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Sample records for appraisal band ligation

  1. Endoscopic band ligation for colonic diverticular hemorrhage.

    PubMed

    Ishii, Naoki; Setoyama, Takeshi; Deshpande, Gautam A; Omata, Fumio; Matsuda, Michitaka; Suzuki, Shoko; Uemura, Masayo; Iizuka, Yusuke; Fukuda, Katsuyuki; Suzuki, Koyu; Fujita, Yoshiyuki

    2012-02-01

    The number of sample cases of colonic diverticular hemorrhage treated with endoscopic band ligation (EBL) has been small to date. To elucidate the safety and efficacy of EBL for colonic diverticular hemorrhage. Retrospective study. General hospital. A total of 29 patients with 31 colonic diverticula with stigmata of recent hemorrhage (SRH). Urgent colonoscopy was performed after bowel preparation. When diverticula with SRH were identified, marking with hemoclips was done near the diverticula. The endoscope was removed and reinserted after a band-ligator device was attached to the tip of endoscope. At first, EBL was attempted. In patients who could not be treated with EBL, epinephrine injection or endoscopic clipping was performed. Procedure time, rate of hemostasis and rebleeding, complications. The mean procedure time was 47 ± 19 minutes. EBL was successfully completed in 27 colonic diverticula (87%); except in 3 diverticula with a small orifice and large dome and 1 diverticula in which the orifice was too large. Early rebleeding after EBL occurred in 3 of 27 cases (11%). Although 2 cases of sigmoid rebleeding could be managed by repeat EBL or conservatively, right hemicolectomy was performed in 1 ascending diverticulum, in which the bleeding source was not identified on repeat colonoscopy. Scar formation at previously banded diverticula was identified in 7 of 11 patients who underwent follow-up colonoscopy. There were no complications after EBL in any of the patients. Retrospective study. EBL is a safe and effective treatment for colonic diverticular hemorrhage, and colonic diverticula resolve after EBL. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  2. Detachable endoloop vs. elastic band ligation for bleeding esophageal varices.

    PubMed

    Naga, Mazen Ibrahim; Okasha, Hussein Hassan; Foda, Ayman Ragaei; Gomaa, Mohamed Saeed; Fouad, Ayman Mohamed; Masoud, Amgad Gerges; El-din, Hazem Hossam

    2004-06-01

    Variceal bleeding is a serious complication with a mortality rate that ranges from 20% to 50%. Patients who have variceal hemorrhage usually are treated by endoscopic injection sclerotherapy or elastic band ligation to eradicate the varices. Endoloop ligation is a newly developed technique for achieving hemostasis and variceal eradication. This study compared endoloop ligation with elastic band ligation in patients with acute esophageal variceal bleeding. Fifty patients with acute esophageal variceal bleeding were recruited: 25 were treated by elastic band ligation and 25 by endoloop ligation. Although the number of patients in whom bleeding recurred during a follow-up period of 6 months was smaller in the endoloop group (12%) vs. the band group (28%), this difference was not statistically significant. Furthermore, no statistically significant difference was found between the two groups with respect to the number of patients in whom variceal eradication was achieved, the number of treatment sessions required for variceal eradication, or the frequency of variceal recurrence. The total cost for variceal obliteration by endoloop ligation was 342 dollars per patient, whereas, the total cost of variceal eradication by elastic band ligation was 356 dollars per patient. The endoloop had certain technical advantages over band application: a better field of vision, tighter application, good results with junctional varices, and a lack of strain exerted by the device on the endoscope. Endoloop ligation is a promising new technique for management of patients with bleeding esophageal varices.

  3. [Rubber band ligation in treatment of hemorrhoids: our experience].

    PubMed

    Gaj, F; Biviano, I; Sportelli, G; Candeloro, L

    2015-01-01

    Hemorrhoids are a very common condition. The treatment depends upon persistence and severity of symptoms. For hemorrhoids of II and III grade the rubber band ligation may be therapeutic. Our aim is to report the outcomes of rubber band ligation of hemorrhoids, with a follow up of 6 months. A total of 50 patients underwent rubber band ligation for symptomatic hemorrhoids (grade II and III) without prolapse, between June 2012 and June 2014. All patients underwent plug test to rule out presence of rectal mucosal prolapse and were classified according to PATE classification (1). Each hemorrhoid was ligated with one rubber band through a ligator. All patients were evaluated immediately at the end of the procedure, after ten days and six months after the treatment. Patient's demographic and operative data were collected and analyzed. The mean patients age was 47.6±12.3 years (range 24-72). All procedures were performed without complications. Before rubber band ligation, 42 patients had rectal bleeding, 38 had perineal discomfort and 27 had itching. Ten days after the treatment, 12 patients presented self-limited rectal bleeding, but 10 of these had more hemorrhoids and underwent a second rubber band ligation. No patients complained perineal discomfort, and 8 patients had itching; 78% and 16% of patients respectively, experienced feeling of a foreign body inside the canal anal and anal pain. After 6 months, only 13 patients were occasionally symptomatic: 4 patients had rectal bleeding, 2 had perineal discomfort and 4 had itching. Three more patients presented both perineal discomfort and hitching. None had the feeling of a foreign body in anal canal or anal pain. Rubber band ligation is an efficacious, cost-effective and simple treatment for the second and third degree hemorrhoids without rectal mucosal prolapsed. In our hands, no severe complications developed and minor complications could be handled with ease.

  4. Rubber band ligation of hemorrhoids: A guide for complications

    PubMed Central

    Albuquerque, Andreia

    2016-01-01

    Rubber band ligation is one of the most important, cost-effective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vaso-vagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier’s gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis. PMID:27721924

  5. Results of rubber band ligation of esophageal varices.

    PubMed

    Leszczyszyn, J; Łebski, I; Massopust, R; Skoczylas, M; Janus, W

    2001-05-01

    The aim of the paper is to analyze the results of endoscopic rubber band ligation of esophageal varices performed between 1 January 1998 and 1 November 2000 at the Department of GI Surgery of 4th Military University Hospital. Cases of 50 patients with massive upper GI variceal bleeding present on admission or with the history of such a bleeding were reviewed. A total of 85 endoscopic procedures of rubber band ligation were performed. In 9 (18%) cases ligation was performed due to massive variceal bleeding, in 1 case the complementary obliteration of stomach fundus varices with Aethoxysclerol was performed. In 10 (20%) cases in grade C of Child-Pough scale of liver failure, 3 endoscopic procedures were performed, in 15 (30%) in grade B--2 procedures, in the remaining 25 (50%) cases, also in grade B--1 procedure was performed. Procedures were conducted with Wilson-Cook Multi-Band Ligator SAEED SixShooter. In all cases with non-bleeding esophageal varices the overall good result of treatment was achieved, with collapsing of variceal columns. In 8 (88.8%) of 9 cases treated due to variceal bleeding, good hemostasis was achieved and no reintervention was necessary. In 1 case of massive variceal bleeding endoscopic treatment failed and patient eventually died. In 25 (50%) cases the complementary (1 or 2) rubber band ligations were performed. Follow-up period has ranged from 1 to 34 months. No cases of severe complications after the procedure were noted. In early period after the procedure 43 (86%) patients complained of transient, mild retrosternal pain and mild to moderate dysphagia. Endoscopic rubber band ligation is a safe and effective treatment for esophageal varices both in cases of variceal bleeding and as elective procedure.

  6. The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids.

    PubMed

    Tiernan, Jim; Hind, Daniel; Watson, Angus; Wailoo, Allan J; Bradburn, Michael; Shephard, Neil; Biggs, Katie; Brown, Steven

    2012-10-25

    Haemorrhoids (piles) are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse), the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option.There are substantial data in the literature concerning efficacy and safety of 'rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III) haemorrhoids. A multi-centre, parallel group randomised controlled trial. The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost

  7. Endoscopic band ligation: Beyond prevention and management of gastroesophageal varices

    PubMed Central

    Ji, Jeong-Seon; Cho, Young-Seok

    2013-01-01

    Endoscopic band ligation (EBL) is the preferred endoscopic technique for the endoscopic treatment of acute esophageal variceal bleeding. EBL has also been used to treat nonvariceal bleeding. Recently, Han et al demonstrated that EBL can be a feasible and safe alternate technique for the management of iatrogenic gastric perforation especially in cases in which closure with endoclips is difficult. EBL is technically simpler to perform than other methods and provides a good view of the lesions under direct pressure and suction from the transparent ligation cap. EBL can be used even if the diameter of the perforation is greater than 10 mm or if there is a severe tangential angle. In this commentary, we discuss the efficacy and safety of EBL for the closure of iatrogenic gastrointestinal perforation. We also discuss the advantages and disadvantages of EBL for the treatment of nonvariceal bleeding. PMID:23885137

  8. Endoscopic band ligation: beyond prevention and management of gastroesophageal varices.

    PubMed

    Ji, Jeong-Seon; Cho, Young-Seok

    2013-07-21

    Endoscopic band ligation (EBL) is the preferred endoscopic technique for the endoscopic treatment of acute esophageal variceal bleeding. EBL has also been used to treat nonvariceal bleeding. Recently, Han et al demonstrated that EBL can be a feasible and safe alternate technique for the management of iatrogenic gastric perforation especially in cases in which closure with endoclips is difficult. EBL is technically simpler to perform than other methods and provides a good view of the lesions under direct pressure and suction from the transparent ligation cap. EBL can be used even if the diameter of the perforation is greater than 10 mm or if there is a severe tangential angle. In this commentary, we discuss the efficacy and safety of EBL for the closure of iatrogenic gastrointestinal perforation. We also discuss the advantages and disadvantages of EBL for the treatment of nonvariceal bleeding.

  9. Comparison of Doppler-guided haemorrhoidal artery ligation without mucopexy and rubber band ligation for haemorrhoids.

    PubMed

    Pol, Robert A; van der Zwet, Wil C; Kaijser, Mirjam; Schattenkerk, Marinus Eeftinck; Eddes, Eric-Hans

    2011-12-01

    Recurrences after Doppler-guided haemorrhoidal artery ligation (DG-HAL) tend to occur in patients with concurrent mucosal prolapse. We retrospectively compared the results of DG-HAL and rubber band ligation (RBL) for the treatment of haemorrhoidal disease. From 2005 to 2009, all patients who underwent either a DG-HAL procedure or RBL were selected. Follow-up was done by telephone using a standardised questionnaire survey to assess patient satisfaction and complaints. When recurrent disease was suspected, patients revisited the clinic for further examination and treatment. A total of 239 DG-HAL patients and 47 RBL patients were analysed. Sixty-seven percent in the DG-HAL group and 79% in the RBL group had an improvement in symptoms after one treatment (p=0.22). Forty-six DG-HAL patients (19%) needed a second procedure versus three patients (6%) in the RBL group (p<0.05). Cox regression analysis showed a significant difference in disease recurrence in favour of RBL (hazard ratio (HR) 3.71, 95% confidence interval (CI) 1.13-12.2). Patients in the DG-HAL group with recurrent haemorrhoids had a higher incidence of mucosal prolapse. DG-HAL seems very effective in treating lower-grade haemorrhoids. In more advanced disease, recurrence occurs due to persisting mucosal prolapse. RBL seems much more effective in reducing the prolapse and the chance of recurrence. Copyright © 2011 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.

  10. Endoscopic band ligation for bleeding lesions in the small bowel.

    PubMed

    Ikeya, Takashi; Ishii, Naoki; Shimamura, Yuto; Nakano, Kaoru; Ego, Mai; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2014-10-16

    To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel. This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy's lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients. Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo. EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel.

  11. Endoscopic band ligation for bleeding lesions in the small bowel

    PubMed Central

    Ikeya, Takashi; Ishii, Naoki; Shimamura, Yuto; Nakano, Kaoru; Ego, Mai; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2014-01-01

    AIM: To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel. METHODS: This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy’s lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients. RESULTS: Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo. CONCLUSION: EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel. PMID:25324920

  12. A comparative study of Barron's rubber band ligation with Kshar Sutra ligation in hemorrhoids

    PubMed Central

    Singh, Rakhi; Arya, Ramesh C.; Minhas, Satinder S.; Dutt, Anil

    2010-01-01

    Despite a long medical history of identification and treatment, hemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease. In this study, Kshar Sutra Ligation (KSL), a modality of treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation (RBL) for grade II and grade III hemorrhoids. This study was conducted in 20 adult patients of either sex with grade II and grade III hemorrhoids at two different hospitals. Patients were randomly allotted to two groups of 10 patients each. Group I patients underwent RBL, whereas patients of group II underwent KSL. Guggul-based Apamarga Kshar Sutra was prepared according to the principles laid down in ancient Ayurvedic texts and methodology standardized by IIIM, Jammu and CDRI, Lucknow. Comparative assessment of RBL and KSL was done according to 16 criteria. Although the two procedures were compared on 15 criteria, treatment outcome of grade II and grade III hemorrhoids was decided chiefly on the basis of patient satisfaction index (subjective criterion) and ability of each procedure to deal with prolapse of internal hemorrhoidal masses (objective criterion): Findings in each case were recorded over a follow-up of four weeks (postoperative days 1, 3, 7, 15 and 30). Statistical analysis was done using Student's t test for parametric data and Chi square test & Mann-Whitney test for non-parametric data. P < 0.05 was considered significant. RBL had the advantages of being an OPD procedure requiring no anesthesia and was attended by significantly lesser postoperative recumbency (P < 0.001 ) and significantly lesser pain (P < 0.005 on day 1) as compared to KSL. However, Group II (KSL) scored better in terms of treatment outcome. In Group II, there was significantly high (P < 0.05) patient satisfaction index as compared to Group I. Group II reported 100% 'cure' (absence of hemorrhoidal masses even on proctoscopy) of internal hemorrhoidal prolapse as against 80

  13. A comparative study of Barron's rubber band ligation with Kshar Sutra ligation in hemorrhoids.

    PubMed

    Singh, Rakhi; Arya, Ramesh C; Minhas, Satinder S; Dutt, Anil

    2010-04-01

    Despite a long medical history of identification and treatment, hemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease. In this study, Kshar Sutra Ligation (KSL), a modality of treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation (RBL) for grade II and grade III hemorrhoids. This study was conducted in 20 adult patients of either sex with grade II and grade III hemorrhoids at two different hospitals. Patients were randomly allotted to two groups of 10 patients each. Group I patients underwent RBL, whereas patients of group II underwent KSL. Guggul-based Apamarga Kshar Sutra was prepared according to the principles laid down in ancient Ayurvedic texts and methodology standardized by IIIM, Jammu and CDRI, Lucknow. Comparative assessment of RBL and KSL was done according to 16 criteria. Although the two procedures were compared on 15 criteria, treatment outcome of grade II and grade III hemorrhoids was decided chiefly on the basis of patient satisfaction index (subjective criterion) and ability of each procedure to deal with prolapse of internal hemorrhoidal masses (objective criterion): Findings in each case were recorded over a follow-up of four weeks (postoperative days 1, 3, 7, 15 and 30). Statistical analysis was done using Student's t test for parametric data and Chi square test & Mann-Whitney test for non-parametric data. P < 0.05 was considered significant. RBL had the advantages of being an OPD procedure requiring no anesthesia and was attended by significantly lesser postoperative recumbency (P < 0.001 ) and significantly lesser pain (P < 0.005 on day 1) as compared to KSL. However, Group II (KSL) scored better in terms of treatment outcome. In Group II, there was significantly high (P < 0.05) patient satisfaction index as compared to Group I. Group II reported 100% 'cure' (absence of hemorrhoidal masses even on proctoscopy) of internal hemorrhoidal prolapse as against 80

  14. Comments to 'Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids'.

    PubMed

    Brown, S R; Watson, A

    2016-09-01

    To review the efficacy and safety of the two most popular conventional methods of haemorrhoidal treatment, rubber band ligation and excisional haemorrhoidectomy (EH). The original study has now been updated using the same search strategy. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL up to October 2010. Randomised controlled trials comparing rubber band ligation with EH for symptomatic haemorrhoids in adult human patients were included. We extracted data on to a previously designed data extraction sheet. Dichotomous data were presented as relative risk and 95 % confidence intervals, and continuous outcomes as weighted mean difference and 95 % confidence intervals. Three trials (of poor methodological quality) met the inclusion criteria. Complete remission of haemorrhoidal symptom was better with EH (three studies, 202 patients, RR 1.68, 95 % CI 1.00-2.83). There was a significant heterogeneity between the studies (I2 = 90.5 %; P = 0.0001). Similar analysis based on the grading of haemorrhoids revealed the superiority of EH over RBL for grade III haemorrhoids (prolapse that needs manual reduction) (two trials, 116 patients, RR 1.23, CI 1.04-1.45; P = 0.01). However, no significant difference was noticed in grade II haemorrhoids (prolapse that reduces spontaneously on cessation of straining) (one trial, 32 patients, RR 1.07, CI 0.94-1.21; P = 0.32). Fewer patients required re-treatment after EH (three trials, RR 0.20, CI 0.09-0.40; P < 0.00001). Patients undergoing EH were at significantly higher risk of post-operative pain (three trials, fixed effect; 212 patients, RR 1.94, 95 % CI 1.62-2.33, P < 0.00001) and of delayed complications (three trials, 204 patients, RR 6.32, CI 1.15-34.89; P = 0.03). The present systematic review confirms the long-term efficacy of EH, at least for grade III haemorrhoids, compared to the less invasive technique of RBL but at the expense of increased pain, higher complications and more time off work. However, despite

  15. A prospective randomised study of local anaesthetic injection after multiple rubber band ligation of haemorrhoids.

    PubMed

    Gokalp, Avni; Baskonus, Ilyas; Maralcan, Gokturk

    2003-01-01

    One hundred and forty-two patients with second and third degree internal haemorrhoids were randomised to rubber band ligation only (n = 72) or rubber band ligation + local anaesthetic injection (n = 70). Pain was assessed by the patients at intervals of 6 hours and 1, 2, 3 and 4 days after banding. Other symptoms, complications, analgesic requirements and patient satisfaction were also recorded for 10 days following the treatment. There was a significant reduction in pain at 60 minutes and 6 hours after the procedure in the rubber band ligation plus local anaesthetic injection patients compared with the rubber band ligation only group (P < 0.05), but there was no reduction in pain when local anaesthetic was used compared with rubber band ligation only on days 1, 2, 3 and 4 days after ligation. On day 10 after banding, there was no difference between the two groups with respect to symptoms such as nausea, feeling of heaviness and/or tenesmus, fainting; complications, analgesic consumption or overall patient satisfaction. Bupivacaine injection after multiple rubber band ligation may be useful in reducing pain during the first 6 hours of the postbanding period.

  16. Endoscopic band ligation for colonic diverticular bleeding: possibility of standardization

    PubMed Central

    Shimamura, Yuto; Ishii, Naoki; Omata, Fumio; Imamura, Noriatsu; Okamoto, Takeshi; Ego, Mai; Nakano, Kaoru; Ikeya, Takashi; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2016-01-01

    Background and aims: Endoscopic band ligation (EBL) has been used to achieve hemostasis in patients with colonic diverticular bleeding. The safety and effectiveness of EBL when performed by non-expert endoscopists have not been sufficiently verified. This study aimed to elucidate the feasibility of the EBL technique when performed by non-expert endoscopists and of considering EBL as a standard treatment for colonic diverticular bleeding. Patients and methods: A retrospective cohort study was conducted in a tertiary referral center in Tokyo, Japan, between June 2009 and October 2014. A total of 95 patients treated with EBL were included in the study and were divided into two groups according to whether they had been treated by expert or non-expert endoscopists. Comorbidities, medications, shock index, hemoglobin level on admission, location of the bleeding diverticula, rate of bowel preparation, procedure time, and EBL-associated adverse events were evaluated in each group. Multivariate linear regression analyses were used to investigate factors related to EBL procedure time, which is the time elapsed between marking the site of bleeding with hemoclips and completion of the band release. Results: A total of 47 (49.5 %) procedures were performed by expert endoscopists. In a bivariate analysis, the median EBL procedure times in the expert and non-expert groups were 15 minutes (range 4 – 45) and 11 minutes (range 4 – 36), respectively (P = 0.03). When a multivariate linear regression model was used, EBL for right-sided diverticula was the factor most significantly affecting EBL procedure time. No adverse events were encountered. Conclusion: EBL can be safely and effectively performed by non-expert endoscopists. A right-sided location of diverticula was the factor most significantly affecting EBL procedure time. PMID:26878056

  17. Endoscopic band ligation for colonic diverticular bleeding: possibility of standardization.

    PubMed

    Shimamura, Yuto; Ishii, Naoki; Omata, Fumio; Imamura, Noriatsu; Okamoto, Takeshi; Ego, Mai; Nakano, Kaoru; Ikeya, Takashi; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2016-02-01

    Endoscopic band ligation (EBL) has been used to achieve hemostasis in patients with colonic diverticular bleeding. The safety and effectiveness of EBL when performed by non-expert endoscopists have not been sufficiently verified. This study aimed to elucidate the feasibility of the EBL technique when performed by non-expert endoscopists and of considering EBL as a standard treatment for colonic diverticular bleeding. A retrospective cohort study was conducted in a tertiary referral center in Tokyo, Japan, between June 2009 and October 2014. A total of 95 patients treated with EBL were included in the study and were divided into two groups according to whether they had been treated by expert or non-expert endoscopists. Comorbidities, medications, shock index, hemoglobin level on admission, location of the bleeding diverticula, rate of bowel preparation, procedure time, and EBL-associated adverse events were evaluated in each group. Multivariate linear regression analyses were used to investigate factors related to EBL procedure time, which is the time elapsed between marking the site of bleeding with hemoclips and completion of the band release. A total of 47 (49.5 %) procedures were performed by expert endoscopists. In a bivariate analysis, the median EBL procedure times in the expert and non-expert groups were 15 minutes (range 4 - 45) and 11 minutes (range 4 - 36), respectively (P = 0.03). When a multivariate linear regression model was used, EBL for right-sided diverticula was the factor most significantly affecting EBL procedure time. No adverse events were encountered. EBL can be safely and effectively performed by non-expert endoscopists. A right-sided location of diverticula was the factor most significantly affecting EBL procedure time.

  18. Triple rubber band ligation for hemorrhoids: prospective, randomized trial of use of local anesthetic injection.

    PubMed

    Law, W L; Chu, K W

    1999-03-01

    Rubber band ligation is a common office procedure for hemorrhoids. Triple rubber band ligation in a single session has been shown to be a safe and economical way of treating hemorrhoids. However, postligation discomfort after triple rubber band ligation is not uncommon. The aim of this study was to evaluate the effectiveness of local anesthetic injection to the banded hemorrhoidal tissue in reducing postligation discomfort. Patients attending an outpatient clinic for symptomatic hemorrhoids suitable for triple rubber band ligation were randomly assigned to two groups. In the treatment group rubber band ligation was performed at three columns of hemorrhoids, and 1 to 2 ml of 2 percent lignocaine was injected into the banded hemorrhoidal tissue. In the control group triple rubber band ligation was performed in a similar manner, but local anesthetic was not given. Patients were followed up by telephone at the second week and in the clinic after six weeks. From April to August 1996, 101 patients entered the trial and were treated with triple rubber band ligation. Sixty-two patients were randomly assigned to the local anesthetic injection group and 39 to the control group. Overall good to excellent results occurred in 89 percent of patients, and there was no difference between the two groups. Postligation pain occurred in 26 and 20 percent of patients in the treatment and control groups, respectively (P > 0.05). Postligation tenesmus occurred in 32 and 41 percent of patients in the treatment and control groups, respectively (P > 0.05). No patients suffered from septic complications or bleeding that required transfusion. Triple rubber band ligation in a single session is a safe, economical, and effective way of treating symptomatic hemorrhoids. Postligation pain and tenesmus occurred in 24 and 37 percent, respectively. Discomfort was usually tolerable. Local anesthetic injection to the banded hemorrhoidal tissue did not help to reduce postligation discomfort.

  19. Long-term result after rubber band ligation for haemorrhoids.

    PubMed

    Forlini, Antonio; Manzelli, Antonio; Quaresima, Silvia; Forlini, Massimo

    2009-09-01

    Rubber band ligation (RBL) is a well-known and recognised outpatient procedure utilised for the treatment of symptomatic internal haemorrhoids. This paper describes a retrospective study which analyses the short- and long-term results of a personal series of patients. A consecutive group of 206 patients with symptomatic internal second- and third-degree haemorrhoids were treated with RBL as outpatients from 1982 to 1989. Two or three piles were legated in a single session. All patients were systematically visited after 1 month and 1 year. Respectively after 10 and 17 years, all the patients were contacted to obtain a telephone follow-up. The short-term follow-up at 1 month and at 1 year showed that 46% of the patients experienced moderate anal pain for 24 h post procedure. Two patients had severe pain (1%) and were admitted in the hospital to be submitted to an operative haemorrhoidectomy within a few days. Only 2.4% of the patients experienced rectal bleeding after a week, and 20% had a second session of RBL after 1 month. At 1 year follow-up, 90% of the patients with second-degree piles and 75% of patients with third-degree piles reported no residual symptoms. The long-term telephone follow-up at 10 and 17 years collected the history of 138 patients (67%). A group of 69% was asymptomatic, 28% had residual symptoms, and 3% needed further surgery. RBL is a safe and effective treatment for symptomatic internal haemorrhoids. Our long-term follow-up demonstrated good long-term results for internal second- and third-degree haemorrhoids.

  20. Can 5-aminosalicylic acid suppository decrease the pain after rectal band ligation?

    PubMed Central

    Kayhan, Burcak; Ozer, Digdem; Akdogan, Meral; Ozaslan, Ersan; Yuksel, Osman

    2008-01-01

    AIM: To investigate the effect of 5-aminosalicylic acid (5-ASA) suppositories on rectal band ligation-induced pain. METHODS: Sixty patients were randomized into two treatment groups. RESULTS: Our results showed that there was no difference between 5-ASA suppository group and the control group for pain control. CONCLUSION: 5-ASA may be an alternative treatment for hemorrhoids; however, it does not affect the rectal band ligation-induced pain. PMID:18567081

  1. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis

    PubMed Central

    2010-01-01

    Background Endoscopic band ligation (EBL) is generally accepted as the treatment of choice for bleeding from esophageal varices. It is also used for secondary prophylaxis of esophageal variceal hemorrhage. However, there is no data or guidelines concerning endoscopic control of ligation ulcers. We conducted a retrospective study of EBL procedures analyzing bleeding complications after EBL. Methods We retrospectively analyzed data from patients who underwent EBL. We analyzed several data points, including indication for the procedure, bleeding events and the time interval between EBL and bleeding. Results 255 patients and 387 ligation sessions were included in the analysis. We observed an overall bleeding rate after EBL of 7.8%. Bleeding events after elective treatment (3.9%) were significantly lower than those after treatment for acute variceal hemorrhage (12.1%). The number of bleeding events from ligation ulcers and variceal rebleeding was 14 and 15, respectively. The bleeding rate from the ligation site in the group who underwent emergency ligation was 7.1% and 0.5% in the group who underwent elective ligation. Incidence of variceal rebleeding did not vary significantly. Seventy-five percent of all bleeding episodes after elective treatment occurred within four days after EBL. 20/22 of bleeding events after emergency ligation occured within 11 days after treatment. Elective EBL has a lower risk of bleeding from treatment-induced ulceration than emergency ligation. Conclusions Patients who underwent EBL for treatment of acute variceal bleeding should be kept under medical surveillance for 11 days. After elective EBL, it may be reasonable to restrict the period of surveillance to four days or even perform the procedure in an out-patient setting. PMID:20074379

  2. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis.

    PubMed

    Petrasch, Florian; Grothaus, Johannes; Mössner, Joachim; Schiefke, Ingolf; Hoffmeister, Albrecht

    2010-01-15

    Endoscopic band ligation (EBL) is generally accepted as the treatment of choice for bleeding from esophageal varices. It is also used for secondary prophylaxis of esophageal variceal hemorrhage. However, there is no data or guidelines concerning endoscopic control of ligation ulcers. We conducted a retrospective study of EBL procedures analyzing bleeding complications after EBL. We retrospectively analyzed data from patients who underwent EBL. We analyzed several data points, including indication for the procedure, bleeding events and the time interval between EBL and bleeding. 255 patients and 387 ligation sessions were included in the analysis. We observed an overall bleeding rate after EBL of 7.8%. Bleeding events after elective treatment (3.9%) were significantly lower than those after treatment for acute variceal hemorrhage (12.1%). The number of bleeding events from ligation ulcers and variceal rebleeding was 14 and 15, respectively. The bleeding rate from the ligation site in the group who underwent emergency ligation was 7.1% and 0.5% in the group who underwent elective ligation. Incidence of variceal rebleeding did not vary significantly. Seventy-five percent of all bleeding episodes after elective treatment occurred within four days after EBL. 20/22 of bleeding events after emergency ligation occurred within 11 days after treatment. Elective EBL has a lower risk of bleeding from treatment-induced ulceration than emergency ligation. Patients who underwent EBL for treatment of acute variceal bleeding should be kept under medical surveillance for 11 days. After elective EBL, it may be reasonable to restrict the period of surveillance to four days or even perform the procedure in an out-patient setting.

  3. Chronology of histological changes after band ligation of esophageal varices in humans.

    PubMed

    Polski, J M; Brunt, E M; Saeed, Z A

    2001-05-01

    While the histological effects of endoscopic sclerotherapy in humans have been extensively described, the effects of endoscopic ligation have been reported in only two cases. The purpose of this study was to reconstruct the chronological sequence of histological changes after ligation of esophageal varices. Autopsy specimens from six patients who received ligation of varices from nine hours to 22 months ante-mortem were evaluated for gross and microscopic changes. Early after ligation, the appearance was that of a polyp with its base compressed by the band. Variceal thrombosis was seen on day 2. Varying degrees of ischemic necrosis of the polyp were present on days 0-5. If the bands did not remain in situ for two days (premature loss), necrosis of the polyp and dilated variceal vessels were seen. On day 22, superficial ulcers were observed. After complete healing, fibrosis was seen in the submucosa. The changes seen in the present study are similar to those described in animals. The delay in ulcer healing, compared with the gross changes reported during follow-up endoscopic examinations, may be related to the severity of the underlying illness and the compromised immune status of patients in the present series.

  4. Comparison between Ultroid and rubber band ligation in treatment of internal hemorrhoids.

    PubMed

    Azizi, Rasoul; Rabani-Karizi, Behzad; Taghipour, Mohammad Ali

    2010-01-01

    Hemorrhoid is one of the most common surgical diseases and different methods are available for its treatment. This study is a comparison between two methods of treatment of internal hemorrhoid, Monopolar low voltage instrument (Ultroid) and Rubber Band Ligation. This method has been carried out prospectively in which 50 patients who were treated with rubber band ligation and 50 patients with Ultroid were compared according to the incidence of complications, post-operative pain and treatment response. According to this study complete success rate with Ultroid was 82% and partial success rate was 10% and no response to treatment was seen in 8%. In Rubber Band method the complete response rate was 94% (P=0.2). With Ultroid, 74% of patient reported no postoperative pain, 24% reported mild and moderate pain and 2% of patients complained of severe pain. With Rubber band ligation, 72% of patients reported no post-operative pain, 26% reported mild and moderate pain and 1% complained of severe pain (P=0.00). Rubber Band ligation and Ultroid are both considered as outpatient procedures for treatment of hemorrhoids. Both methods are mostly used for grade 1, 2 and sometime grade 3 hemorrhoids. In Ultroid method the operator is required to hold the probe for a period of time, and in most cases, the surgeon should spend between 20-25 minutes for the coagulation of three piles. Some surgeons do not have patience for this modality of internal hemorrhoid treatment. In this study we achieved acceptable results comparable with those of other techniques.

  5. [Endoscopic rubber band ligation in treatment of esophageal varices bleeding. Personal experience].

    PubMed

    Geraci, G; Arnone, E; Lo Nigro, C; Sciuto, A; Modica, G; Sciumè, C

    2011-03-01

    Bleeding esophageal varices is the most serious complication of the portal hypertension, and the greater cause of dead (25% of the patients). The survival after esophageal varices bleeding depends in wide part from the swiftness and effectiveness of hemostasis and from the degree of functional liver reserve. Aim of our manuscript is to report our experience about hemostasis bleeding esophageal varices with endoscopic rubber band ligation. From January 1999 to January 2008 we performed 302 esofagogastroduodenoscopy (EGDS) for esophageal varices bleeding (M: F ratio = 1.4:1, mean age 56.4 years, 62% of cases with HCV-related cirrhosis, 29% alcoholic cirrhosis and 9% cryptogenic cirrhosis; 20% suffered from chronic renal failure, 15% diabetes mellitus, 10% hepatocellular carcinoma on cirrhosis, 5% systemic encephalopathy and 1% AIDS). RESULTS; All patients were treated within 6 hours after the first reported episode of haematemesis and all received beta-blocker therapy after the episode. In the first phase of our experience were used rechargeable elastic ligator and then multibyte, even in combination with polidocanol sclerotherapy (8%) or injection of cyanoacrylate (5%). The best results were achieved with band ligation, in terms of primitive haemostasis, rebleeding, (3%), intraoperative mortality (1%) and 6 weeks mortality (1%). To date, no single method applicable to all patients with bleeding esophageal varices, but endoscopic rubber band ligation is currently considered the first-line treatment of proper multidisciplinary approach to the patient, both during the acute event than prevention of rebleeding, because it is an effective, safe and repeatable, in experienced hands.

  6. Comparison of rubber band ligation and sclerosant injection for first and second degree haemorrhoids-- a prospective clinical trial.

    PubMed

    Sim, A J; Murie, J A; Mackenzie, I

    1981-01-01

    Fifty patients with first or mild second degree haemorrhoids were randomly allocated to sclerosant injection (26) or rubber band ligation (24). One year after treatment 24 injection and 22 rubber band ligation patients were assessed. All patients presented with rectal bleeding; injection relieved 14 and rubber band ligation relieved 17 of this symptom (N.S.). Three of seven patients with prolapsing haemorrhoids who had sclerosant injections and five of seven who had rubber band ligation were relieved of this prolapse. However, a further six patients in the injection group developed prolapse for the first time during the one year follow-up period (p less than 0.05). Rubber band ligation relieved anal pain in 10 out of 14 patients whereas injection relieved only one patient of this symptom (p less than 0.05). Neither treatment influenced pruritus ani or faecal soiling. Although rubber band ligation caused more treatment discomfort, it is an effective management for first and mild second degree haemorrhoids and it should be considered as the procedure of choice.

  7. A prospective study of outcome from rubber band ligation in third degree haemorrhoids.

    PubMed

    Khan, Asma Niaz; Khan, Naveed Ali

    2010-11-01

    To evaluate the efficacy and effectiveness of rubber band ligation on 3rd degree haemorrhoids. Study was done at Surgical Unit, Civil Hospital Karachi, during a period of 19 months from December 2006 to July 2008. Out of 344 patients 80 patients were included in the study with 3rd degree internal haemorrhoids and were treated with Rubber band ligation (RBL). Outcome data was recorded for success of treatment. Among 80 patients, 77 (96.25%) were symptom free. After completion of treatment, 1 (16.66%) out of 5 patients had the complaint of pain, 2 (2.85%) out of 70 had complaints of constipation. Before start of treatment 5 (6.25%) patients complained of bleeding per rectum and 73 (91.25%) complained of manually reducible/prolapsed haemorrhoids. Both complaints were cured 100% after treatment. RBL is an efficient, cost-effective and simple out patient procedure for symptomatic third degree haemorrhoids with minimum complications. RBL is a reliable, safe procedure requiring no hospitalization and no use of any anaesthetic drugs.

  8. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases

    PubMed Central

    Nakeeb, Ayman M El; Fikry, Amir A; Omar, Waleed H; Fouda, Elyamani M; Metwally, Tito A El; Ghazy, Hosam E; Badr, Sabry A; Elkhar, Mohmed Y Abu; Elawady, Salih M; Elmoniam, Hisham H Abd; Khafagy, Waiel W; Morshed, Mosaad M; Lithy, Ramadan E El; Farid, Mohamed E

    2008-01-01

    AIM: To study the results for the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) method. METHODS: A retrospective study for 750 patients who came to the colorectal unit from June, 1998 to September, 2006, data was retrieved from archived files. RBL was performed using the Mc Gown applicator on an outpatient basis. The patients were asked to return to out-patient clinic for follow up at 2 wk, 1 mo, 6 mo and through telephone call every 6 mo for 2 years). RESULTS: After RBL, 696 patients (92.8%) were cured with no difference in outcome for second or third degree hemorrhoids (P = 0.31). Symptomatic recurrence was detected in 11.04% after 2 years. A total of 52 patients (6.93%) had 77 complications from RBL which required no hospitalization. Complications were pain, rectal bleeding and vaso-vagal symptoms (4.13%, 4.13% and 1.33% of patients, respectively). At 1 mo there were a significant improvement in mean SF-36 scores over baseline in five items, while after 2 years there were improvement in all items over baseline, but not significant. No significant manometric changes after band ligation. CONCLUSION: RBL is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an out patient procedure with significant improvement in quality of life. RBL doesn’t alter ano-rectal functions. PMID:19030206

  9. Rubber band ligation of haemorrhoids in the out-patient clinic.

    PubMed Central

    Kumar, N.; Paulvannan, S.; Billings, P. J.

    2002-01-01

    Rubber band ligation (RBL) is an effective treatment for symptomatic haemorrhoids but carries significant morbidity. We performed a prospective study of 98 consecutive patients treated by RBL in the out-patient clinic. Immediate, intermediate (within 2 weeks) and late (within 2 months) complications were recorded. Immediate complications occurred in 66 (67.3%) patients. Pain was the predominant symptom in 50 patients (51%). Fifteen (15.3%) patients had vasovagal attacks and 1 (1%) had bleeding. Twenty-five patients (25.5%) were unable to perform normal activities on the day of RBL. One patient needed hospital admission for control of pain. Seventy four (75.5%) patients would have RBL if they needed further treatment for haemorrhoids. Symptomatic cure was achieved in 71 patients (72.4%). RBL is an effective treatment but with significant complications. Patients should be adequately warned, especially of pain and vasovagal attacks. PMID:12092868

  10. Comparison between endoscopic sclerotherapy and band ligation for hemostasis of acute variceal bleeding

    PubMed Central

    Luz, Gustavo Oliveira; Maluf-Filho, Fauze; Matuguma, Sérgio Eiji; Hondo, Fábio Yuji; Ide, Edson; Melo, Jeane Martins; Cheng, Spencer; Sakai, Paulo

    2011-01-01

    AIM: To compare band ligation (BL) with endoscopic sclerotherapy (SCL) in patients admitted to an emergency unit for esophageal variceal rupture. METHODS: A prospective, randomized, single-center study without crossover was conducted. After endoscopic diagnosis of esophageal variceal rupture, patients were randomized into groups for SCL or BL treatment. Sclerotherapy was performed by ethanolamine oleate intravascular injection both above and below the rupture point, with a maximum volume of 20 mL. For BL patients, banding at the rupture point was attempted, followed by ligation of all variceal tissue of the distal esophagus. Primary outcomes for both groups were initial failure of bleeding control (5 d), early re-bleeding (5 d to 6 wk), and complications, including mortality. From May 2005 to May 2007, 100 patients with variceal bleeding were enrolled in the study: 50 SCL and 50 BL patients. No differences between groups were observed across gender, age, Child-Pugh status, presence of shock at admission, mean hemoglobin levels, and variceal size. RESULTS: No differences were found between groups for bleeding control, early re-bleeding rates, complications, or mortality. After 6 wk, 36 (80%) SCL and 33 (77%) EBL patients were alive and free of bleeding. A statistically significant association between Child-Pugh status and mortality was found, with 16% mortality in Child A and B patients and 84% mortality in Child C patients (P<0.001). CONCLUSION: Despite the limited number of patients included, our results suggest that SCL and BL are equally efficient for the control of acute variceal bleeding. PMID:21772940

  11. Local anaesthetic infiltration for the rubber band ligation of early symptomatic haemorrhoids: a systematic review and meta-analysis.

    PubMed

    Sajid, M S; Bhatti, M I; Caswell, J; Sains, P; Baig, M K

    2015-03-01

    The objective of this article is to systematically analyse the randomized, controlled trials evaluating the effectiveness of local anaesthetic infiltration prior to the rubber band ligation of early symptomatic haemorrhoids. Published randomized, controlled trials comparing the use of local anaesthetic (LA) versus no-local anaesthetic (NLA) for the rubber band ligation of early symptomatic haemorrhoids were analysed using RevMan®, and the combined outcomes were expressed as odds ratios (OR) and standardized mean difference (SMD). Four randomized, controlled trials evaluating 387 patients were retrieved from the standard electronic databases. The risk of treatment failure (OR 0.44; 95% CI 0.07, 2.79; z = 0.87; p = 0.39) and post-procedure complications (OR 0.48; 95% CI 0.08, 2.76; z = 0.83; p = 0.41) was similar between two techniques. However, the post-procedure pain score (SMD -5.19; 95% CI -9.08, -1.30; z = 2.62; p < 0.009) was significantly lower in the group of patients undergoing rubber band ligation of haemorrhoids under local anaesthetic injection. The use of LA appears to have clinically measurable advantages over NLA in the rubber band ligation of early symptomatic haemorrhoids to lessen post-procedure pain.

  12. Endoscopic band ligation with a water-jet scope for the treatment of colonic diverticular hemorrhage.

    PubMed

    Ishii, Naoki; Itoh, Toshiyuki; Uemura, Masayo; Maruyama, Masataka; Horiki, Noriyuki; Setoyama, Takeshi; Matsuda, Michitaka; Suzuki, Shoko; Iizuka, Yusuke; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2010-07-01

    Although lower gastrointestinal bleeding generally has a less severe course and stops spontaneously in most cases without therapeutic intervention, some patients require endoscopic, surgical, or angiographic treatment depending on the nature of the bleeding. We applied endoscopic band ligation (EBL) with a water-jet scope to bleeding colonic diverticula and evaluated the efficacy and safety of EBL retrospectively. Five consecutive patients were diagnosed as having colonic diverticular hemorrhage, and were treated with EBL at St Luke's International Hospital in Tokyo from June 2009 to August 2009. Comorbid diseases, usage of anti-platelet agents, hemoglobin level on admission, procedural time, complications such as perforation and abscess formation, and rebleeding after EBL were retrospectively evaluated. In all cases, EBL achieved successful immediate hemostasis without any procedural complications. In four of five cases, bleeding colonic diverticula were everted after EBL. The mean length of hospital stay after EBL was 5 days (range 4-8 days). No patient exhibited clinical evidence of further bleeding during the mean follow-up period of 3 months (range 2-4 months), and no further intervention was needed after EBL. EBL with a water-jet scope is considered to be a safe and effective endoscopic treatment for colonic diverticular hemorrhage.

  13. Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation

    PubMed Central

    Park, Seung Woon; Lee, Han Ah; Park, Sang Jung; Kim, Tae Hyung; Lee, Jae Min; Suh, Sang Jun; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Jung, Young Kul; An, Hyonggin; Yim, Hyung Joon; Jeen, Yoon Tae; Yeon, Jong Eun; Lee, Hong Sik; Chun, Hoon Jai; Byun, Kwan Soo; Um, Soon Ho; Kim, Chang Duck

    2016-01-01

    Background and Aims. Cardiac varices (CVs) in patients with type 1 gastroesophageal varices (GOV1s) usually disappear with treatment for esophageal varices (EVs) by endoscopic injection sclerotherapy (EIS). However, whether this applies to patients treated with endoscopic band ligation (EBL) for EVs remains unclear. We evaluated the effect of EVs eradication by EBL on CVs. Methods. We included cirrhotic patients whose EVs had been eradicated using EBL and excluded those who had been treated using EIS, those who had received endoscopic therapy for CVs, and those who were combined with hepatocellular carcinoma. Results. A total of 123 patients were enrolled. The age was 59.7 ± 11.7 years, and 96 patients (78.0%) were men. Thirty-eight patients (30.9%) had EVs only, while 85 (69.1%) had GOV1s. After EVs eradication, the CVs disappeared in 55 patients (64.7%). EVs recurred in 40 patients, with recurrence rates at 1, 2, and 3 years of 16.0%, 29.6%, and 35.6%, respectively, the recurrence being more frequent in patients who had undergone EBL for secondary prophylaxis and in those with persisting CVs after EVs eradication (P = 0.003). Conclusions. CVs frequently disappeared when EVs were eradicated using EBL in patients with GOV1s. Persistence of CVs after EVs eradication by EBL was associated with EVs recurrence. PMID:28116285

  14. Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation.

    PubMed

    Park, Seung Woon; Seo, Yeon Seok; Lee, Han Ah; Park, Sang Jung; Kim, Tae Hyung; Lee, Jae Min; Suh, Sang Jun; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Jung, Young Kul; Kim, Ji Hoon; An, Hyonggin; Yim, Hyung Joon; Jeen, Yoon Tae; Yeon, Jong Eun; Lee, Hong Sik; Chun, Hoon Jai; Byun, Kwan Soo; Um, Soon Ho; Kim, Chang Duck

    2016-01-01

    Background and Aims. Cardiac varices (CVs) in patients with type 1 gastroesophageal varices (GOV1s) usually disappear with treatment for esophageal varices (EVs) by endoscopic injection sclerotherapy (EIS). However, whether this applies to patients treated with endoscopic band ligation (EBL) for EVs remains unclear. We evaluated the effect of EVs eradication by EBL on CVs. Methods. We included cirrhotic patients whose EVs had been eradicated using EBL and excluded those who had been treated using EIS, those who had received endoscopic therapy for CVs, and those who were combined with hepatocellular carcinoma. Results. A total of 123 patients were enrolled. The age was 59.7 ± 11.7 years, and 96 patients (78.0%) were men. Thirty-eight patients (30.9%) had EVs only, while 85 (69.1%) had GOV1s. After EVs eradication, the CVs disappeared in 55 patients (64.7%). EVs recurred in 40 patients, with recurrence rates at 1, 2, and 3 years of 16.0%, 29.6%, and 35.6%, respectively, the recurrence being more frequent in patients who had undergone EBL for secondary prophylaxis and in those with persisting CVs after EVs eradication (P = 0.003). Conclusions. CVs frequently disappeared when EVs were eradicated using EBL in patients with GOV1s. Persistence of CVs after EVs eradication by EBL was associated with EVs recurrence.

  15. Enodoscopic band ligation (EBL) is superior to endoscopic clipping for the treatment of colonic diverticular hemorrhage.

    PubMed

    Setoyama, Takeshi; Ishii, Naoki; Fujita, Yoshiyuki

    2011-11-01

    Recently, endoscopic band ligation (EBL) has been used to treat colonic diverticular hemorrhage, but the number of EBL cases treated to date has been limited. This study aimed to evaluate the clinical outcomes of EBL in the treatment of colonic diverticular hemorrhage compared with those of endoclips. At St. Luke's International Hospital in Tokyo, 66 patients were treated with EBL or endoclips from January 2004 to October 2010. Early rebleeding was defined as clinical evidence of recurrent bleeding within 30 days after initial treatment. Patients' demographics, rate of early rebleeding, and complications were retrospectively evaluated. Of the 66 patients, 18 were treated with EBL. The initial success rate for hemostasis with EBL was 100% with no complications. Early rebleeding was observed in one patient (6%), for whom eversion of a bleeding diverticulum in the sigmoid colon could not be obtained and early loss of the O-band occurred. However, the patient could be retreated with EBL. On the other hand, complete eversion could be obtained for all 10 patients with right-sided diverticula, and no early rebleeding occurred. Endoclips were used to treat 48 patients. Although the initial success rate for hemostasis was 100% without any complications, the rate of early rebleeding was 33% (16 patients), which was significantly higher than the rate for the EBL-treated group (P = 0.018). According to the findings, EBL should be considered safe, effective, and superior to endoclips for the treatment of colonic diverticular hemorrhage. The EBL procedure should be attempted as the initial therapy especially for the right-sided disease.

  16. Role of EUS evaluation after endoscopic eradication of esophageal varices with band ligation.

    PubMed

    Carneiro, Fred Olavo Aragão Andrade; Retes, Felipe Alves; Matuguma, Sérgio Eiji; Albers, Débora Vieira; Chaves, Dalton Marques; Dos Santos, Marcos Eduardo Lera; Herman, Paulo; Chaib, Eleazar; Sakai, Paulo; Carneiro D'Albuquerque, Luiz Augusto; Maluf Filho, Fauze

    2016-09-01

    Variceal recurrence after endoscopic band ligation (EBL) for secondary prophylaxis is a frequent event. Some studies have reported a correlation between variceal recurrence and variceal rebleeding with the EUS features of paraesophageal vessels. A prospective observational study was conducted to correlate EUS evaluation of paraesophageal varices, azygos vein, and thoracic duct with variceal recurrence after EBL variceal eradication in patients with cirrhosis. EUS was performed before and 1 month after EBL variceal eradication. Paraesophageal varices, azygos vein, and thoracic duct maximum diameters were evaluated in predetermined anatomic stations. After EBL variceal eradication, patients were submitted to endoscopic examinations every 3 months for 1 year. We looked for EUS features that could predict variceal recurrence. Thirty patients completed a 1-year endoscopic follow-up. Seventeen patients (57%) presented variceal recurrence. There was no correlation between azygos vein and thoracic duct diameter with variceal recurrence. Larger paraesophageal varices predicted variceal recurrence in both evaluation periods. Paraesophageal varices diameters that best correlated with variceal recurrence were 6.3 mm before EBL (52.9% sensitivity, 92.3% specificity, and .749 area under the receiver operating characteristic curve [AUROC]) and 4 mm after EBL (70.6% sensitivity, 84.6% specificity, and .801 AUROC). We conclude that paraesophageal varices diameter measured by EUS predicts variceal recurrence within 1 year after EBL variceal eradication. Paraesophageal diameter after variceal eradication is a better recurrence predictor, because it has a lower cut-off parameter, higher sensitivity, and higher AUROC. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  17. Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage

    PubMed Central

    Ikeya, Takashi; Ishii, Naoki; Nakano, Kaoru; Omata, Fumio; Shimamura, Yuto; Ego, Mai; Takagi, Koichi; Nakamura, Kenji; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2015-01-01

    Background and study aims: Endoscopic band ligation (EBL) has been used for hemostasis of colonic diverticular hemorrhage. However, early rebleeding (< 30 days after EBL) has been reported in some cases. The aim of this study was to elucidate risk factors for early rebleeding after EBL in treatment of colonic diverticular hemorrhage. Patients and methods: A total of 101 patients with definite diverticular hemorrhage treated using EBL from June 2009 to October 2014 were included in the retrospective cohort study and divided into rebleeding and non-rebleeding groups, depending on the presence or absence of early rebleeding. Patients’ ages, comorbid diseases, stigmata of recent hemorrhage (SRH) [active bleeding (AB), non-bleeding visible vessel (NBVV), or adherent clot (AC)], locations of bleeding diverticula, and eversions of the diverticula after EBL were retrospectively evaluated in each group. Results: Early rebleeding occurred in 15 cases. The median time (range) of early rebleeding occurrence was 5 days (range, 2 h to 26 days). Early rebleeding could be managed conservatively and/or endoscopically, except in one case in which surgery was done. Multivariate analysis revealed that age under 50 (adjusted OR, 8.7; 95 % CI 1.6 – 52.5; P = 0.014) and AB (adjusted OR, 4.21; 95 % CI 1.15 – 18.1; P = 0.03) were shown to be significant risk factors. The right side of the colon carried less risk than did the left side (adjusted OR, 0.21; 95 % CI 0.04 – 0.84; P = 0.028). Conclusions: Younger age, AB of SRH, and leftsided lesions were identified as the risk factors for early rebleeding after EBL in the treatment of colonic diverticular hemorrhage. PMID:26528512

  18. Small duodenal carcinoids: a case series comparing endoscopic resection and autoamputation with band ligation.

    PubMed

    Scherer, John R; Holinga, Julie; Sanders, Michael; Chennat, Jennifer; Khalid, Asif; Fasanella, Kenneth; Singhi, Aatur D; McGrath, Kevin

    2015-04-01

    We sought to compare the efficacy and safety of endoscopic ultrasound-guided endoscopic resection (ER) and endoscopic band ligation (EBL) for autoamputation of small duodenal carcinoids. The ideal management of small duodenal carcinoid tumors remains unclear. A retrospective review of duodenal carcinoids over a 10-year period (2002 to 2012) was performed at our tertiary-care teaching hospital. All patients with duodenal carcinoids ≤10 mm in size treated with either ER or EBL were included. The main outcome measurements were the efficacy and safety of endotherapy. A total of 37 patients with 39 subcentimeter duodenal carcinoids were identified. In the EBL group, the mean (SD) tumor size was 6.7±2.1 mm compared with 6.7±1.7 mm in the ER group (P=0.943). The mean Ki-67 index was ≤2% in specimens available for histologic analysis in both groups (16/23 EBL and 15/16 ER). The positive deep margin rate in the ER group was 68.8%. Residual carcinoid tumor cells were detected on follow-up biopsies in 1 patient after EBL, and 2 patients after ER. All underwent subsequent successful endotherapy. No adverse events occurred in the EBL group compared with an 18.8% adverse event rate in the ER group (P=0.066). Endoscopic ultrasound-guided EBL is a safe, effective method for removal of small superficial duodenal carcinoids and seems to be a lower risk alternative to conventional ER with cautery.

  19. Clinical outcome of endoscopic management of duodenal Dieulafoy's lesions: endoscopic band ligation versus endoscopic hemoclip placement.

    PubMed

    Ji, Jeong-Seon; Kim, Hyung-Keun; Kim, Sung Soo; Chae, Hiun-Suk; Cho, Hyunjung; Cho, Young-Seok

    2016-08-01

    The most appropriate type of endoscopic hemostasis for bleeding due to duodenal Dieulafoy's lesions (DLs) is not yet established. The aim of this study was to assess the efficacy of mechanical endoscopic hemostasis for duodenal DLs and long-term outcome after successful hemostasis, as well as to compare the efficacy and safety of endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP). Patients admitted to the emergency unit with acute upper gastrointestinal bleeding from duodenal DLs were enrolled in this study. The data were collected prospectively, but data analysis was performed retrospectively. Twenty-four patients with duodenal DLs were treated with EBL (n = 11) or EHP (n = 13). There were no significant differences between groups with respect to clinical or endoscopic characteristics, apart from the number of epinephrine (three cases with EBL vs. 11 cases with EHP; p = 0.011). Primary hemostasis was achieved in all patients. Recurrent bleeding was observed in one patient (9.1 %) from the EBL group and in five patients (38.5 %) from the EHP group (p = 0.166). The recurrent bleeding in the patient from the EBL group was treated by EHP. In the EHP group, all five patients achieved successful secondary hemostasis by endoscopic treatment (EBL in two patients and EHP in three patients). There were no differences in secondary outcomes between the two groups, including the number of endoscopic sessions required, need for angiographic embolization or emergent surgery, transfusion requirements, or length of hospital stay. No complications occurred, and there was no recurrence of bleeding in either group during the follow-up period. Mechanical endoscopic treatments are effective and safe for the treatment of bleeding duodenal DLs. A large-scale, randomized, controlled study is required to confirm the efficacy and safety of EBL and EHP for the management of bleeding duodenal DLs.

  20. Endoscopic resection using band ligation for esophageal SMT in less than 10 mm.

    PubMed

    Hong, Joung Boom; Choi, Cheol Woong; Kim, Hyung Wook; Kang, Dae Hwan; Park, Su Bum; Kim, Su Jin; Kim, Dong Jun

    2015-03-14

    To evaluate the safety and feasibility of endoscopic resection using band ligation (EMR-B) for the diagnostic and therapeutic removal of tumors located in the esophageal subepithelial region having originated from the submucosa. From May 2009 to September 2014, after medical chart and endoscopic ultrasonography report review, a total of 15 esophageal tumors located in the submucosal layer were resected by EMR-B. Previous symptom, location, pathology, complete resection rate, incidence of complications, incidence of minor complication, size, length of procedures time and follow up months were evaluated. To evaluate local recurrence at the resection site, periodic follow-up endoscopic examination was undertaken in all of the patients. The first endoscopic examination was performed about 6 mo after the endoscopic resection. Thereafter, the endoscopic follow up were scheduled annually. The mean age was 50.3 ± 9.67 years. The mean tumor size was 6.93 ± 3.15 mm and most of the lesions size was between 5-10 mm in diameter (10/15, 66.6%). In all patients, endoscopic en bloc resection was achieved. In one patient, the vertical margin was involved. The mean procedural time was 8.86 ± 3.66 min. In all patients, no evidence of severe complications such as perforation or bleeding occurred. Minor complications such as chest pain (2/15, 13.3%) and heartburn (3/15, 13.3%) were reported but they symptoms were controlled by proton pump inhibitors, ulcermin and/or analgesics. Histologic assessments of the removed specimens revealed 10 granular cell tumors (66.6%), 4 leiomyomas (16.6%) and one lipoma (6.6%). No recurrence was observed during the mean follow up period of 45 ± 3.5 mo (range: 5-64 mo). EMR-B might be considered safe and effective for the diagnosis and treatment of lesions measuring less than 10 mm in diameter.

  1. Outcomes of endoscopic treatment of gastroduodenal Dieulafoy's lesion with rubber band ligation and thermal/injection therapy.

    PubMed

    Mumtaz, Rushda; Shaukat, Masud; Ramirez, Francisco C

    2003-04-01

    Dieulafoy's lesion is a rare but important cause of upper gastrointestinal bleeding. Current endoscopic methods used to treat Dieulafoy's lesion include injection, with or without thermal methods, and mechanical methods. The latter include variceal ligation and hemoclips. There are no studies comparing the outcomes of rubber band ligation and injection with or without thermal therapy. To report the outcomes of Dieulafoy's lesion treated endoscopically with rubber band ligation and injection with or without thermal therapy at a single institution. Patients with the diagnosis of Dieulafoy's lesion treated endoscopically at the Carl T. Hayden VA Medical Center in Phoenix, between August 1994 and August 2002 were analyzed. Demographic data, mode of presentation, risk factors for gastrointestinal bleeding, hemodynamic parameters, blood transfusion requirements, endoscopic findings, details of endoscopic therapy, length of stay in ICU/hospital, complications, recurrence of bleeding, and mortality rates were collected and compared between those receiving endoscopic band ligation (EBL group) and those receiving injection with or without thermal therapy (non-EBL group). Twenty-three patients with Dieulafoy's lesion (14 in the EBL group and nine in the non-EBL group) were studied. All patients were men. The mean age, hemoglobin levels on admission, and the transfusion requirements before therapy were similar in both groups. Fourteen patients (eight in the EBL- and six in the non-EBL groups) presented with hematemesis and the remaining with melena. The majority of Dieulafoy's lesions (91.3%) were located in the stomach and two in the duodenum. Active bleeding at the time of endoscopy was seen in 61% of cases, and immediate hemostasis was achieved with either method in 100% of patients. Early rebleeding (within 72 hours of endoscopic therapy) occurred in only one patient treated with epinephrine plus heater probe therapy. The length of stay in ICU was longer in the non

  2. Feasibility appraisal of an elastic band exercise program for older adults in wheelchairs.

    PubMed

    Chen, Kuei-Min; Tseng, Wei-Shyuan; Chang, Ya-Hui; Huang, Hsin-Ting; Li, Chun-Huw

    2013-01-01

    This study appraised the feasibility of an elastic band exercise program for older adults in wheelchairs. A descriptive program review survey was used. A wheelchair-bound senior elastic band (WSEB) exercise program tailored to older adults in wheelchairs was initially developed by a group of 12 experts. A feasibility appraisal survey was administered to 10 older adults in wheelchairs through individual interviews after 4 weeks of the WSEB program. Study participants revealed that the WSEB program was feasible, safe, appropriate, and helpful to them. Participants further suggested practicing the WSEB program 3 times/week for 40 min/session in a group of 15-20 people. The finalized WSEB program has 2 levels: the basic and the advanced WSEB program. It is suggested that the basic level to be taught first with practice until participants are familiar with those exercises before proceeding to the advanced level.

  3. Is it safe to perform endoscopic band ligation for the duodenum? A pilot study in ex vivo porcine models.

    PubMed

    Kakutani, Hiroshi; Sasaki, Shigemasa; Ueda, Kaoru; Takakura, Kazuki; Sumiyama, Kazuki; Imazu, Hiroo; Hino, Syoryoku; Kawamura, Muneo; Tajiri, Hisao

    2013-04-01

    In the digestive tract, endoscopic band ligation (EBL) has been routinely used for the treatment of variceal bleeding and superficial malignancies. In recent years, endoscopic treatments for duodenal varices, adenoma, and cancer have also actively incorporated EBL. Although there have been a number of reports on the risks associated with the use of EBL in the esophagus, stomach, and colon, few studies have focused on EBL in the duodenum. We performed EBL procedures to evaluate the risks associated with the use of EBL in the duodenum. Overall, EBLs were performed at nine sites in duodenum sampled from a pig immediately after sacrifice. Submucosal saline injections were placed in three of the nine studied sites. Regardless of saline injection, the full thickness of the duodenal wall was ligated in all attempts. Routine EBL is not recommended in the duodenum because the risk of perforation is unacceptably high.

  4. Endoscopic band ligation versus endoscopic submucosal dissection and laparoscopic resection for small gastric stromal tumors.

    PubMed

    Meng, Yan; Cao, Chunli; Song, Shujie; Li, Yue; Liu, Side

    2016-07-01

    Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Previous studies have addressed the safety and feasibility of endoscopic band ligation (EBL) for the treatment of small gastric GISTs. However, published reports comparing EBL with other interventions are limited. This current study evaluates the efficacy of EBL and compares EBL to both endoscopic submucosal dissection (ESD) and laparoscopic resection (LAP) for small gastric GISTs less than 15 mm. A total of 339 patients who underwent endoscopic therapy or laparoscopic resection for gastric GISTs between 1998 and 2012 were retrospectively identified and collected from medical records in our hospital. The parameters measured for each procedure type includes clinicopathological characteristics, length of stay, hospitalization expense and surgical outcomes. Among the 147 patients included in our study, 72 (48.98 %) received EBL, 27 (18.37 %) received ESD, and 48 (32.65 %) received LAP. The demographic and clinical characteristics of the patients such as gender, age, tumor site and size were well balanced between the study groups. There was also no significant difference in follow-up time between the study groups. The mean operating time was significantly shorter in the patients receiving EBL than patients receiving ESD and LAP (p < 0.001). The estimated blood loss was significantly different between the three groups (p < 0.001). Complications occurred in 1.39 % of the patients receiving EBL, 18.52 % of the patients receiving ESD and 4.17 % of the patients receiving LAP (p = 0.004), and recurrence rate in 15.00, 9.10 and 11.76 %, respectively (p = 0.705). There was also significant difference about mean hospital stay and hospital cost between three groups (p < 0.001). Our results show a significant advantage in the short-term outcome for EBL compared to ESD and LAP. However, long-term randomized controlled trials are needed to compare the

  5. Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension.

    PubMed

    Zaher, Tarik; Ibrahim, Islam; Ibrahim, Amany

    2011-03-01

    Portal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation (EBL) of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy (SH) in Egyptian patients with portal hypertension. In this study, 26 portal hypertensive patients (with oesophageal and/or fundal varices) with a grade 2-4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL (13 patients) or SH (13 patients) after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12months. Goligher's grades of internal haemorrhoids improved significantly (p=0.018) 12weeks after SH (from 2.9±0.8 to 0.4±0.5; p=0.001) and after EBL (from 2.8±0.8 to 1.1±0.8; p=0.001). Symptom (bleeding and prolapse) scores significantly improved 4weeks after both EBL (from 1.6±0.8 to 0.6±0.8; p<0.001 and from 1.6±0.9 to 0.5±0.5; p=0.002, respectively) and SH (from 1.8±0.8 to 0.2±0.4; p=0.002 and from 1.5±0.9 to 0.2±0.4; p=0.001, respectively). The differences after 4weeks between EBL and SH were not significant (p=0.168 and p=0.225). Pain requiring analgesics occurred in five patients (38.5%) after EBL, compared with six (46.2%) after SH (p=0.691). Minimal bleeding occurred in two patients (15.4%) after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH. For portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However

  6. Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: A meta-analysis

    PubMed Central

    Li, Lan; Yu, Chaohui; Li, Youming

    2011-01-01

    OBJECTIVE: To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the efficacy of endoscopic band ligation (EBL) versus pharmacological therapy for the primary and secondary prophylaxis of variceal hemorrhage in patients with cirrhosis. METHODS: Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases. Eighteen randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis. RESULTS: Among 1023 patients in 12 trials comparing EBL with beta-blockers for primary prevention, there was no significant difference in gastrointestinal bleeding (RR 0.79 [95% CI 0.61 to 1.02]), all-cause deaths (RR 1.06 [95% CI 0.86 to 1.30]) or bleeding-related deaths (RR 0.66 [95% CI 0.38 to 1.16]). There was a reduced trend toward significance in variceal bleeding with EBL compared with beta-blockers (RR 0.72 [95% CI 0.54 to 0.96]). However, variceal bleeding was not significantly different between the two groups in high-quality trials (RR 0.84 [95% CI 0.60 to 1.17]). Among 687 patients from six trials comparing EBL with beta-blockers plus isosorbide mononitrate for secondary prevention, there was no effect on either gastrointestinal bleeding (RR 0.95 [95% CI 0.65 to 1.40]) or variceal bleeding (RR 0.89 [95% CI 0.53 to 1.49]). The risk for all-cause deaths in the EBL group was significantly higher than in the medical group (RR 1.25 [95% CI 1.01 to 1.55]); however, the rate of bleeding-related deaths was unaffected (RR 1.16 [95% CI 0.68 to 1.97]). CONCLUSIONS: Both EBL and beta-blockers may be considered first-line treatments to prevent first variceal bleeding, whereas beta-blockers plus isosorbide mononitrate may be the best choice for the prevention of rebleeding. PMID:21499579

  7. Should we add beta-blockers to band ligation for secondary prophylaxis of variceal bleeding?

    PubMed

    Cotoras, Petre; Faúndez, Jorge; Candia, Roberto

    2017-02-23

    Cirrhotic patients who have had an episode of bleeding from gastroesophageal varices are at high risk of rebleeding, despite treatment with endoscopic variceal ligation. Adding beta-blockers could reduce this risk, but it is associated with adverse effects. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified seven systematic reviews including 21 randomized controlled trials addressing the question of this article. We extracted data, combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded the addition of beta-blockers to endoscopic variceal ligation as secondary prophylaxis of variceal bleeding reduces the risk of rebleeding, but probably does not lead to any difference in terms of mortality. Even though it is associated to frequent adverse effects, these would be mild and generally do not lead to discontinuation of treatment.

  8. Complete Esophageal Obstruction after Endoscopic Variceal Band Ligation in a Patient with a Sliding Hiatal Hernia

    PubMed Central

    Mansour, Munthir; Abdel-Aziz, Yousef; Awadh, Hesham; Shah, Nihar

    2017-01-01

    Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia. PMID:28144613

  9. Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping.

    PubMed

    Kim, Keunmo; Kim, Eun Bee; Choi, Yong Hyeok; Oh, Youngmin; Han, Joung-Ho; Park, Seon Mee

    2017-03-01

    Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm oval-shaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

  10. Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model.

    PubMed

    Han, Joung-Ho; Kim, Myounghwan; Lee, Tae Hoon; Kim, Hyun; Jung, Yunho; Park, Seon Mee; Chae, Heebok; Youn, Seijin; Shin, Ji Yun; Lee, In-Kwang; Lee, Tae Soo; Choi, Seok Hwa

    2015-11-01

    Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model. We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination. The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis. EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

  11. Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids

    PubMed Central

    Jutabha, Rome; Jensen, Dennis M.; Chavalitdhamrong, Disaya

    2013-01-01

    OBJECTIVES: Our purpose was to compare the efficacy, complications, success rate, recurrence rate at 1 year, and crossovers of rubber band ligation (RBL) with those of bipolar electrocoagulation (BPEC) treatment for chronically bleeding internal hemorrhoids. METHODS: A total of 45 patients of mean age 51.5 years, who had rectal bleeding from grade II or III hemorrhoids and in whom intensive medical therapy failed, were randomized in a prospective study comparing RBL with BPEC. Treatment failure was predefined as continued bleeding, occurrence of a major complication, or failure to reduce the size of all internal hemorrhoidal segments to grade I in ≤ 3 treatments. Patients were followed up for 1 year. RESULTS: With similar patients, rectal bleeding and other symptoms were controlled with significantly fewer treatments of RBL than of BPEC (2.3±0.2 vs. 3.8±0.4, P < 0.05), and RBL had a significantly higher success rate (92% vs. 62%, P< 0.05). RBL had more cases of severe pain during treatment (8% vs. 0%, P> 0.05), but significantly fewer failures and crossovers (8% vs. 38%). Symptomatic recurrence at 1 year was 10% RBL and 15% BPEC. CONCLUSIONS: For patients with chronically bleeding grade II or III internal hemorrhoids that are unresponsive to medical therapy, safety and complication rates of banding and BPEC were similar. The success rate was significantly higher with RBL than with BPEC. Symptom recurrence rates at 1 year were similar. PMID:19513028

  12. Endoscopic ultrasound findings predict the recurrence of esophageal varices after endoscopic band ligation: a prospective cohort study.

    PubMed

    Masalaite, Laura; Valantinas, Jonas; Stanaitis, Juozas

    2015-01-01

    Variceal recurrence following endoscopic band ligation (EBL) is common. Esophageal collateral veins (ECV) are observed by endoscopic ultrasound (EUS) in patients with portal hypertension. The aim of the present study was to assess the role of EUS in predicting the recurrence of esophageal varices following EBL. Forty patients who had undergone EBL for eradication of varices were examined over a 12-month period to detect variceal recurrence. EUS was performed before ligation to detect and describe the type, grade, and the number of ECV. EUS findings obtained prior to EBL were compared in the variceal recurrence and non-recurrence groups. Of the 40 patients, 19 (47.5%) had variceal recurrence within 12 months of EBL. Univariate logistic regression analysis showed that severe peri-ECV (p < 0.001), multiple peri-ECV (p < 0.001), and the presence of perforating veins (p < 0.014) were statistically significantly related to the variceal recurrence after EBL. Multivariate logistic regression model found that only severe peri-ECV (odds ratio [OR] = 24.39; 95% confidence interval [CI]: 2.34-253.78) and multiple peri-ECV (OR = 24.39; 95% CI: 2.34-253.78) remained as independent prognostic factors for variceal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence was 89.2% and 90.5%, respectively (prognostic value (AUC) = 0.946). Recurrence rate of esophageal varices after EBL is high (47.5%). EUS can clearly depict ECV and has a value in predicting variceal recurrence after EBL; severe peri-ECV and multiple peri-ECV were significant and independent prognostic factors associated with variceal recurrence risk.

  13. EVALUATION OF PRIMARY PROPHYLAXIS WITH PROPRANOLOL AND ELASTIC BAND LIGATION IN VARICEAL BLEEDING IN CIRRHOTIC CHILDREN AND ADOLESCENTS.

    PubMed

    Pimenta, Júlio Rocha; Ferreira, Alexandre Rodrigues; Bittencourt, Paulo Fernando Souto; Resende, Camilo Brandão de; Fagundes, Eleonora Druve Tavares; Silva, Isabela Maria Lopes da

    2016-01-01

    The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension. This is a cohort study encompassing 26 cirrhotic patients. β-blocker prophylaxis was performed with propranolol. When contraindicated the use of β-blocker, or if side effects presents, the patients were referred to endoscopic therapy with band ligation. Patients were evaluated by endoscopy, and those who had varicose veins of medium and large caliber or reddish spots, regardless of the caliber of varices, received primary prophylaxis. Of the 26 patients evaluated, 9 (34.6%) had contraindications to the use of propranolol and were referred for endoscopic prophylaxis. Six (35.3%) of the 17 patients who received β-blocker (propranolol), had bled after a median follow-up time of 1.9 years. β-blockage dosage varied from 1 mg/kg/day to 3.1 mg/kg/day and seven (41.2%) patients had the propranolol suspended due to fail of the β-blockage or adverse effects, such as drowsiness, bronchospasm and hypotension. Patients who received endoscopic prophylaxis (elastic bandage) had no bleeding during the follow-up period. All of the patients that had upper gastroinstestinal bleeding in this study were under propranolol prophylaxis. The use of propranolol showed a high number of contraindications and side effects, requiring referral to endoscopic prophylaxis. The endoscopic prophylaxis was effective in reducing episodes of bleeding.

  14. Local injection of bupivacaine after rubber band ligation of hemorrhoids: prospective, randomized study.

    PubMed

    Hooker, G D; Plewes, E A; Rajgopal, C; Taylor, B M

    1999-02-01

    The aim of this study was to determine if local injection of bupivacaine after hemorrhoidal banding causes a decrease in pain and in the incidence of associated symptoms. After hemorrhoidal banding, patients were randomly assigned to receive a local injection of bupivacaine with 1:200,000 epinephrine, an injection of normal saline, or no injection, just superior to each band. Pain was graded by the patient and by the study nurse within 30 minutes, and any associated symptoms were recorded. At intervals 6, 24, and 48 hours postbanding, the patient recorded pain, limitation of activities, and analgesic requirements. Associated symptoms while at home were recorded. Of 115 patients studied, 42 received bupivacaine injection, 42 received normal saline injection, and 31 received no injection. In patients receiving bupivacaine compared with no injection, within 30 minutes postbanding there was a significant reduction in pain graded by the patient (P = 0.000002) and by the nurse (P = 0.000005) and a significant reduction in incidence of nausea (P = 0.01) and shaking (P = 0.008). However, in the bupivacaine group compared with the other two groups, at the intervals of 6, 24, and 48 hours postbanding there was no sustained reduction in the severity of pain and no reduction in analgesic requirements or limitation of normal activities. In the week after banding, there was no difference between groups in symptoms of nausea, shaking, lightheadedness, urinary retention, or bleeding. Bupivacaine injection may be useful for reducing pain and associated symptoms long enough to tolerate a trip home from the outpatient department but does not show a sustained effect.

  15. Comparison of long-term outcomes between endoscopic band ligation and endoscopic clipping for colonic diverticular hemorrhage

    PubMed Central

    Nakano, Kaoru; Ishii, Naoki; Ikeya, Takashi; Ego, Mai; Shimamura, Yuto; Takagi, Koichi; Nakamura, Kenji; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2015-01-01

    Background and study aims: Long-term outcomes of endoscopic band ligation (EBL) for colonic diverticular hemorrhage have not been reported to date. The aim of this study was to determine the long-term outcomes of EBL and to retrospectively compare them with those of endoscopic clipping (EC) in the treatment of colonic diverticular hemorrhage. Patients and methods: The study included patients with colonic diverticular hemorrhage who were treated with EBL or EC from January 2004 to November 2014 and followed up more than 1 year (61 patients in the EBL group and 39 patients in the EC group). Time-to-event analysis of rebleeding was performed with the Kaplan-Meier method. A follow-up colonoscopy was performed to confirm the disappearance of the banded diverticula in the EBL group. Results: Rebleeding occurred in 21 patients in the EBL group and in 26 patients in the EC group. The cumulative incidence of rebleeding at 1, 12, 24, and 36 months after first treatments was 14 %, 23 %, 26 %, and 41 % in the EBL group and 38 %, 49 %, 59 %, and 68 % in the EC group, respectively. Time-to-event analysis revealed statistically significant data (Log-rank test, P = 0.0036). Scar formation with fold convergence at the previously banded site was observed in 11 of 24 patients who underwent follow-up colonoscopy (46 %). However, late rebleeding (rebleeding more than 30 days after EBL) occurred in five of these 11 cases. Conclusions: EBL was superior to EC in the treatment of colonic diverticular hemorrhage. However, the risk of rebleeding was not avoided even after the diverticula had been resolved using EBL. PMID:26528513

  16. Comparison of long-term outcomes between endoscopic band ligation and endoscopic clipping for colonic diverticular hemorrhage.

    PubMed

    Nakano, Kaoru; Ishii, Naoki; Ikeya, Takashi; Ego, Mai; Shimamura, Yuto; Takagi, Koichi; Nakamura, Kenji; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2015-10-01

    Long-term outcomes of endoscopic band ligation (EBL) for colonic diverticular hemorrhage have not been reported to date. The aim of this study was to determine the long-term outcomes of EBL and to retrospectively compare them with those of endoscopic clipping (EC) in the treatment of colonic diverticular hemorrhage. The study included patients with colonic diverticular hemorrhage who were treated with EBL or EC from January 2004 to November 2014 and followed up more than 1 year (61 patients in the EBL group and 39 patients in the EC group). Time-to-event analysis of rebleeding was performed with the Kaplan-Meier method. A follow-up colonoscopy was performed to confirm the disappearance of the banded diverticula in the EBL group. Rebleeding occurred in 21 patients in the EBL group and in 26 patients in the EC group. The cumulative incidence of rebleeding at 1, 12, 24, and 36 months after first treatments was 14 %, 23 %, 26 %, and 41 % in the EBL group and 38 %, 49 %, 59 %, and 68 % in the EC group, respectively. Time-to-event analysis revealed statistically significant data (Log-rank test, P = 0.0036). Scar formation with fold convergence at the previously banded site was observed in 11 of 24 patients who underwent follow-up colonoscopy (46 %). However, late rebleeding (rebleeding more than 30 days after EBL) occurred in five of these 11 cases. EBL was superior to EC in the treatment of colonic diverticular hemorrhage. However, the risk of rebleeding was not avoided even after the diverticula had been resolved using EBL.

  17. The development of Fournier's gangrene following rubber band ligation of haemorrhoids

    PubMed Central

    Subramaniam, Daryl; Hureibi, Khalid; Zia, Khawaja; Uheba, Mokthar

    2013-01-01

    The development of Fournier's gangrene in an 80-year-old male patient with diabetes after a routine outpatient haemorrhoid banding procedure is described. Four days following the procedure, the patient noticed an increasing amount of pain and swelling of the perianal region. When the patient presented to the emergency department 18 days later, immediate radical debridement of ischiorectal necrotic tissue was performed. A defunctioning loop sigmoid colostomy was also formed. Subsequent operations required excision of the scrotum and abdominoperineal excision of the rectum. Histology studies later confirmed the presence of necrotising fasciitis. The case acts as a reminder that clinicians should maintain a high index of suspicion for high-risk patients still suffering from problems following the procedure. PMID:24287481

  18. Tubal ligation

    MedlinePlus

    ... tying; Tying the tubes; Hysteroscopic tubal occlusion procedure; Contraception - tubal ligation; Family planning - tubal ligation ... Tubal ligation is considered a permanent form of birth control. It is NOT recommended as a short-term ...

  19. Cyanoacrylate injection versus band ligation for bleeding from cardiac varices along the lesser curvature of the stomach

    PubMed Central

    Park, Sang Jung; Kim, Yong Kwon; Seo, Yeon Seok; Park, Seung Woon; Lee, Han Ah; Kim, Tae Hyung; Suh, Sang Jun; Jung, Young Kul; Kim, Ji Hoon; An, Hyunggin; Yim, Hyung Joon; Jang, Jae Young; Yeon, Jong Eun; Byun, Kwan Soo

    2016-01-01

    Background/Aims Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1. Methods Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded. Results The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001). Conclusion Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1. PMID:28081588

  20. Cyanoacrylate injection versus band ligation for bleeding from cardiac varices along the lesser curvature of the stomach.

    PubMed

    Park, Sang Jung; Kim, Yong Kwon; Seo, Yeon Seok; Park, Seung Woon; Lee, Han Ah; Kim, Tae Hyung; Suh, Sang Jun; Jung, Young Kul; Kim, Ji Hoon; An, Hyunggin; Yim, Hyung Joon; Jang, Jae Young; Yeon, Jong Eun; Byun, Kwan Soo

    2016-12-01

    Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1. Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded. The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001). Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1.

  1. Comparative study of hemorrhoidectomy and rubber band ligation in treatment of second and third degree hemorrhoids in kashmir.

    PubMed

    Gagloo, Mushtaq A; Hijaz, S Wardul; Nasir, S Aijaz; Reyaz, Arjmand; Bakshi, I H; Chowdary, Nisar A; Naqash, Sameer A; Sharief, Banday M

    2013-10-01

    The diagnosis of hemorrhoids is primarily based on the proctoscopic examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1½ year from Jan 2003 to June 2004. It includes 100 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of SMHS Hospital Srinagar, Kashmir. These 100 patients were selected randomly and divided into two groups of 50 patients each (hemorrhoidectomy group and RBL group). Each patient was subjected to sigmoidoscopy to exclude other lesion higher up in rectosigmoid. Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed. The statistical analysis of the study was done using SPSS statistical package in which we used descriptive statistics and correlation analysis for the final evaluation. Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many a hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery or have concurrent disease that contraindicates anesthesia. RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia.

  2. A randomized trial of rubber band ligation with or without injection sclerotherapy in the treatment of piles.

    PubMed

    Ackroyd; Dicks; Shorthouse

    1999-07-01

     Rubber band ligation (RBL) is an effective treatment for piles but may be followed by pain and bleeding. It is postulated that the addition of injection sclerotherapy (IS) may reduce these complications. This trial aims to compare the use of RBL alone with RBL + IS in the treatment of piles.  Sixty patients with piles were randomized to RBL alone (n=30) or RBL + IS (n=30). Each patient was given a pro forma on which to record the amount of pain (on a visual analogue scale) and bleeding (none, slight or heavy) for 10 days following treatment. Patients were subsequently asked to describe the overall symptomatic outcome in the 6-week follow-up clinic (worse, same, slightly better, much better). Long-term outcome was ascertained by a telephone survey.  Symptomatic improvement was similar in both groups (median score (range)=1.5 (0-2) vs 2 (0-2); P=NS), and there was no difference in pain (median score (range)=6 (0-77) vs 6 (0-50); P=NS). However, the amount of bleeding was significantly less in the RBL + IS group (median score (range)=3.5 (0-12) vs 0 (0-10); P < 0.001). The long-term outcome was similar in both groups.  The addition of IS to RBL does not affect procedure-related pain or symptomatic outcome, but significantly reduces the risk of post-bleeding.

  3. Comparison of endoscopic resection therapies for rectal carcinoid tumor: endoscopic submucosal dissection versus endoscopic mucosal resection using band ligation.

    PubMed

    Choi, Cheol W; Kang, Dae H; Kim, Hyung W; Park, Su B; Jo, Woo S; Song, Geun A; Cho, Mong

    2013-01-01

    Endoscopic mucosal resection (EMR) has been the endoscopic treatment of choice for rectal carcinoid tumors <10 mm in size. Endoscopic submucosal dissection (ESD) may cause more severe complications, longer operation time, and higher cost than EMR. : To compare EMR using band ligation (EMR-B) method with ESD for the endoscopic treatment of rectal carcinoid tumors. From November 2008 to September 2011, we enrolled consecutive patients with rectal carcinoid tumors <10 mm in diameter and without lymph node enlargement. Rate of complete resection rate, incidence of complications, and length of procedures were evaluated. Sixty patients were enrolled (31 ESD cases and 29 EMR-B cases). The mean age was 48.03±13.09 years. Both groups had similar mean tumor diameter (EMR-B 4.34±1.75 vs. ESD 5.22±2.09 mm; P=0.084). Resection time was longer in the ESD group than in the EMR-B group (15.09±5.73 vs. 6.37±5.52 min; P<0.001). The complete resection rate was 80.6% (25 of 31) in the ESD group and 82.8% (24 of 29) in the EMR-B group (P=0.833). In incomplete resection cases, neither local recurrence nor distant metastasis was detected during the follow-up period. Compared with ESD, EMR-B resulted in a comparable histologically complete resection rate and took less time to perform. Given the advantages of easier and shorter procedure time, EMR-B may be considered the treatment of choice for small rectal carcinoid tumors.

  4. [Combined G-banded karyotyping and multiplex ligation-dependent probe amplification for the detection of chromosomal abnormalities in fetuses with congenital heart defects].

    PubMed

    Liu, Yang; Xie, Jiansheng; Geng, Qian; Xu, Zhiyong; Wu, Weiqin; Luo, Fuwei; Li, Suli; Wang, Qin; Chen, Wubin; Tan, Hongxi; Zhang, Hu

    2017-02-10

    To assess the value of G-banded karyotyping in combination with multiplex ligation-dependent probe amplification (MLPA) as a tool for the detection of chromosomal abnormalities in fetuses with congenital heart defects. The combined method was used to analyze 104 fetuses with heart malformations identified by ultrasonography. Abnormal findings were confirmed with chromosomal microarray analysis (CMA). Nineteen (18%) fetuses were found to harbor chromosomal aberrations by G-banded karyotyping and MLPA. For 93 cases, CMA has detected abnormalities in 14 cases including 10 pathogenic copy number variations (CNVs) and 4 CNVs of uncertain significance (VOUS). MLPA was able to detect all of the pathogenic CNVs and 1 VOUS CNV. Combined use of G-banded karyotyping and MLPA is a rapid, low-cost and effective method to detect chromosomal abnormalities in fetuses with various heart malformations.

  5. Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement.

    PubMed

    Qiao, Weiguang; Ren, Yutang; Bai, Yang; Liu, Side; Zhang, Qiang; Zhi, Fachao

    2015-10-01

    The evidence for optimal endoscopic management of bleeding gastric varices is lacking. The clinical outcome is controversial in trials comparing cyanoacrylate injection and band ligation. To help guide endoscopic decisions regarding acute gastric variceal bleeding, a meta-analysis was conducted.Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched for all randomized controlled trials (RCTs) containing the 2 interventions. The main outcomes evaluated in the meta-analysis were active bleeding control, blood transfusion, rebleeding, recurrence of varices, complications, and survival.Three RCTs were identified, which included 194 patients with active gastric variceal bleeding from Taiwan and Romania. Active bleeding control was achieved in 46 of 49 (93.9%) patients in the cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14-17.30). Rebleeding rate was comparable in type 2 gastroesophageal varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015). Cyanoacrylate injection was also superior in controlling recurrence of gastric varices to band ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. The major limitation of this meta-analysis is the small number of studies/patients included.Compared with band ligation, injection cyanocrylate have an advantage in the control of acute gastric variceal bleeding, also with lower recurrence rate and rebleeding (except GOV2). The limited amount of studies included attenuates the strength of this meta-analysis; therefore, more high-quality RCTs are needed.

  6. A prospective randomised comparative study of endoscopic band ligation versus injection sclerotherapy of bleeding internal haemorrhoids in patients with liver cirrhosis.

    PubMed

    Awad, Atif ElSayed; Soliman, Hanan Hamed; Saif, Sabry Abdel Latif Abou; Darwish, Abdel Monem Nooman; Mosaad, Samah; Elfert, Asem Ahmed

    2012-06-01

    Bleeding internal haemorrhoids are common and used to be treated surgically with too many complications. Endoscopic therapy is trying to take the lead. Sclerotherapy and rubber band ligation are the candidates to replace surgical therapy especially in patients with liver cirrhosis. The aim of this study was to compare endoscopic injection sclerotherapy (EIS) to endoscopic rubber band ligation (EBL) regarding effectiveness and complications in the treatment of bleeding internal haemorrhoids in Egyptian patients with liver cirrhosis. One hundred and twenty adult patients with liver cirrhosis and bleeding internal haemorrhoids were randomised into two equal groups; the first treated with EBL using Saeed multiband ligator, and the second with EIS using either ethanolamine oleate 5% or N-butyl cyanoacrylate. All groups were matched as regards age, sex, Child score and pre-procedure Doppler values. Patients were followed up clinically and with abdominal ultrasound/Doppler for 6 months. Endoscopic and endosonography/Doppler was done before and one month after the procedure. Pre and post-procedure data were recorded and analysed. Both techniques were highly effective in the control of bleeding from internal haemorrhoids with a low rebleeding [10% in the EBL group and 13.33% in the EIS group] and recurrence [20% in the EBL group 20% in the EIS group] rates. Child score had a positive correlation with rebleeding and recurrence in EIS group only. Pain score and need for analgesia were significantly higher while patient satisfaction was significantly lower in EIS compared to EBL [p<0.05]. No significant difference between ethanolamine and cyanoacrylate subgroups was found [p>0.05]. Both EBL and EIS were effective in the treatment of bleeding internal haemorrhoids in patients with liver cirrhosis. EBL had significantly less pain and higher patient satisfaction than EIS. EBL was also safer in patients with advanced cirrhosis. Copyright © 2012 Arab Journal of Gastroenterology

  7. Propranolol associated with endoscopic band ligation reduces recurrence of esophageal varices for primary prophylaxis of variceal bleeding: a randomized-controlled trial.

    PubMed

    Bonilha, Danielle Queiroz; Lenz, Luciano; Correia, Lucianna Motta; Rodrigues, Rodrigo Azevedo; de Paulo, Gustavo Andrade; Ferrari, Angelo Paulo; Della Libera, Ermelindo

    2015-01-01

    The aim of this study was to compare the recurrence of esophageal varices (EVs) after endoscopic band ligation (EBL) associated with propranolol (PP) versus EBL alone. Sixty-six cirrhotic outpatients (EBL group, n=32 and EBL+PP group, n=34) with high-risk EVs without previous bleeding were studied. The primary outcome was recurrence of EV. The secondary outcomes were EV eradication, bleeding before EV eradication, mortality, and adverse events. Demographic characteristics and the initial endoscopic findings were similar. EV eradication was achieved in all patients. Three patients presented gastrointestinal bleeding before variceal eradication, two in the EBL group and one in the EBL+PP group (P=0.13). Six patients died (liver failure), two in the EBL group and four in the EBL+PP group (P=0.27). Twelve (38%) patients in the EBL group and three (9%) patients in the EBL+PP group had variceal recurrence. The risk of recurrence of EVs after eradication was significantly higher among patients in the EBL group (P=0.003). EBL alone and EBL+PP were effective in the primary prophylaxis of bleeding from EVs in cirrhotic patients (EV eradication, bleeding before EV eradication, mortality, and adverse events were similar in both groups). However, variceal recurrence was lower in the EBL+PP group than band ligation alone.

  8. Multiplex ligation-dependent probe amplification assay identifies additional copy number changes compared with R-band karyotype and provide more accuracy prognostic information in myelodysplastic syndromes

    PubMed Central

    Xu, Zefeng; Zhang, Yue; Liu, Jinqin; Li, Bing; Fang, Liwei; Zhang, Hongli; Pan, Lijuan; Hu, Naibo; Qu, Shiqiang; Cai, Wenyu; Ru, Kun; Jia, Yujiao; Huang, Gang; Xiao, Zhijian

    2017-01-01

    Cytogenetic analysis provides important diagnostic and prognostic information for patients with Myelodysplastic syndromes (MDS) and plays an essential role in the International Prognostic Scoring System (IPSS) and the revised International Prognostic Scoring System (IPSS-R). Multiplex ligation-dependent probe amplification (MLPA) assay is a recently developed technique to identify targeted cytogenetic aberrations in MDS patients. In the present study, we evaluated the results obtained using an MLPA assay in 437 patients with MDS to determine the efficacy of MLPA analysis. Using R-banding karyotyping, 45% (197/437) of MDS patients had chromosomal abnormalities, whereas MLPA analysis detected that 35% (153/437) of MDS cases contained at least one copy-number variations (CNVs) .2/5 individuals (40%) with R-band karyotype failures had trisomy 8 detected using only MLPA. Clonal cytogenetic abnormalities were detected in 20/235 (8.5%) MDS patients with a normal R-band karyotype, and 12/20 (60%) of those patients were reclassified into a higher-risk IPSS-R prognostic category. When sequencing and cytogenetics were combined, the fraction of patients with MDS-related oncogenic lesions increased to 87.3% (233/267 cases). MLPA analysis determined that the median OS of patients with a normal karyotype (n=218) was 65 months compared with 27 months in cases with an aberrant karyotype (P=0.002) in 240 patients with normal or failed karyotypes by R-banding karyotyping. The high-resolution MPLA assay is an efficient and reliable method that can be used in conjunction with R-band karyotyping to detect chromosomal abnormalities in patients with suspected MDS. MLPA may also provide more accurate prognostic information. PMID:27906673

  9. Tubal Ligation

    MedlinePlus

    ... The insert causes scar tissue to form and seal off the tubes. Tubal ligation is an abdominal ... instruments passed through the abdominal wall, your doctor seals the fallopian tubes by destroying segments of the ...

  10. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial.

    PubMed

    Brown, Steven R; Tiernan, James P; Watson, Angus J M; Biggs, Katie; Shephard, Neil; Wailoo, Allan J; Bradburn, Mike; Alshreef, Abualbishr; Hind, Daniel

    2016-07-23

    Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used outpatient treatment. We compared recurrence after HAL versus RBL in patients with grade II-III haemorrhoids. This multicentre, open-label, parallel group, randomised controlled trial included patients from 17 acute UK NHS trusts. We screened patients aged 18 years or older presenting with grade II-III haemorrhoids. We excluded patients who had previously received any haemorrhoid surgery, more than one injection treatment for haemorrhoids, or more than one RBL procedure within 3 years before recruitment. Eligible patients were randomly assigned (in a 1:1 ratio) to either RBL or HAL with Doppler. Randomisation was computer-generated and stratified by centre with blocks of random sizes. Allocation concealment was achieved using a web-based system. The study was open-label with no masking of participants, clinicians, or research staff. The primary outcome was recurrence at 1 year, derived from the patient's self-reported assessment in combination with resource use from their general practitioner and hospital records. Recurrence was analysed in patients who had undergone one of the interventions and been followed up for at least 1 year. This study is registered with the ISRCTN registry, ISRCTN41394716. From Sept 9, 2012, to May 6, 2014, of 969 patients screened, 185 were randomly assigned to the HAL group and 187 to the RBL group. Of these participants, 337 had primary outcome data (176 in the RBL group and 161 in the HAL group). At 1 year post-procedure, 87 (49%) of 176 patients in the RBL group and 48 (30%) of 161 patients in the HAL group had haemorrhoid recurrence (adjusted odds ratio [aOR] 2·23, 95% CI 1·42-3·51; p=0·0005). The main reason for this difference was the number of extra procedures required to achieve improvement (57 [32%] participants in the

  11. Red band needle blight of pines...a tentative appraisal for California

    Treesearch

    Willis W. Wagener

    1967-01-01

    Since it first appeared in Tanganyika in 1957, red band needle blight has become a major forest disease around the world. Apparently spread by high altitude winds, the blight has been found killing Monterey and other pines in California's northwest coastal counties. About 30 pine species are susceptible. Caused by the fungus Dothistroma pini (...

  12. Appraisal of broadband acoustic impedances from first principles and band-limited seismic reflection data

    NASA Astrophysics Data System (ADS)

    Mandal, A.; Ghosh, S. K.

    2015-12-01

    Seismic derived acoustic impedance is an essential output for the quantitative interpretation of seismic data. However, the band limitation of seismic data leads to a nonunique estimate of the acoustic impedance profile. The prevalent methods counter the nonuniqueness either by stabilizing the answer with respect to an initial model or by resorting to an assumption of certain criterion such as sparsity of the reflection coefficients. Making a nominal assumption of a homogeneous layered earth model, we formulate a set of linear equations where the reflection coefficients are the unknowns and the recursively integrated seismic trace constitutes the data. The approach makes a frontal assault on the problem of reconstructing reflection coefficients from band-limited data and stems from first principles, i.e., Zöppritz's equation in this case. Nonuniqueness is countered in part by the layercake assumption, and in part by the adoption of the singular value decomposition (SVD) method of finding an optimal solution to the set of linear equations, provided the objective is to reconstruct a smoothed version of the impedance profile that includes only its coarser structures. The efficacy of the method has been tested with synthetic data added with significant noise and generated from rudimentary earth models as well as from measured logs of acoustic impedance. Emergence of consistent estimates of impedance from synthetic data generated for several frequency bands increases the confidence in the method. The study also proves the successfulness of the method for (a) an accurate estimate of the impedance mean, (b) an accurate reconstruction of the direct-current (dc) frequency of the reflectivity, and (c) an acceptable reconstruction of the broad trend of the original impedance profile. All these outputs can serve as significant constraints for either more refined inversions or geological interpretations. (Keywords: Reflection data, Acoustic impedance, Broadband, Linear

  13. Cyanoacrylate Injection Compared with Band Ligation for Acute Gastric Variceal Hemorrhage: A Meta-Analysis of Randomized Controlled Trials and Observational Studies

    PubMed Central

    Huai, Jiaping; Chen, Yanping

    2014-01-01

    Background. Cyanoacrylate injection (GVO) and band ligation (GVL) are effective treatments for gastric variceal hemorrhage. However, data on the optimal treatment are still controversial. Methods. For our overall analysis, relevant studies were identified from several databases. For each outcome, data were pooled using a fixed-effect or random-effects model according to the result of a heterogeneity test. Results. Seven studies were included. Compared with GVL, GVO was associated with increased likelihood of hemostasis of active bleeding (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.19–4.51) and a longer gastric variceal rebleeding-free period (hazard ratio = 0.37; 95% CI = 0.24–0.56). No significant differences were observed between GVL and GVO for mortality (hazard ratio = 0.66; 95% CI = 0.43–1.02), likelihood of variceal obliteration (OR = 0.89; 95% CI = 0.52–1.54), number of treatment sessions required for complete variceal eradication (weighted mean difference = −0.45; 95% CI = −1.14–0.23), or complications (OR = 1.02; 95% CI = 0.48–2.19). Conclusion. GVO may be superior to GVL for achieving hemostasis and preventing recurrence of gastric variceal rebleeding but has no advantage over GVL for mortality and complications. Additional studies are warranted to enable definitive conclusions. PMID:24868204

  14. The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation.

    PubMed

    Brown, Steven; Tiernan, Jim; Biggs, Katie; Hind, Daniel; Shephard, Neil; Bradburn, Mike; Wailoo, Allan; Alshreef, Abualbishr; Swaby, Lizzie; Watson, Angus; Radley, Simon; Jones, Oliver; Skaife, Paul; Agarwal, Anil; Giordano, Pasquale; Lamah, Marc; Cartmell, Mark; Davies, Justin; Faiz, Omar; Nugent, Karen; Clarke, Andrew; MacDonald, Angus; Conaghan, Phillip; Ziprin, Paul; Makhija, Rohit

    2016-11-01

    Optimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious. The comparison of HAL with RBL for the treatment of grade II/III haemorrhoids. A multicentre, parallel-group randomised controlled trial. UK NHS and Personal Social Services. 17 NHS Trusts. Patients aged ≥ 18 years presenting with grade II/III (second- and third-degree) haemorrhoids, including those who have undergone previous RBL. HAL with Doppler probe compared with RBL. Primary outcome - recurrence at 1 year post procedure; secondary outcomes - recurrence at 6 weeks; haemorrhoid severity score; European Quality of Life-5 Dimensions, 5-level version (EQ-5D-5L); Vaizey incontinence score; pain assessment; complications; and cost-effectiveness. A total of 370 participants entered the trial. At 1 year post procedure, 30% of the HAL group had evidence of recurrence compared with 49% after RBL [adjusted odds ratio (OR) = 2.23, 95% confidence interval (CI) 1.42 to 3.51; p = 0.0005]. The main reason for the difference was the number of extra procedures required to achieve improvement/cure. If a single HAL is compared with multiple RBLs then only 37.5% recurred in the RBL arm (adjusted OR 1.35, 95% CI 0.85 to 2.15; p = 0.20). Persistence of significant symptoms at 6 weeks was lower in both arms than at 1 year (9% HAL and 29% RBL), suggesting significant deterioration in both groups over the year. Symptom score, EQ-5D-5L and Vaizey score improved in both groups compared with baseline, but there was no difference between interventions. Pain was less severe and of shorter duration in the RBL group; most of the HAL group who had pain had mild to moderate pain, resolving by 3 weeks. Complications were low frequency and not significantly different between groups. It appeared that HAL was not cost-effective compared with RBL. In the base

  15. The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation.

    PubMed Central

    Brown, Steven; Tiernan, Jim; Biggs, Katie; Hind, Daniel; Shephard, Neil; Bradburn, Mike; Wailoo, Allan; Alshreef, Abualbishr; Swaby, Lizzie; Watson, Angus; Radley, Simon; Jones, Oliver; Skaife, Paul; Agarwal, Anil; Giordano, Pasquale; Lamah, Marc; Cartmell, Mark; Davies, Justin; Faiz, Omar; Nugent, Karen; Clarke, Andrew; MacDonald, Angus; Conaghan, Phillip; Ziprin, Paul; Makhija, Rohit

    2016-01-01

    BACKGROUND Optimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious. OBJECTIVE The comparison of HAL with RBL for the treatment of grade II/III haemorrhoids. DESIGN A multicentre, parallel-group randomised controlled trial. PERSPECTIVE UK NHS and Personal Social Services. SETTING 17 NHS Trusts. PARTICIPANTS Patients aged ≥ 18 years presenting with grade II/III (second- and third-degree) haemorrhoids, including those who have undergone previous RBL. INTERVENTIONS HAL with Doppler probe compared with RBL. OUTCOMES Primary outcome - recurrence at 1 year post procedure; secondary outcomes - recurrence at 6 weeks; haemorrhoid severity score; European Quality of Life-5 Dimensions, 5-level version (EQ-5D-5L); Vaizey incontinence score; pain assessment; complications; and cost-effectiveness. RESULTS A total of 370 participants entered the trial. At 1 year post procedure, 30% of the HAL group had evidence of recurrence compared with 49% after RBL [adjusted odds ratio (OR) = 2.23, 95% confidence interval (CI) 1.42 to 3.51; p = 0.0005]. The main reason for the difference was the number of extra procedures required to achieve improvement/cure. If a single HAL is compared with multiple RBLs then only 37.5% recurred in the RBL arm (adjusted OR 1.35, 95% CI 0.85 to 2.15; p = 0.20). Persistence of significant symptoms at 6 weeks was lower in both arms than at 1 year (9% HAL and 29% RBL), suggesting significant deterioration in both groups over the year. Symptom score, EQ-5D-5L and Vaizey score improved in both groups compared with baseline, but there was no difference between interventions. Pain was less severe and of shorter duration in the RBL group; most of the HAL group who had pain had mild to moderate pain, resolving by 3 weeks. Complications were low frequency and not significantly different

  16. Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding.

    PubMed

    Luo, Xuefeng; Wang, Zhu; Tsauo, Jiaywei; Zhou, Biao; Zhang, Hailong; Li, Xiao

    2015-07-01

    To compare transjugular intrahepatic portosystemic shunt (TIPS) placement with or without variceal embolization with endoscopic band ligation (EBL) plus propranolol in preventing recurrent esophageal variceal bleeding in patients with advanced cirrhosis and portal vein thrombosis. The present randomized controlled trial was approved by the ethics committee board of West China Hospital. Written informed consent was obtained from each patient. Between January 2010 and December 2012, 73 patients were randomly allocated to receive TIPS (n = 37) or EBL plus propranolol (n = 36). The comparisons of recurrent variceal bleeding, hepatic encephalopathy, and survival rates were based on the Kaplan-Meier method and were compared using the log-rank test. The mean follow-up time was 22.8 months ± 7.7(standard deviation) in the TIPS group and 20.9 months ± 8.9 in the EBL group. The 2-year probability of remaining free of recurrent variceal bleeding was higher in the TIPS group (77.8%) than in the EBL group (42.9%) (P = .002). Overall recanalization was achieved in 24 (64.9%) patients from the TIPS group and seven (19.4%) patients from the EBL group. The hepatic encephalopathy rates exhibited no significant differences between the two groups (P = .53). The 1- and 2-year probability of survival was 86.5% and 72.9%, respectively, in the TIPS group and 83.3% and 57.2%, respectively, in the EBL group, with no significant difference (P = .23). TIPS was more effective than EBL plus propranolol in preventing recurrent esophageal variceal bleeding in patients with advanced cirrhosis and portal vein thrombosis and did not increase the incidence of hepatic encephalopathy. Survival was similar in both groups.

  17. Comparison of endoscopic band ligation and endoclip closure of colonic perforation: technical feasibility and efficacy in an ex vivo pig model.

    PubMed

    Lee, Tae Hoon; Han, Joung-Ho; Jung, Yunho; Jung, Yoonho; Lee, Suck-Ho; Kim, Dae Hoon; Shin, Ji Yun; Lee, Tae Soo; Kim, Myunghwan; Choi, Seok-Hwa; Kim, Hyun; Park, Seonmee; Youn, Seijin

    2014-09-01

    Recent reports have indicated several instances of successful treatment of bowel perforation by using endoscopic band ligation (EBL) when treatment with endoclipping is unsuccessful, but this salvage method has not been investigated in any prospective model. Herein we aimed to compare the technical feasibility and efficacy of EBL and endoclip use in intraluminal closure of colon perforation, in an ex vivo model. Standardized colonic perforations were created using fresh porcine colon and subsequently closed by full-thickness interrupted sutures, endoclip (QuickClip2(TM)), or EBL. Each closure site was tested with compressed air by using a digital pressure monitor for evaluating leak pressure. No significant differences were noted between the endoclip and EBL in leak pressures. Mean (± SD) pressures for air leakage from the perforations closed using the different devices were as follows: normal colon samples, 52.0 ± 13.2 mmHg; perforations closed with hand-sewn sutures, 32.3 ± 8.3 mmHg; perforations closed with endoclipping, 53.5 ± 22.7 mmHg; and perforations closed with EBL, 50.4 ± 12.5 mmHg. Time taken for closure by EBL was significantly less than that for closure by endoclipping (3.2 ± 1.7 min vs 6.8 ± 1.3 min, P < 0.01). Further, the number of devices used to achieve complete closure in the EBL group was lower than that with endoclipping (1.6 ± 0.5 vs 3.7 ± 0.8, P < 0.01). Endoluminal closure of a 1.5-cm colon perforation with EBL decreased procedure time and was not inferior in leak pressure compared with endoclipping in this ex vivo porcine model. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  18. Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia.

    PubMed

    Elhendawy, Mohammed; Mosaad, Samah; Alkhalawany, Walaa; Abo-Ali, Lobna; Enaba, Mohamed; Elsaka, Aymen; Elfert, Asem A

    2016-06-01

    Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent hemorrhage and thus, chronic anemia, in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method, but requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) was found to be a good alternative for APC as a treatment for GAVE, especially in refractory cases. The aim of this prospective randomized controlled study was to evaluate the safety and efficacy of EBL, as compared to APC, in the treatment of GAVE and gastric fundal vascular ectasia (GFVE). A total of 88 cirrhotic patients with GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 2 weeks until complete obliteration was accomplished; then they were followed up endoscopically after 6 months, plus they had monthly measurement of hemoglobin levels during that period. We describe the presence of mucosal and submucosal lesions in the gastric fundal area that were similar to those found in GAVE in 13 patients (29.5%) of the EBL group and 9 patients (20.5%) of the APC group; we named this GFVE. In these cases, we treated the fundal lesions with the same techniques we had used for treating GAVE, according to the randomization. We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (2.98 sessions compared to 3.48 sessions in the APC group (p < 0.05)). Hemoglobin levels increased significantly after obliteration of the lesions in both groups, compared to pretreatment values (p < 0.05), but with no significant difference between the two groups (p > 0.05); however, the EBL group of patients required a significantly smaller number of units of blood transfusion than the APC group of patients (p < 0.05). There were no significant differences in adverse events nor complications between the two groups (p > 0.05). This study

  19. Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia

    PubMed Central

    Mosaad, Samah; Alkhalawany, Walaa; Abo-Ali, Lobna; Enaba, Mohamed; Elsaka, Aymen; Elfert, Asem A

    2015-01-01

    Background Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent hemorrhage and thus, chronic anemia, in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method, but requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) was found to be a good alternative for APC as a treatment for GAVE, especially in refractory cases. The aim of this prospective randomized controlled study was to evaluate the safety and efficacy of EBL, as compared to APC, in the treatment of GAVE and gastric fundal vascular ectasia (GFVE). Patients and methods A total of 88 cirrhotic patients with GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 2 weeks until complete obliteration was accomplished; then they were followed up endoscopically after 6 months, plus they had monthly measurement of hemoglobin levels during that period. Results We describe the presence of mucosal and submucosal lesions in the gastric fundal area that were similar to those found in GAVE in 13 patients (29.5%) of the EBL group and 9 patients (20.5%) of the APC group; we named this GFVE. In these cases, we treated the fundal lesions with the same techniques we had used for treating GAVE, according to the randomization. We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (2.98 sessions compared to 3.48 sessions in the APC group (p < 0.05)). Hemoglobin levels increased significantly after obliteration of the lesions in both groups, compared to pretreatment values (p < 0.05), but with no significant difference between the two groups (p > 0.05); however, the EBL group of patients required a significantly smaller number of units of blood transfusion than the APC group of patients (p < 0.05). There were no significant differences in adverse events nor complications between the

  20. Chemoselective ligation

    DOEpatents

    Saxon, Eliana; Bertozzi, Carolyn Ruth

    2011-12-13

    The present invention features a chemoselective ligation reaction that can be carried out under physiological conditions. In general, the invention involves condensation of a specifically engineered phosphine, which can provide for formation of an amide bond between the two reactive partners resulting in a final product comprising a phosphine moiety, or which can be engineered to comprise a cleavable linker so that a substituent of the phosphine is transferred to the azide, releasing an oxidized phosphine byproduct and producing a native amide bond in the final product. The selectivity of the reaction and its compatibility with aqueous environments provides for its application in vivo (e.g., on the cell surface or intracellularly) and in vitro (e.g., synthesis of peptides and other polymers, production of modified (e.g., labeled) amino acids).

  1. Chemoselective ligation

    DOEpatents

    Saxon, Eliana; Bertozzi, Carolyn

    2006-10-17

    The present invention features a chemoselective ligation reaction that can be carried out under physiological conditions. In general, the invention involves condensation of a specifically engineered phosphine, which can provide for formation of an amide bond between the two reactive partners resulting in a final product comprising a phosphine moiety, or which can be engineered to comprise a cleavable linker so that a substituent of the phosphine is transferred to the azide, releasing an oxidized phosphine byproduct and producing a native amide bond in the final product. The selectivity of the reaction and its compatibility with aqueous environments provides for its application in vivo (e.g., on the cell surface or intracellularly) and in vitro (e.g., synthesis of peptides and other polymers, production of modified (e.g., labeled) amino acids).

  2. Chemoselective ligation

    DOEpatents

    Saxon, Eliana; Bertozzi, Carolyn Ruth

    2010-11-23

    The present invention features a chemoselective ligation reaction that can be carried out under physiological conditions. In general, the invention involves condensation of a specifically engineered phosphine, which can provide for formation of an amide bond between the two reactive partners resulting in a final product comprising a phosphine moiety, or which can be engineered to comprise a cleavable linker so that a substituent of the phosphine is transferred to the azide, releasing an oxidized phosphine byproduct and producing a native amide bond in the final product. The selectivity of the reaction and its compatibility with aqueous environments provides for its application in vivo (e.g., on the cell surface or intracellularly) and in vitro (e.g., synthesis of peptides and other polymers, production of modified (e.g., labeled) amino acids).

  3. Chemoselective ligation

    DOEpatents

    Saxon, Eliana; Bertozzi, Carolyn

    2003-05-27

    The present invention features a chemoselective ligation reaction that can be carried out under physiological conditions. In general, the invention involves condensation of a specifically engineered phosphine, which can provide for formation of an amide bond between the two reactive partners resulting in a final product comprising a phosphine moiety, or which can be engineered to comprise a cleavable linker so that a substituent of the phosphine is transferred to the azide, releasing an oxidized phosphine byproduct and producing a native amide bond in the final product. The selectivity of the reaction and its compatibility with aqueous environments provides for its application in vivo (e.g., on the cell surface or intracellularly) and in vitro (e.g., synthesis of peptides and other polymers, production of modified (e.g., labeled) amino acids).

  4. Chemoselective ligation

    DOEpatents

    Saxon, Eliana; Bertozzi, Carolyn R.

    2010-02-23

    The present invention features a chemoselective ligation reaction that can be carried out under physiological conditions. In general, the invention involves condensation of a specifically engineered phosphine, which can provide for formation of an amide bond between the two reactive partners resulting in a final product comprising a phosphine moiety, or which can be engineered to comprise a cleavable linker so that a substituent of the phosphine is transferred to the azide, releasing an oxidized phosphine byproduct and producing a native amide bond in the final product. The selectivity of the reaction and its compatibility with aqueous environments provides for its application in vivo (e.g. on the cell surface or intracellularly) and in vitro (e.g., synthesis of peptides and other polymers, production of modified (e.g., labeled) amino acids).

  5. Chemoselective ligation

    DOEpatents

    Saxon, Eliana; Bertozzi, Carolyn R.

    2011-04-12

    The present invention features a chemoselective ligation reaction that can be carried out under physiological conditions. In general, the invention involves condensation of a specifically engineered phosphine, which can provide for formation of an amide bond between the two reactive partners resulting in a final product comprising a phosphine moiety, or which can be engineered to comprise a cleavable linker so that a substituent of the phosphine is transferred to the azide, releasing an oxidized phosphine byproduct and producing a native amide bond in the final product. The selectivity of the reaction and its compatibility with aqueous environments provides for its application in vivo (e.g., on the cell surface or intracellularly) and in vitro (e.g., synthesis of peptides and other polymers, production of modified (e.g., labeled) amino acids).

  6. Chemoselective ligation

    DOEpatents

    Saxon, Eliana; Bertozzi, Carolyn R.

    2011-05-10

    The present invention features a chemoselective ligation reaction that can be carried out under physiological conditions. In general, the invention involves condensation of a specifically engineered phosphine, which can provide for formation of an amide bond between the two reactive partners resulting in a final product comprising a phosphine moiety, or which can be engineered to comprise a cleavable linker so that a substituent of the phosphine is transferred to the azide, releasing an oxidized phosphine byproduct and producing a native amide bond in the final product. The selectivity of the reaction and its compatibility with aqueous environments provides for its application in vivo (e.g., on the cell surface or intracellularly) and in vitro (e.g., synthesis of peptides and other polymers, production of modified (e.g., labeled) amino acids).

  7. Changes in wall motion and blood flow in the outflow tract of chick embryonic hearts observed with optical coherence tomography after outflow tract banding and vitelline-vein ligation

    NASA Astrophysics Data System (ADS)

    Rugonyi, Sandra; Shaut, Carley; Liu, Aiping; Thornburg, Kent; Wang, Ruikang K.

    2008-09-01

    Optical coherence tomography (OCT) is a non-contact, non-invasive and high-resolution imaging technique, suited to study early cardiovascular development. Alterations in hemodynamic conditions during early development are known to lead to cardiac defects, presumably as a result of changes in cardiac biomechanics produced by the alterations. In this paper, we demonstrate the use of a spectral domain OCT in visualizing and quantifying changes in cardiac wall motion and blood-flow velocities under normal and altered hemodynamic conditions in chicken embryos at an early stage of development (Hamburger-Hamilton stage HH18, ~3 days of incubation), focusing on the heart outflow tract (OFT). The OCT system employed acquired simultaneously microstructural and blood-flow images at a rate of 92 frames s-1with a spatial resolution of ~10 µm. OCT imaging allowed in vivo visualization of the OFT microstructures, e.g. the lumen, cardiac cushions and myocardium. We found that alterations in hemodynamic conditions, through OFT banding and vitelline-vein ligation, changed blood-flow velocities through the OFT, as expected. Further, OCT allowed quantification of changes in the dynamics of OFT wall motion. Our results therefore establish the utility of spectral domain OCT to study the influence of hemodynamic conditions on heart development in intact, in vivo chicken embryo models.

  8. Tubal ligation - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100044.htm Tubal ligation - Series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 3 Go to slide 2 ...

  9. Self ligating lingual appliance

    PubMed Central

    Juneja, Pankaj; Chopra, S.S.; Jayan, B.K.

    2015-01-01

    Adult demand for orthodontics has grown considerably over the past 10 years propelling increased demand for Esthetic Orthodontics. Lingual appliances are a viable option toward providing Esthetic Orthodontics. The lingual surface of the teeth has a unique morphology that makes it difficult to place brackets in ideal positions. Indirect bonding has become the established methods of overcoming these discrepancies, along with the latest designs of self ligating brackets which offer more efficient mechanics and shorter treatment time. PMID:26843757

  10. Post tubal ligation syndrome or iatrogenic hydrosalpinx.

    PubMed

    Gregory, M G

    1981-10-01

    The purpose of this case report is as follows: to attempt to establish an association between the observed increase in hydrosalpinx and the phenomenal increase in surgical sterilization; to present a credible etiology for iatrogenic hydrosalpinx; and to discuss the pathogenesis of a disease process henceforth referred to as post tubal ligation syndrome. A 36-year-old white woman was admitted to Park View Hospital in Nashville, Tennessee on January 7, 1981 for evaluation of continuous lower abdominal pain, abdominal pressure, and dyspareunia for several months. The woman had 2 children who were delivered vaginally. An abdominal tubal ligation was performed for sterilization when she was 27, and vaginal hysterectomy, with anterior and posterior colporrhaphy, was done for symptomatic pelvic relaxation at age 33. Physical examination showed tenderness without palpable masses in the pelvic adnexal areas. Laboratory studies were within normal limits. On January 9, 1981, the patient underwent exploratory laparotomy, and bilateral salpingo-oophorectomy. She was found to have bilateral hydrosalpinx. Historically, hydrosalpinx has been considered an intermediary step in pelvic inflammatory disease. Iatrogenic hydrosalpinx is, in essence, initiated by an initial insult, e.g., tubal ligation, fulguration, or application of a mechanical clip or band. Theoretically, single point interruption of a fallopian tube should produce no ill effects. The popularity and success of tubal ligation attest to single point interruption of an otherwise normal fallopian tube as an innocuous procedure. A schematic drawing is provided of the same tube insulted a 2nd time and consequently the situation is prefactory to development of hydrosalpinx, i.e., a tube lined with secretory epithelium is closed at both ends. Secretion within this closed system will produce dilatation. This "2nd" insult to the normal fallopian tube, post tubal ligation, may take 1 of several forms. The symptoms of iatrogenic

  11. [Appraisal of Audiovisual Materials.

    ERIC Educational Resources Information Center

    Johnson, Steve

    This document consists of four separate handouts all related to the appraisal of audiovisual (AV) materials: "How to Work with an Appraiser of AV Media: A Convenient Check List for Clients and Their Advisors," helps a client prepare for an appraisal, explaining what is necessary before the appraisal, the appraisal process and its costs,…

  12. Oestrogen deficiency after tubal ligation.

    PubMed

    Cattanach, J

    1985-04-13

    4 of 7 women who had undergone tubal ligation within the past seven years were found to have oestrogen excretion concentrations at ovulation below the tenth percentile. A disturbance in the oestrogen/progesterone ratio as a consequence of localised hypertension at the ovary, when the utero-ovarian arterial loop is occluded at tubal ligation, is proposed as a possible cause of oestrogen deficiency syndrome, dysfunctional uterine bleeding, and menorrhagia after tubal ligation. Similar pathophysiology may occur after hysterectomy with ovarian conservation.

  13. 75 FR 36270 - Appraisal Subcommittee; Appraiser Regulation; Privacy Act Implementation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-25

    ... INSTITUTIONS EXAMINATION COUNCIL 12 CFR Part 1102 Appraisal Subcommittee; Appraiser Regulation; Privacy Act Implementation AGENCY: Appraisal Subcommittee of the Federal Financial Institutions Examination Council...-7577 or alice@asc.gov ; Appraisal Subcommittee; 1401 H Street, NW., Suite 760, Washington, DC...

  14. Tetrazine ligation for chemical proteomics.

    PubMed

    Kang, Kyungtae; Park, Jongmin; Kim, Eunha

    2016-01-01

    Determining small molecule-target protein interaction is essential for the chemical proteomics. One of the most important keys to explore biological system in chemical proteomics field is finding first-class molecular tools. Chemical probes can provide great spatiotemporal control to elucidate biological functions of proteins as well as for interrogating biological pathways. The invention of bioorthogonal chemistry has revolutionized the field of chemical biology by providing superior chemical tools and has been widely used for investigating the dynamics and function of biomolecules in live condition. Among 20 different bioorthogonal reactions, tetrazine ligation has been spotlighted as the most advanced bioorthogonal chemistry because of their extremely faster kinetics and higher specificity than others. Therefore, tetrazine ligation has a tremendous potential to enhance the proteomic research. This review highlights the current status of tetrazine ligation reaction as a molecular tool for the chemical proteomics.

  15. [Post-tubal ligation syndrome].

    PubMed

    Satoh, K; Osada, H

    1993-01-01

    Post-tubal ligation syndrome includes pain during intercourse, aching lower back, premenstrual tension syndrome, difficulty in menstruating, uterine hemorrhage, and absence of menstruation. The syndrome is caused by blood circulation problems in and around the Fallopian tubes and ovaries, pressure on nerves, and intrapelvic adhesion. Differentiating between this syndrome and endometritis during diagnosis and differentiating between functional hemorrhage due to hormonal abnormality and anatomical hemorrhage due to polyp or tumor is very important. Since the symptoms of this syndrome are mild, simple symptomatic treatment is sufficient in most cases. In some cases, however, desquamation surgery or reversal of tubal ligation may be necessary. Endoscopic surgery is also available. In Japan, because of widespread use of condoms and IUDs, tubal ligation is not very common.

  16. [Appraisal: a concept analysis].

    PubMed

    Kuo, Chia-Chi; Lin, Chiu-Chu; Ma, Shu-Ching

    2007-04-01

    Appraisal is a cognitive response by an individual facing an event within a given environment. When the individual has passed through a thought process that gives the event meaning, the coping process is finally completed. Coping heightens an individual's well-being. Negative appraisal will induce an emotional coping response and affect one's quality of life, mental state and health. Several researchers applied the concept of appraisal to their disciplines. The concept of appraisal, however, is poorly defined. This article applies the methodology outlined by Walker and Avant (1995) to analyze the concept of appraisal. The definition of appraisal, examples, and empirical references provided in this paper will be useful in nursing practice in relation to the role of appraisal in coping.

  17. Ligation-assisted endoscopic submucosal resection with circumferential mucosal incision for duodenal carcinoid tumor.

    PubMed

    Harada, Hideaki; Suehiro, Satoshi; Shimizu, Takanori; Katsuyama, Yasushi; Hayasaka, Kenji; Ito, Hideto

    2015-09-14

    Here we present the case of a 64-year-old female with a duodenal carcinoid tumor treated by ligation-assisted endoscopic submucosal resection (ESMR-L) with circumferential mucosal incision (CMI). Band ligation was effective in resecting the duodenal carcinoid tumor after CMI, with an uneventful post-procedural course. Histopathological examination showed clear tumor margins at deeper tissue levels. Thus, in the present case, ESMR-L with CMI was useful for the treatment of duodenal carcinoid tumor.

  18. Ligation-assisted endoscopic submucosal resection with circumferential mucosal incision for duodenal carcinoid tumor

    PubMed Central

    Harada, Hideaki; Suehiro, Satoshi; Shimizu, Takanori; Katsuyama, Yasushi; Hayasaka, Kenji; Ito, Hideto

    2015-01-01

    Here we present the case of a 64-year-old female with a duodenal carcinoid tumor treated by ligation-assisted endoscopic submucosal resection (ESMR-L) with circumferential mucosal incision (CMI). Band ligation was effective in resecting the duodenal carcinoid tumor after CMI, with an uneventful post-procedural course. Histopathological examination showed clear tumor margins at deeper tissue levels. Thus, in the present case, ESMR-L with CMI was useful for the treatment of duodenal carcinoid tumor. PMID:26379409

  19. The postal tubal ligation syndrome.

    PubMed

    Faber, E; Rocko, J M; Timmes, J J; Zolli, A F

    1981-01-01

    The frequency of symptoms following tubal ligation calls for an examination of the basic problem with the methods now used. This discussion recommends a modification of tubal ligation which as performed during the past 2-1/2 years has been symptom free, post operatively. What is meant by symptom free is those symptoms which can be directly related to tubal ligation. Symptomatology is complex and insidious. Characteristically, there is a latent period of no symptoms. This asymptomatic period may be totally subjective and may last several years during which time the correlation between surgery and symptoms is obscured. This is particularly the case if purely symptomatic therapeusis has had some degree of success. The latest period is followed by the gradual development of the following: menstrual disorders; abdominal pain which is usually located in the lower abdomen and is of 2 varieties, i.e., dysmenorrhea and nonmenstrual pain; and infection. Physical examination demonstrates little. This set of symptoms, which has been documented also by Poma et al., and when taken as a whole, constitutes a syndrome which should be termed the posttubal ligation syndrome. These patients give a history of repeat X-rays, biopsies, endoscopies, and surgical exploration. Some of these patients have had 4 or 5 celiotomies. A modification of the traditional method of tubal ligation definitely requires consideration. The characteristics of the oviducts which need mention and emphasis are reviewed. On the basis of the reviewed considerations, it becomes obvious that smooth transport of the ovum is a necessity and that obstruction in the tubes will cause a reaction similar to obstruction anywhere in the body. Tubal ligation should be performed in such a manner so as not to obstruct the ova from passing down the tube. The tubes should be cut fairly close to the uterus and be tied. The rest of the tube from fimbria to the isthmus should be left open. In this manner, the ovum passes into the

  20. Thoracoscopic Pericardial Window Creation and Thoracic Duct Ligation in Neonates

    PubMed Central

    Ouzounian, Steven P.; Napoleon, Lori; Permut, Lester C.; Golombek, Sergio G.

    2003-01-01

    Objective: We describe 2 newborn infants with persistent pericardial effusion treated with thoracoscopic pericardial window and thoracic duct ligation. Methods: Patient 1 was a premature female newborn who presented with severe cardiac anomalies, including dextrocardia. She was treated with pulmonary artery banding and pacemaker placement for complete cardiac block. Postoperatively, she developed pericarditis with persistent symptomatic pericardial effusion. She did not improve despite pericardial drain placement. She was treated with a thoracoscopic pericardial window. Patient 2 was a newborn male who presented with cardiac tamponade secondary to congenital chylopericardium. He did not respond to pericardial drain placement or medical management with fasting, total parenteral nutrition, and octreotide. He was treated with thoracoscopic pericardial window and thoracic duct ligation. Results: Patient 1 improved rapidly. The pericardial effusion disappeared. The chest tube was removed 5 days following surgery. She died 6 weeks later of a cardiac arrhythmia secondary to pacemaker failure. The pericardial effusion had resolved. Patient 2 responded to the pericardial window and thoracic duct ligation. He was discharged 10 days following the procedure. Conclusions: Thoracoscopy provides an excellent approach to the pericardium. Pericardial windows and biopsy can be safely performed with this approach. The thoracic duct can be easily identified and ligated even in small babies. Recovery can be fast with minimal postoperative discomfort. Cosmetic results are excellent and length of hospitalization is minimized. PMID:14626403

  1. Comparative ligational, optical band gap and biological studies on Cr(III) and Fe(III) complexes of hydrazones derived from 2-hydrazinyl-2-oxo-N-phenylacetamide with both vanillin and O-vanillin

    NASA Astrophysics Data System (ADS)

    Yousef, T. A.; Abu El-Reash, G. M.; Attia, M. I.; El-Tabai, M. N.

    2015-09-01

    The Cr(III) and Fe(III) complexes of hydrazones derived from the condensation of 2-hydrazinyl-2-oxo-N-phenylacetamide with both vanillin and o-vanillin synthesized and characterized by different conventional physicochemical techniques. The kinetic and thermodynamic parameters for the different decomposition steps were calculated using Coats-Redfern and Horowitz-Metzger equations. The bond lengths, bond angles, HOMO, LUMO, dipole moment and binding energy calculated by DFT calculations. The optical band gap (Eg) values equal 3.28, 3.03, 3.58 and 3.57 eV for [Cr(HL1)Cl2(H2O)2](0.75H2O), [Cr(HL2)Cl2(H2O)](H2O), [Fe(HL1)Cl2(H2O)2](0.5H2O) and [Fe(HL2)2Cl(H2O)](3H2O) complexes, respectively. The antibacterial activities tested against Bacillus subtilis and Escherichia coli bacteria.

  2. [Latex ligation in treatment of chronic hemorrhoids].

    PubMed

    Ektov, V N; Somov, K A

    2015-01-01

    We analyzed the results of treatment of 432 patients with chronic hemorrhoids using different variants of latex ligation. New technique including ligation of mucosa and submucosa of low-ampullar rectum providing ligation of hemorrhoidalvessels, lifting and recto-anal repair is developed and suggested. This method is advisable to use in case of chronic internal hemorrhoids stages I and II. The authors recommend simultaneous combined ligation of mucosa of low-ampullar rectum and internal hemorrhoids for stages III and IV. Different variants of latex ligation with external hemorrhoids excision were used in 103 patients. Pointed variants of latex ligation preserve important advantages including mini-invasiveness, simplicity and wide availability, low cost. Good remote results were obtained after these procedures in 87.3% of observations. Suggested tactics extends use of latex ligation and increases its effectiveness in treatment of different stages and forms of chronic hemorrhoids.

  3. Appraising Reading Achievement.

    ERIC Educational Resources Information Center

    Ediger, Marlow

    To determine quality sequence in pupil progress, evaluation approaches need to be used which guide the teacher to assist learners to attain optimally. Teachers must use a variety of procedures to appraise student achievement in reading, because no one approach is adequate. Appraisal approaches might include: (1) observation and subsequent…

  4. Does sclerotherapy of remnant little oesophageal varices after endoscopic ligation have impact on the reduction of recurrent varices? Prospective study.

    PubMed

    Grgov, Sasa; Stamenković, Perica

    2011-01-01

    Endoscopic band ligation (EBL) is superior to endoscopic injection sclerotherapy (EIS) of oesophageal varices, however, EBL is associated with a higher rate of variceal recurrences. To examine whether the reduction of recurrent varices can be achieved by additional sclerotherapy of remnant little varices after ligation. Forty-eight patients with liver cirrhosis who had previously bled from oesophageal varices were examined. Endoscopic therapy was performed in order to prevent recurrent variceal bleeding. I group: in 23 patients ligation of oesophageal varices with multi band ligation device was applied (EBL group). II group: in 25 patients sclerotherapy using polydocanol or absolute alcohol was applied after reducing the size of varices using ligation (EBL and EIS group). There was no statistically significant difference between the examined groups of patients in relation to the number of sessions for variceal eradication, recurrence of variceal bleeding, deterioration of portal gastropathy and mortality in the observed period from 18.8 +/- 18.6 months (EBL group) and 22.2 +/- 26.2 months (EBL and EIS group). Variceal recurrence was verified in 21.7% of patients of the EBL group and 16% of the EBL and EIS group, but the difference was not statistically important. Several complications, such as dysphagia and chest pain, were statistically more frequent in the EBL and EIS group of patients. The combined method of ligation and extra sclerosing of remnant small oesophageal varices after ligation does not have advantage in relation to the ligation alone.

  5. Western blot analysis of Src kinase assays using peptide substrates ligated to a carrier protein.

    PubMed

    Xu, Jie; Sun, Luo; Ghosh, Inca; Xu, Ming-Qun

    2004-06-01

    We have applied intein-mediated peptide ligation (IPL) to the use of peptide substrates for kinase assays and subsequent Western blot analysis. IPL allows for the efficient ligation of a synthetic peptide with an N-terminal cysteine residue to an intein-generated carrier protein containing a cysteine reactive C-terminal thioester through a native peptide bond. A distinct advantage of this procedure is that each carrier protein molecule ligates only one peptide, ensuring that the ligation product forms a sharp band on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). We demonstrate the effectiveness of this approach by mutational analysis of peptide substrates derived from human cyclin-dependent kinase, Cdc2, which contains a phosphorylation site of human c-Src protein tyrosine kinase.

  6. Program Facilitates CMMI Appraisals

    NASA Technical Reports Server (NTRS)

    Sweetser, Wesley

    2005-01-01

    A computer program has been written to facilitate appraisals according to the methodology of Capability Maturity Model Integration (CMMI). [CMMI is a government/industry standard, maintained by the Software Engineering Institute at Carnegie Mellon University, for objectively assessing the engineering capability and maturity of an organization (especially, an organization that produces software)]. The program assists in preparation for a CMMI appraisal by providing drop-down lists suggesting required artifacts or evidence. It identifies process areas for which similar evidence is required and includes a copy feature that reduces or eliminates repetitive data entry. It generates reports to show the entire framework for reference, the appraisal artifacts to determine readiness for an appraisal, and lists of interviewees and questions to ask them during the appraisal. During an appraisal, the program provides screens for entering observations and ratings, and reviewing evidence provided thus far. Findings concerning strengths and weaknesses can be exported for use in a report or a graphical presentation. The program generates a chart showing capability level ratings of the organization. A context-sensitive Windows help system enables a novice to use the program and learn about the CMMI appraisal process.

  7. Cognitive appraisals of stereotype threat.

    PubMed

    Berjot, S; Roland-Levy, C; Girault-Lidvan, N

    2011-04-01

    Using the cognitive appraisal conceptualisation of the transactional model of stress, the goal was to assess how victims of stereotype threat respond to this situation in terms of primary appraisals (threat/challenge) and to investigate whether those appraisals may mediate the relation between stereotype threat and performance. Results show that, while participants from North Africa living in France did appraise the situation more as a threat and less as a challenge, only challenge appraisal mediated between stereotype threat and performance.

  8. Determinants of tubal ligation in Puebla, Mexico.

    PubMed

    Rudzik, Alanna E F; Leonard, Susan H; Sievert, Lynnette L

    2011-06-21

    Tubal ligation provides an effective and reliable method by which women can choose to limit the number of children they will bear. However, because of the irreversibility of the procedure and other potential disadvantages, it is important to understand factors associated with women's choice of this method of birth control. Between May 1999 and August 2000, data were collected from 755 women aged 40 to 60 years from a cross-section of neighborhoods of varying socio-economic make-up in Puebla, Mexico, finding a tubal ligation rate of 42.2%. Multiple logistic regression models were utilized to examine demographic, socio-economic, and reproductive history characteristics in relation to women's choice of tubal ligation. Regression analyses were repeated with participants grouped by age to determine how the timing of availability of tubal ligation related to the decision to undergo the procedure. The results of this study suggest that younger age, more education, use of some forms of birth control, and increased parity were associated with women's decisions to undergo tubal ligation. The statistically significant difference of greater tubal ligation and lower hysterectomy rates across age groups reflect increased access to tubal ligation in Mexico from the early 1970s, supporting the idea that women's choice of tubal ligation was related to access.

  9. The "Floss-Ligature" Ligation Technique.

    PubMed

    Dugdale, Charlotte Anne; Malik, Ovais Humair; Waring, David Trevor

    2015-01-01

    This clinical pearl describes an alternative technique to aid effective ligation of rotated teeth during the aligning stage of fixed appliance treatment. This technique has the potential to improve patient experience and confidence, by reducing the risk of trauma and discomfort and treatment efficiency, by ensuring complete ligation of even severely rotated teeth.

  10. 21 CFR 876.4400 - Hemorrhoidal ligator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hemorrhoidal ligator. 876.4400 Section 876.4400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4400 Hemorrhoidal ligator. (a...

  11. 21 CFR 876.4400 - Hemorrhoidal ligator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hemorrhoidal ligator. 876.4400 Section 876.4400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4400 Hemorrhoidal ligator. (a...

  12. Neurodevelopmental outcomes following two different treatment approaches (early ligation and selective ligation) for patent ductus arteriosus.

    PubMed

    Wickremasinghe, Andrea C; Rogers, Elizabeth E; Piecuch, Robert E; Johnson, Bridget C; Golden, Suzanne; Moon-Grady, Anita J; Clyman, Ronald I

    2012-12-01

    To examine whether a change in the approach to managing persistent patent ductus arteriosus (PDA) from early ligation to selective ligation is associated with an increased risk of abnormal neurodevelopmental outcomes. In 2005, we changed our PDA treatment protocol for infants born at ≤27 6/7 weeks' gestation from an early ligation approach, with prompt PDA ligation if the ductus failed to close after indomethacin therapy (period 1: January 1999 to December 2004), to a selective ligation approach, with PDA ligation performed only if specific criteria were met (period 2: January 2005 to May 2009). All infants in both periods received prophylactic indomethacin. Multivariate analysis was used to compare the odds of a composite abnormal neurodevelopmental outcome (Bayley Mental Developmental Index or Cognitive Score <70, cerebral palsy, blindness, and/or deafness) associated with each treatment approach at age 18-36 months (n = 224). During period 1, 23% of the infants in follow-up failed indomethacin treatment, and all underwent surgical ligation. During period 2, 30% of infants failed indomethacin, and 66% underwent ligation after meeting prespecified criteria. Infants treated with the selective ligation strategy demonstrated fewer abnormal outcomes than those treated with the early ligation approach (OR, 0.07; P = .046). Infants who underwent ligation before 10 days of age had an increased incidence of abnormal neurodevelopmental outcome. The significant difference in outcomes between the 2 PDA treatment strategies could be accounted for in part by the earlier age of ligation during period 1. A selective ligation approach for PDAs that fail to close with indomethacin therapy is not associated with worse neurodevelopmental outcomes at age 18-36 months. Copyright © 2012 Mosby, Inc. All rights reserved.

  13. Cloning of DNA fragments: ligation reactions in agarose gel.

    PubMed

    Furtado, Agnelo

    2014-01-01

    Ligation reactions to ligate a desired DNA fragment into a vector can be challenging to beginners and especially if the amount of the insert is limiting. Although additives known as crowding agents, such as PEG 8000, added to the ligation mixes can increase the success one has with ligation reactions, in practice the amount of insert used in the ligation can determine the success or the failure of the ligation reaction. The method described here, which uses insert DNA in gel slice added directly into the ligation reaction, has two benefits: (a) using agarose as the crowding agent and (b) reducing steps of insert purification. The use of rapid ligation buffer and incubation of the ligation reaction at room temperature greatly increase the efficiency of the ligation reaction even for blunt-ended ligation.

  14. 24 CFR 257.114 - Appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Appraisal. 257.114 Section 257.114... PROGRAM Eligibility Requirements and Underwriting Procedures § 257.114 Appraisal. (a) The property shall be appraised by an appraiser on the FHA Appraiser Roster. (b) An appraisal of a property to...

  15. 24 CFR 4001.114 - Appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Appraisal. 4001.114 Section 4001... Requirements and Underwriting Procedures § 4001.114 Appraisal. (a) The property shall be appraised by an appraiser on the FHA Appraiser Roster. (b) An appraisal of a property to be security for a Program...

  16. 12 CFR 34.45 - Appraiser independence.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Appraiser independence. 34.45 Section 34.45 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY REAL ESTATE LENDING AND APPRAISALS Appraisals § 34.45 Appraiser independence. (a) Staff appraisers. If an appraisal is prepared by...

  17. 7 CFR 761.7 - Appraisals.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    .... (a) General. This section describes Agency requirements for: (1) Real estate and chattel appraisals... FLP and Non-program loans. (b) Appraisal standards. (1) Real estate appraisals, technical appraisal... existing real estate appraisal. Except where specified elsewhere, when a real estate appraisal is...

  18. 7 CFR 761.7 - Appraisals.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    .... (a) General. This section describes Agency requirements for: (1) Real estate and chattel appraisals... FLP and Non-program loans. (b) Appraisal standards. (1) Real estate appraisals, technical appraisal... existing real estate appraisal. Except where specified elsewhere, when a real estate appraisal is...

  19. 12 CFR 225.65 - Appraiser independence.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... appraisal is prepared by a staff appraiser, that appraiser must be independent of the lending, investment... qualified persons available to perform an appraisal are involved in the lending, investment, or collection... that the appraisers exercise independent judgment and that the appraisal is adequate. Such steps...

  20. Heterotopic Pregnancy Following Reversal of Tubal Ligation.

    PubMed

    Eschenbach, Stephanie; Entzian, Dirk; Baumgarten, Deborah A

    2008-01-01

    We describe the case of a 37-year-old woman who had undergone reversal of tubal ligation with subsequent heterotopic pregnancy. We review the initial radiological evaluation of heterotopic pregnancies and the subsequent radiologic findings following appropriate therapy.

  1. The Pupil Appraisal Center.

    ERIC Educational Resources Information Center

    Wilborn, Bobbie; Gentile, Lance M.

    The primary purpose of the Pupil Appraisal Center (PAC) is to promote teacher education by providing teachers and students direct experience in resolving behavioral disorders and learning problems. PAC provides specialized teacher training in counseling, reading, hearing, speech, and language development and provides service to area schools for…

  2. Performance Appraisal and Counseling

    ERIC Educational Resources Information Center

    Powers, M. L.

    1972-01-01

    Author, an Associate Professor of Industrial Management Engineering at the University of Oklahoma, has worked with both large and small companies and organizations in many kinds of business and industry. He discusses performance appraisal of employees, merit raises, counseling and interviewing techniques. (Editor/DR)

  3. 32 CFR 644.43 - Gross appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Gross appraisals. 644.43 Section 644.43 National... HANDBOOK Appraisal § 644.43 Gross appraisals. (a) Preparation. (1) The gross appraisal sections of real... reflect actual market conditions and unit prices. (2) Each gross appraisal will be supported by...

  4. 12 CFR 225.65 - Appraiser independence.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... prepared by a staff appraiser, that appraiser must be independent of the lending, investment, and... persons available to perform an appraisal are involved in the lending, investment, or collection functions... the appraisers exercise independent judgment and that the appraisal is adequate. Such steps include...

  5. Tubal ligation and risk of breast cancer

    PubMed Central

    Brinton, L A; Gammon, M D; Coates, R J; Hoover, R N

    2000-01-01

    Although it has been demonstrated in previous studies that tubal ligation can have widespread effects on ovarian function, including a decrease in the risk of subsequent ovarian cancer, few studies have evaluated effects on breast cancer risk. In a population-based case–control study of breast cancer among women 20–54 years of age conducted in three geographic areas, previous tubal ligations were reported by 25.3% of the 2173 cases and 25.8% of the 1990 controls. Initially it appeared that tubal ligations might impart a slight reduction in risk, particularly among women undergoing the procedure at young ages (< 25 years). However, women were more likely to have had the procedure if they were black, less educated, young when they bore their first child, or multiparous. After accounting for these factors, tubal ligations were unrelated to breast cancer risk (relative risk (RR) = 1.09, 95% confidence interval (CI) 0.9–1.3), with no variation in risk by age at, interval since, or calendar year of the procedure. The relationship of tubal ligations to risk did not vary according to the presence of a number of other risk factors, including menopausal status or screening history. Furthermore, effects of tubal ligation were similar for all stages at breast cancer diagnosis. Further studies would be worthwhile given the biologic plausibility of an association. However, future investigations should include information on type of procedure performed (since this may relate to biologic effects) as well as other breast cancer risk factors. © 2000 Cancer Research Campaign PMID:10789731

  6. Torque expression in self-ligating orthodontic brackets and conventionally ligated brackets: A systematic review

    PubMed Central

    Al-Thomali, Yousef; Mohamed, Roshan-Noor; Basha, Sakeenabi

    2017-01-01

    Background To evaluate the torque expression of self ligating (SL) orthodontic brackets and conventionally ligated brackets and the torque expression in active and passive SL brackets. Material and Methods Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles; the date of the last search was April 4th 2016. We graded the methodological quality of the studies by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP). Results In total, 87 studies were identified for screening, and 9 studies were eligible. The quality assessment rated one of the study as being of strong quality, 7 (77.78%) of these studies as being of moderate quality. Three out of 7 studies which compared SL and conventionally ligated brackets showed, conventionally ligated brackets with highest torque expression compared to SL brackets. Badawi showed active SL brackets with highest torque expression compared to passive SL brackets. Major and Brauchli showed no significant differences in torque expression of active and passive SL brackets. Conclusions Conventionally ligated brackets presented with highest torque expression compared to SL brackets. Minor difference was recorded in a torque expression of active and passive SL brackets. Key words:Systematic review, self ligation, torque expression, conventional ligation. PMID:28149476

  7. 12 CFR 564.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Appraisals required; transactions requiring a... SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.3 Appraisals required; transactions requiring a State certified or licensed appraiser. (a) Appraisals required. An appraisal performed by a State certified...

  8. Association of Endoscopic Esophageal Variceal Ligation with Duodenal Ulcer.

    PubMed

    Zhuang, Ze-Hao; Lin, Ai-Fang; Tang, Du-Peng; Wei, Jing-Jing; Liu, Zheng-Ji; Xin, Xiao-Mei; Pan, Yu-Feng

    2016-04-01

    To determine the frequency of duodenal ulcer (DU), as well as other clinical characteristics occurring after endoscopic variceal ligation (EVL) of the esophagus. Descriptive study. The First Affiliated Hospital of Fujian Medical University, Fuzhou, China, from April 2012 to April 2013. A total of 47 patients with esophageal varices (EVr) who had also undergone EVL and gastroscopic follow-up within 3 months of the procedure was retrospectively analyzed. The status of Helicobacter pylori(Hp) infection, Child-Pugh classification, and the grades of portal hypertensive gastropathy (PHG) were collected. Sixty EVr patients without EVL treatment, but with clinical data available, served as the control group. The frequency of DU in the EVL group (29.8%, 14/47) was higher than the control group (6.7%, 4/60) (p=0.02). Hp infection rate in EVLgroup was 19.15% (9/47), while in control group was 21.67% (13/60) (p=0.813). Hp positive rate (12.5%, 1/8) in patients exhibited new DUs after EVL was comparable to the patients without DU in the EVL group (12.1%, 4/33) (p=1.00). Patients with DU after EVL received 18.79 &plusmn;8.48 of ligating bands, while in those who did not exhibit DUs received 13.85 &plusmn;6.47 (z = -2.042, p = 0.041). Logistic regression analysis showed that the occurrence of DU was not associated with age, gender, Child-Pugh classification, or the grade of PHG (p &gt; 0.05). Esophageal EVL is associated with a higher frequency of developing DU, which is related to a larger number of applied bands but is not correlated with Hp infection status or other variables.

  9. 78 FR 60873 - Appraisal Subcommittee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-02

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Meeting AGENCY: Appraisal Subcommittee of the Federal... amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in closed session:...

  10. 7 CFR 1955.128 - Appraisers.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... least one of the following qualifications: (1) Certification by a National or State appraisal society... that the appraiser meets the criteria for a certification in a National or State appraisal society....

  11. Ultrasensitive detection of DNA and RNA based on enzyme-free click chemical ligation chain reaction on dispersed gold nanoparticles.

    PubMed

    Kato, Daiki; Oishi, Motoi

    2014-10-28

    An ultrasensitive colorimetric DNA and RNA assay using a combination of enzyme-free click chemical ligation chain reaction (CCLCR) on dispersed gold nanoparticles (GNPs) and a magnetic separation process has been developed. The click chemical ligation between an azide-containing probe DNA-modified GNP and a dibenzocyclooctyne-containing probe biotinyl DNA occurred through hybridization with target DNA (RNA) to form the biotinyl-ligated GNPs (ligated products). Eventually, both the biotinyl-ligated GNPs and target DNA (RNA) were amplified exponentially using thermal cycling. After separation of the biotinyl-ligated GNPs using streptavidin-modified magnetic beads, the change in intensity of the surface plasmon band at 525 nm in the supernatants was observed by UV/vis measurement and was also evident visually. The CCLCR assay provides ultrasensitive detection (50 zM: several copies) of target DNA that is comparable to PCR-based approaches. Note that target RNA could also be detected with similar sensitivity without the need for reverse transcription to the corresponding cDNA. The amplification efficiency of the CCLCR assay was as high as 82% due to the pseudohomogeneous reaction behavior of CCLCR on dispersed GNPs. In addition, the CCLCR assay was able to discriminate differences in single-base mismatches and to specifically detect target DNA and target RNA from the cell lysate.

  12. Performance Appraisal Applied to Leadership

    ERIC Educational Resources Information Center

    Jefferson, Anne L.

    2010-01-01

    Performance appraisal is a measurement process of how well an individual is doing her or his job. In most organisations, this appraisal is an annual event. Generally, it is done to encourage job performance, to flag areas that need attention, to inform both parties as to expectations. Much of the literature speaks to this process in terms of the…

  13. Neurodevelopmental Outcomes Following Two Different Treatment Approaches (Early Ligation versus Selective Ligation) for Patent Ductus Arteriosus

    PubMed Central

    Wickremasinghe, Andrea C.; Rogers, Elizabeth E.; Piecuch, Robert E.; Johnson, Bridget C.; Golden, Suzanne; Moon-Grady, Anita J.; Clyman, Ronald I.

    2012-01-01

    Objective To examine whether a change in the approach to management of persistent patent ductus arteriosus (PDA), from “early ligation” to “selective ligation,” is associated with an increased risk of abnormal neurodevelopmental outcome. Study design In 2005, we changed our PDA treatment protocol (in infants ≤27 6/7 weeks gestation) from an “early ligation” approach, with PDA ligation quickly if they failed to close after indomethacin (Period 1: 1/99–12/04), to a “selective ligation” approach, with PDA ligation only if specific criteria were met (Period 2: 1/05–5/09). All infants in both periods received prophylactic indomethacin. Multivariate analysis was used to compare the odds of a composite Abnormal Neurodevelopmental Outcome (Bayley MDI or Cognitive score <70, cerebral palsy, blindness, and/or deafness) associated with each treatment approach at 18–36 months (n=224). Results During Period 1, 23% of the infants in follow-up failed indomethacin treatment, and all were ligated; during Period 2, 30% of infants failed indomethacin, and 66% were ligated after meeting pre-specified criteria. Infants treated with the “selective ligation” strategy had fewer Abnormal Outcomes than infants treated with the “early ligation” approach (OR=0.07, p=0.046). Infants ligated before 10 days of age had an increased incidence of Abnormal Neurodevelopmental Outcome. The significant difference in outcomes between the two PDA treatment strategies could be accounted for, in part, by the earlier age of ligation during Period 1. Conclusions A “selective ligation” approach for PDAs that fail to close with indomethacin does not worsen neurodevelopmental outcome at 18–36 months. PMID:22795222

  14. A specific instrument to facilitate thoracoscopic ligation.

    PubMed

    Wei, Bo; Jiang, Fusheng; Yin, Jinshu

    2014-09-01

    The rigid wall of the thoracic cavity provides an ideal cavity for minimally invasive surgery without the need for the cumbersome CO2 insufflation that is essential to perform laparoscopic surgery. And by that, the novel ligation technique facilitating minithoracotomy, which we published before, is possible to be transferred to the video-assisted thoracoscopic surgery (VATS). We attempt to modify the structure of the conventional right angle forceps and its usage so as to accommodate VATS. The unique shape of this instrument facilitates its passage through a trocar or a true VATS intercostal access instead of a rib spreading minithoracotomy. Its clinical performance renders that it a cheaper and better alternative to commercially available products. This new device has the potential to make a substantial contribution to the manual ligation practice of VATS. Georg Thieme Verlag KG Stuttgart · New York.

  15. Left atrial laceration with epicardial ligation device.

    PubMed

    Keating, Vincent P; Kolibash, Christopher P; Khandheria, Bijoy K; Bajwa, Tanvir; Sra, Jasbir; Kress, David C

    2014-01-01

    Many new devices and techniques are being developed to attempt a reduction in embolic stroke risk for patients with atrial fibrillation who are either unable or unwilling to maintain long-term anticoagulation. One of these new devices (LARIAT®, SentreHEART Inc., Redwood City, California, USA) employs delivery of an epicardial suture to ligate the left atrial appendage after percutaneous pericardial and transseptal access. This series presents three clinical cases that demonstrate a serious and recurrent complication of left atrial laceration and cardiac tamponade shortly following delivery of an epicardial suture ligation to the left atrial appendage. Three clinical cases are described in detail with pre- and postprocedure angiography and echocardiography as well as illustrations reflecting the surgeon's findings on direct visualization of the left atrial lacerations postligation. Potential hypotheses of each injury are examined in light of the case timelines and findings at sternotomy. There was no suggestion that tamponade was related to pericardial or transseptal access, but rather a complication with device delivery. These three patients quickly progressed to clinical cardiac tamponade despite attempted drainage, stressing the importance of cardiovascular surgery backup, including a cardiopulmonary bypass pump, when delivering novel, percutaneous ligation devices for the left atrial appendage.

  16. 7 CFR 4279.144 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Appraisals. 4279.144 Section 4279.144 Agriculture... Appraisals. Lenders will be responsible for ensuring that appraisal values adequately reflect the actual value of the collateral. All real property appraisals associated with Agency guaranteed loanmaking...

  17. 48 CFR 1437.7002 - Appraisal standards.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Appraisal standards. 1437... CATEGORIES OF CONTRACTING SERVICE CONTRACTING Appraisal Services (Real Property) 1437.7002 Appraisal standards. (a) All real property appraisals for condemnation purposes shall be consistent with...

  18. 36 CFR 223.222 - Appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Appraisal. 223.222 Section... DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER Special Forest Products Appraisal and Pricing § 223.222 Appraisal... methods to determine appraised value include, but are not limited to, transaction evidence...

  19. 7 CFR 770.9 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Appraisals. 770.9 Section 770.9 Agriculture... SPECIAL PROGRAMS INDIAN TRIBAL LAND ACQUISITION LOANS § 770.9 Appraisals. (a) The applicant or the borrower, as appropriate, will pay the cost of any appraisal required under this part. (b) Appraisals...

  20. 12 CFR 34.85 - Appraisal requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Appraisal requirements. 34.85 Section 34.85... APPRAISALS Other Real Estate Owned § 34.85 Appraisal requirements. (a) General. (1) Upon transfer to OREO, a national bank shall substantiate the parcel's market value by obtaining either: (i) An appraisal...

  1. 78 FR 60872 - Appraisal Subcommittee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-02

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Meeting AGENCY: Appraisal Subcommittee of the Federal... amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open session for its....) Discussion Agenda Appraisal Foundation May, June and July 2013 Grant Reimbursement Requests Phase 2...

  2. 36 CFR 254.9 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... requirements that meet the intent of Title XI, Financial Institutions Reform, Recovery, and Enforcement Act of... appraiser(s) shall provide to the authorized officer appraisals estimating the market value of Federal and... meeting the requirements of FIRREA. (b) Market value. (1) In estimating market value, the appraiser...

  3. 7 CFR 761.7 - Appraisals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... section describes Agency requirements for: (1) Real estate and chattel appraisals made in connection with... loans. (b) Appraisal standards. (1) Real estate appraisals, technical appraisal reviews and their... State Office) or other format containing the same information. (c) Use of an existing real...

  4. 7 CFR 761.7 - Appraisals.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    .... (a) General. This section describes Agency requirements for: (1) Real estate and chattel appraisals... FLP and Non-program loans. (b) Appraisal standards. (1) Real estate appraisals, technical appraisal...) or other format containing the same information. (3) For direct FO loans secured by real estate...

  5. 7 CFR 1955.128 - Appraisers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... real estate properties, all contract (fee) appraisers should include the sales comparison, income (when... Inventory Property § 1955.128 Appraisers. (a) Real property. The State Director may authorize the County... estate contract appraisers must be certified as State-Certified General Appraisers. (b) Chattel...

  6. 7 CFR 1955.128 - Appraisers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... real estate properties, all contract (fee) appraisers should include the sales comparison, income (when... Inventory Property § 1955.128 Appraisers. (a) Real property. The State Director may authorize the County... estate contract appraisers must be certified as State-Certified General Appraisers. (b) Chattel...

  7. 7 CFR 1955.128 - Appraisers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... real estate properties, all contract (fee) appraisers should include the sales comparison, income (when... Inventory Property § 1955.128 Appraisers. (a) Real property. The State Director may authorize the County... estate contract appraisers must be certified as State-Certified General Appraisers. (b) Chattel...

  8. 7 CFR 1955.128 - Appraisers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... real estate properties, all contract (fee) appraisers should include the sales comparison, income (when... Inventory Property § 1955.128 Appraisers. (a) Real property. The State Director may authorize the County... estate contract appraisers must be certified as State-Certified General Appraisers. (b) Chattel...

  9. 12 CFR 323.5 - Appraiser independence.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... appraiser, that appraiser must be independent of the lending, investment, and collection functions and not... appraisal are involved in the lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise independent...

  10. 12 CFR 34.45 - Appraiser independence.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... staff appraiser, that appraiser must be independent of the lending, investment, and collection functions... perform an appraisal are involved in the lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise...

  11. 12 CFR 34.45 - Appraiser independence.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... staff appraiser, that appraiser must be independent of the lending, investment, and collection functions... perform an appraisal are involved in the lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise...

  12. 12 CFR 34.45 - Appraiser independence.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... staff appraiser, that appraiser must be independent of the lending, investment, and collection functions... perform an appraisal are involved in the lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise...

  13. 12 CFR 34.45 - Appraiser independence.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... staff appraiser, that appraiser must be independent of the lending, investment, and collection functions... perform an appraisal are involved in the lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise...

  14. Ligating Internal Iliac Artery: Success beyond Hesitation.

    PubMed

    Singh, Abha; Kishore, Ruchi; Saxena, Saveri Sarbhai

    2016-10-01

    To study the outcomes, benefits and complications of internal iliac artery ligation in both obstetric and gynecological cases. To study the outcomes, effectiveness and complications of internal iliac artery ligation (IIAL). This is an analytical longitudinal study done among women who have undergone internal iliac artery ligation in Dr. BRAMH a tertiary referral center from July 2013 to June 2015. Follow-up was done through color Doppler analysis of pelvic arteries before discharge, after 6 weeks and after 6 months. The efficacy of IIAL was 96.87 %. The mean shock index was 0.94 ± 0.26. Sixty-four women underwent IIAL out of which placenta previa (21.8 %) was the major indication. There were four maternal deaths. There were no intraoperative or ischemic complications. The greater the time interval between onset of hemorrhage and IIAL, the graver the outcome. For all women in whom uterus could be salvaged, resumption of menstrual cycles was seen within 6 months of IIAL. There was a significant decrease in the RI and PI of uterine arteries. In the ovarian arteries, there was a significant increase in RI and no significant change in PI initially. Flow in distal part of ligated internal iliac arteries could be detected in 54 (90 %) women out of 60 after 6 months of ligation of internal iliac arteries. IIAL is an effective life-saving method to control obstetric and gynecological hemorrhage, and a hysterectomy can often be avoided. Early resort to IIAL is vital for improving the patient outcome. Uterine perfusion is well maintained, while there may be a decrease in ovarian perfusion. Resumption of menstrual cycles and presence of distal flow in internal iliac artery within 6 months suggest the preservation of future fertility; in order to better understand the impact of IIAL on ovarian functions and future fertility, larger studies with longer follow-up periods need to be conducted.

  15. Embolic stroke after ligation of the pulmonary artery in patients with functional single ventricle.

    PubMed

    Oski, J A; Canter, C E; Spray, T L; Kan, J S; Cameron, D E; Murphy, A M

    1996-10-01

    In the setting of functional single ventricle with pulmonary overcirculation, pulmonary artery banding is frequently used to alleviate symptoms and to prepare for staged repair. At subsequent cavopulmonary anastomosis or Fontan procedure, the pulmonary artery may be ligated at the site of the pulmonary band. This article describes the association of embolic stroke and thrombus in a ligated or divided pulmonary artery stump in three patients with functional single ventricle. These events occurred from 1990 through 1992 among the 1700 inpatient pediatric cardiology admissions at two institutions. The patients, ranging in age from 15 months to 9 years, had cerebral infarctions documented by computed axial tomography scan or magnetic resonance imaging associated with the echocardiographic finding of thrombus in the proximal pulmonary artery stump after the embolic strokes. The strokes occurred 5 days to 5 years after surgery. Two patients had a second infarction within 2 to 5 weeks of the initial stroke. It is concluded that the presence of the ligated pulmonary artery stump may place patients at risk for embolic stroke. Surgical approaches to reduce the risk of thrombus formation should be considered prospectively in this patient group.

  16. Enzyme-mediated ligation technologies for peptides and proteins.

    PubMed

    Schmidt, Marcel; Toplak, Ana; Quaedflieg, Peter Jlm; Nuijens, Timo

    2017-02-18

    With the steadily increasing complexity and quantity requirements for peptides in industry and academia, the efficient and site-selective ligation of peptides and proteins represents a highly desirable goal. Within this context, enzyme-mediated ligation technologies for peptides and proteins have attracted great interest in recent years as they represent an extremely powerful extension to the scope of chemical methodologies (e.g. native chemical ligation) in basic and applied research. Compared to chemical ligation methods, enzymatic strategies using ligases such as sortase, butelase, peptiligase or omniligase generally feature excellent chemoselectivity, therefore making them valuable tools for protein and peptide chemists.

  17. Streamlined expressed protein ligation using split inteins.

    PubMed

    Vila-Perelló, Miquel; Liu, Zhihua; Shah, Neel H; Willis, John A; Idoyaga, Juliana; Muir, Tom W

    2013-01-09

    Chemically modified proteins are invaluable tools for studying the molecular details of biological processes, and they also hold great potential as new therapeutic agents. Several methods have been developed for the site-specific modification of proteins, one of the most widely used being expressed protein ligation (EPL) in which a recombinant α-thioester is ligated to an N-terminal Cys-containing peptide. Despite the widespread use of EPL, the generation and isolation of the required recombinant protein α-thioesters remain challenging. We describe here a new method for the preparation and purification of recombinant protein α-thioesters using engineered versions of naturally split DnaE inteins. This family of autoprocessing enzymes is closely related to the inteins currently used for protein α-thioester generation, but they feature faster kinetics and are split into two inactive polypeptides that need to associate to become active. Taking advantage of the strong affinity between the two split intein fragments, we devised a streamlined procedure for the purification and generation of protein α-thioesters from cell lysates and applied this strategy for the semisynthesis of a variety of proteins including an acetylated histone and a site-specifically modified monoclonal antibody.

  18. Respiratory variables during thoracotomy for PDA ligation.

    PubMed

    Puri, G D; Hariwir, S; Chari, P; Gujral, J S

    1996-06-01

    Physiological deadspace fraction of tidal volume (VD/VT), arterial to end-tidal carbon dioxide tension differences [P(a-E')CO2], arterial oxygen tension (PaO2) and respiratory system compliance were studied in twenty patients with patent ductus ateriosus scheduled for multiple ligation and transfixation through posterolateral thoracotomy under general anaesthesia with controlled ventilation. The study period was divided into six stages: stage 1--supine posture under anaesthesia, stage 2--lateral posture before start of surgery, stage 3--after chest opening before lung manipulation, stage 4--after ductus ligation and lung re-expansion before chest closure, stage 5--lateral posture, chest closed, stage 6--supine stage before reversal. There was a significant (P < 0.01) increase of VD/VT on attaining the lateral posture. The fraction decreased significantly (P < 0.05) on opening of the chest (stage 3) and subsequently increased at stage 4. There was no significant change in mean P(a-E')CO2 at various stages of thoracotomy. PaO2 fell significantly on opening of the chest and was lowest before chest closure (stage 4). PaO2 increased following chest closure but was still significantly lower than the pre-surgical supine stage. Respiratory system compliance was lowest at stage 4. Changes in deadspace fraction VD/VT do not correspond favourably to arterial oxygen tensions during posterolateral thoractomy.

  19. 77 FR 20633 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-05

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... agenda.) Discussion Agenda Appraisal Foundation December 2011 grant reimbursement request....

  20. 78 FR 9050 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-07

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... agenda.) Discussion Agenda Appraisal Complaint National Hotline. Missouri Compliance Review. How...

  1. 77 FR 40051 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-06

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in... discussion agenda.) Discussion Agenda Appraisal Foundation March 2012 Grant Reimbursement Request....

  2. 77 FR 14014 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-08

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... discussion agenda.) Discussion Agenda: ] Appraisal Foundation September-November 2011 Grant...

  3. 76 FR 31961 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... discussion agenda.) Discussion Agenda: Appraisal Foundation January 2011 Grant Reimbursement...

  4. As fast and selective as enzymatic ligations: unpaired nucleobases increase the selectivity of DNA-controlled native chemical PNA ligation.

    PubMed

    Ficht, Simon; Dose, Christian; Seitz, Oliver

    2005-11-01

    DNA-controlled reactions offer interesting opportunities in biological, chemical, and nanosciences. In practical applications, such as in DNA sequence analysis, the sequence fidelity of the chemical-ligation reaction is of central importance. We present a ligation reaction that is as fast as and much more selective than enzymatic T4 ligase-mediated oligonucleotide ligations. The selectivity was higher than 3000-fold in discriminating matched from singly mismatched DNA templates. It is demonstrated that this enormous selectivity is the hallmark of the particular ligation architecture, which is distinct from previous ligation architectures designed as "nick ligations". Interestingly, the fidelity of the native chemical ligation of peptide nucleic acids was increased by more than one order of magnitude when performing the ligation in such a way that an abasic-site mimic was formed opposite an unpaired template base. It is shown that the high sequence fidelity of the abasic ligation could facilitate the MALDI-TOF mass-spectrometric analysis of early cancer onset by allowing the detection of as little as 0.2 % of single-base mutant DNA in the presence of 99.8 % wild-type DNA.

  5. 4 CFR 4.2 - Performance appraisal.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... appraisal. (a) The GAO shall develop one or more performance appraisal systems which provide for periodic... the critical elements of the employee's position. (3) Annually evaluating each employee during the...

  6. 4 CFR 4.2 - Performance appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... appraisal. (a) The GAO shall develop one or more performance appraisal systems which provide for periodic... the critical elements of the employee's position. (3) Annually evaluating each employee during the...

  7. 4 CFR 4.2 - Performance appraisal.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... appraisal. (a) The GAO shall develop one or more performance appraisal systems which provide for periodic... the critical elements of the employee's position. (3) Annually evaluating each employee during the...

  8. Performance Appraisal: A Win/Win Approach.

    ERIC Educational Resources Information Center

    Kaye, Beverly; Krantz, Shelley

    1983-01-01

    Training managers fully for the performance appraisal process can transform an appraisal discussion from an administrative exercise to a worthwhile experience that contributes to the organization as a whole. (Author/SSH)

  9. 12 CFR 34.43 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... by a State certified or licensed appraiser is required for all real estate-related financial transactions except those in which: (1) The transaction value is $250,000 or less; (2) A lien on real estate..., DEPARTMENT OF THE TREASURY REAL ESTATE LENDING AND APPRAISALS Appraisals § 34.43 Appraisals...

  10. Appraisal of family doctors: an evaluation study.

    PubMed Central

    Lewis, Malcolm; Elwyn, Glyn; Wood, Fiona

    2003-01-01

    BACKGROUND: Appraisal has evolved to become a key component of workforce management. However, it is not clear from existing proposals for appraisal of doctors whether employers, health authorities or primary care organisations should take responsibility for appraisal processes. AIMS: To evaluate the introduction of a pilot peer appraisal system in general practice and to gain insight into the reactions of appraisers and doctors. DESIGN OF STUDY: Semi-structured telephone interviews combined with participant surveys and documentary analysis. SETTING: Five health authorities in Wales. PARTICIPANTS: General practitioners (GPs) appointed as appraisers and volunteer practitioners (doctors). METHOD: Twenty-six appraisers were appointed and given training in the appraisal process, each appraising an average of eight individuals. Appraisers and appraised doctors participated in semi-structured telephone interviews and completed separate participant questionnaires. RESULTS: GPs willingly undertook peer appraisal in a volunteer-based pilot study where participation was recompensed. The majority of participating clinicians were positive, with appraisers reporting the most gain. Appraisers were enthusiastic, provided the process remained non-judgemental and did not threaten or burden their colleagues. Appraised doctors were less enthusiastic but the most significant perceived benefit was the opportunity to reflect on individual performance with a supportive colleague. There were, however, repeated concerns about time, confusion with revalidation and personal development plans, worries about including health and probity queries, and an opinion that the process would be entirely different if conducted with non-volunteers or by representatives of 'management'. CONCLUSION: This study illustrated three fundamental problems for appraisal systems in general practice. First, there is as yet no organisational hierarchy in general practice. Perhaps the aggregation of practices into

  11. (Bio)molecular surface patterning by phototriggered oxime ligation.

    PubMed

    Pauloehrl, Thomas; Delaittre, Guillaume; Bruns, Michael; Meißler, Maria; Börner, Hans G; Bastmeyer, Martin; Barner-Kowollik, Christopher

    2012-09-03

    Making light work of ligation: A novel method utilizes light for oxime ligation chemistry. A quantitative, low-energy photodeprotection generates aldehyde, which subsequently reacts with aminooxy moieties. The spatial control allows patterning on surfaces with a fluoro marker and GRGSGR peptide, and can be imaged by time-of-flight secondary-ion mass spectrometry.

  12. A new 10-min ligation method using a modified buffer system with a very low amount of T4 DNA ligase: the "Coffee Break Ligation" technique.

    PubMed

    Yoshino, Yuki; Ishida, Masaharu; Horii, Akira

    2007-10-01

    The ligation reaction is widely used in molecular biology. There are several kits available that complete the ligation reaction very rapidly but they are rather expensive. In this study, we successfully modified the ligation buffer with much lower cost than existing kits. The ligation reaction can be completed in 10 min using very low activities such as 0.01 U T4 DNA ligase, and costs only $1 for 100 reactions of 20 microl scale. We name this ligation system the "Coffee Break Ligation" system; one can complete ligation reaction while drinking a cup of coffee, and perform 100 reactions by spending money equivalent to a cup of coffee.

  13. A simple microfluidic assay for the detection of ligation product.

    PubMed

    Zhang, Lei; Wang, Jingjing; Roebelen, Johann; Tripathi, Anubhav

    2015-02-01

    We present a novel microfluidic-based approach to detect ligation products. The conformal specificity of ligases is used in various molecular assays to detect point mutations. Traditional methods of detecting ligation products include denaturing gel electrophoresis, sequence amplification, and melting curve analysis. Gel electrophoresis is a labor- and time-intensive process, while sequence amplification and melting curve analysis require instruments capable of accurate thermal ramping and sensitive optical detection. Microfluidics has been widely applied in genomics, proteomics, and cell cytometry to enable rapid and automated assays. We designed an assay that fluorogenically detects ligation products following a simple magnetic separation through a microfluidic channel. 100 nM of synthetic HIV-1 K103N minority mutant templates were successfully detected in 30 min. This simple and rapid method can be coupled with any ligation assay for the detection of ligation products.

  14. Irreversible sortase A-mediated ligation driven by diketopiperazine formation.

    PubMed

    Liu, Fa; Luo, Ethan Y; Flora, David B; Mezo, Adam R

    2014-01-17

    Sortase A (SrtA)-mediated ligation has emerged as an attractive tool in bioorganic chemistry attributing to the remarkable specificity of the ligation reaction and the physiological reaction conditions. However, the reversible nature of this reaction limits the efficiency of the ligation reaction and has become a significant constraint to its more widespread use. We report herein a novel set of SrtA substrates (LPETGG-isoacyl-Ser and LPETGG-isoacyl-Hse) that can be irreversibly ligated to N-terminal Gly-containing moieties via the deactivation of the SrtA-excised peptide fragment through diketopiperazine (DKP) formation. The convenience of the synthetic procedure and the stability of the substrates in the ligation buffer suggest that both LPETGG-isoacyl-Ser and LPETGG-isoacyl-Hse are valuable alternatives to existing irreversible SrtA substrate sequences.

  15. Template-directed oligonucleotide ligation on hydroxylapatite

    NASA Technical Reports Server (NTRS)

    Acevedo, O. L.; Orgel, L. E.

    1986-01-01

    It has been suggested that the prebiotic synthesis of the precursors of biopolymers could have occurred on a solid surface such as that provided by clay or some other mineral. One such scheme envisages that growing polymers were localized by adsorption to a mineral surface where an activating agent or activated monomers were supplied continuously or cyclically. Here, it is reported that a sequence of reactions in which initially formed oligo(G)s are reactivated by conversion to phosphorimidazolides in the presence of poly(C) and then allowed to ligate is ideal, in that repeated cycles can be carried out on the surface of hydroxylapatite, whereas in the liquid phase the cycle could be achieved only with considerable difficulty.

  16. A new resorbable device for ligation of blood vessels - A pilot study

    PubMed Central

    2011-01-01

    Background During surgery, controlled haemostasis to prevent blood loss is vital for a successful outcome. It can be difficult to ligate vessels located deep in the abdomen. A device that is easy to use and enables secure ligatures could be beneficial. Cable ties made of nylon have been used for ligation but the non-resorbable material caused tissue reactions. The objective of this study was to use a resorbable material to construct a device with a self-locking mechanism and to test its mechanical strength and ligation efficiency. Methods The device was manufactured by injection moulding of polydioxanone, a resorbable polymer used for suture materials. Polydioxanone with inherent viscosities of 1.9 dL/g and 1.3 dL/g were tested. The device consisted of a perforated flexible band which could be pulled through a case with a locking mechanism. After a first version of the device had been tested, some improvements were made. The locking case was downsized, corners were rounded off, the band was made thicker and the mould was redesigned to produce longer devices. Tensile tests were performed with the second version. The first version of the device was used to ligate the ovarian pedicle in a euthanized dog and to test echogenicity of the device with ultrasound. Compression of vessels of the ovarian pedicle was examined by histology. Both versions of the device were tested for haemostasis of and tissue grip on renal arteries in six anaesthetised pigs. Results The tensile strength of the flexible band of the devices with inherent viscosity of 1.9 dL/g was 50.1 ± 5.5 N (range 35.2-62.9 N, n = 11) and the devices with inherent viscosity of 1.3 dL/g had a tensile strength of 39.8 ± 8.1 N (range 18.6-54.2 N, n = 11). Injection moulding of the polymer with lower inherent viscosity resulted in a longer flow distance. Both versions of the device had an effective tissue grip and complete haemostasis of renal arteries was verified. The device attached to the ovarian pedicle could

  17. A new resorbable device for ligation of blood vessels - A pilot study.

    PubMed

    Höglund, Odd V; Hagman, Ragnvi; Olsson, Kerstin; Mindemark, Jonas; Borg, Niklas; Lagerstedt, Anne-Sofie

    2011-07-08

    During surgery, controlled haemostasis to prevent blood loss is vital for a successful outcome. It can be difficult to ligate vessels located deep in the abdomen. A device that is easy to use and enables secure ligatures could be beneficial. Cable ties made of nylon have been used for ligation but the non-resorbable material caused tissue reactions. The objective of this study was to use a resorbable material to construct a device with a self-locking mechanism and to test its mechanical strength and ligation efficiency. The device was manufactured by injection moulding of polydioxanone, a resorbable polymer used for suture materials. Polydioxanone with inherent viscosities of 1.9 dL/g and 1.3 dL/g were tested. The device consisted of a perforated flexible band which could be pulled through a case with a locking mechanism. After a first version of the device had been tested, some improvements were made. The locking case was downsized, corners were rounded off, the band was made thicker and the mould was redesigned to produce longer devices. Tensile tests were performed with the second version.The first version of the device was used to ligate the ovarian pedicle in a euthanized dog and to test echogenicity of the device with ultrasound. Compression of vessels of the ovarian pedicle was examined by histology. Both versions of the device were tested for haemostasis of and tissue grip on renal arteries in six anaesthetised pigs. The tensile strength of the flexible band of the devices with inherent viscosity of 1.9 dL/g was 50.1 ± 5.5 N (range 35.2-62.9 N, n = 11) and the devices with inherent viscosity of 1.3 dL/g had a tensile strength of 39.8 ± 8.1 N (range 18.6-54.2 N, n = 11). Injection moulding of the polymer with lower inherent viscosity resulted in a longer flow distance.Both versions of the device had an effective tissue grip and complete haemostasis of renal arteries was verified. The device attached to the ovarian pedicle could be seen with ultrasound, and

  18. Appraisal and Evaluation: Chimera, Fantasy, or Practicality?

    ERIC Educational Resources Information Center

    Marland, Michael

    1986-01-01

    Looks beyond the threatening and remunerative aspects of teacher appraisal in the United Kingdom to the contribution that evaluation can make to professional and school development. Considers five sound reasons for appraisal, the roles and behaviors to be appraised, and some workable approaches and techniques. Effective leadership is the key.…

  19. Appraisal and Evaluation: Chimera, Fantasy, or Practicality?

    ERIC Educational Resources Information Center

    Marland, Michael

    1986-01-01

    Looks beyond the threatening and remunerative aspects of teacher appraisal in the United Kingdom to the contribution that evaluation can make to professional and school development. Considers five sound reasons for appraisal, the roles and behaviors to be appraised, and some workable approaches and techniques. Effective leadership is the key.…

  20. 25 CFR 700.39 - Appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Appraisal. 700.39 Section 700.39 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Policies and Instructions Definitions § 700.39 Appraisal. The appraisal is an estimate of the fair market value which...

  1. 7 CFR 761.7 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Appraisals. 761.7 Section 761.7 Agriculture... SPECIAL PROGRAMS GENERAL PROGRAM ADMINISTRATION General Provisions § 761.7 Appraisals. (a) General. This section describes Agency requirements for: (1) Real estate and chattel appraisals made in connection...

  2. 7 CFR 762.127 - Appraisal requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Appraisal requirements. 762.127 Section 762.127... AGRICULTURE SPECIAL PROGRAMS GUARANTEED FARM LOANS § 762.127 Appraisal requirements. (a) General. The Agency may require a lender to obtain an appraisal based on the type of security, loan size, and whether...

  3. 32 CFR 644.436 - Appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Appraisal. 644.436 Section 644.436 National... HANDBOOK Disposal Disposal of Fee-Owned Real Property and Easement Interests § 644.436 Appraisal. Under the... classification. Appraisals will not be undertaken for property which has been or is likely to be classified...

  4. 7 CFR 3550.62 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Appraisals. 3550.62 Section 3550.62 Agriculture... DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Section 502 Origination § 3550.62 Appraisals. (a) Requirement. An appraisal is required when the debt to be secured exceeds $15,000 or whenever RHS...

  5. 5 CFR 9901.411 - Appraisal period.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Appraisal period. 9901.411 Section 9901... PERSONNEL SYSTEM (NSPS) Performance Management § 9901.411 Appraisal period. (a) Except as provided in paragraphs (a)(1) through (3) and (b) of this section, the appraisal period will be October 1 to September...

  6. 25 CFR 152.24 - Appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Appraisal. 152.24 Section 152.24 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER ISSUANCE OF PATENTS IN FEE, CERTIFICATES OF COMPETENCY... Restricted Lands § 152.24 Appraisal. Except as otherwise provided by the Secretary, an appraisal shall...

  7. Problem Solving Appraisal of Delinquent Adolescents.

    ERIC Educational Resources Information Center

    Perez, Ruperto M.; And Others

    The study investigated the following: (1) the relationship of problem solving appraisal to narcissistic vulnerability, locus of control, and depression; (2) the differences in problem solving appraisal, locus of control, and depression in first-time and repeat offenders; and (3) the prediction of problem solving appraisal by narcissistic…

  8. Staff Appraisal and Development through Interviewing

    ERIC Educational Resources Information Center

    Randell, G. A.

    1975-01-01

    The working paper discusses the purposes and problems of staff appraisal and recommends guidelines for the creation of an active and effective appraisal and development scheme in organization. Charts illustrate the principles around which management training can be oriented regarding appraisal interviews and observation of behavior. (Author/JB)

  9. 5 CFR 430.307 - Appraising performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Appraising performance. 430.307 Section 430.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.307 Appraising performance. (a) Annual appraisals...

  10. 5 CFR 430.307 - Appraising performance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Appraising performance. 430.307 Section 430.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.307 Appraising performance. (a) Annual appraisals...

  11. 5 CFR 430.307 - Appraising performance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Appraising performance. 430.307 Section 430.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.307 Appraising performance. (a) Annual appraisals...

  12. 5 CFR 430.307 - Appraising performance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Appraising performance. 430.307 Section 430.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.307 Appraising performance. (a) Annual appraisals...

  13. Teacher Appraisal: Back to the Future.

    ERIC Educational Resources Information Center

    Mortimore, Peter; Mortimore, Jo

    1991-01-01

    Reviews the government's progress in introducing a formal, systematic, and compulsory system of teacher appraisal across England and Wales, using comparisons with civil service, business, and commerce appraisal techniques. Describes national government-initiated pilot appraisal schemes, concluding with a discussion of implications for developing a…

  14. 30 CFR 882.12 - Appraisals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... actually occurred. Such updated appraisal shall not include any increase in value of the land as... LAND RECLAMATION RECLAMATION ON PRIVATE LAND § 882.12 Appraisals. (a) A notarized appraisal of private land to be reclaimed which may be subject to a lien under § 882.13 shall be obtained from...

  15. 12 CFR 34.85 - Appraisal requirements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... APPRAISALS Other Real Estate Owned § 34.85 Appraisal requirements. (a) General. (1) Upon transfer to OREO, a national bank shall substantiate the parcel's market value by obtaining either: (i) An appraisal in... develop a prudent real estate collateral evaluation policy that allows the bank to monitor the value...

  16. 7 CFR 762.127 - Appraisal requirements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... experience or training to establish market (not retail) values as determined by the Agency. (d) Real estate appraisals. A current real estate appraisal is required when real estate will be primary security. Agency... market or on the subject real estate and the appraisal was either completed within the past 12 months...

  17. 7 CFR 762.127 - Appraisal requirements.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... experience or training to establish market (not retail) values as determined by the Agency. (d) Real estate appraisals. A current real estate appraisal is required when real estate will be primary security. Agency... market or on the subject real estate and the appraisal was either completed within the past 12 months...

  18. 7 CFR 762.127 - Appraisal requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... experience or training to establish market (not retail) values as determined by the Agency. (d) Real estate appraisals. A current real estate appraisal is required when real estate will be primary security. Agency... market or on the subject real estate and the appraisal was either completed within the past 12 months...

  19. 25 CFR 700.39 - Appraisal.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 2 2011-04-01 2011-04-01 false Appraisal. 700.39 Section 700.39 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Policies and Instructions Definitions § 700.39 Appraisal. The appraisal is an estimate of the fair market value which is...

  20. 12 CFR 722.5 - Appraiser independence.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., that appraiser must be independent of the lending, investment, and collection functions and not... appraisal are involved in the lending, investment, or collection functions of the credit union, the credit union shall take appropriate steps to ensure that the appraisers exercise independent judgment. Such...

  1. 12 CFR 722.5 - Appraiser independence.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., that appraiser must be independent of the lending, investment, and collection functions and not... appraisal are involved in the lending, investment, or collection functions of the credit union, the credit union shall take appropriate steps to ensure that the appraisers exercise independent judgment. Such...

  2. 19 CFR 162.43 - Appraisement.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) INSPECTION, SEARCH, AND SEIZURE Treatment of Seized Merchandise § 162.43 Appraisement. (a) Property under seizure and subject to forfeiture. Seized property shall be appraised as required by section... to the place of appraisement shall be reported. (b) Property not under seizure. The basis for a claim...

  3. 19 CFR 162.43 - Appraisement.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (CONTINUED) INSPECTION, SEARCH, AND SEIZURE Treatment of Seized Merchandise § 162.43 Appraisement. (a) Property under seizure and subject to forfeiture. Seized property shall be appraised as required by section... to the place of appraisement shall be reported. (b) Property not under seizure. The basis for a claim...

  4. Board & Supt. Share Appraisal Benefits.

    ERIC Educational Resources Information Center

    Glaub, Gerald R.

    1983-01-01

    Although some board members and superintendents may consider superintendent evaluation as potentially disturbing for their working relationships, such evaluations may become more appealing when considered as part of a broader system of school governance and management. What is needed is a performance appraisal system developed jointly by…

  5. Psychotherapy: A 40-Year Appraisal.

    ERIC Educational Resources Information Center

    Garfield, Sol L.

    1981-01-01

    Appraises selected issues and developments in the field of psychotherapy since 1940. Discusses increased participation of clinical psychologists in the area of psychotherapy, increased popularity of psychotherapy, declining influence of psychoanalysis and related views, emergence of behavioral and cognitive therapies, and recent emphasis on…

  6. Principal Appraisals Get a Remake

    ERIC Educational Resources Information Center

    Zubrzycki, Jaclyn

    2013-01-01

    A growing number of school districts--including large ones like those in Chicago, Dallas, Los Angeles, and Hawaii--have become recent converts to new principal-evaluation systems that tie school leaders' appraisals to student test scores. As of this school year, student achievement accounts for 40 percent to 50 percent of principals' evaluations…

  7. Critical Appraisal of Medical Literature

    PubMed Central

    Labrecque, Michel

    1989-01-01

    This skill-testing exercise is intended to update the “Critical Appraisal Package: Therapy,” published by the College of Family Physicians of Canada in 1986. The format follows the design of the original practical exercises of the package: clinical scenario, article, worksheet, and methodology notes. PMID:21249024

  8. Appraisal Psychology, Neurobiology, and Language.

    ERIC Educational Resources Information Center

    Schumann, John H.

    2001-01-01

    Proposes that the confluence of stimulus appraisal and social cognition that is effected by the neural system in the brain has important implications for language and learning theories. Describes the anatomy and functions of this neural system and discusses how it may operate in motivation for second language acquisition and how in conjunction…

  9. Efficient Ligation of the Schistosoma Hammerhead Ribozyme †

    PubMed Central

    Canny, Marella D.; Jucker, Fiona M.; Pardi, Arthur

    2011-01-01

    The hammerhead ribozyme from Schistosoma mansoni is the best characterized of the natural hammerhead ribozymes. Biophysical, biochemical, and structural studies have shown that the formation of the loop-loop tertiary interaction between stems I and II alters the global folding, cleavage kinetics, and conformation of the catalytic core of this hammerhead, leading to a ribozyme that is readily cleaved under physiological conditions. This study investigates the ligation kinetics and the internal equilibrium between cleavage and ligation for the Schistosoma hammerhead. Single turnover kinetic studies on a construct where the ribozyme cleaves and ligates substrate(s) in trans showed up to 23% ligation when starting from fully cleaved products. This was achieved by a ~2,000-fold increase in the rate of ligation compared to a minimal hammerhead without the loop-loop tertiary interaction, yielding an internal equilibrium that ranges from 2–3 at physiological Mg2+ ion concentrations (0.1 –1 mM). Thus, the natural Schistosoma hammerhead ribozyme is almost as efficient at ligation as it is at cleavage. The results here are consistent with a model where formation of the loop-loop tertiary interaction leads to a higher population of catalytically active molecules, and where formation of this tertiary interaction has a much larger effect on the ligation than the cleavage activity of the Schistosoma hammerhead ribozyme. PMID:17319693

  10. Appraisal-emotion relationships in daily life.

    PubMed

    Nezlek, John B; Vansteelandt, Kristof; Van Mechelen, Iven; Kuppens, Peter

    2008-02-01

    Using a daily process design, the present study examined relationships between momentary appraisals and emotional experience based on Smith and Lazarus' (1993) theory of emotions (1993). Nine times a day for 2 weeks, participants (N = 33, 23 women) recorded their momentary experience of 2 positive emotions (joy, love) and 4 negative emotions (anger, guilt, fear, sadness) and the core relational theme appraisal contents Smith and Lazarus hypothesized as corresponding to these emotions. A series of multilevel modeling analyses found that the hypothesized relationships between appraisal contents and these emotions were stronger than relationships between contents and other emotions, although appraisals were related to other emotions in many cases. Moreover, there were some individual differences in the strength of these relationships. These results suggest that there are no one-to-one relationships between appraisal contents and specific emotional experiences, and that specific emotions are associated with different appraisal contents, and that specific appraisals are associated with different emotions.

  11. Selective suppression of interleukin-12 induction after macrophage receptor ligation.

    PubMed

    Sutterwala, F S; Noel, G J; Clynes, R; Mosser, D M

    1997-06-02

    Interleukin (IL)-12 is a monocyte- and macrophage-derived cytokine that plays a crucial role in both the innate and the acquired immune response. In this study, we examined the effects that ligating specific macrophage receptors had on the induction of IL-12 by lipopolysaccharide (LPS). We report that ligation of the macrophage Fcgamma, complement, or scavenger receptors inhibited the induction of IL-12 by LPS. Both mRNA synthesis and protein secretion were diminished to near-undetectable levels following receptor ligation. Suppression was specific to IL-12 since IL-10 and tumor necrosis factor-alpha (TNF-alpha) production were not inhibited by ligating macrophage receptors. The results of several different experimental approaches suggest that IL-12 downregulation was due to extracellular calcium influxes that resulted from receptor ligation. First, preventing extracellular calcium influxes, by performing the assays in EGTA, abrogated FcgammaR-mediated IL-12(p40) mRNA suppression. Second, exposure of macrophages to the calcium ionophores, ionomycin or A23187, mimicked receptor ligation and inhibited IL-12(p40) mRNA induction by LPS. Finally, bone marrow-derived macrophages from FcR gamma chain-deficient mice, which fail to flux calcium after receptor ligation, failed to inhibit IL-12(p40) mRNA induction. These results indicate that the calcium influxes that occur as a result of receptor ligation are responsible for inhibiting the induction of IL-12 by LPS. Hence, the ligation of phagocytic receptors on macrophages can lead to a dramatic decrease in IL-12 induction. This downregulation may be a way of limiting proinflammatory responses of macrophages to extracellular pathogens, or suppressing the development of cell-mediated immunity to intracellular pathogens.

  12. Convergent synthesis of proteins by kinetically controlled ligation

    DOEpatents

    Kent, Stephen; Pentelute, Brad; Bang, Duhee; Johnson, Erik; Durek, Thomas

    2010-03-09

    The present invention concerns methods and compositions for synthesizing a polypeptide using kinetically controlled reactions involving fragments of the polypeptide for a fully convergent process. In more specific embodiments, a ligation involves reacting a first peptide having a protected cysteyl group at its N-terminal and a phenylthioester at its C-terminal with a second peptide having a cysteine residue at its N-termini and a thioester at its C-termini to form a ligation product. Subsequent reactions may involve deprotecting the cysteyl group of the resulting ligation product and/or converting the thioester into a thiophenylester.

  13. Chemical ligation of oligonucleotides using an electrophilic phosphorothioester

    PubMed Central

    Oikawa, Ryota; Hayakawa, Mayu; Takamori, Shono; Kimura, Yasuaki; Abe, Naoko; Tsuji, Genichiro; Matsuda, Akira; Shuto, Satoshi; Ito, Yoshihiro

    2017-01-01

    Abstract We developed a new approach for chemical ligation of oligonucleotides using the electrophilic phosphorothioester (EPT) group. A nucleophilic phosphorothioate group on oligonucleotides was converted into the EPT group by treatment with Sanger's reagent (1-fluoro-2,4-dinitrobenzene). EPT oligonucleotides can be isolated, stored frozen, and used for the ligation reaction. The reaction of the EPT oligonucleotide and an amino-modified oligonucleotide took place without any extra reagents at pH 7.0–8.0 at room temperature, and resulted in a ligation product with a phosphoramidate bond with a 39–85% yield. This method has potential uses in biotechnology and chemical biology. PMID:28520986

  14. Analysis of Genes, Transcripts, and Proteins via DNA Ligation

    NASA Astrophysics Data System (ADS)

    Conze, Tim; Shetye, Alysha; Tanaka, Yuki; Gu, Jijuan; Larsson, Chatarina; Göransson, Jenny; Tavoosidana, Gholamreza; Söderberg, Ola; Nilsson, Mats; Landegren, Ulf

    2009-07-01

    Analytical reactions in which short DNA strands are used in combination with DNA ligases have proven useful for measuring, decoding, and locating most classes of macromolecules. Given the need to accumulate large amounts of precise molecular information from biological systems in research and in diagnostics, ligation reactions will continue to offer valuable strategies for advanced analytical reactions. Here, we provide a basis for further development of methods by reviewing the history of analytical ligation reactions, discussing the properties of ligation reactions that render them suitable for engineering novel assays, describing a wide range of successful ligase-based assays, and briefly considering future directions.

  15. Ligation and quaternary structure induced changes in the heme pocket of hemoglobin: a transient resonance Raman study.

    PubMed

    Friedman, J M; Stepnoski, R A; Stavola, M; Ondrias, M R; Cone, R L

    1982-04-27

    The extent to which ligation and quaternary structure modify the heme-heme pocket configuration is determined by generating and analyzing transient resonance Raman spectra from various photolyzed and partially photolyzed hemoglobins (Hb). From small frequently shifts in Raman band I (approximately 1355 cm-1) it is determined that ligation induces a configurational change about the heme. The extent to which ligation modifies the heme pocket is influenced by the quaternary structure. With respect to the structural parameter responsible for variations in the pi orbital electron density of the porphyrin, the degree of alteration of the heme pocket configuration relative to deoxy-Hb(T) follows the sequence: liganded Hb(R) greater than liganded Hb(R) + IHP greater than liganded Hb(T) [alpha chain greater than beta chain] greater than deoxy-Hb(R). This progression of configurations also forms a sequence with respect to the "retentiveness" of the heme pocket as reflected in the ligand dynamics associated with geminate recombination. The results indicate that the heme-heme pocket of the R-state Hb's, relative to those of the T-state species, favors ligand retention in a dynamic, as well as thermodynamic, sense. The analysis of these and other related data implicates a ligation and quaternary structure modulated electronic and/or electrostatic interaction between the pi system of the porphyrin and the surrounding heme pocket as the basis for this variation in ligand dynamics as well as for the energetics of cooperativity.

  16. Formatting and ligating biopolymers using adjustable nanoconfinement

    NASA Astrophysics Data System (ADS)

    Berard, Daniel J.; Shayegan, Marjan; Michaud, Francois; Henkin, Gil; Scott, Shane; Leslie, Sabrina

    2016-07-01

    Sensitive visualization and conformational control of long, delicate biopolymers present critical challenges to emerging biotechnologies and biophysical studies. Next-generation nanofluidic manipulation platforms strive to maintain the structural integrity of genomic DNA prior to analysis but can face challenges in device clogging, molecular breakage, and single-label detection. We address these challenges by integrating the Convex Lens-induced Confinement (CLiC) technique with a suite of nanotopographies embedded within thin-glass nanofluidic chambers. We gently load DNA polymers into open-face nanogrooves in linear, concentric circular, and ring array formats and perform imaging with single-fluorophore sensitivity. We use ring-shaped nanogrooves to access and visualize confinement-enhanced self-ligation of long DNA polymers. We use concentric circular nanogrooves to enable hour-long observations of polymers at constant confinement in a geometry which eliminates the confinement gradient which causes drift and can alter molecular conformations and interactions. Taken together, this work opens doors to myriad biophysical studies and biotechnologies which operate on the nanoscale.

  17. Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation

    PubMed Central

    Xu, Liang; Ji, Feng; Xu, Qin-Wei; Zhang, Mie-Qing

    2011-01-01

    AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL). METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010. were included in this study. The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy. A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication. RESULTS: The incidence of early rebleeding after EVL was 7.60%, and the morbidity of rebleeding was 26.9%. Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83, 95% CI: 9.39-420.56, P < 0.001], the number of bands placed (OR 17.36, 95% CI: 4.00-75.34, P < 0.001), the extent of varices (OR 15.41, 95% CI: 2.84-83.52, P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35, 95% CI: 1.93-66.70, P = 0.007). CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites, number of rubber bands used to ligate, severity of varices and prolonged PT. Effective measures for prevention and treatment should be adopted before and after EVL. PMID:21876624

  18. Open Surgical Management of Hypogastric Artery during Aortic Surgery: Ligate or Not Ligate?

    PubMed

    Marconi, Michele; Ceragioli, Sabrina; Mocellin, Davide M; Alberti, Aldo; Tomei, Francesca; Adami, Daniele; Berchiolli, Raffaella N; Ferrari, Mauro

    2015-01-01

    Abdominal aortic aneurysm (AAA) is associated with 43% of cases with common iliac artery aneurysms and an extension of prosthetic replacement distal to the iliac bifurcation is needed. The decision about preserving the hypogastric artery (HA) is a source of discussion, in particular when only one HA is interested. The low risk of pelvic ischemia, even if existing, has to be compared with the greater technical difficulty of the vascular reconstruction. The aim of this study is to evaluate retrospectively the perioperative results in patients who underwent ligation or reconstruction of the HA during open surgical procedures for AAA. Over a period of 11 years (January 2002 to December 2012), 1,487 patients were treated electively for AAA. In 235 cases (15.8%), the aneurysm involved the iliac bifurcation with need to extend distally the prosthetic reconstruction; among them, 63 patients were subjected to HA ligation (26.8%, group 1) and 172 to HA bypass (73.2%, group 2). Indication for ligation was the presence of extended HA aneurysm in 34 cases (54%) and heavy calcification of HA in 29 (46%). Perioperative mortality and morbidity rates were, respectively, 1.6% (1/63) and 7.9% (5/63) in group 1 and 1.2% (2/172) and 6.4% (11/172) in group 2 (P = 0.902 and 0.689). The incidence of buttock claudication was significantly higher in group 1 (6/63, 9.5% vs. 4/172, 2.3% P = 0.025), while there were no significant differences in other complications of pelvic ischemia. In group 2, higher intraoperative blood loss (754 ± 721 vs. 996 ± 608 mL, P = 0.011), longer operating time (283.2 ± 104.7 vs. 302 ± 109 min, P = 0.053), and longer postoperative length of stay (PLOS) (5.8 ± 2.2 vs. 6.7 ± 3.6 days, P = 0.049) occurred. HA bypass during open surgery for AAA is a safe procedure. If compared with ligation, it reduces the risk of buttock claudication without increasing perioperative morbidity and mortality. However, the increased complexity of the

  19. Analyzing ligation mixtures using a PCR based method

    PubMed Central

    Wikel, Stephen K.

    2005-01-01

    We have developed a simple and effective method (Lig-PCR) for monitoring ligation reactions using PCR and primers that are common to many cloning vectors. Ligation mixtures can directly be used as templates and the results can be analyzed by conventional gel electrophoresis. The PCR products are representative of the recombinant molecules created during ligation and the corresponding transformants. Orientation of inserts can also be determined using an internal primer. The usefulness of this method has been demonstrated using ligation mixtures of two cDNA’s derived from the salivary glands of Aedes aegypti mosquitoes. The method described here is sensitive and easy to perform compared to currently available methods. PMID:16136227

  20. Serine/threonine ligation for the chemical synthesis of proteins.

    PubMed

    Lee, Chi Lung; Li, Xuechen

    2014-10-01

    Advances in the development of efficient peptide ligation methods have enabled the total synthesis of complex proteins to be successfully undertaken. Recently, a Ser/Thr ligation has emerged as a new tool in synthetic protein chemistry. The chemoselective reaction between an N-terminal serine or threonine of an unprotected peptide segment and a C-terminal salicylaldehyde ester of another unprotected peptide segment gives rise to an N,O-benzylidene acetal linked product, which upon acidolysis produces a native peptide bond at the site of ligation. Ser/Thr ligation has been used for the synthesis of the human erythrocyte acylphosphatase protein and MUC1 glycopeptide segments, semisynthesis of peptoid/PEG-RNase S protein hybrids, and cyclic peptide synthesis including cyclic tetrapeptides, cyclomontanin B, yunnanin C, mahafacyclin B, and daptomycin. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Cross-ligation and exchange reactions catalyzed by hairpin ribozymes.

    PubMed Central

    Komatsu, Y; Koizumi, M; Sekiguchi, A; Ohtsuka, E

    1993-01-01

    The negative strand of the satellite RNA of tobacco ringspot virus (sTobRV(-)) contains a hairpin catalytic domain that shows self-cleavage and self-ligation activities in the presence of magnesium ions. We describe here that the minimal catalytic domain can catalyze a cross-ligation reaction between two kinds of substrates in trans. The cross-ligated product increased when the reaction temperature was decreased during the reaction from 37 degrees C to 4 degrees C. A two-stranded hairpin ribozyme, divided into two fragments between G45 and U46 in a hairpin loop, showed higher ligation activity than the nondivided ribozyme. The two stranded ribozyme also catalyzed an exchange reaction of the 3'-portion of the cleavage site. Images PMID:8441626

  2. Hairpin ribozyme-catalyzed ligation in water-alcohol solutions.

    PubMed

    Vlassov, Alexander V; Johnston, Brian H; Kazakov, Sergei A

    2005-12-01

    The hairpin ribozyme (HPR) is a naturally existing RNA that catalyzes site-specific RNA cleavage and ligation. At 37 degrees C and in the presence of divalent metal ions (M(2+)), the HPR efficiently cleaves RNA substrates in trans. Here, we show that the HPR can catalyze efficient M(2+)-independent ligation in trans in aqueous solutions containing any of several alcohols, including methanol, ethanol, and isopropanol, and millimolar concentrations of monovalent cations. Ligation proceeds most efficiently in 60% isopropanol at 37 degrees C, whereas the reverse (cleavage) reaction is negligible under these conditions. We suggest that dehydration of the RNA is the key factor promoting HPR activity in water- alcohol solutions. Alcohol-induced ribozyme ligation may have practical applications.

  3. A Photo-Triggered Traceless Staudinger-Bertozzi Ligation Reaction.

    PubMed

    Hu, Peng; Feng, Tianshi; Yeung, Chi-Chung; Koo, Chi-Kin; Lau, Kai-Chung; Lam, Michael H W

    2016-08-08

    The use of light to control the course of a chemical/biochemical reaction is an attractive idea because of its ease of administration with high precision and fine spatial resolution. Staudinger ligation is one of the commonly adopted conjugation processes that involve a spontaneous reaction between azides and arylphosphines to form iminophosphoranes, which further hydrolyze to give stable amides. We designed an anthracenylmethyl diphenylphosphinothioester (1) that showed promising Staudinger ligation reactivity upon photo-excitation. Broadband photolysis at 360-400 nm in aqueous organic solvents induced heterolytic cleavage of its anthracenylmethyl-phosphorus bond, releasing a diphenylphosphinothioester (2) as an efficient traceless Staudinger-Bertozzi ligation reagent. The quantum yield of such a photo-induced heterolytic bond-cleavage at the optimal wavelength of photolysis (376 nm) at room temperature is ≥0.07. This work demonstrated the feasibility of photocaging arylphosphines to realize the photo-triggering of the Staudinger ligation reaction.

  4. Band heterotopia.

    PubMed

    Alam, M S; Naila, N

    2010-01-01

    Band heterotopias are one of the rarest groups of congenital disorder that result in variable degree of structural abnormality of brain parenchyma. Band of heterotopic neurons result from a congenital or acquired deficiency of the neuronal migration. MRI is the examination of choice for demonstrating these abnormalities because of the superb gray vs. white matter differentiation, detail of cortical anatomy and ease of multiplanar imaging. We report a case of band heterotopia that showed a bilateral band of gray matter in deep white matter best demonstrated on T2 Wt. and FLAIR images.

  5. 25 CFR 700.117 - Criteria for appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Criteria for appraisals. 700.117 Section 700.117 Indians... Acquisition and Disposal of Habitations and/or Improvements § 700.117 Criteria for appraisals. (a) Appraisal standards. The Commission's appraisals shall be based upon nationally recognized appraisal standards...

  6. 75 FR 36088 - Appraisal Subcommittee; Rules of Operation; Amendment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-24

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Rules of Operation; Amendment AGENCY: Appraisal... governing the Chairperson and Vice Chairperson of the Appraisal Subcommittee. SUMMARY: The Appraisal... , respectively, or by U.S. Mail at Appraisal Subcommittee, 1401 H Street, NW., Suite 760, Washington, DC...

  7. 49 CFR 24.103 - Criteria for appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Criteria for appraisals. 24.103 Section 24.103... appraisals. (a) Appraisal requirements. This section sets forth the requirements for real property acquisition appraisals for Federal and federally-assisted programs. Appraisals are to be prepared according...

  8. 49 CFR 24.104 - Review of appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Review of appraisals. 24.104 Section 24.104... appraisals. The Agency shall have an appraisal review process and, at a minimum: (a) A qualified review... market information in all appraisals to assure that they meet the definition of appraisal found in 49...

  9. 7 CFR 3550.111 - Appraisals (loans only).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Appraisals (loans only). 3550.111 Section 3550.111... Waste Disposal Grants § 3550.111 Appraisals (loans only). An appraisal is required when the section 504... adequacy of the security. RHS may charge an appraisal fee. Appraisals must be made in accordance with...

  10. 12 CFR 722.4 - Minimum appraisal standards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Minimum appraisal standards. 722.4 Section 722... APPRAISALS § 722.4 Minimum appraisal standards. For federally related transactions, all appraisals shall, at a minimum: (a) Conform to generally accepted appraisal standards as evidenced by the...

  11. 7 CFR 3560.753 - Agency appraisal standards and requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... concluded by each approach. (f) Real estate history. Appraisals must contain a 5-year ownership and sales... estate, which is the land and improvements, and the real property, or property rights, being appraised...) Appraisers. MFH appraisals prepared for the Agency will be written by Agency appraisers or independent...

  12. 7 CFR 3560.753 - Agency appraisal standards and requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... concluded by each approach. (f) Real estate history. Appraisals must contain a 5-year ownership and sales... estate, which is the land and improvements, and the real property, or property rights, being appraised...) Appraisers. MFH appraisals prepared for the Agency will be written by Agency appraisers or independent...

  13. X-ray snapshots for metalloporphyrin axial ligation

    SciTech Connect

    Chen, L. X.; Zhang, X.; Wasinger, E. C.; Lockard, J. V.; Stickrath, A. B.; Mara, M. W.; Attenkofer, K.; Jennings, G.; Smolentsev, G.; Soldatov, A.

    2010-01-01

    Axial ligation mechanisms of a metalloporphyrin, nickel(II) tetramesitylporphyrin (NiTMP), were investigated by static and transient X-ray absorption spectroscopy at Ni K-edge (8.333 keV). A surprisingly broad (i.e. {approx}1.4 eV) linewidth for the 1s {yields} 3d{sub x2-y2} transition in the ground state was attributed to strong geometry dependent 3d molecular orbital (MO) energies due to coexisting conformers in solution. The broad distribution of 3d MO energy levels enables transient degeneracy of the 3d{sub z2} and 3d{sub x2-y2} MOs to produce a temporary vacancy in the 3d{sub z2} MO which favors axial ligation. Photoexcitation also induces the vacancy in the 3d{sub z2} MO, leading to a more than two-fold enhancement in the axial ligated species. Therefore, a unified axial ligation mechanism for both the ground and excited state is proposed based on the elucidation of the excited state structural dynamics, which will have a broad impact in understanding and controlling axial ligation in enzymatic reactions and molecular catalysis involving transient axial ligation.

  14. Irritable bowel syndrome in women undergoing hysterectomy and tubular ligation

    PubMed Central

    Khoshbaten, Manouchehr; Melli, Manigheh Syah; Fattahi, Monireh Jabar; Sharifi, Nasrin; Mostafavi, Seyed Abolfazl

    2011-01-01

    Aim The aim of this study was to assess the incidence of irritable bowel syndrome in women undergoing hysterectomy and tubular ligation. Background The results of previous studies have shown an increased incidence of irritable bowel syndrome after gynecological surgeries. Patients and methods Participants were patients of Alzahra and Taleghani University hospitals in Tabriz. One hundred and seventy two women without gastrointestinal symptoms or a diagnosis of the irritable bowel syndrome underwent tubular ligation and 164 women underwent hysterectomy. Patients were assessed every 3 month after hysterectomy and tubular ligation for 12 months. Irritable bowel syndrome was diagnosed by a questionnaire based on Rome II criteria. Results During 12 months after surgeries, 19 (11%) patients in tubular ligation group and 19 (11%) in hysterectomy group had abdominal pain with at least two symptoms of irritable bowel syndrome. Irritable bowel syndrome was diagnosed in 9 (5%) patients in the tubular ligation and 13 (8%) patients in hysterectomy groups (P>0.05). In both studied groups, the most prevalent symptoms along with abdominal pain were chronic constipation and abnormal bowel movement and the least prevalent were diarrhea and passage of mucus. Conclusion These results suggest that gynecological surgeries (tubular ligation and hysterectomy) may predispose to the development of the irritable bowel syndrome. PMID:24834172

  15. Ligation with nucleic acid sequence-based amplification.

    PubMed

    Ong, Carmichael; Tai, Warren; Sarma, Aartik; Opal, Steven M; Artenstein, Andrew W; Tripathi, Anubhav

    2012-01-01

    This work presents a novel method for detecting nucleic acid targets using a ligation step along with an isothermal, exponential amplification step. We use an engineered ssDNA with two variable regions on the ends, allowing us to design the probe for optimal reaction kinetics and primer binding. This two-part probe is ligated by T4 DNA Ligase only when both parts bind adjacently to the target. The assay demonstrates that the expected 72-nt RNA product appears only when the synthetic target, T4 ligase, and both probe fragments are present during the ligation step. An extraneous 38-nt RNA product also appears due to linear amplification of unligated probe (P3), but its presence does not cause a false-positive result. In addition, 40 mmol/L KCl in the final amplification mix was found to be optimal. It was also found that increasing P5 in excess of P3 helped with ligation and reduced the extraneous 38-nt RNA product. The assay was also tested with a single nucleotide polymorphism target, changing one base at the ligation site. The assay was able to yield a negative signal despite only a single-base change. Finally, using P3 and P5 with longer binding sites results in increased overall sensitivity of the reaction, showing that increasing ligation efficiency can improve the assay overall. We believe that this method can be used effectively for a number of diagnostic assays.

  16. Rapamycin delays salivary gland atrophy following ductal ligation.

    PubMed

    Bozorgi, S S; Proctor, G B; Carpenter, G H

    2014-03-27

    Salivary gland atrophy is a frequent consequence of head and neck cancer irradiation therapy but can potentially be regulated through the mammalian target of rapamycin (mTOR). Excretory duct ligation of the mouse submandibular gland provokes severe glandular atrophy causing activation of mTOR. This study aims to discover the effects of blocking mTOR signaling in ligation-induced atrophic salivary glands. Following 1 week of unilateral submandibular excretory duct ligation: gland weights were significantly reduced, 4E-BP1 and S6rp were activated, and tissue morphology revealed typical signs of atrophy. However, 3 days following ligation with rapamycin treatment, a selective mTOR inhibitor, gland weights were maintained, 4E-BP1 and S6rp phosphorylation was inhibited, and there were morphological signs of recovery from atrophy. However, following 5 and 7 days of ligation and rapamycin treatment, glands expressed active mTOR and showed signs of considerable atrophy. This evidence suggests that inhibition of mTOR by rapamycin delays ligation-induced atrophy of salivary glands.

  17. Precise Sequential DNA Ligation on A Solid Substrate: Solid-Based Rapid Sequential Ligation of Multiple DNA Molecules

    PubMed Central

    Takita, Eiji; Kohda, Katsunori; Tomatsu, Hajime; Hanano, Shigeru; Moriya, Kanami; Hosouchi, Tsutomu; Sakurai, Nozomu; Suzuki, Hideyuki; Shinmyo, Atsuhiko; Shibata, Daisuke

    2013-01-01

    Ligation, the joining of DNA fragments, is a fundamental procedure in molecular cloning and is indispensable to the production of genetically modified organisms that can be used for basic research, the applied biosciences, or both. Given that many genes cooperate in various pathways, incorporating multiple gene cassettes in tandem in a transgenic DNA construct for the purpose of genetic modification is often necessary when generating organisms that produce multiple foreign gene products. Here, we describe a novel method, designated PRESSO (precise sequential DNA ligation on a solid substrate), for the tandem ligation of multiple DNA fragments. We amplified donor DNA fragments with non-palindromic ends, and ligated the fragment to acceptor DNA fragments on solid beads. After the final donor DNA fragments, which included vector sequences, were joined to the construct that contained the array of fragments, the ligation product (the construct) was thereby released from the beads via digestion with a rare-cut meganuclease; the freed linear construct was circularized via an intra-molecular ligation. PRESSO allowed us to rapidly and efficiently join multiple genes in an optimized order and orientation. This method can overcome many technical challenges in functional genomics during the post-sequencing generation. PMID:23897972

  18. Positive emotion, appraisal, and the role of appraisal overlap in positive emotion co-occurrence.

    PubMed

    Tong, Eddie M W; Jia, Lile

    2017-02-01

    Appraisal research has traditionally focused on negative emotions but has not addressed issues concerning the relationships between several positive emotions and appraisals in daily life and the extent to which co-occurrence of positive emotions can be explained by overlap in appraisals. Driven by a priori hypotheses on appraisal-emotion relationships, this study investigated 12 positive emotions and 13 appraisal dimensions using Ecological Momentary Assessment. The results provide strong evidence that positive emotions and appraisals correlate significantly in daily life. Importantly, we found that the positive emotions' overlap on theoretically relevant, as compared to irrelevant, appraisals was stronger and more predictive of their co-occurrence. Furthermore, appraisal overlap on theoretically relevant appraisals predicted the co-occurrence of positive emotions even when the appraisal of pleasantness was excluded, indicating that positive emotions do not co-occur just by virtue of their shared valence. Our findings affirmed and refined the appraisal profiles of positive emotions and underscore the importance of appraisals in accounting for the commonality and differences among positive emotions. (PsycINFO Database Record

  19. 12 CFR 323.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Appraisals required; transactions requiring a State certified or licensed appraiser. 323.3 Section 323.3 Banks and Banking FEDERAL DEPOSIT INSURANCE... State certified or licensed appraiser is required for all real estate-related financial transactions...

  20. 12 CFR 225.63 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... State certified or licensed appraiser. 225.63 Section 225.63 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) BANK HOLDING COMPANIES AND CHANGE IN... require an appraisal prepared by a State certified appraiser. (3) Complex residential transactions of $250...

  1. Test Takers' Performance Appraisals, Appraisal Calibration, and Cognitive and Metacognitive Strategy Use

    ERIC Educational Resources Information Center

    Phakiti, Aek

    2016-01-01

    The current study explores the nature and relationships among test takers' performance appraisals, appraisal calibration, and reported cognitive and metacognitive strategy use in a language test situation. Performance appraisals are executive processes of strategic competence for judging test performance (e.g., evaluating the correctness or…

  2. Test Takers' Performance Appraisals, Appraisal Calibration, and Cognitive and Metacognitive Strategy Use

    ERIC Educational Resources Information Center

    Phakiti, Aek

    2016-01-01

    The current study explores the nature and relationships among test takers' performance appraisals, appraisal calibration, and reported cognitive and metacognitive strategy use in a language test situation. Performance appraisals are executive processes of strategic competence for judging test performance (e.g., evaluating the correctness or…

  3. 77 FR 61404 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-09

    ... From the Federal Register Online via the Government Publishing Office ] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  4. 78 FR 2995 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-15

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of..., and Enforcement Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee...

  5. 78 FR 28218 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-14

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  6. 76 FR 42126 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-18

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as ] amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  7. 77 FR 72862 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-06

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  8. 78 FR 14301 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-05

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  9. 76 FR 1165 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  10. 75 FR 57468 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  11. 75 FR 74732 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-01

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  12. 78 FR 25084 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-29

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  13. 78 FR 71611 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-29

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  14. 78 FR 9050 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-07

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  15. 77 FR 40051 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-06

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  16. 76 FR 57741 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-16

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  17. 78 FR 20318 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-04

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  18. 77 FR 14014 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-08

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  19. 77 FR 26280 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  20. 76 FR 25690 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-05

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  1. 76 FR 31962 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  2. 77 FR 66840 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  3. 77 FR 20633 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-05

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  4. 76 FR 13188 - Appraisal Subcommittee Notice of meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-10

    ... From the Federal Register Online via the Government Publishing Office ] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  5. 75 FR 62819 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-13

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  6. 76 FR 61704 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-05

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  7. 77 FR 58140 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-19

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  8. 77 FR 66840 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  9. Tubal ligation and survival of ovarian cancer patients.

    PubMed

    Zhang, Min; Holman, C D'Arcy J

    2012-01-01

    The aim of the present study was to investigate associations between ovarian cancer survival and reproductive, gynecological and hormone factors. A prospective follow-up study was conducted in the Southeast of China. The cohort comprised 202 patients with histopathologically confirmed epithelial ovarian cancer who were enrolled during 1999-2000 and followed-up for 5years subsequently. One hundred and ninety five (96.5%) of the cohort or their close relatives were traced. Information was obtained on reproductive, gynecological and hormone factors prior to diagnosis, actual survival time and number of deaths. Cox proportional models were used to estimate mortality hazard ratios (HR) and associated 95% confidence intervals (CI) for tubal ligation, adjusting for age at diagnosis, body mass index (BMI), menopausal status, International Federation of Gynaecology and Obstetrics (FIGO) stage, histological grade of differentiation, cytology of ascites, and chemotherapy status. The HR was significantly increased and survival was worse in ovarian cancer patients with a previous tubal ligation, but not with any other reproductive, gynecological and hormone factor. Only 21 (38.9%) of 54 patients who had tubal ligation survived to the time of interview, in contrast to 95 women (67.4%) still alive among the 141 women without tubal ligation (P<0.001). Compared to the patients who had no tubal ligation, the adjusted HR was 1.62 (95% CI 1.01-2.59; P=0.04) for those who had tubal ligation. There was no association with age at menarche, menopausal status, parity, breastfeeding, hormone replacement therapy, oral contraceptive use, and hysterectomy. Previous tubal ligation was an independently adverse prognostic factor for epithelial ovarian cancer survival. Further studies that examine the relationship are warranted to confirm these results. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  10. Clinical application of a ligation-independent pathway of multiplex ligation-dependent probe amplification for the determination of quinolone susceptibility of Streptococcus pneumoniae.

    PubMed

    Uno, Naoki; Araki, Nobuko; Kaku, Norihito; Kosai, Kosuke; Hasegawa, Hiroo; Yanagihara, Katsunori

    2016-09-01

    We previously uncovered a ligation-independent pathway of multiplex ligation-dependent probe amplification (MLPA) through which products of MLPA could be amplified without both hybridization and ligation reactions. Here, we utilized this pathway to detect an antibiotic resistance mutation of quinolones in Streptococcus pneumoniae. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. [Post-translational ligation and function of dual-vector transferred split CFTR gene].

    PubMed

    Zhu, Fu-Xiang; Liu, Ze-Long; Qu, Hui-Ge; Chi, Xiao-Yan

    2010-01-01

    The mutation of cystic fibrosis transmembrane conductance regulator (CFTR) gene leads to an autosomal recessive genetic disorder cystic fibrosis (CF). The gene therapy for CF using adeno-associated virus (AAV) vectors delivering CFTR gene is restricted by the contents limitation of AAV vectors. In this study the split CFTR genes severed at its regulatory domain were delivered by a dual-vector system with an intein-mediated protein trans-splicing as a technique to investigate the post-translational ligation of CFTR half proteins and its function as a chloride ion channel. A pair of eukaryotic expression vectors was constructed by breaking the human CFTR cDNA before Ser712 codon and fusing with Ssp DnaB intein coding sequences. After co-transfection into baby hamster kidney (BHK) cells followed by transient expression, patch clamps were carried out to record the chloride current of whole-cell and the activity of a single channel, and the ligation of two halves of CFTR was observed by Western blotting. The results showed that the intein-fused half genes co-transfected cells displayed a high whole cell chloride current and activity of a single channel indicating the functional recovery of chloride channel, and an intact CFTR protein band was figured out by CFTR-specific antibodies indicating that intein can efficiently ligate the separately expressed half CFTR proteins. The data demonstrated that protein splicing strategy could be used as a strategy in delivering CFTR gene by two vectors, encouraging our ongoing research program on dual AAV vector system based gene transfer in gene therapy for cystic fibrosis.

  12. Ligation under vision of haemorrhoidal cushions for therapy of bleeding haemorrhoids.

    PubMed

    Bronstein, M; Issa, N; Gutman, M; Neufeld, D

    2008-06-01

    Ligation under vision (LUV) is a simple method for the surgical treatment of haemorrhoids. In this study, we evaluated the results of our initial experience with the procedure in terms of postoperative pain, patients' final satisfaction and complications. We reviewed a group of patients who had undergone suture ligation of symptomatic haemorrhoids of grade II and III. This was performed with the haemorrhoids under direct vision and without the use of any ancillary instrumentation such as a Doppler sensor. All interventions were performed in the day-care surgical unit using general or regional anaesthesia. Surgical outcome and degree of postoperative pain were determined from outpatient clinic follow-up and individual phone interviews. A total of 32 patients (19 men and 13 women) with a mean age of 59 years had undergone LUV. There were 23 patients (72%) with grade II and 9 patients (28%) with grade III haemorrhoids. The indication for the surgery was bleeding in 19 patients (59%), prolapse in 6 (19%) and both in 7 (22%). A previous rubber band ligation had been carried out in 17 patients (53%). On average, the surgery took 22 min. All patients were discharged on the same day. Four %patients (12%) suffered only mild postoperative pain, 14 (44%) suffered from moderate pain and another 14 (44%) had severe pain. At follow-up (median 21 months, range 9-33 months), 28 %patients (87.5%) were completely asymptomatic at the time of the phone interview. The final result was assessed as excellent by 19 patients (60%), successful by 10 (31%), and unsuccessful by 3 (9%). All patients had complete functional recovery and there were no major surgical complications. Our data show that LUV of symptomatic haemorrhoids is a simple and safe procedure. It can be performed as effective isolated surgery for symptomatic haemorrhoids and as an additional procedure in the treatment of complex perianal pathology.

  13. [Post-translational ligation of split CFTR severed before TMD2 and its chloride channel function].

    PubMed

    Zhu, Fuxiang; Gong, Xiandi; Liu, Zelong; Yang, Shude; Qu, Huige; Chi, Xiaoyan

    2010-12-01

    Mutations of cystic fibrosis transmembrane conductance regulator (CFTR) gene leads to cystic fibrosis, an autosomal recessive genetic disorder affecting a number of organs including the lung airways, pancreas and sweat glands. In order to investigate the post-translational ligation of CFTR with reconstructed functional chloride ion channel and the split Ssp DnaB intein-mediated protein trans-splicing was explored to co-deliver CFTR gene into eukaryotic cells with two vectors. The human CFTR cDNA was split after Glu838 codon before the second transmembrane dome (TMD2) into two halves of N- and C-parts and fused with the coding sequences of split Ssp DnaB intein. Pair of eukaryotic expression vectors pEGFP-NInt and pEYFP-IntC were constructed by inserting them into the vectors pEGFP-N1 and pEYFP-N1 respectively. The transient expression was carried out for observing the ligation of CFTR by Western blotting and recording the chloride current by patch clamps when cotransfection of the pair of vectors into baby hamster kidney (BHK) cells. The results showed that an obvious protein band proven to be ligated intact CFTR can be seen and a higher chloride current and activity of chloride channel were recorded after cotransfection. These data demonstrated that split Ssp DnaB intein could be used as a strategy in delivering CFTR gene by two vectors providing evidence for application of dual adeno-associated virus (AAV) vectors to overcome the limitation of packaging size in cystic fibrosis gene therapy.

  14. Appraisal of Meconium at Delivery

    PubMed Central

    Paes, Bosco A.; Thompson, Penelope

    1992-01-01

    A critical appraisal of the scientific literature on managing mesconium in labor identified 15 studies which were used to evaluate intervention strategies. Only four were randomized trials: two on the use of amnioinfusion in labor, one on the technique of bulb versus DeLee catheter suction of the newborn, and one on the need for endotracheal intubation and suction in meconium-stained neonates. Current practice is dictated by the most favorable tradeoff between benefit and risk because of limited scientific evidence. PMID:21221284

  15. A Review of Instruments on Cognitive Appraisal of Stress.

    PubMed

    Carpenter, Roger

    2016-04-01

    The purpose of this paper is to present a review of theoretically based measures of cognitive appraisal, and discuss psychometric strengths and limitations. Understanding how an individual appraises stressful events becomes important when faced with alterations in mental health. Cognitive appraisals influence how an individual copes with stressful events and life crises that leads to changes in mental health. Measures on how an individual appraises a stressful event lack conceptual soundness and are limited by weak psychometric properties. Health and Psychosocial Instruments (HAPI) electronic database was searched using combinations of the key words cognitive appraisal, primary appraisal, secondary appraisal, appraisal of illness, appraisal of health, and stress appraisal. The quality of these instrument sources was assessed by published psychometric data in the primary source. Five instruments were found that measure cognitive appraisal as theoretically described: the Meaning of Illness Questionnaire, the Stress Appraisal Measure, the Appraisal of Illness Scale, the Cognitive Appraisal of Health Scale, and the Primary Appraisal/Secondary Appraisal scale. A description of each tool, including purpose, scoring, and psychometric support, is provided. There are a limited number of instruments that measure cognitive appraisal as theoretically described. Theoretically sound instruments with established psychometric support are needed to make accurate inferences about the role of cognitive appraisal in the mental and physical health of individuals experiencing stress. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Ectopic tubal pregnancy after hysterectomy and tubal ligation.

    PubMed

    Rosa, Marilin; Mohammadi, Amir; Monteiro, Carmela

    2009-01-01

    Posthysterectomy ectopic pregnancy is an unusual condition that may present soon after hysterectomy or several years later. Similarly, although tubal ligation is a widespread method of contraception, tubal pregnancy after tubal ligation is not common either. If any of these conditions are rare, having an ectopic pregnancy after hysterectomy and tubal ligation is even more infrequent and only one of such cases was found in our review of the literature. We describe the case of a 35-year-old patient, with history of bilateral tubal ligation and vaginal hysterectomy that looked for medical attention due to abdominal pain. A pregnancy test was positive and a transvaginal ultrasound demonstrated the presence of a gestational sac at the vaginal cuff, adjacent to the ovary. An exploratory laparotomy showed a ruptured ectopic pregnancy located in the distal portion of the left fallopian tube. The occurrence of an ectopic pregnancy several years following tubal ligation and vaginal hysterectomy is a rare phenomenon that appears to be secondary to a fistulous connection into the peritoneal cavity.

  17. 12 CFR 225.65 - Appraiser independence.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Appraiser independence. 225.65 Section 225.65 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM BANK HOLDING COMPANIES AND CHANGE IN BANK CONTROL (REGULATION Y) Regulations Appraisal Standards for...

  18. 12 CFR 225.65 - Appraiser independence.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 3 2012-01-01 2012-01-01 false Appraiser independence. 225.65 Section 225.65 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM BANK HOLDING COMPANIES AND CHANGE IN BANK CONTROL (REGULATION Y) Regulations Appraisal Standards...

  19. 12 CFR 225.65 - Appraiser independence.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 3 2014-01-01 2014-01-01 false Appraiser independence. 225.65 Section 225.65 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) BANK HOLDING COMPANIES AND CHANGE IN BANK CONTROL (REGULATION Y) Regulations Appraisal...

  20. 36 CFR 254.9 - Appraisals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Appraisals. 254.9 Section 254.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS Land Exchanges § 254.9 Appraisals. The Federal and non-Federal parties to an exchange shall...

  1. 36 CFR 254.9 - Appraisals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Appraisals. 254.9 Section 254.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS Land Exchanges § 254.9 Appraisals. The Federal and non-Federal parties to an exchange shall...

  2. 36 CFR 254.9 - Appraisals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Appraisals. 254.9 Section 254.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS Land Exchanges § 254.9 Appraisals. The Federal and non-Federal parties to an exchange shall...

  3. 36 CFR 254.9 - Appraisals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Appraisals. 254.9 Section 254.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS Land Exchanges § 254.9 Appraisals. The Federal and non-Federal parties to an exchange shall...

  4. 36 CFR 254.26 - Appraisal.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Appraisal. 254.26 Section 254.26 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS National Forest Townsites § 254.26 Appraisal. Fair market value of townsite tracts shall be...

  5. 36 CFR 254.26 - Appraisal.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Appraisal. 254.26 Section 254.26 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS National Forest Townsites § 254.26 Appraisal. Fair market value of townsite tracts shall be...

  6. 36 CFR 254.26 - Appraisal.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Appraisal. 254.26 Section 254.26 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS National Forest Townsites § 254.26 Appraisal. Fair market value of townsite tracts shall be...

  7. Moral Appraisals Affect Doing/Allowing Judgments

    ERIC Educational Resources Information Center

    Cushman, Fiery; Knobe, Joshua; Sinnott-Armstrong, Walter

    2008-01-01

    An extensive body of research suggests that the distinction between doing and allowing plays a critical role in shaping moral appraisals. Here, we report evidence from a pair of experiments suggesting that the converse is also true: moral appraisals affect doing/allowing judgments. Specifically, morally bad behavior is more likely to be construed…

  8. Tennessee Extension Agents' Perceptions of Performance Appraisal

    ERIC Educational Resources Information Center

    Donaldson, Joseph L.; French, Russell L.

    2013-01-01

    Performance appraisal is necessary for summative decisions about employees, such as merit pay and promotion. The research reported here describes Extension agent perceptions of their performance appraisal system. The population studied consisted of all Tennessee Extension agents (N = 312). Surveys were completed by 218 respondents, for a completed…

  9. Children's Appraisal of Moderately Stressful Situations

    ERIC Educational Resources Information Center

    Hood, Brianne; Power, Thomas; Hill, Laura

    2009-01-01

    This study investigated 2 questions: (1) do children show consistent styles of appraisal across a range of moderately stressful events?, and (2) what are the adjustment and parenting correlates of individual differences in children's appraisal style? Ninety-nine 3rd though 5th grade children and their mothers participated. For each of 6 vignettes…

  10. 24 CFR 266.642 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Appraisals. 266.642 Section 266.642... Obligations Claim Procedures § 266.642 Appraisals. Where actions taken or caused to be taken by the HFA have the effect of the recovery of less than the face amount of the HFA Debenture held by HUD, an...

  11. Teaching Critical Appraisal of Articles on Psychopharmacology

    ERIC Educational Resources Information Center

    Mohr, Pavel; Hoschl, Cyril; Volavka, Jan

    2012-01-01

    Objective: Psychiatrists and other physicians sometimes read publications superficially, relying excessively on abstracts. The authors addressed this problem by teaching critical appraisal of individual articles. Method: The authors developed a 23-item appraisal instrument to assess articles in the area of psychopharmacology. The results were…

  12. 30 CFR 882.12 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR ABANDONED MINE... be considered in determining a lien. OSM shall provide appraisal standards for Federal projects, and the State or Indian tribes shall provide appraisal standards for State or Indian tribal projects...

  13. 30 CFR 882.12 - Appraisals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR ABANDONED MINE... be considered in determining a lien. OSM shall provide appraisal standards for Federal projects, and the State or Indian tribes shall provide appraisal standards for State or Indian tribal projects...

  14. 9 CFR 50.9 - Appraisals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES ANIMALS DESTROYED BECAUSE OF TUBERCULOSIS General Indemnity § 50.9 Appraisals. (a) Livestock to be destroyed because of tuberculosis under § 50.3 must be appraised within 15 days after being classified as infected with tuberculosis, except that the veterinarian...

  15. 9 CFR 50.9 - Appraisals.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES ANIMALS DESTROYED BECAUSE OF TUBERCULOSIS General Indemnity § 50.9 Appraisals. (a) Livestock to be destroyed because of tuberculosis under § 50.3 must be appraised within 15 days after being classified as infected with tuberculosis, except that the veterinarian...

  16. 9 CFR 50.9 - Appraisals.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES ANIMALS DESTROYED BECAUSE OF TUBERCULOSIS General Indemnity § 50.9 Appraisals. (a) Livestock to be destroyed because of tuberculosis under § 50.3 must be appraised within 15 days after being classified as infected with tuberculosis, except that the veterinarian...

  17. 9 CFR 50.9 - Appraisals.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES ANIMALS DESTROYED BECAUSE OF TUBERCULOSIS General Indemnity § 50.9 Appraisals. (a) Livestock to be destroyed because of tuberculosis under § 50.3 must be appraised within 15 days after being classified as infected with tuberculosis, except that the veterinarian...

  18. How to … be an active appraiser.

    PubMed

    Austin, Trevor

    2013-07-01

    Being an active appraiser is very challenging in terms of knowing a doctor's work well enough to appraise them effectively. It also requires a set of skills that need to be developed and applied well in a complex system and in the context of an individual doctor's career development. Being 'active' means bringing these skills and principles together.

  19. Performance Appraisals Can Yield Tangible Results.

    ERIC Educational Resources Information Center

    Blai, Boris, Jr.

    An objective, measure-oriented job performance appraisal plan permits management to evaluate worker performance more accurately and precisely, and provides a means for assessing the degree-of-match between employee qualifications and job skills requirements for hiring, advancement, and dismissal decisions. Deficient appraisals may be costly,…

  20. 32 CFR 644.42 - Appraisal report.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... VALUE. The appraiser's opinion of the value of the land shall be supported by confirmed sales of... to show how they indicate the value of the land being appraised. 13. VALUE ESTIMATE BY COMPARATIVE... judgment in developing his value conclusions. (b) Scope of reports. (1) It is the Corps' practice that...

  1. 25 CFR 152.24 - Appraisal.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER ISSUANCE OF PATENTS IN FEE, CERTIFICATES OF COMPETENCY, REMOVAL OF RESTRICTIONS, AND SALE OF CERTAIN INDIAN LANDS Sales, Exchanges and Conveyances of Trust Or Restricted Lands § 152.24 Appraisal. Except as otherwise provided by the Secretary, an appraisal shall...

  2. 43 CFR 2201.3 - Appraisals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... appraising the values of the Federal and non-Federal lands involved in an exchange. ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Appraisals. 2201.3 Section 2201.3 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT,...

  3. 43 CFR 2201.3 - Appraisals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... appraising the values of the Federal and non-Federal lands involved in an exchange. ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Appraisals. 2201.3 Section 2201.3 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT,...

  4. 43 CFR 2201.3 - Appraisals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... appraising the values of the Federal and non-Federal lands involved in an exchange. ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Appraisals. 2201.3 Section 2201.3 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT,...

  5. 48 CFR 1437.7002 - Appraisal standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Appraisal standards. 1437.7002 Section 1437.7002 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR SPECIAL... of the Interagency Land Acquisition Conference publication “Uniform Appraisal Standards for...

  6. 36 CFR 254.26 - Appraisal.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Appraisal. 254.26 Section 254.26 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS National Forest Townsites § 254.26 Appraisal. Fair market value of townsite tracts shall...

  7. 36 CFR 254.26 - Appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Appraisal. 254.26 Section 254.26 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP ADJUSTMENTS National Forest Townsites § 254.26 Appraisal. Fair market value of townsite tracts shall...

  8. 5 CFR 9901.411 - Appraisal period.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PERSONNEL SYSTEM (NSPS) Performance Management § 9901.411 Appraisal period. (a) Except as provided in... period, an employee has not met the minimum period of performance, management may extend the appraisal....411 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR...

  9. 9 CFR 50.9 - Appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES ANIMALS DESTROYED BECAUSE OF TUBERCULOSIS General Indemnity § 50.9 Appraisals. (a) Livestock to be destroyed because of tuberculosis under § 50.3 must be appraised within 15 days after being classified as infected with tuberculosis, except that the veterinarian...

  10. Risk Appraisal in Scripted Acquaintance Rape Scenarios.

    ERIC Educational Resources Information Center

    Wright, Doris J.

    Cognitive appraisals are believed to influence how women judge or appraise risk in acquaintance interactions which lead to sexual assault. Ways in which men and women judge the presence of risk factors in scripted acquaintance rape scenarios, and whether alcohol was a significant factor in assessing risk, are examined in this paper. Participants…

  11. Teaching Critical Appraisal of Articles on Psychopharmacology

    ERIC Educational Resources Information Center

    Mohr, Pavel; Hoschl, Cyril; Volavka, Jan

    2012-01-01

    Objective: Psychiatrists and other physicians sometimes read publications superficially, relying excessively on abstracts. The authors addressed this problem by teaching critical appraisal of individual articles. Method: The authors developed a 23-item appraisal instrument to assess articles in the area of psychopharmacology. The results were…

  12. 7 CFR 762.127 - Appraisal requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 7 2014-01-01 2014-01-01 false Appraisal requirements. 762.127 Section 762.127 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS GUARANTEED FARM LOANS § 762.127 Appraisal requirements. (a) General. The...

  13. 7 CFR 356.2 - Appraisement.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 5 2012-01-01 2012-01-01 false Appraisement. 356.2 Section 356.2 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FORFEITURE PROCEDURES § 356.2 Appraisement. Promptly following the seizure or...

  14. 5 CFR 301.303 - Performance appraisal.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Performance appraisal. 301.303 Section....303 Performance appraisal. As soon as practicable, but beginning not later than January 1, 1984, overseas agencies are required to evaluate the performance of employees who serve under overseas local...

  15. 5 CFR 301.303 - Performance appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Performance appraisal. 301.303 Section....303 Performance appraisal. As soon as practicable, but beginning not later than January 1, 1984, overseas agencies are required to evaluate the performance of employees who serve under overseas local...

  16. Children's Appraisal of Moderately Stressful Situations

    ERIC Educational Resources Information Center

    Hood, Brianne; Power, Thomas; Hill, Laura

    2009-01-01

    This study investigated 2 questions: (1) do children show consistent styles of appraisal across a range of moderately stressful events?, and (2) what are the adjustment and parenting correlates of individual differences in children's appraisal style? Ninety-nine 3rd though 5th grade children and their mothers participated. For each of 6 vignettes…

  17. Faculty Appraisal--an MBO Approach.

    ERIC Educational Resources Information Center

    Wooten, Bob

    1980-01-01

    Recommends that a "Management by Objectives" (MBO) approach be considered for an effective faculty appraisal system. MBO appraisal is based on the assumptions that faculty members are capable of committing themselves to their work and that they will be allowed to participate in the administration of their areas. (JOW)

  18. 7 CFR 356.2 - Appraisement.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 5 2011-01-01 2011-01-01 false Appraisement. 356.2 Section 356.2 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FORFEITURE PROCEDURES § 356.2 Appraisement. Promptly following the seizure or other...

  19. 12 CFR 626.6015 - Nondiscriminatory appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Nondiscriminatory appraisal. 626.6015 Section 626.6015 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM NONDISCRIMINATION IN LENDING § 626.6015 Nondiscriminatory appraisal. No Farm Credit institution shall discriminate against any...

  20. 12 CFR 564.5 - Appraiser independence.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... independent of the lending, investment, and collection functions and not involved, except as an appraiser, in... lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise independent judgment and that the...

  1. 12 CFR 164.5 - Appraiser independence.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... independent of the lending, investment, and collection functions and not involved, except as an appraiser, in... lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise independent judgment and that the...

  2. 12 CFR 564.5 - Appraiser independence.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... independent of the lending, investment, and collection functions and not involved, except as an appraiser, in... lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise independent judgment and that the...

  3. 12 CFR 564.5 - Appraiser independence.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... independent of the lending, investment, and collection functions and not involved, except as an appraiser, in... lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise independent judgment and that the...

  4. 12 CFR 164.5 - Appraiser independence.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... independent of the lending, investment, and collection functions and not involved, except as an appraiser, in... lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise independent judgment and that the...

  5. 21 CFR 1316.74 - Appraisement.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... PROCEDURES Seizure, Forfeiture, and Disposition of Property § 1316.74 Appraisement. The custodian shall appraise the property to determine the domestic value at the time and place of seizure. The domestic value... no market for the property at the place of seizure, the domestic value shall be considered the value...

  6. New chemistries for chemoselective peptide ligations and the total synthesis of proteins.

    PubMed

    Harmand, Thibault J R; Murar, Claudia E; Bode, Jeffrey W

    2014-10-01

    The identification of fast, chemoselective bond-forming reactions is one of the major contemporary challenges in chemistry. The requirements of the native chemical ligation - an N-terminal cysteine and C-terminal thioesters - have encouraged a search for alternative amide-forming ligation reactions. Among successful alternatives to native chemical ligation, are the α-ketoacid-hydroxylamine ligation with 5-oxaproline and, serine/threonine ligation, and potassium acyltrifluoroborate (KAT) ligation. In addition, the KAT ligation, along with the non-amide forming alkyne-azide ligation, is very useful for synthetic conjugations. All of these recent ligation methods were applied to synthesize different proteins, and have allowed chemists to incorporate unnatural amino acids, or to modify the peptide backbone. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Appraisal patterns of envy and related emotions.

    PubMed

    van de Ven, Niels; Zeelenberg, Marcel; Pieters, Rik

    2012-06-01

    Envy is a frustrating emotion that arises from upward social comparison. Two studies investigated the appraisals that distinguish benign envy (aimed at improving one's own situation) from malicious envy (aimed at pulling down the superior other). Study 1 found that appraisals of deservingness and control potential differentiated both types of envy. We manipulated these appraisals in Study 2 and found that while both did not influence the intensity of envy, they did determine the type of envy that resulted. The more a situation was appraised as undeserved, the more participants experienced malicious envy. Benign envy was experienced more when the situation was not undeserved, and the most when the situation was appraised as both deserved and controllable. The current research also clarifies how the types of envy differ from the related emotions admiration and resentment.

  8. Ligation of Glycophorin A Generates Reactive Oxygen Species Leading to Decreased Red Blood Cell Function.

    PubMed

    Khoory, Joseph; Estanislau, Jessica; Elkhal, Abdallah; Lazaar, Asmae; Melhorn, Mark I; Brodsky, Abigail; Illigens, Ben; Hamachi, Itaru; Kurishita, Yasutaka; Ivanov, Alexander R; Shevkoplyas, Sergey; Shapiro, Nathan I; Ghiran, Ionita C

    2016-01-01

    Acute, inflammatory conditions associated with dysregulated complement activation are characterized by significant increases in blood concentration of reactive oxygen species (ROS) and ATP. The mechanisms by which these molecules arise are not fully understood. In this study, using luminometric- and fluorescence-based methods, we show that ligation of glycophorin A (GPA) on human red blood cells (RBCs) results in a 2.1-fold, NADPH-oxidase-dependent increase in intracellular ROS that, in turn, trigger multiple downstream cascades leading to caspase-3 activation, ATP release, and increased band 3 phosphorylation. Functionally, using 2D microchannels to assess membrane deformability, GPS-ligated RBCs travel 33% slower than control RBCs, and lipid mobility was hindered by 10% using fluorescence recovery after photobleaching (FRAP). These outcomes were preventable by pretreating RBCs with cell-permeable ROS scavenger glutathione monoethyl ester (GSH-ME). Our results obtained in vitro using anti-GPA antibodies were validated using complement-altered RBCs isolated from control and septic patients. Our results suggest that during inflammatory conditions, circulating RBCs significantly contribute to capillary flow dysfunctions, and constitute an important but overlooked source of intravascular ROS and ATP, both critical mediators responsible for endothelial cell activation, microcirculation impairment, platelet activation, as well as long-term dysregulated adaptive and innate immune responses.

  9. Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids

    PubMed Central

    Su, Ming-Yao; Chiu, Cheng-Tang; Lin, Wei-Pin; Hsu, Chen-Ming; Chen, Pang-Chi

    2011-01-01

    AIM: To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids. METHODS: A total of 759 consecutive patients (415 males and 344 females) were enrolled. Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients). All patients received EHL at outpatient clinics. Hemorrhoid severity was classified by Goligher’s grading. The mean follow-up period was 55.4 mo (range, 45-92 mo). RESULTS: The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients. Bleeding was controlled in 587 (98.0%) patients, while prolapse was reduced in 137 (82.5%) patients. After treatment, 93 patients experienced anal pain and 48 patients had mild bleeding. Patient subjective satisfaction was 93.6%. Repeat treatment or surgery was performed if symptoms were not relieved in the first session. In the bleeding group, the recurrence rate was 3.7% (22 patients) at 1 year, and 6.6% and 13.0% at 2 and 5 years. In the prolapsed group, the recurrence rate was 3.0%, 9.6% and 16.9% at 1, 2 and 5 years, respectively. CONCLUSION: EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids, with good long-term results. PMID:21633644

  10. Ligation of Glycophorin A Generates Reactive Oxygen Species Leading to Decreased Red Blood Cell Function

    PubMed Central

    Khoory, Joseph; Estanislau, Jessica; Elkhal, Abdallah; Lazaar, Asmae; Melhorn, Mark I.; Brodsky, Abigail; Illigens, Ben; Hamachi, Itaru; Kurishita, Yasutaka; Ivanov, Alexander R.; Shevkoplyas, Sergey; Shapiro, Nathan I.; Ghiran, Ionita C.

    2016-01-01

    Acute, inflammatory conditions associated with dysregulated complement activation are characterized by significant increases in blood concentration of reactive oxygen species (ROS) and ATP. The mechanisms by which these molecules arise are not fully understood. In this study, using luminometric- and fluorescence-based methods, we show that ligation of glycophorin A (GPA) on human red blood cells (RBCs) results in a 2.1-fold, NADPH-oxidase-dependent increase in intracellular ROS that, in turn, trigger multiple downstream cascades leading to caspase-3 activation, ATP release, and increased band 3 phosphorylation. Functionally, using 2D microchannels to assess membrane deformability, GPS-ligated RBCs travel 33% slower than control RBCs, and lipid mobility was hindered by 10% using fluorescence recovery after photobleaching (FRAP). These outcomes were preventable by pretreating RBCs with cell-permeable ROS scavenger glutathione monoethyl ester (GSH-ME). Our results obtained in vitro using anti-GPA antibodies were validated using complement-altered RBCs isolated from control and septic patients. Our results suggest that during inflammatory conditions, circulating RBCs significantly contribute to capillary flow dysfunctions, and constitute an important but overlooked source of intravascular ROS and ATP, both critical mediators responsible for endothelial cell activation, microcirculation impairment, platelet activation, as well as long-term dysregulated adaptive and innate immune responses. PMID:26784696

  11. RNA-Catalyzed RNA Ligation on an External RNA Template

    NASA Technical Reports Server (NTRS)

    McGinness, Kathleen E.; Joyce, Gerald F.

    2002-01-01

    Variants of the hc ligase ribozyme, which catalyzes ligation of the 3' end of an RNA substrate to the 5' end of the ribozyme, were utilized to evolve a ribozyme that catalyzes ligation reactions on an external RNA template. The evolved ribozyme catalyzes the joining of an oligonucleotide 3'-hydroxyl to the 5'-triphosphate of an RNA hairpin molecule. The ribozyme can also utilize various substrate sequences, demonstrating a largely sequence-independent mechanism for substrate recognition. The ribozyme also carries out the ligation of two oligonucleotides that are bound at adjacent positions on a complementary template. Finally, it catalyzes addition of mononucleoside '5-triphosphates onto the '3 end of an oligonucleotide primer in a template-dependent manner. The development of ribozymes that catalyze polymerase-type reactions contributes to the notion that an RNA world could have existed during the early history of life on Earth.

  12. Splint ligation of RNA with T4 DNA ligase

    PubMed Central

    Kershaw, Christopher J.; O’Keefe, Raymond T.

    2014-01-01

    Splint ligation of RNA, whereby specific RNA molecules are ligated together, can be carried out using T4 DNA ligase and a bridging DNA oligonucleotide complementary to the RNAs. This method takes advantage of the property of T4 DNA ligase to join RNA molecules when they are in an RNA:DNA hybrid. Splint ligation is a useful tool for the introduction of modified nucleotides into RNA molecules, insertion of a radiolabel into a specific position within an RNA and for the assembly of smaller synthetic RNAs into longer RNA molecules. Such modifications enable a wide range of experiments to be carried out with the modified RNA including structural studies, co-immunoprecipitations, and the ability to map sites of RNA:RNA and RNA:protein interactions. PMID:23065567

  13. Template-Directed Ligation of Peptides to Oligonucleotides

    NASA Technical Reports Server (NTRS)

    Bruick, Richard K.; Dawson, Philip E.; Kent, Stephen BH; Usman, Nassim; Joyce, Gerald F.

    1996-01-01

    Synthetic oligonucleotides and peptides have enjoyed a wide range of applications in both biology and chemistry. As a consequence, oligonucleotide-peptide conjugates have received considerable attention, most notably in the development of antisense constructs with improved pharmacological properties. In addition, oligonucleotide-peptide conjugates have been used as molecular tags, in the assembly of supramolecular arrays and in the construction of encoded combinatorial libraries. To make these chimeric molecules more accessible for a broad range of investigations, we sought to develop a facile method for joining fully deprotected oligonucleotides and peptides through a stable amide bond linkage. Furthermore, we wished to make this ligation reaction addressable, enabling one to direct the ligation of specific oligonucleotide and peptide components.To confer specificity and accelerate the rate of the reaction, the ligation process was designed to be dependent on the presence of a complementary oligonucleotide template.

  14. Protein response to ligation reactions in myoglobin

    SciTech Connect

    Causgrove, T.P.; Dyer, R.B.

    1992-01-01

    The protein response to the photodissociation, escape and subsequent rebinding of carbon monoxide in myoglobin is studied using time-resolved infrared (TRIR) spectroscopy. All phases of these reactions areinvestigated, from ultrafast phenomena (picoseconds) to relatively slow processes (milliseconds). Conformational changes in myoglobin (Mb) are detected by time-resolved absorption changes in the amide I band. On the hundreds of nanoseconds to milliseconds timescale, a real-time'' apparatus is used. This apparatus is based on a tunable diode laser operating in the region of 1650 cm[sup [minus]1] . The time course ofchanges in the amide I band are shown to follow the recombination of CO with photolyzed Mb. On the basis of the rise times of the amide I and FE-CO signals, it is concluded that protein motion is complete within 100 n. A time-resolved difference spectrum in the amide I region is generated from single wavelength transients taken throughout the amide I envelope. A static difference spectrum is also generated by subtracting FTIR spectra of carbonmonoxy and deoxy myoglobin. The two difference spectra are compared and are interpreted in terms of the three-dimensional structures of deoxy and carbonmonoxy Mb. Preliminary picosecond TRIR data are also given for the ultrafast response of the protein immediately following photodissociation of CO.

  15. Protein response to ligation reactions in myoglobin

    NASA Astrophysics Data System (ADS)

    Causgrove, Timothy P.; Dyer, R. B.

    1993-05-01

    The protein response to the photodissociation, escape and subsequent rebinding of carbon monoxide in myoglobin is studied using time-resolved infrared (TRIR) spectroscopy. All phases of these reactions are investigated, from ultrafast phenomena (picoseconds) to relatively slow processes (milliseconds). Conformational changes in myoglobin (Mb) are detected by time-resolved infrared absorption changes in the amide I band. On the hundreds of nanoseconds to milliseconds timescale, a 'real-time' apparatus is used. This apparatus is based on a tunable diode laser operating in the region of 1650 cm-1. The time course of changes in the amide I band are shown to follow the recombination of CO with photolyzed Mb. On the basis of the rise times of the amide I and Fe-CO signals, it is concluded that protein motion is complete within 100 ns. A time-resolved difference spectrum in the amide I region is generated from single wavelength transients taken throughout the amide I envelope. A static difference spectrum is also generated by subtracting FTIR spectra of carbonmonoxy and deoxy myoglobin. The two difference spectra are compared and are interpreted in terms of the three-dimensional structures of deoxy and carbonmonoxy Mb. Preliminary picosecond TRIR data are also given for the ultrafast response of the protein immediately following photodissociation of CO.

  16. Protein response to ligation reactions in myoglobin

    SciTech Connect

    Causgrove, T.P.; Dyer, R.B.

    1992-12-31

    The protein response to the photodissociation, escape and subsequent rebinding of carbon monoxide in myoglobin is studied using time-resolved infrared (TRIR) spectroscopy. All phases of these reactions areinvestigated, from ultrafast phenomena (picoseconds) to relatively slow processes (milliseconds). Conformational changes in myoglobin (Mb) are detected by time-resolved absorption changes in the amide I band. On the hundreds of nanoseconds to milliseconds timescale, a ``real-time`` apparatus is used. This apparatus is based on a tunable diode laser operating in the region of 1650 cm{sup {minus}1} . The time course ofchanges in the amide I band are shown to follow the recombination of CO with photolyzed Mb. On the basis of the rise times of the amide I and FE-CO signals, it is concluded that protein motion is complete within 100 n. A time-resolved difference spectrum in the amide I region is generated from single wavelength transients taken throughout the amide I envelope. A static difference spectrum is also generated by subtracting FTIR spectra of carbonmonoxy and deoxy myoglobin. The two difference spectra are compared and are interpreted in terms of the three-dimensional structures of deoxy and carbonmonoxy Mb. Preliminary picosecond TRIR data are also given for the ultrafast response of the protein immediately following photodissociation of CO.

  17. Development of an Improved Animal Model of Overactive Bladder: Transperineal Ligation versus Transperitoneal Ligation in Male Rats

    PubMed Central

    Kim, Woo Hyun; Bae, Woong Jin; Park, Jung Woo; Choi, Jin Bong; Kim, Su Jin; Cho, Hyuk Jin; Ha, U Syn; Hong, Sung Hoo; Lee, Ji Youl; Hwang, Sung Yeoun

    2016-01-01

    Purpose We compared a transperineal ligation model and a transperitoneal ligation model in male rats to determine which animal model of overactive bladder (OAB) was more useful based on cystometrography, estimations of oxidative stress, and measurements of pro-inflammatory cytokine levels. Materials and Methods Male rats were randomly divided into three groups (n=15 in each): the control group, the transperineal ligation group, and the transperitoneal ligation group. Four weeks after the ligation procedure, cystometrography was performed and oxidative stress, pro-inflammatory cytokine levels, and histologic changes were evaluated. Oxidative stress was assessed by measuring 8-hydroxy-20-deoxyguanosine and superoxide dismutase, and pro-inflammatory cytokine activity was investigated by measuring levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α. Results The transperineal model led to results similar to those observed for the transperitoneal model, namely (1) increased voiding frequency and reductions in the non-voiding contraction interval and the maximal vesical pressure, (2) increased levels of oxidative stress markers, (3) increased pro-inflammatory cytokine levels, and (4) fibrotic changes in the bladder tissue. Conclusions We suggest that the transperineal procedure can be used as an alternative OAB model in male rats. PMID:27574597

  18. Butelase-mediated cyclization and ligation of peptides and proteins.

    PubMed

    Nguyen, Giang K T; Qiu, Yibo; Cao, Yuan; Hemu, Xinya; Liu, Chuan-Fa; Tam, James P

    2016-10-01

    Enzymes that catalyze efficient macrocyclization or site-specific ligation of peptides and proteins can enable tools for drug design and protein engineering. Here we describe a protocol to use butelase 1, a recently discovered peptide ligase, for high-efficiency cyclization and ligation of peptides and proteins ranging in size from 10 to >200 residues. Butelase 1 is the fastest known ligase and is found in pods of the common medicinal plant Clitoria ternatea (also known as butterfly pea). It has a very simple C-terminal-specific recognition motif that requires Asn/Asp (Asx) at the P1 position and a dipeptide His-Val at the P1' and P2' positions. Substrates for butelase-mediated ligation can be prepared by standard Fmoc (9-fluorenylmethyloxycarbonyl) chemistry or recombinant expression with the minimal addition of this tripeptide Asn-His-Val motif at the C terminus. Butelase 1 achieves cyclizations that are 20,000 times faster than those of sortase A, a commonly used enzyme for backbone cyclization. Unlike sortase A, butelase is traceless, and it can be used for the total synthesis of naturally occurring peptides and proteins. Furthermore, butelase 1 is also useful for intermolecular ligations and synthesis of peptide or protein thioesters, which are versatile activated intermediates necessary for and compatible with many chemical ligation methods. The protocol describes steps for isolation and purification of butelase 1 from plant extract using a four-step chromatography procedure, which takes ∼3 d. We then describe steps for intramolecular cyclization, intermolecular ligation and butelase-mediated synthesis of protein thioesters. Butelase reactions are generally completed within minutes and often achieve excellent yields.

  19. Brachial artery aneurysms following brachio-cephalic AV fistula ligation.

    PubMed

    Khalid, Usman; Parkinson, Frances; Mohiuddin, Kamran; Davies, Paula; Woolgar, Justin

    2014-01-01

    Peripheral artery aneurysms proximal to a long-standing arteriovenous (AV) fistula can be a serious complication. It is important to be aware of this and manage it appropriately. Vascular access nurses input all data regarding patients undergoing dialysis access procedures into a securely held database prospectively. This was retrospectively reviewed to identify cases of brachial artery aneurysms over the last 3 years. In Morriston Hospital, around 200 forearm and arm AV fistulas are performed annually for vascular access in renal dialysis patients. Of these, approximately 15 (7.5%) are ligated. Three patients who had developed brachial artery aneurysms following AV fistula ligation were identified. All 3 patients had developed brachial artery aneurysms following ligation of a long-standing brachio-cephalic AV fistula. Two patients presented with pain and a pulsatile mass in the arm, and one presented with pins and needles and discoloration of fingertips. Two were managed with resection of the aneurysm and reconstruction with a reversed long saphenous vein interposition graft, the third simply required ligation of a feeding arterial branch. True aneurysm formation proximal to an AV fistula that has been ligated is a rare complication. There are several reasons for why these aneurysms develop in such patients, the most plausible one being the increase in blood flow and resistance following ligation of the AV fistula. Of note, all the patients in this study were on immunosuppressive therapy following successful renal transplantation. Vigilance by the vascular access team and nephrologists is paramount to identify those patients who may warrant further evaluation and investigation by the vascular surgeon.

  20. Tubal ligation, hysterectomy and ovarian cancer: A meta-analysis

    PubMed Central

    2012-01-01

    Purpose The purpose of this meta-analysis was to determine the strength of the association between gynecologic surgeries, tubal ligation and hysterectomy, and ovarian cancer. Methods We searched the PubMed, Web of Science, and Embase databases for all English-language articles dated between 1969 through March 2011 using the keywords “ovarian cancer” and “tubal ligation” or “tubal sterilization” or “hysterectomy.” We identified 30 studies on tubal ligation and 24 studies on hysterectomy that provided relative risks for ovarian cancer and a p-value or 95% confidence interval (CI) to include in the meta-analysis. Summary RRs and 95% CIs were calculated using a random-effects model. Results The summary RR for women with vs. without tubal ligation was 0.70 (95%CI: 0.64, 0.75). Similarly, the summary RR for women with vs. without hysterectomy was 0.74 (95%CI: 0.65, 0.84). Simple hysterectomy and hysterectomy with unilateral oophorectomy were associated with a similar decrease in risk (summery RR = 0.62, 95%CI: 0.49-0.79 and 0.60, 95%CI: 0.47-0.78, respectively). In secondary analyses, the association between tubal ligation and ovarian cancer risk was stronger for endometrioid tumors (summary RR = 0.45, 95%CI: 0.33, 0.61) compared to serous tumors. Conclusion Observational epidemiologic evidence strongly supports that tubal ligation and hysterectomy are associated with a decrease in the risk of ovarian cancer, by approximately 26-30%. Additional research is needed to determine whether the association between tubal ligation and hysterectomy on ovarian cancer risk differs by individual, surgical, and tumor characteristics. PMID:22587442

  1. Treatment of spontaneous tumours by temporary local ligation

    PubMed Central

    Allen, Frederick M.; Kaplan, Martin M.; Meranze, David R.; Gradess, Morton

    1960-01-01

    Previous work in some human cases and in laboratory animals has indicated that temporary local ligation of spontaneous tumours has a selective destructive effect on these tumours, with only temporary inflammation resulting in normal tissues. In the experiments described in this paper, 49 spontaneous accessible tumours in dogs were treated by this method, with periods of ligation of from 4 to 11 hours. Success, as measured by selective necrosis of tumour tissue as compared with normal tissue, was achieved in 29 out of 41 benign tumours, including lipomas, angiomas, adenomas and mixed mammary tumours. Treatment failures were encountered in two cases each of papillomas and fibromas, six mixed mammary tumours and two testicular tumours. Total necrosis of tumour cells occurred in all eight malignant tumours encountered in this series. The outstanding feature was the specific destruction of tumour tissue by a bodily process without participation of any outside agent. Emphasis was placed on an adequate inflammatory response following temporary anoxia, although a precise definition of this inflammation could not be offered. Post-ligation bacterial multiplication, which may be expected to occur in necrotic tumour tissue, is considered to be a secondary effect rather than a possible primary cause of regression and disappearance of the tumour. If ligation treatment can be shown to be successful for a particular type of tumour, it may be possible to apply it to human patients for the treatment of areas not amenable to surgery. The results reported here warrant new experimental approaches to the study of neoplasms at the cellular level to define more precisely the anoxic and inflammatory processes involved in the selective lethal effect on tumour tissues; and the authors suggest that trials should be undertaken of combinations of chemotherapy or irradiation with ligation to reduce ligation time and extend the possible benefits. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6FIG. 7

  2. Endocrine profile of patients with post-tubal-ligation syndrome.

    PubMed

    Hargrove, J T; Abraham, G E

    1981-07-01

    The endocrine profile of the midluteal phase was assessed in 29 patients with the post-tubal-ligation syndrome, consisting of pain, bleeding and premenstrual tension. Compared to normal controls, the patients had a high serum estradiol and a low serum progesterone level. This abnormal luteal function may be responsible for the symptoms observed and may also explain the failure to conceive following successful reversal of tubal ligation. It is recommended that patients seeking sterilization reversal be screened for abnormal luteal function preoperatively. Selection of sterilization procedures that minimize alteration in luteal function should be given high priority.

  3. Sequelae of tubal ligation: an analysis of 75 consecutive hysterectomies.

    PubMed

    Stock, R J

    1984-10-01

    Seventy-five consecutive patients undergoing hysterectomy subsequent to elective sterilization were studied regarding the occurrence of the post-tubal-ligation syndrome of pelvic pain and/or menorrhagia. Twenty patients were clinically considered to have the syndrome. In none of the patients operated on specifically for menstrual abnormalities could the findings be remotely attributed to the sterilization procedure. Five of the 20 patients had pelvic varicosities and one had pelvic adhesions that may have been a consequence of previous sterilization and conceivably the cause for the pelvic pain for which the patients were undergoing hysterectomy. I question the legitimacy of the post-tubal-ligation syndrome as a reason for hysterectomy.

  4. RNA self-ligation: from oligonucleotides to full length ribozymes.

    PubMed

    Gwiazda, Slawomir; Salomon, Kristina; Appel, Bettina; Müller, Sabine

    2012-07-01

    The RNA-world-theory is one possible explanation of how life on earth has evolved. In this context it is of high interest to search for molecular systems, capable of self-organization into structures with increasing complexity. We have engineered a simple catalytic system in which two short RNA molecules can catalyze their own ligation to form a larger RNA construct. The system is based on the hairpin ribozyme using a 2',3'-cyclophosphate as activated species for ligation. 2',3'-cyclic phosphates can be easily formed and occur in many natural systems, thus being superior candidates for activated building blocks in RNA world scenarios.

  5. Alternative Okazaki Fragment Ligation Pathway by DNA Ligase III.

    PubMed

    Arakawa, Hiroshi; Iliakis, George

    2015-06-23

    Higher eukaryotes have three types of DNA ligases: DNA ligase 1 (Lig1), DNA ligase 3 (Lig3) and DNA ligase 4 (Lig4). While Lig1 and Lig4 are present in all eukaryotes from yeast to human, Lig3 appears sporadically in evolution and is uniformly present only in vertebrates. In the classical, textbook view, Lig1 catalyzes Okazaki-fragment ligation at the DNA replication fork and the ligation steps of long-patch base-excision repair (BER), homologous recombination repair (HRR) and nucleotide excision repair (NER). Lig4 is responsible for DNA ligation at DNA double strand breaks (DSBs) by the classical, DNA-PKcs-dependent pathway of non-homologous end joining (C-NHEJ). Lig3 is implicated in a short-patch base excision repair (BER) pathway, in single strand break repair in the nucleus, and in all ligation requirements of the DNA metabolism in mitochondria. In this scenario, Lig1 and Lig4 feature as the major DNA ligases serving the most essential ligation needs of the cell, while Lig3 serves in the cell nucleus only minor repair roles. Notably, recent systematic studies in the chicken B cell line, DT40, involving constitutive and conditional knockouts of all three DNA ligases individually, as well as of combinations thereof, demonstrate that the current view must be revised. Results demonstrate that Lig1 deficient cells proliferate efficiently. Even Lig1/Lig4 double knockout cells show long-term viability and proliferate actively, demonstrating that, at least in DT40, Lig3 can perform all ligation reactions of the cellular DNA metabolism as sole DNA ligase. Indeed, in the absence of Lig1, Lig3 can efficiently support semi-conservative DNA replication via an alternative Okazaki-fragment ligation pathway. In addition, Lig3 can back up NHEJ in the absence of Lig4, and can support NER and HRR in the absence of Lig1. Supporting observations are available in less elaborate genetic models in mouse cells. Collectively, these observations raise Lig3 from a niche-ligase to a

  6. Strengthening medical appraisal: reactions to proposals for a new appraisal system to support revalidation.

    PubMed

    Ball, Kerry; Lyons, Nick; Conlon, Maurice; Critchley, Ralph

    2011-11-01

    This paper introduces the first stage of the NHS Revalidation Support Team's (RST) proposals to strengthen medical appraisal. It reports on four focus groups held at London Deanery in 2010, with the aim of gauging initial reactions from general practitioners (GPs). The four groups consisted of two groups of appraisers and two groups of appraisees. After presentation of the proposals to strengthen appraisal, participants were invited to make comparisons between existing appraisal, and the new proposals, Interestingly, the matter which attracted most discussion was a proposal to include an element of self-assessment by the appraisee prior to appraisal, and not, as might have been expected, the proposals for assessment of the appraisee's progress towards revalidation by the appraiser. Since these focus groups, the model of strengthened medical appraisal referred to in this paper has been the subject of testing in the pathfinder pilot, a large scale pilot involving 3000 doctors in various settings in England. The evaluation of the pathfinder pilot was published (July 2011). After further refinement of the appraisal process, including taking into account new GMC and Royal College publications and more testing and piloting, the final version of medical appraisal to support revalidation, known as the Medical Appraisal Guide (MAG) is due to be published in March 2012, in time to permit the expected commencement of revalidation in late 2012.

  7. [Detection of microdeletion in Williams syndrome by multiplex ligation-dependent probe amplification].

    PubMed

    Peng, Yuan-yuan; Meng, Yan; Qiu, Zheng-qing; Wang, Ou; Huang, Shang-zhi

    2009-08-01

    To establish a method of multiplex ligation-dependent probe amplification (MLPA) for clinical screening of Williams syndrome (WS) and for routine use in WS diagnosis. Probes for MLPA were designed according to the frequent deletion regions, and used to screen the two patients suspected with Williams syndrome, and the density of the bands were analyzed with software. Linkage analysis using polymorphic markers was performed to confirm the positive result of MLPA. The MLPA data indicated that the two children had possible microdeletions in the WS critical region. The deletions were confirmed and both were maternal origin by polymorphism analysis. MLPA is a quick and convenient method for detecting deletion or duplication mutations. It can provide reliable and helpful information for clinical diagnose of Williams syndrome.

  8. Critical appraisal of published literature.

    PubMed

    Umesh, Goneppanavar; Karippacheril, John George; Magazine, Rahul

    2016-09-01

    With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader's work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.

  9. Critical appraisal of published literature

    PubMed Central

    Umesh, Goneppanavar; Karippacheril, John George; Magazine, Rahul

    2016-01-01

    With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader's work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice. PMID:27729695

  10. 78 FR 25084 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-29

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open....) Discussion Agenda Revised ASC Policy Statements Appraisal Foundation January 2013 Grant Reimbursement...

  11. 77 FR 33458 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-06

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... Delegations of Authority to include monitoring of the appraisal requirements established by the...

  12. 75 FR 74732 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-01

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... moved to the discussion agenda.) Discussion Agenda: Appraisal Foundation July 2010 Grant...

  13. 76 FR 6134 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-03

    ...] Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the Federal Financial... is hereby given that the Appraisal Subcommittee (ASC) will meet in open session for its regular... item be moved to the discussion agenda.) Discussion Agenda Appraisal Foundation October 2010...

  14. 76 FR 61703 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-05

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... the discussion agenda.) Discussion Agenda Appraisal Foundation June 2011 Grant Reimbursement...

  15. 76 FR 47182 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-04

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open...; Appraisal Foundation April 2011 Grant Reimbursement Request; Delaware Compliance Review; Illinois...

  16. 76 FR 13187 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-10

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... agenda.) Discussion Agenda Appraisal Foundation November 2010 Grant Reimbursement Request. North...

  17. 77 FR 58140 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-19

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... the discussion agenda.) Discussion Agenda Appraisal Foundation FY13 Grant Proposal ASC FY13...

  18. 12 CFR 202.14 - Rules on providing appraisal reports.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Rules on providing appraisal reports. 202.14... EQUAL CREDIT OPPORTUNITY ACT (REGULATION B) § 202.14 Rules on providing appraisal reports. (a) Providing appraisals. A creditor shall provide a copy of an appraisal report used in connection with an application...

  19. 7 CFR 766.115 - Challenging the Agency appraisal.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Challenging the Agency appraisal. 766.115 Section 766... Challenging the Agency appraisal. (a) A borrower considered for primary loan servicing who does not agree with the Agency's appraisal of the borrower's assets may: (1) Obtain a technical appraisal review of...

  20. 76 FR 57741 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-16

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in... item be moved to the discussion agenda.) Discussion Agenda Appraisal Foundation May 2011...

  1. 12 CFR 528.2a - Nondiscriminatory appraisal and underwriting.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Nondiscriminatory appraisal and underwriting... NONDISCRIMINATION REQUIREMENTS § 528.2a Nondiscriminatory appraisal and underwriting. (a) Appraisal. No savings association may use or rely upon an appraisal of a dwelling which the savings association knows, or...

  2. 12 CFR 950.10 - Collateral valuation; appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Collateral valuation; appraisals. 950.10...-BALANCE SHEET ITEMS ADVANCES Advances to Members § 950.10 Collateral valuation; appraisals. (a) Collateral...) Appraisals. A Bank may require a member to obtain an appraisal of any item of collateral, and to perform...

  3. 78 FR 33419 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open....) Discussion Agenda Illinois Compliance Update Appraisal Foundation February 2013 Grant Reimbursement...

  4. 78 FR 14300 - Appraisal Subcommittee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-05

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Meeting AGENCY: Appraisal Subcommittee of... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in... agenda.) Discussion Agenda Appraisal Complaint National Hotline Illinois Compliance Review How to...

  5. 77 FR 72862 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-06

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... moved to the discussion agenda.) Discussion Agenda: ASC Policy for the Appraisal Complaint...

  6. 12 CFR 564.4 - Minimum appraisal standards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Minimum appraisal standards. 564.4 Section 564.4 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.4 Minimum appraisal standards. For federally related transactions, all appraisals shall, at a minimum:...

  7. 76 FR 1164 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... item be moved to the discussion agenda.) Discussion Agenda Appraisal Foundation September 2010...

  8. 76 FR 42126 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-18

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... agenda.) Discussion Agenda Appraisal Foundation 2010 Agreed Upon Procedures Grant Report....

  9. 77 FR 5249 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-02

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as ] amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... requests that an item be moved to the discussion agenda.) Discussion Agenda Appraisal Foundation 2012...

  10. Angry and Afraid: Women's Appraisal of Sexual Harassment during Litigation

    ERIC Educational Resources Information Center

    Wright, Caroline Vaile; Fitzgerald, Louise F.

    2007-01-01

    The purpose of this study was to examine primary appraisal of sexual harassment, that is, a victim's cognitive evaluation of the harassment and the factors that influence this appraisal. The perspectives of 72 female plaintiffs were investigated by measuring their primary appraisal of the event, examining the structure of this appraisal, and…

  11. Stigma, Reflected Appraisals, and Recovery Outcomes in Mental Illness

    ERIC Educational Resources Information Center

    Markowitz, Fred E.; Angell, Beth; Greenberg, Jan S.

    2011-01-01

    Drawing on modified labeling theory and the reflected appraisals process and using longitudinal data from 129 mothers and their adult children with schizophrenia, we estimate models of the effects of mothers' stigmatized identity appraisals of their mentally ill children on reflected and self-appraisals, and how appraisals affect outcomes…

  12. Angry and Afraid: Women's Appraisal of Sexual Harassment during Litigation

    ERIC Educational Resources Information Center

    Wright, Caroline Vaile; Fitzgerald, Louise F.

    2007-01-01

    The purpose of this study was to examine primary appraisal of sexual harassment, that is, a victim's cognitive evaluation of the harassment and the factors that influence this appraisal. The perspectives of 72 female plaintiffs were investigated by measuring their primary appraisal of the event, examining the structure of this appraisal, and…

  13. 25 CFR 11.706 - Appointment and duties of appraiser.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... appraiser to appraise all of the decedent's real and personal property within the estate. (b) It shall be... 25 Indians 1 2011-04-01 2011-04-01 false Appointment and duties of appraiser. 11.706 Section 11... OFFENSES AND LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a)...

  14. 25 CFR 11.706 - Appointment and duties of appraiser.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... appraiser to appraise all of the decedent's real and personal property within the estate. (b) It shall be... 25 Indians 1 2010-04-01 2010-04-01 false Appointment and duties of appraiser. 11.706 Section 11... OFFENSES AND LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a)...

  15. 25 CFR 11.706 - Appointment and duties of appraiser.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... appraiser to appraise all of the decedent's real and personal property within the estate. (b) It shall be... 25 Indians 1 2014-04-01 2014-04-01 false Appointment and duties of appraiser. 11.706 Section 11... OFFENSES AND LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a)...

  16. 25 CFR 11.706 - Appointment and duties of appraiser.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... appraiser to appraise all of the decedent's real and personal property within the estate. (b) It shall be... 25 Indians 1 2013-04-01 2013-04-01 false Appointment and duties of appraiser. 11.706 Section 11... OFFENSES AND LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a)...

  17. 25 CFR 11.706 - Appointment and duties of appraiser.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... appraiser to appraise all of the decedent's real and personal property within the estate. (b) It shall be... 25 Indians 1 2012-04-01 2011-04-01 true Appointment and duties of appraiser. 11.706 Section 11.706... LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a) Upon...

  18. Stigma, Reflected Appraisals, and Recovery Outcomes in Mental Illness

    ERIC Educational Resources Information Center

    Markowitz, Fred E.; Angell, Beth; Greenberg, Jan S.

    2011-01-01

    Drawing on modified labeling theory and the reflected appraisals process and using longitudinal data from 129 mothers and their adult children with schizophrenia, we estimate models of the effects of mothers' stigmatized identity appraisals of their mentally ill children on reflected and self-appraisals, and how appraisals affect outcomes…

  19. Band Together!

    ERIC Educational Resources Information Center

    Olson, Cathy Applefeld

    2011-01-01

    After nearly a decade as band director at St. James High School in St. James, Missouri, Derek Limback knows that the key to building a successful program is putting the program itself above everything else. Limback strives to augment not only his students' musical prowess, but also their leadership skills. Key to his philosophy is instilling a…

  20. Magnetic Ligation Method for Quantitative Detection of MicroRNAs

    PubMed Central

    Liong, Monty; Im, Hyungsoon; Majmudar, Maulik D.; Aguirre, Aaron D.; Sebas, Matthew; Lee, Hakho; Weissleder, Ralph

    2014-01-01

    A magnetic ligation method is utilized for the detection of microRNAs amongst a complex biological background without polymerase chain reaction or nucleotide modification. The sandwich probes assay can be adapted to analyze a panel of microRNAs associated with cardiovascular diseases in heart tissue samples. PMID:24532323

  1. A Simple Suturing Technique for Laparoscopic Ligation of Vascular Pedicles

    PubMed Central

    Aqua, Keith A.

    1996-01-01

    We report on the performance of 348 adnexectomies and 35 uterine artery ligations for both benign and malignant disease using a simple laparoscopic suturing technique. Only 5-mm ports are required, and there was no morbidity directly associated with this approach. The procedure can be performed quickly, is relatively inexpensive, and allows hysterectomy and oophorectomy to be performed without bipolar electrocautery. PMID:18493392

  2. Protein chemical synthesis by α-ketoacid-hydroxylamine ligation.

    PubMed

    Harmand, Thibault J; Murar, Claudia E; Bode, Jeffrey W

    2016-06-01

    Total chemical synthesis of proteins allows researchers to custom design proteins without the complex molecular biology that is required to insert non-natural amino acids or the biocontamination that arises from methods relying on overexpression in cells. We describe a detailed procedure for the chemical synthesis of proteins with the α-ketoacid-hydroxylamine (KAHA ligation), using (S)-5-oxaproline (Opr) as a key building block. This protocol comprises two main parts: (i) the synthesis of peptide fragments by standard fluorenylmethoxycarbonyl (Fmoc) chemistry and (ii) the KAHA ligation between fragments containing Opr and a C-terminal peptide α-ketoacid. This procedure provides an alternative to native chemical ligation (NCL) that could be valuable for the synthesis of proteins, particularly targets that do not contain cysteine residues. The ligation conditions-acidic DMSO/H2O or N-methyl-2-pyrrolidinone (NMP)/H2O-are ideally suited for solubilizing peptide segments, including many hydrophobic examples. The utility and efficiency of the protocol is demonstrated by the total chemical synthesis of the mature betatrophin (also called ANGPTL8), a 177-residue protein that contains no cysteine residues. With this protocol, the total synthesis of the betatrophin protein has been achieved in around 35 working days on a multimilligram scale.

  3. Optimization of ligation reaction conditions in gene synthesis.

    PubMed

    Theriault, N Y; Carter, J B; Pulaski, S P

    1988-05-01

    Several phosphorylation, annealing and ligation reaction conditions have been investigated for the enzymatic assembly of genes of interest. The use of longer oligodeoxyribonucleotides (40-60 bases long) also improved the enzymatic reaction. Furthermore, the use of longer oligonucleotides and the elimination of long stretches of G's or C's lowered the mutation rate.

  4. Sequence fidelity of a template-directed PNA-ligation reaction.

    PubMed

    Mattes, A; Seitz, O

    2001-10-21

    The ligation method and an appended duplex-stabilizing dye affect both yield and sequence selectivity of a template-controlled PNA-ligation. The highest selectivity was obtained with a peptide condensation that formed an abasic site.

  5. A new extraction technique for rectal foreign bodies with a rubber band ligation device.

    PubMed

    Calişkan, Cemil; Karaca, Can; Akgün, Erhan; Korkut, Mustafa A

    2010-06-01

    Foreign bodies in the rectum are a rare clinical condition that should be noted. The most frequently encountered cause is erotic activity. The first goal of the therapy is extraction of the foreign body using the simplest method possible while protecting the integrity of the intestine. Many instruments and methods have been suggested for this purpose. This report discusses a new management strategy for these patients along with a review of the literature.

  6. Click nucleic acid ligation: applications in biology and nanotechnology.

    PubMed

    El-Sagheer, Afaf H; Brown, Tom

    2012-08-21

    Biochemical strategies that use a combination of synthetic oligonucleotides, thermostable DNA polymerases, and DNA ligases can produce large DNA constructs up to 1 megabase in length. Although these ambitious targets are feasible biochemically, comparable technologies for the chemical synthesis of long DNA strands lag far behind. The best available chemical approach is the solid-phase phosphoramidite method, which can be used to assemble DNA strands up to 150 bases in length. Beyond this point, deficiencies in the chemistry make it impossible to produce pure DNA. A possible alternative approach to the chemical synthesis of large DNA strands is to join together carefully purified synthetic oligonucleotides by chemical methods. Click ligation by the copper-catalyzed azide-alkyne (CuAAC) reaction could facilitate this process. In this Account, we describe the synthesis, characterization, and applications of oligonucleotides prepared by click ligation. The alkyne and azide oligonucleotide strands can be prepared by standard protocols, and the ligation reaction is compatible with a wide range of chemical modifications to DNA and RNA. We have employed click ligation to synthesize DNA constructs up to 300 bases in length and much longer sequences are feasible. When the resulting triazole linkage is placed in a PCR template, various DNA polymerases correctly copy the entire base sequence. We have also successfully demonstrated both in vitro transcription and rolling circle amplification through the modified linkage. This linkage has shown in vivo biocompatibility: an antibiotic resistance gene containing triazole linkages functions in E. coli . Using click ligation, we have synthesized hairpin ribozymes up to 100 nucleotides in length and a hammerhead ribozyme with the triazole linkage located at the substrate cleavage site. At the opposite end of the length scale, click-ligated, cyclic mini-DNA duplexes have been used as models to study base pairing. Cyclic duplexes have

  7. The effect of tubal ligation on the incidence of epithelial cancer of the ovary.

    PubMed

    Koch, M; Starreveld, A A; Hill, G B; Jenkins, H

    1984-01-01

    A retrospective review of 666 women who underwent tubal ligation between 1930 and 1969 in Alberta, Canada, was undertaken to assess the effect of tubal ligation on the incidence of ovarian cancer. Tubal ligation did not affect the risk of ulterior ovarian cancer except in women who underwent tubal ligation between the ages of 20 and 29. These women showed a slight but statistically significant (p = 0.03) increase in observed versus expected cases of ovarian cancer.

  8. Tubal ligation and ovarian cancer risk in African American women.

    PubMed

    McNamara, Chrissy; Abbott, Sarah E; Bandera, Elisa V; Qin, Bo; Peres, Lauren C; Camacho, Fabian; Moorman, Patricia G; Alberg, Anthony J; Barnholtz-Sloan, Jill S; Bondy, Melissa; Cote, Michele L; Funkhouser, Ellen; Peters, Edward S; Schwartz, Ann G; Schildkraut, Joellen M; Terry, Paul

    2017-09-04

    Tubal ligation has been associated with reduced risk of epithelial ovarian cancer (EOC) in studies of primarily white women, but less is known about the association in African American (AA) women. We sought to evaluate the associations among 597 invasive ovarian cancer cases and 742 controls of AA descent recruited from the African American Cancer Epidemiology Study, a population-based case-control study in 11 geographical areas in the US. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potentially confounding factors. An inverse association between tubal ligation and EOC was observed that was not statistically significant (OR 0.88, 95% CI 0.68-1.14). However, an inverse association with EOC risk was observed among women who had a tubal ligation at age 35 years or older (OR 0.64; 95% CI 0.41-0.98), but not among those who had a tubal ligation before age 35 (OR 0.98; 95% CI 0.74-1.29) (p for interaction = 0.08). The association also varied considerably by tumor subtype. A strong inverse association was observed for endometrioid tumors (OR 0.31, 95% CI 0.14-0.70), whereas associations with mucinous (OR 0.87, 95% CI 0.36-2.12) and serous (OR 0.94, 95% CI 0.71-1.24) tumors were weaker and not statistically significant. A statistically non-significant positive association for clear cell tumors (OR 1.84, 95% CI 0.58-5.82) was based on a low number of cases. Our findings show that tubal ligation may confer a reduced risk for EOC among AA women that is comparable to the associations that have been previously observed in primarily white populations.

  9. Corrosion behavior of self-ligating and conventional metal brackets

    PubMed Central

    Maia, Lúcio Henrique Esmeraldo Gurgel; Lopes Filho, Hibernon; Ruellas, Antônio Carlos de Oliveira; Araújo, Mônica Tirre de Souza; Vaitsman, Delmo Santiago

    2014-01-01

    Objective To test the null hypothesis that the aging process in self-ligating brackets is not higher than in conventional brackets. Methods Twenty-five conventional (GN-3M/Unitek; GE-GAC; VE-Aditek) and 25 self-ligating (SCs-3M/Unitek; INs-GAC; ECs-Aditek) metal brackets from three manufacturers (n = 150) were submitted to aging process in 0.9% NaCl solution at a constant temperature of 37 ± 1ºC for 21 days. The content of nickel, chromium and iron ions in the solution collected at intervals of 7, 14 and 21 days was quantified by atomic absorption spectrophotometry. After the aging process, the brackets were analyzed by scanning electron microscopy (SEM) under 22X and 1,000X magnifications. Results Comparison of metal release in self-ligating and conventional brackets from the same manufacturer proved that the SCs group released more nickel (p < 0.05) than the GN group after 7 and 14 days, but less chromium (p < 0.05) after 14 days and less iron (p < 0.05) at the three experimental time intervals. The INs group released less iron (p < 0.05) than the GE group after 7 days and less nickel, chromium and iron (p < 0.05) after 14 and 21 days. The ECs group released more nickel, chromium and iron (p < 0.05) than the VE group after 14 days, but released less nickel and chromium (p < 0.05) after 7 days and less chromium and iron (p < 0.05) after 21 days. The SEM analysis revealed alterations on surface topography of conventional and self-ligating brackets. Conclusions The aging process in self-ligating brackets was not greater than in conventional brackets from the same manufacturer. The null hypothesis was accepted. PMID:24945521

  10. Frictional forces related to self-ligating brackets.

    PubMed

    Pizzoni, L; Ravnholt, G; Melsen, B

    1998-06-01

    Orthodontic tooth movement can be regarded as teeth sliding on a wire like pearls on a string, the force being supplied by springs or elastics. The movement implies friction between wire and bracket, taking up part of the force and leaving an uncontrolled amount to act on the teeth. The friction is likely to depend on bracket construction and wire material. Therefore, in this investigation the friction of self-ligating brackets and beta-titanium wires was evaluated, as opposed to more conventional configurations. Carried by low-friction linear ball bearings, a bracket was made to slide along an out-stretched archwire with minimal (and known) basic friction, either parallel or at an angle to the wire. Two self-ligating brackets were used in their closed position without any normal force. Friction was tested against four wires: stainless steel and beta-titanium, both in round and rectangular cross-sections. The force used to overcome friction and to move the bracket was measured on a testing machine at 10 mm/min, and the basic friction was subtracted. The results show that round wires had a lower friction than rectangular wires, the beta-titanium wires had a markedly higher friction than stainless steel wires, and friction increased with angulation for all bracket/wire combinations. The self-ligating brackets had a markedly lower friction than conventional brackets at all angulations, and self-ligating brackets, closed by the capping of a conventional design, exhibited a significantly lower friction than self-ligating brackets closed by a spring. The selection of bracket design, wire material, and wire cross-section significantly influences the forces acting in a continuous arch system.

  11. SCAMPI Lead Appraiser (Service Mark) Body of Knowledge (SLA BOK)

    DTIC Science & Technology

    2007-10-01

    Competencies • CMP 3.2.2, Defining the appraisal team roles and responsibilities Examples • The initial set of appraisal team norms are agreed on...Competencies • CMP 3.1.1, Managing stakeholder involvement • CMP 3.2.2, Defining the appraisal team roles and responsibilities Examples • A site...appraisal team roles and responsibilities Associated Skills • Balancing appraisal team members’ workloads based on team member capabilities and

  12. Application of an omonasteine ligation strategy for the total chemical synthesis of the BRD7 bromodomain.

    PubMed

    Van de Vijver, Pieter; Scheer, Liesbeth; van Beijnum, Judy; Griffioen, Arjan; Hackeng, Tilman M

    2012-09-28

    The use of omonasteine (Omo) in sequential peptide ligation strategies extends the scope of homocysteine (Hcy) ligation to longer, methionine-rich proteins. Hcy-to-Omo conversion can be performed on-resin, while the Omo-to-Hcy deprotection can be performed in situ after peptide ligation. This strategy was successfully applied in the synthesis of the BRD7 bromodomain.

  13. 32 CFR 644.42 - Appraisal report.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... vacancy and credit losses; (c) an itemized estimate of total expenses including reserves for replacements... sources of rates and factors. 16. INTERPRETATION AND CORRELATION OF ESTIMATES. The appraiser shall...

  14. 32 CFR 644.42 - Appraisal report.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... vacancy and credit losses; (c) an itemized estimate of total expenses including reserves for replacements... sources of rates and factors. 16. INTERPRETATION AND CORRELATION OF ESTIMATES. The appraiser shall...

  15. 32 CFR 644.42 - Appraisal report.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... vacancy and credit losses; (c) an itemized estimate of total expenses including reserves for replacements... sources of rates and factors. 16. INTERPRETATION AND CORRELATION OF ESTIMATES. The appraiser shall...

  16. 32 CFR 644.42 - Appraisal report.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... vacancy and credit losses; (c) an itemized estimate of total expenses including reserves for replacements... sources of rates and factors. 16. INTERPRETATION AND CORRELATION OF ESTIMATES. The appraiser shall...

  17. Performance Appraisal: What Does the Future Hold?

    ERIC Educational Resources Information Center

    Lazer, Robert I.

    1980-01-01

    Included in this examination of performance appraisal practices is an outline of the characteristics of a good system--one that is cheap to install and only requires a manager to do his/her job. (Author/IRT)

  18. Health Risk Appraisal Use at Headquarters

    NASA Technical Reports Server (NTRS)

    Borcherding, Donald

    1997-01-01

    Specific topics which relate to the NASA Health Risk Appraisal (HRA) include: (1) What is a HRA?; (2) Risk factors; (3) Program use at NASA Headquarters; (4) An alternative approach; (5) Group HRA reports; and (6) Future considerations and conclusion.

  19. 19 CFR 162.43 - Appraisement.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) INSPECTION, SEARCH, AND SEIZURE Treatment of Seized Merchandise § 162.43 Appraisement. (a... 606, Tariff Act of 1930, as amended (19 U.S.C. 1606). The term “domestic value” as used therein shall...

  20. Health Risk Appraisal Use at Headquarters

    NASA Technical Reports Server (NTRS)

    Borcherding, Donald

    1997-01-01

    Specific topics which relate to the NASA Health Risk Appraisal (HRA) include: (1) What is a HRA?; (2) Risk factors; (3) Program use at NASA Headquarters; (4) An alternative approach; (5) Group HRA reports; and (6) Future considerations and conclusion.

  1. Use of appraisals for professional effectiveness.

    PubMed

    Birabi, Bridget

    2006-01-01

    Appraisal is usually linked with performance but it can also apply to intervention programmes. It is a distinct and formal management procedure used in the evaluation of work performance or the impact of a programme based on set objectives which are usually SMART. Every programme requires continual and meaningful feedback that transforms what looks technical into a dynamic and interactive process. This ties outcomes to intervention. Of great importance for a professional is self appraisal. When a professional is passion-driven to meet the needs of a client, the need to build capacity becomes obvious to remain in the market. Facility appraisal is as important as the environment of any service delivery and psychologically impacts on the consumer. Appraisal seems both inevitable and universal. To continually raise the standard of health care delivery, capacity building is at the crux. This will thoroughly equip health professionals for client-patient centered "best practices."

  2. Clustering of worry appraisals among college students.

    PubMed

    Schwab, Nicholas G; Cullum, Jerry C; Harton, Helen C

    2016-01-01

    The present study investigated the potential clustering of worry appraisals within college social networks. Participants living in campus residence buildings responded to online surveys across the course of several months. Worry appraisals were measured 10 weeks into the fall semester and again approximately 6 months later. Analysis of sociometric data suggests that the majority of participants' social interactions occurred within their respective residence building floors, indicating that proximity strongly influenced the development of social network ties and sources of social influence. Further, significant clustering of worry appraisals occurred across time, and more importantly, within residence building floors. The present findings compliment previous work suggesting that several physical and psychological states appear to spread and cluster within social networks. Implications for the study of emotional appraisals and future research are discussed.

  3. Performance Appraisal: What Does the Future Hold?

    ERIC Educational Resources Information Center

    Lazer, Robert I.

    1980-01-01

    Included in this examination of performance appraisal practices is an outline of the characteristics of a good system--one that is cheap to install and only requires a manager to do his/her job. (Author/IRT)

  4. 21 CFR 1316.74 - Appraisement.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... appraise the property to determine the domestic value at the time and place of seizure. The domestic value shall be considered the price at which such or similar property is freely offered for sale. If there...

  5. Savannah River Site ALARA Program appraisals

    SciTech Connect

    Johnson, J.R.

    1992-06-01

    ALARA Program audits are recommended in PNL-6566, ``Health Physics Manual of Good Practices for Reducing Radiation Exposure to Levels that are As Low As Reasonably Achievable (ALARA).`` The Department of Energy (DOE) Order 5480.11, ``Radiation Protection For Occupational Workers,`` requires contractors to conduct internal audits of all functional elements of the radiological protection program, which includes the ALARA program, as often as necessary, but at a minimum every three years. At the Savannah River Site (SRS), these required audits are performed as part of the Health Protection Internal Appraisal Program. This program was established to review the Site radiological protection program, which includes the ALARA program, on an ongoing basis and to provide recommendations for improvement directly to senior Health Protection management. This paper provides an overview of the SRS Health Protection Internal Appraisal program. In addition, examples of specific performance criteria and detailed appraisal guidelines used ALARA appraisals are provided.

  6. Savannah River Site ALARA Program appraisals

    SciTech Connect

    Johnson, J.R.

    1992-01-01

    ALARA Program audits are recommended in PNL-6566, Health Physics Manual of Good Practices for Reducing Radiation Exposure to Levels that are As Low As Reasonably Achievable (ALARA).'' The Department of Energy (DOE) Order 5480.11, Radiation Protection For Occupational Workers,'' requires contractors to conduct internal audits of all functional elements of the radiological protection program, which includes the ALARA program, as often as necessary, but at a minimum every three years. At the Savannah River Site (SRS), these required audits are performed as part of the Health Protection Internal Appraisal Program. This program was established to review the Site radiological protection program, which includes the ALARA program, on an ongoing basis and to provide recommendations for improvement directly to senior Health Protection management. This paper provides an overview of the SRS Health Protection Internal Appraisal program. In addition, examples of specific performance criteria and detailed appraisal guidelines used ALARA appraisals are provided.

  7. Neural circuits associated with positive and negative self-appraisal.

    PubMed

    Brühl, A B; Rufer, M; Kaffenberger, T; Baur, V; Herwig, U

    2014-04-18

    Self-worth is particularly influenced by self-appraisal, which is negatively biased in many psychiatric disorders. Positive and negative self-appraisals also shape current emotional states or even evoke defensive reactions, when they are incongruent with a subject's current state. Prior studies have mainly used externally given evaluative appraisals. In this study, 30 subjects used individual negative and positive self-appraisals during functional magnetic resonance imaging. We additionally investigated the effects of such self-appraisals onto the subsequent perception of photos of the individual subjects. Both self-appraisal conditions activated dorsomedial and dorsolateral prefrontal cortex compared to the neutral condition. Positive self-appraisal evoked stronger activity than negative self-appraisal in the amygdala, ventral striatum and anterior cingulate cortex, whereas negative self-appraisal was associated with increased activity in the occipital regions. Positive self-appraisal had no effect on the perception of a photo of oneself, whereas negative appraisal increased activity in the anterior insula and parietal regions. Overall, positive self-appraisal activated more emotion-related brain regions, whereas negative self-appraisal had a relatively stronger influence on perception-related brain activity. These findings could on the one hand explain the effect of negative self-appraisal on the behavior in the real world and on the other hand support a stronger focus of psychotherapy on enhancing positive self-appraisals.

  8. Balloon-augmented Onyx endovascular ligation: initial human experience and comparison with coil ligation.

    PubMed

    Osanai, Toshiya; Bain, Mark D; Toth, Gabor; Hussain, M Shazam; Hui, Ferdinand K

    2015-08-01

    Carotid artery sacrifice remains an important procedure for cerebral vascular disorders despite the development of new endovascular devices. Conventional carotid artery sacrifice with detachable coils alone often requires numerous coils to complete occlusion. To describe the initial human experience with balloon-augmented Onyx and coil vessel sacrifice based on our previous experience with animals. We performed a retrospective review of patients who underwent carotid artery sacrifice between 2008 and 2012 in accordance with local investigational review board approval. Two methods were used to occlude carotid arteries-namely, combined Onyx and coil embolization and traditional coil embolization. We compared the two methods for the cost of embolizate, time to occlude the vessels, and the number of coils. Eight consecutive patients (combined group n=3, traditional group n=5) were assessed. The median cost of embolic material was $6321 in the combined Onyx and coil embolization group and $29 996 in the traditional coil embolization group. The median time from first coil placement to achievement of vessel occlusion was 52 min in the Onyx group and 113 min in the coil embolization group. The median number of coils used was 4 in the Onyx group and 35 in the coil embolization group (p<0.05). No symptomatic complications or recurrences were seen in the combined group. Balloon-augmented Onyx endovascular ligation may reduce costs and fluoroscopy times during vessel sacrifice. Further studies in a larger number of patients are needed to confirm these findings. 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.

  9. Treatment efficiency of conventional vs self-ligating brackets: effects of archwire size and material.

    PubMed

    Turnbull, Nicholas R; Birnie, David J

    2007-03-01

    In this prospective clinical study, we assessed the relative speed of archwire changes, comparing self-ligating brackets with conventional elastomeric ligation methods, and further assessed this in relation to the stage of orthodontic treatment represented by different wire sizes and types. The time taken to remove and ligate archwires for 131 consecutive patients treated with either self-ligating or conventional brackets was prospectively assessed. The study was carried out in the orthodontic department of a district general hospital in the United Kingdom. The main outcome measure was the time to remove or place elastomeric ligatures or open/close self-ligating brackets for 2 matched groups of fixed appliance patients: Damon2 self-ligating bracket (SDS Ormco, Orange, Calif) and a conventional mini-twin bracket (Orthos, SDS Ormco). The relative effects of various wire sizes and materials on ligation times were investigated. The study was carried out by 1 operator experienced in the use of self-ligating and conventional brackets. The Damon2 self-ligating system had a significantly shorter mean archwire ligation time for both placing (P <.001) and removing (P <.01) wires compared with the conventional elastomeric system. Ligation of an archwire was approximately twice as quick with the self-ligating system. Opening a Damon slide was on average 1 second quicker per bracket than removing an elastic from the mini-twin brackets, and closing a slide was 2 seconds faster per bracket. This difference in ligation time between the Damon2 and the conventional mini-twin brackets became more marked for larger wire sizes used in later treatment stages. The type of bracket and the size of wire used are statistically significant predictors for speed of ligation and chairside time. The self-ligating system offered quicker and arguably more efficient wire removal and placement for most orthodontic treatment stages.

  10. Laparoscopic gastric banding

    MedlinePlus

    ... adjustable gastric banding; Bariatric surgery - laparoscopic gastric banding; Obesity - gastric banding; Weight loss - gastric banding ... gastric banding is not a "quick fix" for obesity. It will greatly change your lifestyle. You must ...

  11. Etiopathogenesis of cataract: An appraisal

    PubMed Central

    Gupta, Varun B; Rajagopala, Manjusha; Ravishankar, Basavaiah

    2014-01-01

    Natural eye lens is a crystalline substance to produce a clear passage for light. Cataract is opacity within the clear lens of the eye and is the dominant cause of socio-medical problem i.e., blindness worldwide. The only available treatment of cataract is surgery. However, insufficient surgical facilities in poor and developing countries and post-operative complications inspire researchers to find out other modes of treatment for cataract. In this review, an attempt has been made to appraise various etiological factors of cataract to make their perception clear to build up counterpart treatment. Present study is an assortment of various available literatures and electronic information in view of cataract etiopathogenesis. Various risk factors have been identified in development of cataracts. They can be classified in to genetic factors, ageing (systemic diseases, nutritional and trace metals deficiencies, smoking, oxidative stress etc.), traumatic, complicated (inflammatory and degenerative diseases of eye), metabolic (diabetes, galactosemia etc.), toxic substances including drugs abuses, alcohol etc., radiation (ultraviolet, electromagnetic waves etc.) are implicated as significant risk factors in the development of cataract. PMID:24618482

  12. Recent extensions to native chemical ligation for the chemical synthesis of peptides and proteins.

    PubMed

    Malins, Lara R; Payne, Richard J

    2014-10-01

    Native chemical ligation continues to play a pivotal role in the synthesis of increasingly complex peptide and protein targets twenty years after its initial report. This opinion article will highlight a number of recent, powerful extensions of the technology that have expanded the scope of the reaction, accelerated ligation rates, enabled chemoselective post-ligation modifications, and streamlined the ligation of multiple peptide fragments. These advances have facilitated the synthesis of a number of impressive protein targets to date and hold great promise for the continued application of native chemical ligation for the detailed study of protein structure and function. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Ligation-free ribosome profiling of cell type-specific translation in the brain.

    PubMed

    Hornstein, Nicholas; Torres, Daniela; Das Sharma, Sohani; Tang, Guomei; Canoll, Peter; Sims, Peter A

    2016-07-05

    Ribosome profiling has emerged as a powerful tool for genome-wide measurements of translation, but library construction requires multiple ligation steps and remains cumbersome relative to more conventional deep-sequencing experiments. We report a new, ligation-free approach to ribosome profiling that does not require ligation. Library construction for ligation-free ribosome profiling can be completed in one day with as little as 1 ng of purified RNA footprints. We apply ligation-free ribosome profiling to mouse brain tissue to identify new patterns of cell type-specific translation and test its ability to identify translational targets of mTOR signaling in the brain.

  14. Addition of HOBt improves the conversion of thioester-Amine chemical ligation.

    PubMed

    Todorovski, Toni; Suñol, David; Riera, Antoni; Macias, Maria J

    2015-11-01

    The syntheses of large peptides and of those containing non-natural amino acids can be facilitated by the application of convergent approaches, dissecting the native sequence into segments connected through a ligation reaction. We describe an improvement of the ligation protocol used to prepare peptides and proteins without cysteine residues at the ligation junction. We have found that the addition of HOBt to the ligation, improves the conversion of the ligation reaction without affecting the epimerization rate or chemoselectivity, and it can be efficiently used with peptides containing phosphorylated amino acids.

  15. Developing a tool for analysis of recorded appraisal discussions.

    PubMed

    Rowlands, Mark; Rees, Lynne

    2011-07-01

    Appraisal in Wales is organised and quality assured through Cardiff University on behalf of the Local Health Boards. This has enabled the development of a standardised and consistent appraisal experience for GPs in Wales. Central to this is regular feedback to all GP appraisers from their line managers, their appraisal co-ordinator, about their work and especially the quality of the Form 4 document (the appraisal summary). Included is feedback about GP experience of the appraisal process, including the appraisal discussion. Presently there are no methods of directly assessing the quality of the appraisal discussion. The authors, who are both appraisal co-ordinators (ACs), have developed a method of assessing the quality of a recording of a real appraisal discussion. The information gathered from this assessment has been used in a facilitative style to feedback to the appraiser to acknowledge their skills in the appraisal discussion and to identify areas for development. This paper describes the work done to create an appraisal discussion assessment method (ADAM), and suggestions about how to use it. Using a Delphi approach, we have developed descriptors to aid formative assessment of the appraisal discussion.

  16. Quality Appraisal of Single-Subject Experimental Designs: An Overview and Comparison of Different Appraisal Tools

    ERIC Educational Resources Information Center

    Wendt, Oliver; Miller, Bridget

    2012-01-01

    Critical appraisal of the research literature is an essential step in informing and implementing evidence-based practice. Quality appraisal tools that assess the methodological quality of experimental studies provide a means to identify the most rigorous research suitable for evidence-based decision-making. In single-subject experimental research,…

  17. 12 CFR 390.442 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... licensed appraiser is required for all real estate-related financial transactions except those in which: (1) The transaction value is $250,000 or less; (2) A lien on real estate has been taken as collateral in... appraiser are not necessary in order to protect Federal financial and public policy interests in real...

  18. 12 CFR 390.442 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... licensed appraiser is required for all real estate-related financial transactions except those in which: (1) The transaction value is $250,000 or less; (2) A lien on real estate has been taken as collateral in... appraiser are not necessary in order to protect Federal financial and public policy interests in real...

  19. 12 CFR 225.63 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    .... An appraisal performed by a State certified or licensed appraiser is required for all real estate... lien on real estate has been taken as collateral in an abundance of caution; (3) The transaction is not secured by real estate; (4) A lien on real estate has been taken for purposes other than the real...

  20. 12 CFR 390.442 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... licensed appraiser is required for all real estate-related financial transactions except those in which: (1) The transaction value is $250,000 or less; (2) A lien on real estate has been taken as collateral in... appraiser are not necessary in order to protect Federal financial and public policy interests in real...

  1. 12 CFR 225.63 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    .... An appraisal performed by a State certified or licensed appraiser is required for all real estate... lien on real estate has been taken as collateral in an abundance of caution; (3) The transaction is not secured by real estate; (4) A lien on real estate has been taken for purposes other than the real...

  2. 12 CFR 722.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., including mortgage-backed securities, and each loan or interest in a loan, pooled loan, or real property... transaction in which the appraisal conforms to the Federal National Mortgage Association or Federal Home Loan Mortgage Corporation appraisal standards applicable to that category of real estate; or (9) The regional...

  3. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy.

    PubMed

    Camuzcuoglu, Hakan; Toy, Harun; Vural, Mehmet; Yildiz, Fahrettin; Aydin, Halef

    2010-06-01

    The aim of this study was to evaluate the effect of internal iliac artery (IIA) ligation performed for severe postpartum hemorrhage (PPH). Thirty-three women who underwent IIA ligation to control PPH in a tertiary referral center between June 2007 and May 2009 were included in this retrospective analysis. IIA ligation was performed as the primary surgical intervention or to control bleeding following hysterectomy. The 33 women underwent IIA ligation due to uterine atony (n = 22), placenta previa accreta/increta/percreta (n = 5), uterine rupture (n = 4), and placental abruption (n = 2). Twenty-four women underwent IIA ligation as the primary surgical intervention. IIA ligation resulted in control of bleeding in 18/24 women (75%), and only 6/24 women (25%) showed unsuccessful management of bleeding with IIA ligation. In the six women for whom the bleeding was not controlled with IIA ligation, hysterectomy was urgently performed before closure of the abdomen. After obtaining adequate hemostasis with IIA ligation, no women required relaparotomy in the postoperative period. Nine women with persistent bleeding following hysterectomy were also treated with IIA ligation. In our study, there were no intraoperative or postoperative complications related to the procedure. IIA ligation may be an effective and safe treatment option to arrest severe PPH. This procedure may also be useful to arrest persistent hemorrhage after hysterectomy. Increased understanding of the retroperitoneal anatomy is needed to reduce the risk of intraoperative and postoperative serious complications.

  4. Acute salivary gland hypofunction in the duct ligation model in the absence of inflammation

    PubMed Central

    Correia, PN; Carpenter, GH; Osailan, SM; Paterson, KL; Proctor, GB

    2008-01-01

    Objective The commonly associated aetiology of salivary gland inflammation and salivary hypofunction has led to the widely held belief that inflammation causes salivary gland hypofunction. Indeed, our own recent study seemed to support this contention. Here, we tested the hypothesis that, in an acute duct ligation model, eliminating inflammation the submandibular gland would recover normal function. Materials and methods Ligation of the rat submandibular gland excretory duct for 24 h was used to induce inflammation and salivary gland hypofunction. A group of duct ligated rats was compared with a second group given dexamethasone, on the day of duct ligation. Twenty-four hours later salivary gland function was assessed and salivary glands were collected. Results Histology and myeloperoxidase activity assay revealed a profound decrease in inflammatory cell infiltration of ligated glands from rats given dexamethasone, compared with ligated glands in the absence of dexamethasone. Salivary flow rate evoked by methacholine was decreased (P < 0.01) by approximately 56% (ligated vs control, 79 ± 9 μl min−1 g−1vs 177 ± 11 μl min−1 g−1) and salivary flow from ligated dexamethasone-treated and ligated glands was similar. Conclusion Despite eliminating the inflammatory reaction in the ligated gland, salivary hypofunction was not reversed, suggesting that other mechanisms must be at work in the ligation-induced salivary hypofunction. PMID:18221457

  5. [Ssp DnaB intein-mediated ligation of heavy and light chains of coagulation factor VIII in Escherichia coli].

    PubMed

    Zhu, Fuxiang; Liu, Zelong; Qu, Huige; Xin, Xiaolin; Dong, Hongxin; Liu, Xiangqin

    2009-07-01

    We studied the ligation of coagulation factor VIII heavy and light chains in Escherichia coli by utilizing the intein-mediated protein trans-splicing. A B-domain deleted factor VIII (BDD-FVIII) gene was broken into two halves of heavy and light chains before Ser1657 which meets the splicing required conserved residue and then fused to 106 and 48 amino acid-containing N-part termed Int-N and C-part termed Int-C coding sequences of split mini Ssp DnaB intein respectively. These two fusion genes were constructed into a prokaryotic expression vector pBV220. Through induction for expression of recombinant protein it displayed an obvious protein band as predicted size of BDD-FVIII protein on SDS-PAGE gel. Western blotting using factor VIII specific antibodies confirmed that this protein band is BDD-FVIII produced by protein trans-splicing. It demonstrated that the heavy and light chains of BDD-FVIII can be efficiently ligated with the Ssp DnaB intein-mediated protein trans-splicing. These results provided evidence for encouraging our ongoing investigation with intein as a means in dual AAV vectors carrying the factor VIII gene to overcome the packaging size limitation of a single AAV vector in hemophilia A gene therapy.

  6. Critical evaluation and rate constants of chemoselective ligation reactions for stoichiometric conjugations in water.

    PubMed

    Saito, Fumito; Noda, Hidetoshi; Bode, Jeffrey W

    2015-04-17

    Chemoselective ligation reactions have contributed immensely to the development of organic synthesis and chemical biology. However, the ligation of stoichiometric amounts of large molecules for applications such as protein-protein conjugates is still challenging. Conjugation reactions need to be fast enough to proceed under dilute conditions and chemoselective in the presence of unprotected functional groups; the starting materials and products must be stable under the reaction conditions. To compare known ligation reactions for their suitability under these conditions, we determined the second-order rate constants of ligation reactions using peptide substrates with unprotected functional groups. The reaction conditions, the chemoselectivity of the reactions, and the stability of the starting materials and products were carefully evaluated. In some cases, the stability could be improved by modifying the substrate structure. These data obtained under the ligation conditions provide a useful guide to choose an appropriate ligation reaction for synthesis of large molecules by covalent ligation reactions of unprotected substrates in water.

  7. The Fidelity of Template-Directed Oligonucleotide Ligation and the Inevitability of Polymerase Function

    NASA Astrophysics Data System (ADS)

    James, Kenneth D.; Ellington, Andrew D.

    1999-08-01

    The first living systems may have employed template-directed oligonucleotide ligation for replication. The utility of oligonucleotide ligation as a mechanism for the origin and evolution of life is in part dependent on its fidelity. We have devised a method for evaluating ligation fidelity in which ligation substrates are selected from random sequence libraries. The fidelities of chemical and enzymatic ligation are compared under a variety of conditions. While reaction conditions can be found that promote high fidelity copying, departure from these conditions leads to error-prone copying. In particular, ligation reactions with shorter oligonucleotide substrates are less efficient but more faithful. These results support a model for origins in which there was selective pressure for template-directed oligonucleotide ligation to be gradually supplanted by mononucleotide polymerization.

  8. Alkene-tetrazine ligation for imaging cellular DNA.

    PubMed

    Rieder, Ulrike; Luedtke, Nathan W

    2014-08-25

    5-Vinyl-2'-deoxyuridine (VdU) is the first reported metabolic probe for cellular DNA synthesis that can be visualized by using an inverse electron demand Diels-Alder reaction with a fluorescent tetrazine. VdU is incorporated by endogenous enzymes into the genomes of replicating cells, where it exhibits reduced genotoxicity compared to 5-ethynyl-2'-deoxyuridine (EdU). The VdU-tetrazine ligation reaction is rapid (k≈0.02 M(-1) s(-1)) and chemically orthogonal to the alkyne-azide "click" reaction of EdU-modified DNA. Alkene-tetrazine ligation reactions provide the first alternative to azide-alkyne click reactions for the bioorthogonal chemical labeling of nucleic acids in cells and facilitate time-resolved, multicolor labeling of DNA synthesis. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. Reactions of buffers in cyanogen bromide-induced ligations.

    PubMed

    Vogel, Heike; Gerlach, Claudia; Richert, Clemens

    2013-01-01

    Rapid, template-directed ligation reactions between a phosphate-terminated oligonucleotide and an unphosphorylated reaction partner may be induced by cyanogen bromide (BrCN). Frequently, however, the reaction is low yielding, and even a large excess of the condensing agent can fail to induce quantitative conversions. In this study, we used BrCN to induce chemical primer extension reactions. Here, we report that buffers containing hydroxyl groups react with short oligodeoxynucleotides in the presence of BrCN. One stable adduct between HEPBS buffer and cytosine was characterized by mass spectrometry and NMR after HPLC purification, indicating that a side reaction occurred at this nucleobase. Further, a first example of a primer extension reaction between an unmodified oligodeoxynucleotide as primer and dGMP is reported. Together, our results shed light on the potency, as well as the drawbacks of BrCN as a highly reactive condensing reagent for the ligation of unmodified nucleic acids.

  10. Tubal ligation and the risk of ovarian carcinoma.

    PubMed

    Cornelison, T L; Natarajan, N; Piver, M S; Mettlin, C J

    1997-01-01

    To assess the relationship of tubal ligation and risk of ovarian carcinoma, we conducted a case-control, retrospective analysis of 300 ovarian carcinoma cases and 606 nonmalignant disease controls, seen between 1982 and 1988 at Roswell Park Cancer Institute, Buffalo, New York. Women who had a tubal ligation had reduced risk for the development of ovarian cancer. This relative risk was 0.52, with a 95% confidence interval 0.31 to 0.85 (p = 0.0076). Controls were matched by age. Multivariate analysis adjusted for socioeconomic level, marital status, parity, age at first pregnancy, menarche age, menopause age, irregular menses, breast-feeding duration, body habitus, and oral contraceptive use. Suggested explanations for this observation are offered.

  11. Click chemistry for rapid labeling and ligation of RNA.

    PubMed

    Paredes, Eduardo; Das, Subha R

    2011-01-03

    The copper(I)-promoted azide-alkyne cycloaddition reaction (click chemistry) is shown to be compatible with RNA (with free 2'-hydroxyl groups) in spite of the intrinsic lability of RNA. RNA degradation is minimized through stabilization of the Cu(I) in aqueous buffer with acetonitrile as cosolvent and no other ligand; this suggests the general possibility of "ligandless" click chemistry. With the viability of click chemistry validated on synthetic RNA bearing "click"-reactive alkynes, the scope of the reaction is extended to in-vitro-transcribed or, indeed, any RNA, as a click-reactive azide is incorporated enzymatically. Once clickable groups are installed on RNA, they can be rapidly click labeled or conjugated together in click ligations, which may be either templated or nontemplated. In click ligations the resultant unnatural triazole-linked RNA backbone is not detrimental to RNA function, thus suggesting a broad applicability of click chemistry in RNA biological studies.

  12. Is ligation the only solution to the pyrophosphate problem?

    NASA Technical Reports Server (NTRS)

    Visscher, J.; Jongbloets, R.; Schwartz, Alan W.

    1993-01-01

    Pyrophosphate linkages are easily formed during the nonenzymatic oligomerization of activated nucleotides. They often form `caps' which terminate an oligonucleotide with a 5'-5' pyrophosphate. Owing to their structural resemblance to the intermediates in enzymatic ligation reactions, it has been suggested that pyrophosphate caps might have been capable of acting as activating groups in chain elongation processes. We argue that an alternative possibility would have been the specific hydrolysis of pyrophosphates.

  13. Is ligation the only solution to the pyrophosphate problem?

    NASA Astrophysics Data System (ADS)

    Visscher, J.; Jongbloets, R.; Schwartz, Alan W.

    1993-12-01

    Pyrophosphate linkages are easily formed during the nonenzymatic oligomerization of activated nucleotides. They often form ‘caps’ which terminate an oligonucleotide with a 5'-5' pyrophosphate. Owing to their structural resemblance to the intermediates in enzymatic ligation reactions, it has been suggested that pyrophosphate caps might have been capable of acting as activating groups in chain elongation processes. We argue that an alternative possibility would have been the specific hydrolysis of pyrophosphates.

  14. Comparison of Hi-C results using in-solution versus in-nucleus ligation.

    PubMed

    Nagano, Takashi; Várnai, Csilla; Schoenfelder, Stefan; Javierre, Biola-Maria; Wingett, Steven W; Fraser, Peter

    2015-08-26

    Chromosome conformation capture and various derivative methods such as 4C, 5C and Hi-C have emerged as standard tools to analyze the three-dimensional organization of the genome in the nucleus. These methods employ ligation of diluted cross-linked chromatin complexes, intended to favor proximity-dependent, intra-complex ligation. During development of single-cell Hi-C, we devised an alternative Hi-C protocol with ligation in preserved nuclei rather than in solution. Here we directly compare Hi-C methods employing in-nucleus ligation with the standard in-solution ligation. We show in-nucleus ligation results in consistently lower levels of inter-chromosomal contacts. Through chromatin mixing experiments we show that a significantly large fraction of inter-chromosomal contacts are the result of spurious ligation events formed during in-solution ligation. In-nucleus ligation significantly reduces this source of experimental noise, and results in improved reproducibility between replicates. We also find that in-nucleus ligation eliminates restriction fragment length bias found with in-solution ligation. These improvements result in greater reproducibility of long-range intra-chromosomal and inter-chromosomal contacts, as well as enhanced detection of structural features such as topologically associated domain boundaries. We conclude that in-nucleus ligation captures chromatin interactions more consistently over a wider range of distances, and significantly reduces both experimental noise and bias. In-nucleus ligation creates higher quality Hi-C libraries while simplifying the experimental procedure. We suggest that the entire range of 3C applications are likely to show similar benefits from in-nucleus ligation.

  15. Immunodesign of experimental sepsis by cecal ligation and puncture

    PubMed Central

    Rittirsch, Daniel; Huber-Lang, Markus S; Flierl, Michael A; Ward, Peter A

    2009-01-01

    Sepsis remains a prevalent clinical challenge and the underlying pathophysiology is still poorly understood. To investigate the complex molecular mechanisms of sepsis, various animal models have been developed, the most frequently used being the cecal ligation and puncture (CLP) model in rodents. In this model, sepsis originates from a polymicrobial infectious focus within the abdominal cavity, followed by bacterial translocation into the blood compartment, which then triggers a systemic inflammatory response. A requirement of this model is that it is performed with high consistency to obtain reproducible results. Evidence is now emerging that the accompanying inflammatory response varies with the severity grade of sepsis, which is highly dependent on the extent of cecal ligation. In this protocol, we define standardized procedures for inducing sepsis in mice and rats by applying defined severity grades of sepsis through modulation of the position of cecal ligation. The CLP procedure can be performed in as little as 10 min for each animal by an experienced user, with additional time required for subsequent postoperative care and data collection. PMID:19131954

  16. DNA hybridization and ligation for directed colloidal assembly

    NASA Astrophysics Data System (ADS)

    Shyr, Margaret

    Colloidal assembly using DNA hybridization has been pursued as a means assemble non-conventional ordered colloidal structures. However, to date it is undetermined whether DNA hybridization can be used to achieve non-FCC colloidal crystals. Using microcontact printing techniques, we have fabricated covalently bound single stranded DNA (ssDNA) two-dimensional arrays on glass surfaces, which were used to direct the assembly of complementary DNA functionalized polystyrene colloids. Two of the hallmarks of DNA hybridization, sequence specificity and thermal reversibility, were demonstrated. Due to the periodicity of these arrays, laser diffraction was used to directly monitor these structures during assembly. To demonstrate the versatility of the 2D colloidal array assembled via DNA hybridization, a catalytic DNA sequence or DNAzyme was incorporated into the colloidal array system. By tethering the enzymatic strand to the patterned glass surface and the substrate strand to polystyrene colloids, we showed that the DNAzyme could prevent the assembly of the arrays when the required Pb2+ cofactor was provided. Attempts to assemble the colloid arrays and disassemble via the Pb2+-DNAzyme induced cleavage were unsuccessful, likely due to the incomplete cleavage of the multitude of hybridized linkages between each colloid and the surface. Since DNA is not only capable of catalyzing reactions, but also capable of being reacted upon by a variety of biological enzymes, we examined the use of DNA ligase as a means to control the assembly of DNA-functionalized colloids. A three-sequence linker system was used for the hybridization mediated assembly of colloids: one sequence was tethered to the surface of the glass slide or colloids, one was tethered to another colloid surface, and the linker sequence hybridizes simultaneously to both tethered sequences. Once hybridized, the two tethered fragments can be ligated using DNA ligase, resulting in a continuous sequence tethered on one end

  17. Novel Model of Pulmonary Artery Banding Leading to Right Heart Failure in Rats

    PubMed Central

    Hirata, Masataka; Ousaka, Daiki; Arai, Sadahiko; Okuyama, Michihiro; Tarui, Suguru; Kobayashi, Junko; Kasahara, Shingo; Sano, Shunji

    2015-01-01

    Background. Congenital heart diseases often involve chronic pressure overload of the right ventricle (RV) which is a major cause of RV dysfunction. Pulmonary artery (PA) banding has been used to produce animal models of RV dysfunction. We have devised a new and easier method of constricting the PA and compared it directly with the partial ligation method. Methods. Eight-week-old male Sprague-Dawley rats (240–260 g) were divided into three groups: sham operation, partial pulmonary artery ligation (PAL) procedure, and pulmonary artery half-closed clip (PAC) procedure. RV function and remodeling were determined by echocardiography and histomorphometry. Results. Surgical mortality was significantly lower in the PAC group while echocardiography revealed significantly more signs of RV dysfunction. At the 8th week after surgery RV fibrosis rate was significantly higher in the PAC group. Conclusions. This procedure of pulmonary artery banding in rats is easier and more efficient than partial ligation. PMID:26504827

  18. Assessing and appraising nursing students' professional communication

    NASA Astrophysics Data System (ADS)

    Diers, Jane E.

    The purpose of this research was to define professional communication in nursing and to develop a prototype to assess and appraise communication at a selected college. The research focused on verbal and nonverbal communication between the nurse and the client using a simulated environment. The first objective was to identify the major characteristics of professional communication in nursing. In this study, the characteristics of professional communication emerged from the constant comparison method of the results of research studies in the fields of healthcare and communication. These characteristics became the elements, representative properties, and descriptive dimensions to assess and appraise verbal and nonverbal communication at the college of study. The second objective was to develop a template to assess verbal and nonverbal communication at a selected college. Using a two-fold process, the researcher used the results from the first objective to begin template construction. First, specialists in the fields of communication and nursing established the content validity of the elements, representative properties, and descriptive dimensions. Second, the course educators determined the relevancy and importance of the elements, properties, and descriptive dimensions to the objectives of two courses at the college of study. The third objective was to develop a rubric to appraise nursing students' verbal and nonverbal communication in a videotaped communication review. An appraisal rubric was constructed from an extension of the template. This rubric was then tested by faculty at the selected college to appraise the communication of five students each in the junior and senior years of the nursing program.

  19. Appraisals, burnout and outcomes in informal caregiving.

    PubMed

    Lee, Haejung; Singh, Jagdip

    2010-03-01

    This study draws from the resource depletion and conservation theories to develop a process model of informal caregiving. The model includes the burnout as a key mediator of the relationship between benefit/threat appraisals and critical outcomes including perceived physical health, depression and life satisfaction. A self-report questionnaire was utilized to collect relevant data from 137 informal caregivers of older adults. The proposed model and hypotheses were evaluated with the Structural Equation Modeling method using the software EQS. The relatively high reported levels of emotional exhaustion and reduced personal accomplishment established the relevance of the burnout construct for informal caregivers. In addition, the test of the proposed model provides support for the hypothesis that burnout is an important mediator in the appraisal process model of informal caregiving. However, while burnout effectively mediates the influence of threat appraisals, its role in mediating the effect of benefit appraisals is mixed. The proposed model and results highlight the significance and potential for utilizing a process approach for understanding the link between appraisals and outcomes for informal caregivers. More importantly, the proposed model suggests that attention must be paid toward burnout tendencies to reveal fruitful intervention directions for researchers and practitioners to enhance the positive outcomes of informal caregivers, and maintain their psychological and physical well-being. Copyright © 2010 Korean Society of Nursing Science. Published by . All rights reserved.

  20. Prostate cancer: appraisal, coping, and health status.

    PubMed

    Ahmad, Muayyad M; Musil, Carol M; Zauszniewski, Jaclene A; Resnick, Martin I

    2005-10-01

    The purpose of this study was to identify how cognitive appraisal and types of coping affect the health status of men with prostate cancer. Lazarus and Folkman's model of stress and coping guided this correlational, cross-sectional study. The convenience sample was composed of 131 men with prostate cancer who completed the Cognitive Appraisal of Health Scale, the Ways of Coping Checklist, and the Short-Form Health Survey using mailed questionnaires. Participants who appraised more harm or loss experienced worse physical and mental health. When participants perceived their diagnosis as posing more harm or loss or a greater threat, they were more likely to use emotion-focused coping. When the diagnosis was perceived as a challenge, men were more likely to use more problem-focused coping. The findings of this study enable health care providers to be more attentive to the psychosocial needs of prostate cancer patients.

  1. [Evaluation of Wits appraisal with superimposition method].

    PubMed

    Xu, T; Ahn, J; Baumrind, S

    1999-07-01

    To compare the conventional Wits appraisal with superimposed Wits appraisal in evaluation of sagittal jaw relationship change between pre and post orthodontic treatment. The sample consists of 48-case pre and post treatment lateral head films. Computerized digitizing is used to get the cephalometric landmarks and measure conventional Wits value, superimposed Wits value and ANB angle. The correlation analysis among these three measures was done by SAS statistical package. The change of ANB angle has higher correlation with the change of superimposed Wits than that of the conventional Wits. The r-value is as high as 0.849 (P < 0.001). The superimposed Wits appraisal reflects the change of sagittal jaw relationship more objectively than the conventional one.

  2. Surgical ligation of patent ductus arteriosus in premature infants: trends and practice variation.

    PubMed

    Weinberg, Jacqueline G; Evans, Frank J; Burns, Kristin M; Pearson, Gail D; Kaltman, Jonathan R

    2016-08-01

    We sought to analyse the variation in the incidence of patent ductus arteriosus over three recent time points and characterise ductal ligation practices in preterm infants in the United States, adjusting for demographic and morbidity factors. Using the Kids' Inpatient Database from 2003, 2006, and 2009, we identified infants born at ⩽32 weeks of gestation with International Classification of Diseases, Ninth Revision diagnosis of patent ductus arteriosus and ligation code. We examined patient and hospital characteristics and identified patient and hospital variables associated with ligation. Of 182,610 preterm births, 30,714 discharges included a patent ductus arteriosus diagnosis. The rate of patent ductus arteriosus diagnosis increased from 14% in 2003 to 21% in 2009 (p<0.001). A total of 4181 ligations were performed, with an overall ligation rate of 14%. Ligation rate in infants born at ⩽28 weeks of gestation was 20% overall, increasing from 18% in 2003 to 21% in 2009 (p<0.001). The ligation rate varied by state (4-28%), and ligation was associated with earlier gestational age, associated diagnoses, hospital type, teaching hospital status, and region (p<0.001). The rates of patent ductus arteriosus diagnosis and ligation have increased in the recent years. Variation exists in the practice of patent ductus arteriosus ligation and is influenced by patient and non-patient factors.

  3. What is interesting? Exploring the appraisal structure of interest.

    PubMed

    Silvia, Paul J

    2005-03-01

    Relative to other emotions, interest is poorly understood. On the basis of theories of appraisal process and structure, it was predicted that interest consists of appraisals of novelty (factors related to unfamiliarity and complexity) and appraisals of coping potential (the ability to understand the new, complex thing). Four experiments, using in vivo rather than retrospective methods, supported this appraisal structure. The findings were general across measured and manipulated appraisals, interesting stimuli (random polygons, visual art, poetry), and measures of interest (self-reports, forced-choice, behavioral measures). Furthermore, the appraisal structure was specific to interest (it did not predict enjoyment, a related positive emotion), and appraisals predicted interest beyond relevant traits (curiosity, openness). The appraisal perspective offers a powerful way of construing the causes of interest.

  4. 9 CFR 52.3 - Appraisal of swine.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... § 52.3 Appraisal of swine. (a) Herds of swine and individual breeding sows to be destroyed because they... determined by the meat or breeding value of the animals. Animals may be appraised in groups, provided...

  5. 9 CFR 52.3 - Appraisal of swine.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... § 52.3 Appraisal of swine. (a) Herds of swine and individual breeding sows to be destroyed because they... determined by the meat or breeding value of the animals. Animals may be appraised in groups, provided...

  6. 75 FR 67968 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ...] [FR Doc No: 2010-27909] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL [Docket No. AS10-9] Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the Federal Financial... Title XI of the [[Page 67969

  7. 24 CFR 200.35 - Appraisal standards-nondiscrimination requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... the selection of appraiser. In the selection of an appraiser, there shall be no discrimination on the... Practice must include a statement that the racial/ethnic composition of the neighborhood surrounding the...

  8. Mono- and bis-phosphine-ligated H93G myoglobin: spectral models for ferrous-phosphine and ferrous-CO cytochrome P450.

    PubMed

    Sun, Shengfang; Sono, Masanori; Dawson, John H

    2013-10-01

    To further investigate the properties of phosphines as structural and functional probes of heme proteins, mono- and bis-phosphine [tris(hydroxymethyl)phosphine, THMP] adducts of H93G myoglobin (Mb) have been prepared by stepwise THMP titrations of exogenous ligand-free ferric and ferrous H93G Mb, respectively. Bubbling with CO or stepwise titration with imidazole (Im) of the bis-THMP-ligated ferrous protein generated a mixed ligand (THMP/CO or THMP/Im, respectively) ferrous complexes. Stable oxyferrous H93G(THMP) Mb was formed at -40°C by bubbling the mono-THMP-Fe(II) protein with O2. A THMP-ligated ferryl H93G Mb moiety has been partially formed upon addition of H2O2 to the ferric mono-THMP adduct. All the species prepared above have been characterized with UV-visible (UV-vis) absorption and magnetic circular dichroism (MCD) spectroscopy in this study. The six-coordinate ferrous bis-phosphine and mono-phosphine/CO complexes of H93G Mb exhibit characteristic spectral features (red-shifted Soret/unique-shaped MCD visible bands and hyperporphyrin spectra, respectively) that only have been seen for the analogous phosphine or CO-complexes of thiolate-ligated heme proteins such as cytochrome P450 (P450) and Caldariomyces fumago chloroperoxidase (CPO). However, such resemblance is not seen in phosphine-ligated ferric H93G Mb even though phosphine-bound ferric P450 and CPO display hyperporphyrin spectra. In fact, bis-THMP-bound ferric H93G Mb exhibits MCD and UV-vis absorption spectra that are similar to those of bis-amine- and bis-thioether-ligated H93G Mb complexes. This study also further demonstrates the utility of the H93G cavity mutant for preparing novel heme iron coordination structures. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Verification of 'learning credits' by GP appraisers.

    PubMed

    Murie, Jill; Wakeling, Judy

    2011-11-01

    The RCGP CPD Learning Credits system aims to enable GPs to demonstrate knowledge and skills relevant to their daily practice. Credits are self-assessed and will form part of the 'evidence' necessary for successful revalidation. At an appraisal, GP appraisers verify the credits in terms of the time spent on the CPD activity and its impact on the GP's practice. The purpose of this study was to examine the extent to which GPs (as appraisees) are able to self-assess their own learning and, as appraisers, verify credits in a standardised way. All 17 GP appraisers in NHS Lanarkshire were invited to participate in a study, which triangulated three sources of evidence on credits: self-rating, peer-assessment and workshop discussion. The resultant data were analysed on an Excel spreadsheet. Outcomes included self-assessed credit value, peer-assessed mean score (range) and free text. Of the 17 appraisers, 15 completed the paperwork and 13 attended the workshop. GPs' self-assessed learning credits were equivalent to peer-assessed score in 5/15 cases, but considered overestimates in 4/15 and underestimates in 6/15 cases. The most extreme variance was for an oncology module, where the variance ranged from 28% to 200% of the self-assessed score. GPs have a variable understanding of how to award themselves learning credits and of how to judge the credits of potential appraisees. Without adequate resources for appraisal training, validated instruments, calibration and reliability, verification of the learning credit system will be flawed by its subjective and arbitrary nature.

  10. 41 CFR 102-75.320 - Does appraisal information need to be kept confidential?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Does appraisal... PROPERTY 75-REAL PROPERTY DISPOSAL Surplus Real Property Disposal Appraisal § 102-75.320 Does appraisal information need to be kept confidential? Yes, appraisals, appraisal reports, appraisal analyses, and...

  11. 7 CFR 1980.444 - Appraisal of property serving as collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 14 2010-01-01 2009-01-01 true Appraisal of property serving as collateral. 1980.444... Program § 1980.444 Appraisal of property serving as collateral. (a) Appraisal reports prepared by... the appraisal to be made by a qualified appraiser on the lender's staff with experience appraising...

  12. 7 CFR 1980.334 - Appraisal of property serving as collateral.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... appraiser. The Lender will use an appraiser that is properly licensed or certified, as appropriate, to make residential real estate appraisals in accordance with the criteria set forth by the Appraiser Qualification Board (AQB) of the Appraisal Foundation regardless of the amount of the loan. Appraisers may...

  13. 7 CFR 1980.334 - Appraisal of property serving as collateral.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... appraiser. The Lender will use an appraiser that is properly licensed or certified, as appropriate, to make residential real estate appraisals in accordance with the criteria set forth by the Appraiser Qualification Board (AQB) of the Appraisal Foundation regardless of the amount of the loan. Appraisers may...

  14. 7 CFR 1980.334 - Appraisal of property serving as collateral.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... appraiser. The Lender will use an appraiser that is properly licensed or certified, as appropriate, to make residential real estate appraisals in accordance with the criteria set forth by the Appraiser Qualification Board (AQB) of the Appraisal Foundation regardless of the amount of the loan. Appraisers may...

  15. 7 CFR 1980.334 - Appraisal of property serving as collateral.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... appraiser. The Lender will use an appraiser that is properly licensed or certified, as appropriate, to make residential real estate appraisals in accordance with the criteria set forth by the Appraiser Qualification Board (AQB) of the Appraisal Foundation regardless of the amount of the loan. Appraisers may...

  16. Examination of Performance Appraisal Behavior Structure.

    PubMed

    Tziner, Aharon; Levy, Shlomit

    2016-01-01

    The personality (dispositional) characteristics, attitudes, beliefs, and orientation of 498 managers and military officers toward performance appraisal and organization were collected in order to examine their structural relationships to raters' behavior, in terms of (a) mean appraisal ratings, (b) measures of performance dimensions discrimination, and (c) rate discrimination. A mapping sentence comprising a modality, a reference group, and an aspect (content) facet were used. The empirical results largely confirmed this definitional system. Moreover, a polarizing partition of the space into three regions-Self (rater), Ratee, and Organization/System-was found, possibly implying that these three considerations are equally proximal in determining rater behavior. Future directions for research are advanced.

  17. Examination of Performance Appraisal Behavior Structure

    PubMed Central

    Tziner, Aharon; Levy, Shlomit

    2017-01-01

    The personality (dispositional) characteristics, attitudes, beliefs, and orientation of 498 managers and military officers toward performance appraisal and organization were collected in order to examine their structural relationships to raters' behavior, in terms of (a) mean appraisal ratings, (b) measures of performance dimensions discrimination, and (c) rate discrimination. A mapping sentence comprising a modality, a reference group, and an aspect (content) facet were used. The empirical results largely confirmed this definitional system. Moreover, a polarizing partition of the space into three regions–Self (rater), Ratee, and Organization/System–was found, possibly implying that these three considerations are equally proximal in determining rater behavior. Future directions for research are advanced. PMID:28119659

  18. Characteristics of Appraisal Systems That Promote Job Satisfaction of Teachers

    ERIC Educational Resources Information Center

    Deneire, Alexia; Vanhoof, Jan; Faddar, Jerich; Gijbels, David; Van Petegem, Peter

    2014-01-01

    This article examines if and how characteristics of appraisal systems used for secondary school teachers affect job satisfaction. Using multilevel analyses on data of 3 473 teachers in Flanders (Belgium), we found that appraisals with a developmental purpose and appraisals perceived as being a fair judgement, both have a positive impact on job…

  19. 43 CFR 2201.3-3 - Appraisal report standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) The purpose and/or the function of the appraisal, a definition of the estate being appraised, and a...; an analysis of highest and best use; and at least a 5-year sales history of the property; (e) A... present on the property being appraised; (f) A comparative market analysis and, if more than one method of...

  20. Performance Appraisal for Librarians: A Guided Self-Study Approach.

    ERIC Educational Resources Information Center

    Stevenson, Sally

    Intended for use by library managers, this self-study guide provides an introduction to performance appraisal as an effective tool in human resource management, and a review of the extensive management literature on performance appraisal. Topics discussed include: (1) the functions of performance appraisal, which include the provision of…

  1. 76 FR 6135 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-03

    ... No: 2011-2389] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL [Docket No. AS11-05] Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the Federal Financial Institutions Examination... that the Appraisal Subcommittee (ASC) will meet in closed session: Location: FDIC--L. William...

  2. 77 FR 33459 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-06

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  3. 76 FR 71034 - Appraisal Subcommittee; Notice of Special Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-16

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee; Notice of Special Meeting AGENCY: Appraisal...), notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open session for a special...: November 17, 2011. Time: 10 a.m. Status: Open. Matters to be Considered Discussion Agenda:...

  4. 75 FR 57468 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in open... member of the ASC requests that an item be moved to the discussion agenda.) Discussion Agenda...

  5. 50 CFR 34.6 - Schedule of appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Schedule of appraisals. 34.6 Section 34.6... NATIONAL WILDLIFE REFUGE SYSTEM REFUGE REVENUE SHARING WITH COUNTIES § 34.6 Schedule of appraisals. The Secretary shall make fair market value appraisals of areas administered by the Service within five...

  6. 77 FR 45610 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... Doc No: 2012-18760] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL [Docket No. AS12-15] Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the Federal Financial Institutions Examination... that the Appraisal Subcommittee (ASC) will meet in closed session: Location: OCC--250 E Street...

  7. 78 FR 39729 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-02

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  8. 77 FR 45610 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... Doc No: 2012-18761] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL [Docket No. AS12-14] Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the Federal Financial Institutions Examination... that the Appraisal Subcommittee (ASC) will meet in open session for its regular meeting: Location:...

  9. 76 FR 19773 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-08

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  10. 78 FR 47698 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-06

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  11. 76 FR 76410 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  12. 7 CFR 3560.753 - Agency appraisal standards and requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Agency appraisal standards and requirements. 3560.753... SERVICE, DEPARTMENT OF AGRICULTURE DIRECT MULTI-FAMILY HOUSING LOANS AND GRANTS Appraisals § 3560.753 Agency appraisal standards and requirements. (a) General. The Agency recognizes USPAP as the...

  13. 12 CFR 552.14 - Dissenter and appraisal rights.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Dissenter and appraisal rights. 552.14 Section... ASSOCIATIONS-INCORPORATION, ORGANIZATION, AND CONVERSION § 552.14 Dissenter and appraisal rights. (a) Right to... part of management's proxy solicitation for such meeting. (2) Demand for appraisal and payment....

  14. 9 CFR 52.3 - Appraisal of swine.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Appraisal of swine. 52.3 Section 52.3... § 52.3 Appraisal of swine. (a) Herds of swine and individual breeding sows to be destroyed because they... an APHIS employee alone. (b) The appraisal of swine will be based on the fair market value...

  15. 76 FR 25690 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-05

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  16. 7 CFR 764.107 - General appraisal requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false General appraisal requirements. 764.107 Section 764....107 General appraisal requirements. (a) Establishing value for real estate. The value of real estate will be established by an appraisal completed in accordance with § 761.7 of this chapter....

  17. 77 FR 5249 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-02

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  18. 75 FR 67969 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ... Doc No: 2010-27911] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL [Docket No. AS10-8] Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the Federal Financial Institutions Examination... that the Appraisal Subcommittee (ASC) will meet in open session for its regular meeting: Location:...

  19. 76 FR 47182 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-04

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  20. 76 FR 68187 - Appraisal Subcommittee Notice of meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-03

    ... Doc No: 2011-28463] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL [Docket No. AS11-29] Appraisal Subcommittee Notice of meeting AGENCY: Appraisal Subcommittee of the Federal Financial Institutions Examination... that the Appraisal Subcommittee (ASC) will meet in closed session: Location: OCC--250 E Street...

  1. Teacher Appraisal and Its Outcomes in Singapore Primary Schools

    ERIC Educational Resources Information Center

    Kelly, Khim Ong; Ang, Shi Yun Angela; Chong, Wei Ling; Hu, Wei Sheng

    2008-01-01

    Purpose: The purpose of this paper is to examine the attributes of the performance appraisal system used for primary school teachers in Singapore, and how those attributes affect satisfaction with the appraisal system, stress experienced with the appraisal system, attitudes towards performance bonus, job satisfaction and motivation, and perceived…

  2. 78 FR 33419 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ... From the Federal Register Online via the Government Publishing Office ] FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet in...

  3. 75 FR 62819 - Appraisal Subcommittee Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-13

    ... From the Federal Register Online via the Government Publishing Office FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee Notice of Meeting AGENCY: Appraisal Subcommittee of the... Act of 1989, as amended, notice is hereby given that the Appraisal Subcommittee (ASC) will meet...

  4. 32 CFR 644.47 - Appraisal of other interests.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Appraisal of other interests. 644.47 Section 644.47 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Appraisal § 644.47 Appraisal of other interests. (a) Minerals. (1) In all...

  5. 28 CFR 345.41 - Performance appraisal for inmate workers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Performance appraisal for inmate workers... FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Worker Standards and Performance Appraisal § 345.41 Performance appraisal for inmate workers. Work supervisors should complete a performance...

  6. Characteristics of Appraisal Systems That Promote Job Satisfaction of Teachers

    ERIC Educational Resources Information Center

    Deneire, Alexia; Vanhoof, Jan; Faddar, Jerich; Gijbels, David; Van Petegem, Peter

    2014-01-01

    This article examines if and how characteristics of appraisal systems used for secondary school teachers affect job satisfaction. Using multilevel analyses on data of 3 473 teachers in Flanders (Belgium), we found that appraisals with a developmental purpose and appraisals perceived as being a fair judgement, both have a positive impact on job…

  7. 38 CFR 36.4347 - Lender Appraisal Processing Program.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... that appraiser to remove or change information that might be considered detrimental to the subject... information under this system to VA on demand. While the quality control personnel need not be appraisers, they should have basic familiarity with appraisal theory and techniques and the ability to...

  8. Teacher Appraisal: A Lesson on Confusion over Purpose

    ERIC Educational Resources Information Center

    Gratton, Robert

    2004-01-01

    This article describes a study of a large urban school's teacher appraisal system to ascertain the teachers' perceptions of the purpose of the appraisal system in use. The study initially involved an examination of government promulgations, which establish the requirement for an appraisal system, and a similar examination of the school's…

  9. Performance Appraisal in UK Universities: A Case of Procedural Compliance?

    ERIC Educational Resources Information Center

    Bryman, Alan; And Others

    1994-01-01

    Research evidence concerning the introduction of performance appraisal in United Kingdom universities is presented. The notion of "procedural compliance" is introduced to draw attention to the largely externally imposed appraisal of universities and to the nature of institutional response. Findings of a study of appraisal in four…

  10. 43 CFR 2201.3-4 - Appraisal review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... market value of the lands appraised. (c) The review appraiser shall prepare a written review report... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Appraisal review. 2201.3-4 Section 2201.3-4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND...

  11. Performance Appraisal for Librarians: A Guided Self-Study Approach.

    ERIC Educational Resources Information Center

    Stevenson, Sally

    Intended for use by library managers, this self-study guide provides an introduction to performance appraisal as an effective tool in human resource management, and a review of the extensive management literature on performance appraisal. Topics discussed include: (1) the functions of performance appraisal, which include the provision of…

  12. Teacher Performance Appraisal in Thailand: Poison or Panacea?

    ERIC Educational Resources Information Center

    Pimpa, Nattavud

    2005-01-01

    This research focuses on the examination of problems related to the national teacher performance appraisal system by the Thai Ministry of Education. It highlights major problems of the current performance appraisal system by delineating the weaknesses and pitfalls of the current appraisal system. The findings indicate problems to three major…

  13. Appraising and Improving the Performance of School Administrative Personnel.

    ERIC Educational Resources Information Center

    Castetter, William B.; Heisler, Richard S.

    This monograph deals with the appraisal and improvement of school administrative personnel performance. It attempts to help the reader understand what performance appraisal is, why it is essential in school organization administration, how an appraisal system functions, and how it can be made to work more effectively. In order to achieve these…

  14. Teacher Performance Appraisal in Thailand: Poison or Panacea?

    ERIC Educational Resources Information Center

    Pimpa, Nattavud

    2005-01-01

    This research focuses on the examination of problems related to the national teacher performance appraisal system by the Thai Ministry of Education. It highlights major problems of the current performance appraisal system by delineating the weaknesses and pitfalls of the current appraisal system. The findings indicate problems to three major…

  15. 36 CFR 228.48 - Appraisal and measurement.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Appraisal and measurement... MINERALS Disposal of Mineral Materials General Provisions § 228.48 Appraisal and measurement. (a) Appraisal... weight equivalent. In all cases the units of measurement must correspond to the units used in the...

  16. 38 CFR 36.4347 - Lender Appraisal Processing Program.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... that appraiser to remove or change information that might be considered detrimental to the subject... information under this system to VA on demand. While the quality control personnel need not be appraisers, they should have basic familiarity with appraisal theory and techniques and the ability to prescribe...

  17. 38 CFR 36.4347 - Lender Appraisal Processing Program.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... that appraiser to remove or change information that might be considered detrimental to the subject... information under this system to VA on demand. While the quality control personnel need not be appraisers, they should have basic familiarity with appraisal theory and techniques and the ability to prescribe...

  18. 38 CFR 36.4347 - Lender Appraisal Processing Program.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... that appraiser to remove or change information that might be considered detrimental to the subject... information under this system to VA on demand. While the quality control personnel need not be appraisers, they should have basic familiarity with appraisal theory and techniques and the ability to prescribe...

  19. Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

    PubMed

    Ellinas, A; Jervis, P; Kenyon, G; Flood, L M

    2017-04-01

    Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

  20. Modern tools for the chemical ligation and synthesis of modified peptides and proteins.

    PubMed

    Gentilucci, Luca; Tosi, Pierluigi; Bauer, Adriano; Marco, Rossella De

    2016-12-01

    The ability to improve nature's capacity by introducing modification of biological interest in proteins and peptides (P&P) is one of the modern challenges in synthetic chemistry. Due to the unfavorable pharmacokinetic properties, many native P&P are of little use as therapeutic agents. Today, few methods for the preparation of modified proteins are available. Initially introduced to realize the ligation between two standard peptidic sequences, and hence to afford native proteins, the modern chemical methodologies, in other words native chemical ligation, expressed ligation, Staudinger ligation, auxiliary mediated ligation, aldehyde capture, etc., can be virtually utilized to ligate a variety of peptidomimetic partners, allowing a systematic access to modified, unnatural large P&P.