iron(III) and aquachloro iron(III) having low and high hydrolysis degree. Transmission electron microscope (TEM) images showed spherical gold nanoparticles (GNPs) in water, particles which are strongly agglomerated with intimate contact at their interfaces in hexachloro iron(III) and individual separated particles with a halo of an iron component in aquachloro iron(III). In addition, no combination of Au and Fe was found in HAADF analysis or X-ray diffraction (XRD) patterns. In optical investigations, it was observed that gold nanoparticles made in hexachloro iron(III) solutions have localized surface plasmon resonance (LSPR) peaks broader than in the case of water that are quenched after a few hours, while ablation in the aquachloro iron(III) solution provides narrow LSPR absorption with a long-term stability. According to X-ray photoelectron spectroscopy (XPS) there are metallic Au and Fe2+ states in the drop-casted samples. By comparison of cyclic voltammetry of solutions before and after laser ablation, strong agglomeration in hexachloro iron(III) was attributed to the reducing role of iron(III) creating an unstable gold surface in the chloride solution. In aquachloro iron(III), however, the observed stability was attributed to the formation of the halo of an iron compound around the particles.

Emerging needle ablation technology in urology.

PubMed

Leveillee, Raymond J; Pease, Karli; Salas, Nelson

2014-01-01

Thermal ablation of urologic tumors in the form of freezing (cryoablation) and heating (radiofrequency ablation) have been utilized successfully to treat and ablate soft tissue tumors for over 15 years. Multiple studies have demonstrated efficacy nearing that of extirpative surgery for certain urologic conditions. There are technical limitations to their speed and safety profile because of the physical limits of thermal diffusion. Recently, there has been a desire to investigate other forms of energy in an effort to circumvent the limitations of cryoblation and radiofrequency ablation. This review will focus on three relatively new energy applications as they pertain to tissue ablation: microwave, irreversible electroporation, and water vapor. High-intensity-focused ultrasound nor interstitial lasers are discussed, as there have been no recently published updates. Needle and probe-based ablative treatments will continue to play an important role. As three-dimensional imaging workstations move from the advanced radiologic interventional suite to the operating room, surgeons will likely still play a pivotal role in the +-application of these probe ablative devices. It is essential that the surgeon understands the fundamentals of these devices in order to optimize their application.

Monitoring radiofrequency ablation with ultrasound Nakagami imaging.

PubMed

Wang, Chiao-Yin; Geng, Xiaonan; Yeh, Ta-Sen; Liu, Hao-Li; Tsui, Po-Hsiang

2013-07-01

Radiofrequency ablation (RFA) is a widely used alternative modality in the treatment of liver tumors. Ultrasound B-mode imaging is an important tool to guide the insertion of the RFA electrode into the tissue. However, it is difficult to visualize the ablation zone because RFA induces the shadow effect in a B-scan. Based on the randomness of ultrasonic backscattering, this study proposes ultrasound Nakagami imaging, which is a well-established method for backscattered statistics analysis, as an approach to complement the conventional B-scan for evaluating the ablation region. Porcine liver samples (n = 6) were ablated using a RFA system and monitored by employing an ultrasound scanner equipped with a 7.5 MHz linear array transducer. During the stages of ablation (0-12 min) and postablation (12-24 min), the raw backscattered data were acquired at a sampling rate of 30 MHz for B-mode, Nakagami imaging, and polynomial approximation of Nakagami imaging. The contrast-to-noise ratio (CNR) was also calculated to compare the image contrasts of the B-mode and Nakagami images. The results demonstrated that the Nakagami image has the ability to visualize changes in the backscattered statistics in the ablation zone, including the shadow region during RFA. The average Nakagami parameter increased from 0.2 to 0.6 in the ablation stage, and then decreased to approximately 0.3 at the end of the postablation stage. Moreover, the CNR of the Nakagami image was threefold that of the B-mode image, showing that the Nakagami image has a better image contrast for monitoring RFA. Specifically, the use of the polynomial approximation equips the Nakagami image with an enhanced ability to estimate the range of the ablation region. This study demonstrated that ultrasound Nakagami imaging based on the analysis of backscattered statistics has the ability to visualize the RFA-induced ablation zone, even if the shadow effect exists in the B-scan.

EU-FP7-iMARS: analysis of Mars multi-resolution images using auto-coregistration, data mining and crowd source techniques: A Mid-term Report

NASA Astrophysics Data System (ADS)

Muller, J.-P.; Yershov, V.; Sidiropoulos, P.; Gwinner, K.; Willner, K.; Fanara, L.; Waelisch, M.; van Gasselt, S.; Walter, S.; Ivanov, A.; Cantini, F.; Morley, J. G.; Sprinks, J.; Giordano, M.; Wardlaw, J.; Kim, J.-R.; Chen, W.-T.; Houghton, R.; Bamford, S.

2015-10-01

Understanding the role of different solid surface formation processes within our Solar System is one of the fundamental goals of planetary science research. There has been a revolution in planetary surface observations over the last 8 years, especially in 3D imaging of surface shape (down to resolutions of 10s of cms) and subsequent terrain correction of imagery from orbiting spacecraft. This has led to the potential to be able to overlay different epochs back to the mid-1970s. Within iMars, a processing system has been developed to generate 3D Digital Terrain Models (DTMs) and corresponding OrthoRectified Images (ORIs) fully automatically from NASA MRO HiRISE and CTX stereo-pairs which are coregistered to corresponding HRSC ORI/DTMs. In parallel, iMars has developed a fully automated processing chain for co-registering level-1 (EDR) images from all previous NASA orbital missions to these HRSC ORIs and in the case of HiRISE these are further co-registered to previously co-registered CTX-to-HRSC ORIs. Examples will be shown of these multi-resolution ORIs and the application of different data mining algorithms to change detection using these co-registered images. iMars has recently launched a citizen science experiment to evaluate best practices for future citizen scientist validation of such data mining processed results. An example of the iMars website will be shown along with an embedded Version 0 prototype of a webGIS based on OGC standards.

Longitudinal outcomes of radiofrequency ablation versus surveillance endoscopy for Barrett's esophagus with low-grade dysplasia.

PubMed

Kahn, A; Al-Qaisi, M; Kommineni, V T; Callaway, J K; Boroff, E S; Burdick, G E; Lam-Himlin, D M; Temkit, M; Vela, M F; Ramirez, F C

2018-04-01

Radiofrequency ablation of Barrett's esophagus with low-grade dysplasia is recommended in recent American College of Gastroenterology guidelines, with endoscopic surveillance considered a reasonable alternative. Few studies have directly compared outcomes of radiofrequency ablation to surveillance and those that have are limited by short duration of follow-up. This study aims to compare the long-term effectiveness of radiofrequency ablation versus endoscopic surveillance in a large, longitudinal cohort of patients with Barrett's esophagus, and low-grade dysplasia.We conducted a retrospective analysis of patients with confirmed low-grade dysplasia at a single academic medical center from 1991 to 2014. Patients progressing to high-grade dysplasia or esophageal adenocarcinoma within one year of index LGD endoscopy were defined as missed dysplasia and excluded. Risk factors for progression were assessed via Cox proportional hazards model. Comparison of progression risk was conducted using a Kaplan-Meier analysis. Subset analyses were conducted to examine the effect of reintroducing early progressors and excluding patients diagnosed prior to the advent of ablative therapy. Of 173 total patients, 79 (45.7%) underwent radiofrequency ablation while 94 (54.3%) were untreated, with median follow up of 90 months. Seven (8.9%) patients progressed to high-grade dysplasia or adenocarcinoma despite ablation, compared with 14 (14.9%) undergoing surveillance (P = 0.44). This effect was preserved when patients diagnosed prior to the introduction of radiofrequency ablation were excluded (8.9% vs 13%, P = 0.68). Reintroduction of patients progressing within the first year of follow-up resulted in a trend toward significance for ablation versus surveillance (11.1% vs 23.8%, P = 0.053).In conclusion, progression to high-grade dysplasia or adenocarcinoma was not significantly reduced in the radiofrequency ablation cohort when compared to surveillance. Despite recent studies