Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis.

PubMed

Offodile, Anaeze C; Sheckter, Clifford C; Tucker, Austin; Watzker, Anna; Ottino, Kevin; Zammert, Martin; Padula, William V

2017-10-01

Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

The comparative evaluation of safety and efficacy of unilateral paravertebral block with conventional spinal anaesthesia for inguinal hernia repair

PubMed Central

Sinha, Sunil Kumar; Brahmchari, Yudhyavir; Kaur, Manpreet; Jain, Aruna

2016-01-01

Background and Aims: Unilateral paravertebral block (PVB) as a sole anaesthetic technique is underutilised even in experienced hands. Hence, this study was undertaken regarding the efficacy and safety of PVB and compared with subarachnoid block (SAB) for inguinal hernia repair procedures. Methods: Sixty-three consenting adult male patients scheduled for unilateral inguinal hernia repair were randomly assigned to receive either PVB or SAB (Group P: PVBs at T10–L2 levels, 5 mL of 0.5% bupivacaine at each segment; Group S: SAB at L3–L4 level with 12.5 mg 0.5% of hyperbaric bupivacaine). Primary objective was to compare duration of post-operative analgesia and time to reach discharge criteria (modified Aldrete scores and modified post-anaesthetic discharge scoring [PADS] scores). Secondary objectives were to compare the block characteristics (time required for performing the block, time to surgical anaesthesia, time to ambulation, time to the first analgesic, total rescue analgesic consumption) and adverse effects. Independent Student's t-test was used for continuous data and Pearson Chi-square test for categorical data. P <0.05 was considered as statistically significant. Results: The duration of post-operative analgesia (min) was 384.57 ± 38.67 in Group P and 194.27 ± 20.30 in Group S (P < 0.05). Modified PADS scores were significantly higher at 4 h and 6 h (P < 0.0001) in Group P. Time to reach the discharge criteria was early in Group P than Group S. Conclusion: PVB provides excellent post-operative analgesic conditions with lesser adverse effects and shorter time to reach the discharge criteria compared to SAB. PMID:27512167

Continuous bilateral thoracic paravertebral blockade for analgesia after cardiac surgery: a randomised, controlled trial.

PubMed

Lockwood, Geoff G; Cabreros, Leilani; Banach, Dorota; Punjabi, Prakash P

2017-10-01

Continuous bilateral thoracic paravertebral blockade has been used for analgesia after cardiac surgery, but its efficacy has never been formally tested. Fifty adult patients were enrolled in a double-blind, randomised, controlled study of continuous bilateral thoracic paravertebral infusion of 0.5% lidocaine (1 mg.kg -1 .hr -1 ) for analgesia after coronary surgery. Control patients received a subcutaneous infusion of lidocaine at the same rate through catheters inserted at the same locations as the study group. The primary outcome was morphine consumption at 48 hours using patient-controlled analgesia (PCA). Secondary outcomes included pain, respiratory function, nausea and vomiting. Serum lidocaine concentrations were measured on the first two post-operative days. There was no difference in morphine consumption or in any other outcome measure between the groups. Serum lidocaine concentrations increased during the study, with a maximum of 5.9 mg.l -1 . There were no adverse events as a consequence of the study. Bilateral paravertebral infusion of lidocaine confers no advantage over systemic lidocaine infusion after cardiac surgery. ISRCTN13424423 ( https://www.isrctn.com ).

Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis.

PubMed

Peek, Jesse; Smeeing, Diederik P J; Hietbrink, Falco; Houwert, Roderick M; Marsman, Marije; de Jong, Mirjam B

2018-02-06

Many studies report on outcomes of analgesic therapy for (suspected) traumatic rib fractures. However, the literature is inconclusive and diverse regarding the management of pain and its effect on pain relief and associated complications. This systematic review and meta-analysis summarizes and compares reduction of pain for the different treatment modalities and as secondary outcome mortality during hospitalization, length of mechanical ventilation, length of hospital stay, length of intensive care unit stay (ICU) and complications such as respiratory, cardiovascular, and/or analgesia-related complications, for four different types of analgesic therapy: epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks. PubMed, EMBASE and CENTRAL databases were searched to identify comparative studies investigating epidural, intravenous, paravertebral and intercostal interventions for traumatic rib fractures, without restriction for study type. The search strategy included keywords and MeSH or Emtree terms relating blunt chest trauma (including rib fractures), analgesic interventions, pain management and complications. A total of 19 papers met our inclusion criteria and were finally included in this systematic review. Significant differences were found in favor of epidural analgesia for the reduction of pain. No significant differences were observed between epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks, for the secondary outcomes. Results of this study show that epidural analgesia provides better pain relief than the other modalities. No differences were observed for secondary endpoints like length of ICU stay, length of mechanical ventilation or pulmonary complications. However, the quality of the available evidence is low, and therefore, preclude strong recommendations.

Paravertebral anaesthesia for breast surgery an initial experience at the University Hospital of the West Indies.

PubMed

Crawford-Sykes, A M; Chin, D E; Hambleton, I R

2004-06-01

Paravertebral blockade (PVB) is a regional anaesthetic technique that allows the injection of local anaesthetic agents into the paravertebral space. It has been used for acute and chronic pain relief and as an anaesthetic technique for unilateral surgery of the chest, breast, shoulder, kidney, and inguinal region. Paravertebral blockade has been performed on a limited basis for breast surgery at the University Hospital of the West Indies (UHWI) since 1998. This retrospective review was undertaken to report the initial experience with this block. We reviewed the notes of all patients who were given a PVB alone, or in combination with general anaesthesia (GA). Twenty-one patients had P VB: twenty females and one male, with age range of 24 to 90 years. Six were attempted with PVB alone, but two of these needed supplementation with a GA. Fifteen were done in combination with GA. No complications were recorded The initial experience shows that the performance of PVB is both possible and safe; it may offer an alternative to GA for breast surgery. A randomized prospective study is underway to allow a detailed comparison between the two methods.

The Use of Liposomal Bupivacaine in Erector Spinae Plane Block to Minimize Opioid Consumption for Breast Surgery: A Case Report.

PubMed

Kumar, Amanda; Hulsey, Alina; Martinez-Wilson, Hector; Kim, James; Gadsden, Jeff

2018-05-01

The erector spinae plane block is a novel interfascial plane block that can provide thoracic and abdominal analgesia. We describe a patient with opioid intolerance scheduled for breast surgery who received an erector spinae plane block with liposomal bupivacaine as well as a supplemental T1 paravertebral block resulting in profound analgesia throughout her postoperative course. This case report demonstrates that use of liposomal bupivacaine in the erector spinae plane block can be successful in providing extended duration postoperative analgesia and minimizing systemic opioid requirements.

The Use of Liposomal Bupivacaine in Erector Spinae Plane Block to Minimize Opioid Consumption for Breast Surgery: A Case Report.

PubMed

Kumar, Amanda; Hulsey, Alina; Martinez-Wilson, Hector; Kim, James; Gadsden, Jeff

2017-11-16

The erector spinae plane block is a novel interfascial plane block that can provide thoracic and abdominal analgesia. We describe a patient with opioid intolerance scheduled for breast surgery who received an erector spinae plane block with liposomal bupivacaine as well as a supplemental T1 paravertebral block resulting in profound analgesia throughout her postoperative course. This case report demonstrates that use of liposomal bupivacaine in the erector spinae plane block can be successful in providing extended duration postoperative analgesia and minimizing systemic opioid requirements.

Lymphatic Drainage to the Paravertebral Lymph Nodes in Breast Cancer Patients.

PubMed

Roman, Mirela Mariana; Barbieux, Romain; Leduc, Olivier; Bourgeois, Pierre

2017-03-01

Aberrant, altered, or blocked lymphatic drainage may contribute to the high recurrence rate of breast cancer. Thus, an efficient evaluation of lymphatic drainage from the breasts and/or upper limbs is essential in the management of lymphedema and in ipsilateral primary or contralateral recurrent breast cancer patients. There are very few reports of lymphatic drainage to the paravertebral lymph nodes in patients with a lymphedema after breast cancer surgery with or without reconstruction. We used lymphoscintigraphy to examine lymphatic drainage in a case series. We observed five patients with upper limb and/or mammary lymphedema (after breast cancer surgery with or without reconstruction) who had lymphatic drainage from the upper limb or breast to the posterior intercostal and/or paravertebral lymph nodes. One patient also presented with nodal relapse at the time of our investigation. The cases from this study demonstrate the unusual, and mostly unrecognized, lymphatic drainage pathways toward lymph nodes, which may be at risk for further evolution of breast cancer.

Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial.

PubMed

Kulhari, S; Bharti, N; Bala, I; Arora, S; Singh, G

2016-09-01

Pectoral nerve (PecS) block is a recently introduced technique for providing surgical anaesthesia and postoperative analgesia during breast surgery. The present study was planned to compare the efficacy and safety of ultrasound-guided PecS II block with thoracic paravertebral block (TPVB) for postoperative analgesia after modified radical mastectomy. Forty adult female patients undergoing radical mastectomy were randomly allocated into two groups. Group 1 patients received a TPVB with ropivacaine 0.5%, 25 ml, whereas Group 2 patents received a PecS II block using same volume of ropivacaine 0.5% before induction of anaesthesia. Patient-controlled morphine analgesia was used for postoperative pain relief. The duration of analgesia was significantly prolonged in patients receiving the PecS II block compared with TPVB [mean (sd), 294.5 (52.76) vs 197.5 (31.35) min in the PecS II and TPVB group, respectively; P<0.0001]. The 24 h morphine consumption was also less in the PecS II block group [mean (sd), 3.90 (0.79) vs 5.30 (0.98) mg in PecS II and TPVB group, respectively; P<0.0001]. Postoperative pain scores were lower in the PecS II group compared with the TVPB group in the initial 2 h after surgery [median (IQR), 2 (2-2.5) vs 4 (3-4) in the Pecs II and TPVB group, respectively; P<0.0001]. Seventeen patients in the PecS II block group had T2 dermatomal spread compared with four patients in the TPVB group (P<0.001). No block-related complication was recorded. We found that the PecS II block provided superior postoperative analgesia than the TPVB in patients undergoing modified radical mastectomy without causing any adverse effect. CTRI/2014/06/004692. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Randomized Prospective Trial Comparing Paravertebral Block and General Anesthesia for Operative Treatment of Breast Cancer

DTIC Science & Technology

2001-10-01

block the anesthetic of choice for operative treatment of breast cancer. To test this hypothesis we proposed a prospective randomized clinical trial ...coordinators. Months 4-6. Status: Complete The study’s existing part-time Clinical Trial Coordinator, Mr. John Arbo, was enlisted full-time in June...of full-time Clinical Trial Coordinator for Mount Sinai. ■ Poster presentation by Mount Sinai staff of study goals and methods at a Department of

Transthoracic Arteriovenous Graft Repair With the Pectoralis (PECS) II Nerve Block for Primary Intraoperative Anesthesia and Postoperative Analgesia: A Case Report.

PubMed

Farkas, Gabriel; Weber, Garret; Miller, Jonathon; Xu, Jeff

2018-05-07

The PECS II nerve block is a relatively new regional anesthetic technique that targets the medial and lateral pectoral nerves, as well as the lateral cutaneous branches of the intercostal nerves. It has been described for surgical cases involving the breast, as an adjunct or alternative to neuraxial or paravertebral techniques. This case report describes the first successful use of the PECS II nerve block placed using ultrasound guidance as the primary anesthetic and postoperative analgesic in a non-breast-related chest wall surgery.

Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures.

PubMed

Yeying, Ge; Liyong, Yuan; Yuebo, Chen; Yu, Zhang; Guangao, Ye; Weihu, Ma; Liujun, Zhao

2017-12-01

Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management and preservation of pulmonary function compared with intravenous, patient-controlled analgesia (IVPCA) in patients with multiple rib fractures (MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study and randomly assigned to the TPVB or IVPCA group. The visual analogue scale (VAS) pain score, blood gas analysis, and bedside spirometry were measured and recorded at different time points after analgesia. Results TPVB and IVPCA provided good pain relief. VAS scores were significantly lower in the TPVB group than in the IVPCA group at rest and during coughing ( P < 0.05). Patients in the TPVB group had a higher PaO 2 and PaO 2 /FiO 2 and lower P (A-a) O 2 compared with the IVPCA group ( P < 0.05). Moreover, patients in the TPVB group showed higher FVC, FEV1/FVC, and PEFR, and fewer complications than did the IVPCA group ( P < 0.05). Conclusion TPVB is superior to IVPCA in pain relief and preservation of pulmonary function in patients with MRFs.

A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone

PubMed Central

Župčić, Miroslav; Graf, Sandra; Župčić; Duzel, Viktor; Šimurina, Tatjana; Šakić, Livija; Fudurić, Jurica; Peršec, Jasminka; Milošević, Milan; Stanec, Zdenko; Korušić, Anđelko; Barišin, Stjepan

2017-01-01

Aim To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two local anesthetics. Method A prospective, single-center, randomized, double-blinded, controlled trial was conducted from June 2014 until September 2015. A total of 85 women with breast cancer were assigned to receive PVB with either 0.5% levobupivacaine (n = 42) or 0.5% levobupivacaine with 2% lidocaine (n = 43). Hemodynamic variables of interest included intraoperative stroke volume variation (SVV), mean arterial pressure, heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use of inotropes. Analgesic variables of interest were time to block onset, duration of analgesia, and postoperative serial pain assessment using a visual analogue scale. Results Although the use of 0.5% levobupivacaine with 2% lidocaine solution for PVB decreased the mean time-to-block onset (14 minutes; P < 0.001), it also caused significantly higher SVV values over the 60 minutes of monitoring (mean difference: 4.33; P < 0.001). Furthermore, the patients who received 0.5% levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia (105 minutes; P = 0.006) and more episodes of hypotension (17.5%; P = 0.048) and received more intraoperative crystalloids (mean volume: 550 mL; P < 0.001). Conclusion The use of 0.5% levobupivacaine in comparison with 0.5% levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block onset, but it also reduced hemodynamic disturbances and prolonged the analgesic effect. Registration No.: NTC02004834 PMID:28857520

Sensory blockade after thoracic paravertebral injection of ropivacaine or bupivacaine.

PubMed

Hura, G; Knapik, P; Misiołek, H; Krakus, A; Karpe, J

2006-08-01

No clinical trials comparing the characteristics of sensory blockade caused by various local anaesthetics in thoracic paravertebral blockade have been published. The aim of this prospective study was a clinical assessment of sensory blockade after paravertebral injection of ropivacaine or bupivacaine in patients undergoing modified radical mastectomy. Seventy ASA I-II patients were randomized to receive a single injection of ropivacaine 0.5% (n = 35) or bupivacaine 0.5% (n = 35) at the T4 level. General anaesthesia with propofol and fentanyl was provided during the procedure and patients were not intubated. The following parameters were analysed: duration and dynamics of the sensory blockade and the patient's and surgeon's assessment. Both ropivacaine and bupivacaine provided a similar level of analgesia. Ropivacaine was characterized by more rapid onset - after only 5 min 53% of patients in this group had the extent of sensory blockade wide enough to perform modified radical mastectomy in comparison to only 20% after bupivacaine (P 9 segments blocked) was noted more often in the ropivacaine group (88% vs. 65%, P < 0.05), lasted longer and appeared to be wider than sensory blockade produced by bupivacaine. Regression of sensory blockade was initially similar, but after 24 h sensory blockade in the ropivacaine group still had a potential to provide analgesia for modified radical mastectomy in 81% of patients in comparison to only 50% of such patients in the bupivacaine group (P < 0.05). Degree of postoperative pain, performance of the cardiovascular system, consumption of medications and complications were all similar between the study groups. Both agents provide satisfactory conditions for mastectomy, but ropivacaine seems to be superior to bupivacaine for thoracic paravertebral blockade during breast cancer surgery.

Single-shot pectoral plane (PECs I and PECs II) blocks versus continuous local anaesthetic infusion analgesia or both after non-ambulatory breast-cancer surgery: a prospective, randomised, double-blind trial.

PubMed

O'Scanaill, P; Keane, S; Wall, V; Flood, G; Buggy, D J

2018-04-01

Pectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be at least equivalent to single-shot paravertebral anaesthesia. However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs blocks with LA infusion, or a combination of both in patients undergoing non-ambulatory breast-cancer surgery. This single-centre, prospective, randomised, double-blind trial analysed 45 women to receive either PECs blocks [levobupivacaine 0.25%, 10 ml PECs I and levobupivacaine 0.25%, 20 ml PECs II (PECs group); LA infusion catheter (levobupivacaine 0.1% at 10 ml h -1 for 24 h (LA infusion group); or both (PECs and LA infusion)]. The primary outcome measure was area under the curve of the pain verbal rating score whilst moving vs time (AUC) over 24 h. Secondary outcomes included total opioid consumption at 24 h. AUC moving was mean (SD) 71 (34) mm h -1 vs 58 (41) vs 23 (20) in PECs, LA infusion, and both, respectively; P=0.002. AUC at rest was also significantly lower in patients receiving both. The total 24 h opioid consumption [median (25-75%)] was 14 mg (9-26) vs 11 (8-24) vs 9 (5-11); P=0.4. No adverse events were observed. The combination of both pre-incisional PECs blocks and postoperative LA infusion provides better analgesia over 24 h than either technique alone after non-ambulatory breast-cancer surgery. NCT 03024697. Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Analgesic Choice in Management of Rib Fractures: Paravertebral Block or Epidural Analgesia?

PubMed

Malekpour, Mahdi; Hashmi, Ammar; Dove, James; Torres, Denise; Wild, Jeffrey

2017-06-01

Rib fractures are commonly encountered in the setting of trauma. The aim of this study was to assess the association between the clinical outcome of rib fracture and epidural analgesia (EA) versus paravertebral block (PVB) using the National Trauma Data Bank (NTDB). Using the 2011 and 2012 versions of the NTDB, we retrieved completed records for all patients above 18 years of age who were admitted with rib fractures. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), intensive care unit (ICU) admission, ICU LOS, mechanical ventilation, duration of mechanical ventilation, development of pneumonia, and development of any other complication. Clinical outcomes were first compared between propensity score-matched EA and PVB patients. Then, EA and PVB patients were combined into the procedure group and the outcomes were compared with propensity score-matched patients that received neither intervention (no-procedure group). A total of 194,766 patients were included in the study with 1073 patients having EA, 1110 patients having PVB, and 192,583 patients having neither procedure. After propensity score matching, comparison of primary and secondary outcomes between EA and PVB patients showed no difference. Comparison of propensity score-matched procedure and no-procedure patients showed prolonged LOS and more frequent ICU admissions in patients receiving a procedure (both P < .0001), yet having no procedure was associated with a significantly increased odds of mortality (odds ratio: 2.25; 95% confidence interval, 1.14-3.84; P = .002). Using the NTDB, EA and PVB were not found to be significantly different in management of rib fractures. There was an association between use of a block and improved outcome, but this could be explained by selection of healthier patients to receive a block. Prospective study of this association is recommended.

Reliability of Waveform Analysis as an Adjunct to Loss of Resistance for Thoracic Epidural Blocks.

PubMed

Leurcharusmee, Prangmalee; Arnuntasupakul, Vanlapa; Chora De La Garza, Daniel; Vijitpavan, Amorn; Ah-Kye, Sonia; Saelao, Abhidej; Tiyaprasertkul, Worakamol; Finlayson, Roderick J; Tran, De Q H

2015-01-01

The epidural space is most commonly identified with loss of resistance (LOR). Although sensitive, LOR lacks specificity, as cysts in interspinous ligaments, gaps in ligamentum flavum, paravertebral muscles, thoracic paravertebral spaces, and intermuscular planes can yield nonepidural LOR. Epidural waveform analysis (EWA) provides a simple confirmatory adjunct for LOR. When the needle is correctly positioned inside the epidural space, measurement of the pressure at its tip results in a pulsatile waveform. In this observational study, we set out to assess the sensitivity, specificity, as well as positive and negative predictive values of EWA for thoracic epidural blocks. We enrolled a convenience sample of 160 patients undergoing thoracic epidural blocks for thoracic surgery, abdominal surgery, or rib fractures. The choice of patient position (sitting or lateral decubitus), approach (midline or paramedian), and LOR medium (air or normal saline) was left to the operator (attending anesthesiologist, fellow, or resident). After obtaining a satisfactory LOR, the operator injected 5 mL of normal saline through the epidural needle. A sterile tubing, connected to a pressure transducer, was attached to the needle to measure the pressure at the needle tip. A 4-mL bolus of lidocaine 2% with epinephrine 5 μg/mL was then administered and, after 10 minutes, the patient was assessed for sensory blockade to ice. The failure rate (incorrect identification of the epidural space with LOR) was 23.1%. Of these 37 failed epidural blocks, 27 provided no sensory anesthesia at 10 minutes. In 10 subjects, the operator was unable to thread the catheter through the needle. When compared with the ice test, the sensitivity, specificity, and positive and negative predictive values of EWA were 91.1%, 83.8%, 94.9%, and 73.8%, respectively. Epidural waveform analysis (with pressure transduction through the needle) provides a simple adjunct to LOR for thoracic epidural blocks. Although its use was devoid of complications, further confirmatory studies are required before its routine implementation in clinical practice.

Physiological response to submaximal isometric contractions of the paravertebral muscles

NASA Technical Reports Server (NTRS)

Jensen, B. R.; Jorgensen, K.; Hargens, A. R.; Nielsen, P. K.; Nicolaisen, T.

1999-01-01

STUDY DESIGN: Brief (30-second) isometric trunk extensions at 5%, 20%, 40%, 60%, and 80% of maximal voluntary contraction (MVC) and 3 minutes of prolonged trunk extension (20% MVC) in erect position were studied in nine healthy male subjects. OBJECTIVES: To investigate the intercorrelation between intramuscular pressure and tissue oxygenation of the paravertebral muscles during submaximal isometric contractions and further, to evaluate paravertebral electromyogram and intramuscular pressure as indicators of force development. SUMMARY OF BACKGROUND DATA: Local physiologic responses to muscle contraction are incompletely understood. METHODS: Relative oxygenation was monitored with noninvasive near-infrared spectroscopy, intramuscular pressure was measured with a transducer-tipped catheter, and surface electromyogram was monitored at three recording sites. RESULTS: The root mean square amplitudes of the paravertebral electromyogram (L4, left and right; T12, right) and intramuscular pressure measured in the lumbar multifidus muscle at L4 increased with greater force development in a curvilinear manner. A significant decrease in the oxygenation of the lumbar paravertebral muscle in response to muscle contraction was found at an initial contraction level of 20% MVC. This corresponded to a paravertebral intramuscular pressure of 30-40 mm Hg. However, during prolonged trunk extension, no further decrease in tissue oxygenation was found compared with the tissue oxygenation level at the end of the brief contractions, indicating that homeostatic adjustments (mean blood pressure and heart rate) over time were sufficient to maintain paravertebral muscle oxygen levels. CONCLUSION: At a threshold intramuscular pressure of 30-40 mm Hg during muscle contraction, oxygenation in the paravertebral muscles is significantly reduced. The effect of further increase in intramuscular pressure on tissue oxygenation over time may be compensated for by an increase in blood pressure and heart rate. Surface electromyogram amplitudes and intramuscular pressure can be used as indicators of paravertebral muscle force.

Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block.

PubMed

Luftig, Josh; Mantuani, Daniel; Herring, Andrew A; Dixon, Brittany; Clattenburg, Eben; Nagdev, Arun

2017-12-28

The Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society Guidelines recommend prompt and effective multimodal analgesia for rib fractures that combines regional anesthesia (RA) techniques with pharmacotherapy to treat pain, optimize pulmonary function, and reduce opioid related complications. However, RA techniques such as epidurals and paravertebral blocks, are generally underutilized or unavailable for emergency department (ED) patients. The recently described serratus anterior plane block (SAPB) is a promising technique, but failures with posterior rib fractures have been observed. The erector spinae plane block (ESPB) is conceptually similar to the SAPB, but targets the posterior thorax making it likely more effective for ED patients with posterior rib fractures. Our initial experience demonstrates consistent success with the ESPB for traumatic posterior rib fracture analgesia. Herein, we present the first description of the ESPB utilized in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

Vitamin D Receptor gene (VDR) transcripts in bone, cartilage, muscles and blood and microarray analysis of vitamin D responsive genes expression in paravertebral muscles of Juvenile and Adolescent Idiopathic Scoliosis patients

PubMed Central

2012-01-01

Background VDR may be considered as a candidate gene potentially related to Idiopathic Scoliosis susceptibility and natural history. Transcriptional profile of VDR mRNA isoforms might be changed in the structural tissues of the scoliotic spine and potentially influence the expression of VDR responsive genes. The purpose of the study was to determine differences in mRNA abundance of VDR isoforms in bone, cartilage and paravertebral muscles between tissues from curve concavity and convexity, between JIS and AIS and to identify VDR responsive genes differentiating Juvenile and Adolescent Idiopathic Scoliosis in paravertebral muscles. Methods In a group of 29 patients with JIS and AIS, specimens of bone, cartilage, paravertebral muscles were harvested at the both sides of the curve apex together with peripheral blood samples. Extracted total RNA served as a matrix for VDRs and VDRl mRNA quantification by QRT PCR. Subsequent microarray analysis of paravertebral muscular tissue samples was performed with HG U133A chips (Affymetrix). Quantitative data were compared by a nonparametric Mann Whitney U test. Microarray results were analyzed with GeneSpring 11GX application. Matrix plot of normalized log-intensities visualized the degree of differentiation between muscular tissue transcriptomes of JIS and AIS group. Fold Change Analysis with cutoff of Fold Change ≥2 identified differentially expressed VDR responsive genes in paravertebral muscles of JIS and AIS. Results No significant differences in transcript abundance of VDR isoforms between tissues of the curve concavity and convexity were found. Statistically significant difference between JIS and AIS group in mRNA abundance of VDRl isoform was found in paravertebral muscles of curve concavity. Higher degree of muscular transcriptome differentiation between curve concavity and convexity was visualized in JIS group. In paravertebral muscles Tob2 and MED13 were selected as genes differentially expressed in JIS and AIS group. Conclusions In Idiopathic Scolioses transcriptional activity and alternative splicing of VDR mRNA in osseous, cartilaginous, and paravertebral muscular tissues are tissue specific and equal on both sides of the curve. The number of mRNA copies of VDRl izoform in concave paravertebral muscles might be one of the factors differentiating JIS and AIS. In paravertebral muscles Tob2 and Med13 genes differentiate Adolescent and Juvenile type of Idiopathic Scoliosis. PMID:23259508

Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries

PubMed Central

Khetarpal, Ranjana; Bali, Kusum; Chatrath, Veena; Bansal, Divya

2016-01-01

The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words “analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive.” More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered. PMID:26957682

Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery.

PubMed

Blanco, R; Fajardo, M; Parras Maldonado, T

2012-11-01

The Pecs block (pectoral nerves block) is an easy and reliable superficial block inspired by the infraclavicular block approach and the transversus abdominis plane blocks. Once the pectoralis muscles are located under the clavicle the space between the two muscles is dissected to reach the lateral pectoral and the medial pectoral nerves. The main indications are breast expanders and subpectoral prosthesis where the distension of these muscles is extremely painful. A second version of the Pecs block is described, called "modified Pecs block" or Pecs block type II. This novel approach aims to block at least the pectoral nerves, the intercostobrachial, intercostals III-IV-V-VI and the long thoracic nerve. These nerves need to be blocked to provide complete analgesia during breast surgery, and it is an alternative or a rescue block if paravertebral blocks and thoracic epidurals failed. This block has been used in our unit in the past year for the Pecs I indications described, and in addition for, tumorectomies, wide excisions, and axillary clearances. The ultrasound sequence to perform this block is shown, together with simple X-ray dye images and gadolinium MRI images to understand the spread and pathways that can explain the benefit of this novel approach. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Retrospective assessment of peripheral nerve block techniques used in cats undergoing hindlimb orthopaedic surgery.

PubMed

Vettorato, Enzo; Corletto, Federico

2016-10-01

The aim of this study was to assess retrospectively the efficacy and complication rate of hindlimb peripheral nerve blocks (PNBs) in cats. Clinical records of cats that received PNBs and underwent hindlimb orthopaedic surgery from February 2010 to October 2014 were examined. Type of PNB, type and dose of local anaesthetic used, end-expiratory fraction of isoflurane (FE'Iso) administered, additional intraoperative analgesia, incidence of hypotension, postoperative opioid requirement, postoperative contralateral limb paralysis and neurological complications at the 6 week re-examination were investigated. Eighty-nine records were retrieved but only 69 were analysed. Four combinations of PNBs were used: 34 lateral preiliac (LPI) approach to lumbar plexus (LP) associated with lumbar paravertebral approach to sciatic nerve (SN); 20 LPI-LP associated with the lateral approach to SN; three LPI-LP associated with gluteal approach to SN; 12 dorsal-paravertebral (DPV) approach to LP associated with lateral SN. Levobupivacaine was used for the majority of PNBs. The mean intraoperative FE'Iso was 1.15%; hypotension was documented in 55.1% of anaesthetics, while 31.8% of cats received fentanyl and/or ketamine intraoperatively. Postoperatively, 72.7% of cats received at least one dose of opioid, while five cats required further postoperative analgesia (ketamine constant rate infusion and/or gabapentin). No cats showed contralateral limb paralysis and neurological complications at the 6 week re-examination. No differences were found when comparing the different PNBs used. PNBs contributed to perioperative anaesthesia/analgesia in cats undergoing hindlimb orthopaedic surgery. However, the clinical relevance of intraoperative hypotension needs further investigation. © The Author(s) 2015.

Thoracic paravertebral ganglioneuroma with high immunohistochemical expression of TrkA.

PubMed

Nishio, S; Hamada, Y; Nakagawara, A; Haga, S; Suzuki, S; Fukui, M

1999-01-01

A 21-year-old man, who had previously undergone a total resection for a retroperitoneal ganglioneuroblastoma at 7 months of age, was revealed to have a thoracic paravertebral ganglioneuroma, in which immunohistochemical expression of neuron-specific enolase and neurofilament was noted. Furthermore, immunohistochemical expression of TrkA, which is a high-affinity receptor for nerve growth factor, was evident. Although the exact histogenesis remains uncertain, TrkA was considered to be involved in the development of this thoracic paravertebral tumor.

Gastric adenocarcinoma concurrent with paravertebral plasmacytoma: A case report

PubMed Central

Du, Fengcai; Jiang, Lixin; Zhu, Fangqing; Gong, Zhao Hua; Chen, Jian; Zhang, Liangming

2016-01-01

Here, we report the case of a 77-year-old male patient who was revealed to have an unsuspected case of gastric adenocarcinoma with paravertebral plasmacytoma following biopsy. Plasmacytoma may be classified into two main groups: Multiple myeloma and plasmacytoma without marrow involvement. It comprises isolated plasmacytoma of the bone and extramedullary plasmacytoma. Extramedullary plasmacytoma (EMP) accounts for 3% of all plasmacytomas; however, ~80% are located in the upper respiratory tract and upper gastrointestinal tract. It occurs extremely rarely in paravertebral areas. Case reports of EMP and other types of malignant tumor occurring at the same time have not been identified in searches of the literature. In the present study, we describe the diagnosis and treatment process of a case of gastric adenocarcinoma concurrent with paravertebral plasmacytoma. It may be helpful for early clinical diagnosis and treatment of such cases. PMID:27446469

Epidural technique for postoperative pain: gold standard no more?

PubMed

Rawal, Narinder

2012-01-01

Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for cesarean delivery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. Although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.

Contralateral cerebral hemoglobin oxygen saturation changes in patients undergoing thoracotomy with general anesthesia with or without paravertebral block: a randomized controlled trial.

PubMed

Mukaihara, Keika; Hasegawa-Moriyama, Maiko; Kanmura, Yuichi

2017-12-01

Perioperative analgesia during thoracotomy is often achieved by combining paravertebral block (PVB) with general anesthesia (GA). Functional near-infrared spectroscopy (NIRS) can detect changes in cerebral oxygenation resulting from nociceptive stimuli in the awake state or under sedation. We used NIRS to measure changes in cerebral blood flow provoked by thoracotomy incision made under GA and determine how these changes were influenced by supplementation of GA with PVB. Thirty-four patients undergoing elective thoracotomy were enrolled. Patients were randomly assigned to a group receiving only GA, or GA combined with PVB (GA + PVB). Changes in cerebral oxygenated hemoglobin (ΔO 2 Hb), deoxygenated-Hb (ΔHHb), and total-Hb (ΔtotalHb) were evaluated by NIRS as surgery began. In the GA group, ΔO 2 Hb was significantly higher in the hemisphere contralateral to the side of surgery when the incision was made and 2 min after incision compared with the ipsilateral side (start of surgery, P < 0.01; 2 min, P < 0.05). In contrast, there were no significant changes in the ΔO 2 Hb at any of the time points in the GA + PVB group. Comparable with ΔO 2 Hb, the concentration of ΔtotalHb was significantly higher in the contralateral hemisphere in the GA group at the start of surgery (P < 0.05). Changes in the cerebral O 2 Hb concentration were detected by NIRS immediately after surgical incision under GA, but not in the presence of a PNB. NIRS could be used to monitor surgical pain. PVB inhibited changes in oxygenation induced by incision-provoked pain.

Paravertebral blocks reduce the risk of postoperative urinary retention in inguinal hernia repair.

PubMed

Bojaxhi, E; Lee, J; Bowers, S; Frank, R D; Pak, S H; Rosales, A; Padron, S; Greengrass, R A

2018-06-16

Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair. Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression. PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit. PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.

Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature.

PubMed

Garg, Rakesh; Bhan, Swati; Vig, Saurabh

2018-04-01

Surgical resection of the primary tumour with axillary dissection is one of the main modalities of breast cancer treatment. Regional blocks have been considered as one of the modalities for effective perioperative pain control. With the advent of ultrasound, newer interventions such as fascial plane blocks have been reported for perioperative analgesia in breast surgeries. Our aim is to review the literature for fascial plane blocks for analgesia in breast surgeries. The research question for initiating the review was 'What are the reported newer regional anaesthesia techniques (fascial plane blocks) for female patients undergoing breast surgery and their analgesic efficacy?.' The participants, intervention, comparisons, outcomes and study design were followed. Due to the paucity of similar studies and heterogeneity, the assessment of bias, systematic review or pooled analysis/meta-analysis was not feasible. Of the 989 manuscripts, the present review included 28 manuscripts inclusive of all types of published manuscripts. 15 manuscripts directly related to the administration of fascial plane blocks for breast surgery across all type of study designs and cases were reviewed for the utility of fascial plane blocks in breast surgeries. Interfascial blocks score over regional anaesthetic techniques such as paravertebral block as they have no risk of sympathetic blockade, intrathecal or epidural spread which may lead to haemodynamic instability and prolonged hospital stay. This review observed that no block effectively covers the whole of breast and axilla, thus a combination of blocks should be used depending on the site of incision and extent of surgical resection.

Spinal Cord Injury-Induced Dysautonomia via Plasticity in Paravertebral Sympathetic Postganglionic

DTIC Science & Technology

2017-10-01

their near anatomical inaccessibility. We have solved the accessibility problem with a strategic methodological advance. We will determine the extent...inaccessibility. We have solved the accessibility problem with a strategic methodological advance. We will determine the extent to which paravertebral

1.5 T augmented reality navigated interventional MRI: paravertebral sympathetic plexus injections

PubMed Central

Marker, David R.; U-Thainual, Paweena; Ungi, Tamas; Flammang, Aaron J.; Fichtinger, Gabor; Iordachita, Iulian I.; Carrino, John A.; Fritz, Jan

2017-01-01

PURPOSE The high contrast resolution and absent ionizing radiation of interventional magnetic resonance imaging (MRI) can be advantageous for paravertebral sympathetic nerve plexus injections. We assessed the feasibility and technical performance of MRI-guided paravertebral sympathetic injections utilizing augmented reality navigation and 1.5 T MRI scanner. METHODS A total of 23 bilateral injections of the thoracic (8/23, 35%), lumbar (8/23, 35%), and hypogastric (7/23, 30%) paravertebral sympathetic plexus were prospectively planned in twelve human cadavers using a 1.5 Tesla (T) MRI scanner and augmented reality navigation system. MRI-conditional needles were used. Gadolinium-DTPA-enhanced saline was injected. Outcome variables included the number of control magnetic resonance images, target error of the needle tip, punctures of critical nontarget structures, distribution of the injected fluid, and procedure length. RESULTS Augmented-reality navigated MRI guidance at 1.5 T provided detailed anatomical visualization for successful targeting of the paravertebral space, needle placement, and perineural paravertebral injections in 46 of 46 targets (100%). A mean of 2 images (range, 1–5 images) were required to control needle placement. Changes of the needle trajectory occurred in 9 of 46 targets (20%) and changes of needle advancement occurred in 6 of 46 targets (13%), which were statistically not related to spinal regions (P = 0.728 and P = 0.86, respectively) and cadaver sizes (P = 0.893 and P = 0.859, respectively). The mean error of the needle tip was 3.9±1.7 mm. There were no punctures of critical nontarget structures. The mean procedure length was 33±12 min. CONCLUSION 1.5 T augmented reality-navigated interventional MRI can provide accurate imaging guidance for perineural injections of the thoracic, lumbar, and hypogastric sympathetic plexus. PMID:28420598

1.5 T augmented reality navigated interventional MRI: paravertebral sympathetic plexus injections.

PubMed

Marker, David R; U Thainual, Paweena; Ungi, Tamas; Flammang, Aaron J; Fichtinger, Gabor; Iordachita, Iulian I; Carrino, John A; Fritz, Jan

2017-01-01

The high contrast resolution and absent ionizing radiation of interventional magnetic resonance imaging (MRI) can be advantageous for paravertebral sympathetic nerve plexus injections. We assessed the feasibility and technical performance of MRI-guided paravertebral sympathetic injections utilizing augmented reality navigation and 1.5 T MRI scanner. A total of 23 bilateral injections of the thoracic (8/23, 35%), lumbar (8/23, 35%), and hypogastric (7/23, 30%) paravertebral sympathetic plexus were prospectively planned in twelve human cadavers using a 1.5 Tesla (T) MRI scanner and augmented reality navigation system. MRI-conditional needles were used. Gadolinium-DTPA-enhanced saline was injected. Outcome variables included the number of control magnetic resonance images, target error of the needle tip, punctures of critical nontarget structures, distribution of the injected fluid, and procedure length. Augmented-reality navigated MRI guidance at 1.5 T provided detailed anatomical visualization for successful targeting of the paravertebral space, needle placement, and perineural paravertebral injections in 46 of 46 targets (100%). A mean of 2 images (range, 1-5 images) were required to control needle placement. Changes of the needle trajectory occurred in 9 of 46 targets (20%) and changes of needle advancement occurred in 6 of 46 targets (13%), which were statistically not related to spinal regions (P = 0.728 and P = 0.86, respectively) and cadaver sizes (P = 0.893 and P = 0.859, respectively). The mean error of the needle tip was 3.9±1.7 mm. There were no punctures of critical nontarget structures. The mean procedure length was 33±12 min. 1.5 T augmented reality-navigated interventional MRI can provide accurate imaging guidance for perineural injections of the thoracic, lumbar, and hypogastric sympathetic plexus.

Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

PubMed Central

Andreae, Michael H; Andreae, Doerthe A

2014-01-01

Background Regional anaesthesia may reduce the rate of persistent (chronic) pain after surgery, a frequent and debilitating condition. Objectives To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), PubMed (1966 to April 2012), EMBASE (1966 to May 2012) and CINAHL (1966 to May 2012) without any language restriction. We used a combination of free text search and controlled vocabulary search. The results were limited to randomized controlled clinical trials (RCTs). We conducted a handsearch in reference lists of included trials, review articles and conference abstracts. Selection criteria We included RCTs comparing local anaesthetics or regional anaesthesia versus conventional analgesia with a pain outcome at six or 12 months after surgery. Data collection and analysis Two authors independently assessed trial quality and extracted data, including information on adverse events. We contacted study authors for additional information. Results are presented as pooled odds ratios (OR) with 95% confidence intervals (CI), based on random-effects models (inverse variance method). We grouped studies according to surgical interventions. We employed the Chi2 test and calculated the I2 statistic to investigate study heterogeneity. Main results We identified 23 RCTs studying local anaesthetics or regional anaesthesia for the prevention of persistent (chronic) pain after surgery. Data from a total of 1090 patients with outcomes at six months and of 441 patients with outcomes at 12 months were presented. No study included children. We pooled data from 250 participants after thoracotomy, with outcomes at six months. Data favoured regional anaesthesia for the prevention of chronic pain at six months after thoracotomy with an OR of 0.33 (95% CI 0.20 to 0.56). We pooled two studies on paravertebral block for breast cancer surgery; the pooled data of 89 participants with outcomes at five to six months favoured paravertebral block with an OR of 0.37 (95% CI 0.14 to 0.94).The methodological quality of the included studies was intermediate. Adverse effects were not studied systematically and were reported sparsely. Clinical heterogeneity, attrition and sparse outcome data hampered the assessment of effects, especially at 12 months. Authors’ conclusions Epidural anaesthesia may reduce the risk of developing chronic pain after thoracotomy in about one patient out of every four patients treated. Paravertebral block may reduce the risk of chronic pain after breast cancer surgery in about one out of every five women treated. Our conclusions are significantly weakened by performance bias, shortcomings in allocation concealment, considerable attrition and incomplete outcome data. We caution that our evidence synthesis is based on only a few, small studies. More studies with high methodological quality, addressing various types of surgery and different age groups, including children, are needed. PMID:23076930

Pupillary Reflex for Evaluation of Thoracic Paravertebral Block: A Prospective Observational Feasibility Study.

PubMed

Duceau, Baptiste; Baubillier, Mélanie; Bouroche, Gaëlle; Albi-Feldzer, Aline; Jayr, Christian

2017-10-01

Although thoracic paravertebral block (TPVB) is recommended in major breast surgery, there is no gold standard to assess the success of TPVB. Pupillary dilation reflex (PDR) is the variation of the pupillary diameter after a noxious stimulus. The objective was to evaluate the feasibility of recording the PDR to assess analgesia in an anesthetized thoracic dermatome after TPVB. This prospective, observational, single-center study included 32 patients requiring breast surgery under general anesthesia and TPVB. TPVB was performed before surgery under ultrasound guidance with 20 mL of 0.75% ropivacaine. At the end of the surgery, remifentanil was stopped and the PDR was recorded after a 5-second tetanic stimulation (60 mA, 100 Hz) applied to the anterior chest wall. The PDR was defined as the maximal increase in pupil diameter after a standardized noxious stimulus, expressed as a percentage of the initial pupil diameter. The PDR was recorded twice in the same eye for each patient after a stimulus on both the TPVB and the control sides. Postoperative pain scores were recorded in a postanesthesia care unit. The primary outcome was the difference between the PDR on the TPVB and the control sides. The median (interquartile range) PDR was 9% (4%-13%) on the TPVB side and 41% (27%-66%) on the control side. There was a significant difference in the PDR between the TPVB and the control sides with a Hodges-Lehmann estimate of absolute difference of 37% points (95% confidence interval, 25-52, P < .001). Median postoperative pain scores (interquartile range) in the postanesthesia care unit were 1 (0-3) at rest and 1 (0-3) during mobilization, respectively. There was a linear correlation between maximal postoperative pain scores and the PDR on the TPVB side with a Pearson's correlation coefficient r = 0.40 (95% confidence interval, 0.06-0.66, P = .02). No correlation was found between the number of blocked dermatomes and maximal postoperative pain scores (P = .06) or between the number of blocked dermatomes and the PDR on the TPVB side (P = .15). This proof-of-concept trial suggests that the effect of TPVB could be monitored by measuring the PDR after anterior chest wall stimulation in the dermatome of interest.

Effect of Continuous Paravertebral Dexmedetomidine Administration on Intraoperative Anesthetic Drug Requirement and Post-Thoracotomy Pain Syndrome After Thoracotomy: A Randomized Controlled Trial.

PubMed

Dutta, Vikas; Kumar, Bhupesh; Jayant, Aveek; Mishra, Anand K

2017-02-01

To assess the effect of paravertebral administration of dexmedetomidine as an adjuvant to local anesthetic on the intraoperative anesthetic drug requirement and incidence of post-thoracotomy pain syndrome. Prospective, randomized, controlled, double-blind trial. Single university hospital. The study comprised 30 patients who underwent elective thoracotomy and were assigned randomly to either the Ropin or Dexem group (n = 15 each). All patients received the study medications through paravertebral catheter. Patients in the Ropin group received a bolus of 15 mL of 0.75% ropivacaine over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine at 0.1 mL/kg/hour. Patients in the Dexem group received 15 mL of 0.75% ropivacaine plus dexmedetomidine, 1 µg/kg bolus over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine plus 0.2 µg/kg/hour of dexmedetomidine at 0.1 mL/kg/hour. The primary outcome of the study was intraoperative anesthetic drug requirement. The secondary outcome was the incidence of post-thoracotomy pain syndrome 2 months after surgery. The amount of propofol required for induction of anesthesia was significantly less in the Dexem group (Dexem 49.33±20.51 v 74.33±18.40 in the Ropin group, p = 0.002). End-tidal isoflurane needed to maintain target entropy was significantly less in the Dexem group at all time points. Intraoperative fentanyl requirement was lower in the Dexem group (Dexem 115.33±33.77 v 178.67±32.48 in the Ropin group, p = 0.002). Postoperative pain scores and morphine consumption were significantly less in the Dexem group (p<0.001). The incidence of post-thoracotomy pain syndrome was comparable between the 2 groups (69.23% v 50%, p = 0.496). Paravertebral dexmedetomidine administration resulted in decreased intraoperative anesthetic drug requirement, less pain, and lower requirements of supplemental opioid in the postoperative period. However, it had no effect on the incidence of post-thoracotomy pain syndrome. Copyright © 2017 Elsevier Inc. All rights reserved.

Paravertebral block catheter breakage by electrocautery during thoracic surgery.

PubMed

Saeki, Noboru; Sugimoto, Yuki; Mori, Yoko; Kato, Takahiro; Miyoshi, Hirotsugu; Nakamura, Ryuji; Koga, Tomomichi

2017-06-01

Advantages of thoracic paravertebral analgesia (TPA) include placement of the catheter closer to the surgical field; however, the catheter can become damaged during the operation. We experienced a case of intraoperative TPA catheter breakage that prompted us to perform an experiment to investigate possible causes. A 50-year-old male underwent a thoracoscopic lower lobectomy under general anesthesia with TPA via an intercostal approach. Following surgery, it was discovered that the catheter had become occluded, as well as cut and fused, so we reopened the incision and removed the residual catheter. From that experience, we performed an experiment to examine electrocautery-induced damage in normal (Portex™, Smith's Medical), radiopaque (Perifix SoftTip™, BBraun), and reinforced (Perifix FX™, BBraun) epidural catheters (n = 8 each). Chicken meat was penetrated by each catheter and then cut by electrocautery. In the normal group, breakage occurred in 8 and occlusion in 6 of the catheters, and in the radiopaque group breakage occurred in 8 and occlusion in 7. In contrast, breakage occurred in only 3 and occlusion in none in the reinforced group, with the 5 without breakage remaining connected only by the spring coil. Furthermore, in 7 of the reinforced catheters, electric arc-induced thermal damage was observed at the tip of the catheter. A TPA catheter for thoracic surgery should be inserted via the median approach, or it should be inserted after surgery to avoid catheter damage during surgery.

[Sclerosing epithelioid fibrosarcoma of the paravertebral column. Case report and literature review].

PubMed

Puerta Roldán, Patricia; Rodríguez Rodríguez, Rodrigo; Bagué Rossell, Silvia; de Juan Delago, Manel; Molet Teixidó, Joan

2013-01-01

Sclerosing epithelioid fibrosarcoma (SEF) is a rare variant of low-grade fibrosarcoma, with specific histological and immunohistochemical features and a poor prognosis. We report a case of SEF of the paravertebral column in a 49-year old male who presented a paraspinal mass with extension into the L4-L5 neural foramen and invasion of the L5 nerve root. Histology of the tumourectomy specimen and its immunohistochemical study led to the diagnosis of SEF. This case was particularly unusual due to its paravertebral column location and, despite its low grade, illustrates the malignant potential of SEF. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Examining the Role of Perioperative Nerve Blocks in Hip Arthroscopy: A Systematic Review.

PubMed

Kay, Jeffrey; de Sa, Darren; Memon, Muzammil; Simunovic, Nicole; Paul, James; Ayeni, Olufemi R

2016-04-01

This systematic review examined the efficacy of perioperative nerve blocks for pain control after hip arthroscopy. The databases Embase, PubMed, and Medline were searched on June 2, 2015, for English-language studies that reported on the use of perioperative nerve blocks for hip arthroscopy. The studies were systematically screened and data abstracted in duplicate. Nine eligible studies were included in this review (2 case reports, 2 case series, 3 non-randomized comparative studies, and 2 randomized controlled trials). In total, 534 patients (534 hips), with a mean age of 37.2 years, who underwent hip arthroscopy procedures were administered nerve blocks for pain management. Specifically, femoral (2 studies), fascia iliaca (2 studies), lumbar plexus (3 studies), and L1 and L2 paravertebral (2 studies) nerve blocks were used. All studies reported acceptable pain scores after the use of nerve blocks, and 4 studies showed significantly lower postoperative pain scores acutely with the use of nerve blocks over general anesthesia alone. The use of nerve blocks also resulted in a decrease in opioid consumption in 4 studies and provided a higher level of patient satisfaction in 2 studies. No serious acute complications were reported in any study, and long-term complications from lumbar plexus blocks, such as local anesthetic system toxicity (0.9%) and long-term neuropathy (2.8%), were low in incidence. The use of perioperative nerve blocks provides effective pain management after hip arthroscopy and may be more effective in decreasing acute postoperative pain and supplemental opioid consumption than other analgesic techniques. Level IV, systematic review of Level I to Level IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols.

PubMed

Piccioni, Federico; Segat, Matteo; Falini, Stefano; Umari, Marzia; Putina, Olga; Cavaliere, Lucio; Ragazzi, Riccardo; Massullo, Domenico; Taurchini, Marco; Del Naja, Carlo; Droghetti, Andrea

2018-03-01

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

PubMed Central

Piccioni, Federico; Segat, Matteo; Falini, Stefano; Umari, Marzia; Putina, Olga; Cavaliere, Lucio; Ragazzi, Riccardo; Massullo, Domenico; Taurchini, Marco; Droghetti, Andrea

2018-01-01

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors’ experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy. PMID:29629202

Opioid-sparing effects of the thoracic interfascial plane blocks: A meta-analysis of randomized controlled trials.

PubMed

Singh, Preet Mohinder; Borle, Anuradha; Kaur, Manpreet; Trikha, Anjan; Sinha, Ashish

2018-01-01

Thoracic interfascial plane blocks and modification (PECS) have recently gained popularity for analgesic potential during breast surgery. We evaluate/consolidate the evidence on opioid-sparing effect of PECS blocks in comparison with conventional intravenous analgesia (IVA) and paravertebral block (PVB). Prospective, randomized controlled trials comparing PECS block to conventional IVA or PVB in patients undergoing breast surgery published till June 2017 were searched in the medical database. Comparisons were made for 24-h postoperative morphine consumption and intraoperative fentanyl-equivalent consumption. Final analysis included nine trials (PECS vs. IVA 4 trials and PECS vs. PVB 5 trials). PECS block showed a decreased intraoperative fentanyl consumption over IVA by 49.20 mcg (95% confidence interval [CI] =42.67-55.74) ( I 2 = 98.47%, P < 0.001) and PVB by 15.88 mcg (95% CI = 12.95-18.81) ( I 2 = 95.51%, P < 0.001). Postoperative, 24-h morphine consumption with PECS block was lower than IVA by 7.66 mg (95% CI being 6.23-9.10) ( I 2 = 63.15, P < 0.001) but was higher than PVB group by 1.26 mg (95% CI being 0.91-1.62) ( I 2 = 99.53%, P < 0.001). Two cases of pneumothorax were reported with PVB, and no complication was reported in any other group. Use of PECS block and its modifications with general anesthesia for breast surgery has significant opioid-sparing effect intraoperatively and during the first 24 h after surgery. It also has higher intraoperative opioid-sparing effect when compared to PVB. During the 1 st postoperative day, PVB has slightly more morphine sparing potential that may however be associated with higher complication rates. The present PECS block techniques show marked interstudy variations and need standardization.

Continuous intercostal nerve blockade for rib fractures: ready for primetime?

PubMed

Truitt, Michael S; Murry, Jason; Amos, Joseph; Lorenzo, Manuel; Mangram, Alicia; Dunn, Ernest; Moore, Ernest E

2011-12-01

Providing analgesia for patients with rib fractures continues to be a management challenge. The objective of this study was to examine our experience with the use of a continuous intercostal nerve block (CINB). Although this technique is being used, little data have been published documenting its use and efficacy. We hypothesized that a CINB would provide excellent analgesia, improve pulmonary function, and decrease length of stay (LOS). Consecutive adult blunt trauma patients with three or more unilateral rib fractures were prospectively studied over 24 months. The catheters were placed at the bedside in the extrathoracic, paravertebral location, and 0.2% ropivacaine was infused. Respiratory rate, preplacement (PRE) numeric pain scale (NPS) scores, and sustained maximal inspiration (SMI) lung volumes were determined at rest and after coughing. Parameters were repeated 60 minutes after catheter placement (POST). Hospital LOS comparison was made with historical controls using epidural analgesia. Over the study period, 102 patients met inclusion criteria. Mean age was 69 (21-96) years, mean injury severity score was 14 (9-16), and the mean number of rib fractures was 5.8 (3-10). Mean NPS improved significantly (PRE NPS at rest = 7.5 vs. POST NPS at rest = 2.6, p < 0.05, PRE NPS after cough = 9.4, POST after cough = 3.6, p < 0.05) which was associated with an increase in the SMI (PRE SMI = 0.4 L and POST SMI = 1.3 L, p < 0.05). Respiratory rate decreased significantly (p < 0.05) and only 2 of 102 required mechanical ventilation. Average LOS for the study population was 2.9 days compared with 5.9 days in the historical control. No procedural or drug-related complications occurred. Utilization of CINB significantly improved pulmonary function, pain control, and shortens LOS in patients with rib fractures.

Vertebral Osteomyelitis and Acinetobacter Spp. Paravertebral Soft Tissue Infection in a 4-Year-Old Boy With X-Linked Chronic Granulomatous Disease.

PubMed

Vignesh, Pandiarajan; Bhattad, Sagar; Shandilya, Jitendra-Kumar; Vyas, Sameer; Garg, Rashi; Rawat, Amit

2016-09-01

Vertebral osteomyelitis is known to occur in chronic granulomatous disease, a phagocytic disorder and the etiology is usually a fungus. Indolent spread of fungal infection from lungs to adjacent ribs and vertebra often results in persistent pneumonia and vertebral deformities. We report a 4-year-old boy with chronic cough and kyphosis, who had a fungal vertebral osteomyelitis and Acinetobacter spp. paravertebral soft tissue infection related to X-linked chronic granulomatous disease.

Spectral Analysis of Ultrasound Radiofrequency Backscatter for the Detection of Intercostal Blood Vessels.

PubMed

Klingensmith, Jon D; Haggard, Asher; Fedewa, Russell J; Qiang, Beidi; Cummings, Kenneth; DeGrande, Sean; Vince, D Geoffrey; Elsharkawy, Hesham

2018-04-19

Spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels during ultrasound-guided placement of paravertebral nerve blocks and intercostal nerve blocks. Autoregressive models were used for spectral estimation, and bandwidth, autoregressive order and region-of-interest size were evaluated. Eight spectral parameters were calculated and used to create random forests. An autoregressive order of 10, bandwidth of 6 dB and region-of-interest size of 1.0 mm resulted in the minimum out-of-bag error. An additional random forest, using these chosen values, was created from 70% of the data and evaluated independently from the remaining 30% of data. The random forest achieved a predictive accuracy of 92% and Youden's index of 0.85. These results suggest that spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels. (jokling@siue.edu) © 2018 World Federation for Ultrasound in Medicine and Biology. Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.

Diagnosis of Brugada's syndrome after subarachnoid injection of prilocaine.

PubMed

Oliván, B; Arbeláez, A; de Miguel, M; Pelavski, A

2016-10-01

Brugada syndrome is an autosomal dominant genetic disease affecting sodium ion channels. It is characterised by right bundle branch block and ST elevation in the right precordial leads, and with no structural cardiac abnormalities. It is associated with sudden death. This disease may be unmasked by certain drugs and sudden changes in autonomic tone. Local anaesthetics may increase ECG changes due to a blockade of the sodium channels, mainly depending on the dose and the type of anaesthetic. Thus, there have been reported electrocardiographic changes consistent with Brugada syndrome, triggered after epidural or paravertebral infusion of bupivacaine and ropivacaine. The case is described of a 66 years old man, scheduled for inguinal herniorrhaphy as an outpatient. He had no history of syncope or arrhythmias. After spinal anaesthesia with 40mg of prilocaine the ECG showed ST elevation>2mm, and right bundle branch block in V1-V3. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Efficacy and Safety of Ketamine Added to Local Anesthetic in Modified Pectoral Block for Management of Postoperative Pain in Patients Undergoing Modified Radical Mastectomy.

PubMed

Othman, Ahmed H; El-Rahman, Ahmad M Abd; El Sherif, Fatma

2016-01-01

Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. A randomized, double-blind, prospective study. Academic medical center. This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 - 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total morphine consumption, sedation score, and side effects. Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P < 0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P = 0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation, VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05). This study is limited by its sample size. The addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy. Ketamine, bupivacaine, pecs block, postoperative, pain, breast cancer.

An unusual case of lumbar paravertebral miositis ossificans mimicking muscular skeletal tumor.

PubMed

Zoccali, C; Chichierchia, G; Covello, R

2013-12-01

Several lesions have clinical and radiological characteristics mimicking muscular skeletal tumor. Myositis ossificans usually presents a typical pattern making biopsy unnecessary; nevertheless, in rare cases, neoplasm must be ruled out. Biopsy is often sufficient to allow a diagnosis and a correct related treatment, but, unfortunately, sometimes it may lead to erroneous treatment. We report an unusual case of a lumbar paravertebral mass that had an MRI aspect similar to a chondrosarcoma, a histology pattern based on biopsy compatible with neurinoma and a definitive diagnosis of myosistis ossificans.

Opioid-sparing effects of the thoracic interfascial plane blocks: A meta-analysis of randomized controlled trials

PubMed Central

Singh, Preet Mohinder; Borle, Anuradha; Kaur, Manpreet; Trikha, Anjan; Sinha, Ashish

2018-01-01

Background: Thoracic interfascial plane blocks and modification (PECS) have recently gained popularity for analgesic potential during breast surgery. We evaluate/consolidate the evidence on opioid-sparing effect of PECS blocks in comparison with conventional intravenous analgesia (IVA) and paravertebral block (PVB). Materials and Methods: Prospective, randomized controlled trials comparing PECS block to conventional IVA or PVB in patients undergoing breast surgery published till June 2017 were searched in the medical database. Comparisons were made for 24-h postoperative morphine consumption and intraoperative fentanyl-equivalent consumption. Results: Final analysis included nine trials (PECS vs. IVA 4 trials and PECS vs. PVB 5 trials). PECS block showed a decreased intraoperative fentanyl consumption over IVA by 49.20 mcg (95% confidence interval [CI] =42.67–55.74) (I2 = 98.47%, P < 0.001) and PVB by 15.88 mcg (95% CI = 12.95–18.81) (I2 = 95.51%, P < 0.001). Postoperative, 24-h morphine consumption with PECS block was lower than IVA by 7.66 mg (95% CI being 6.23–9.10) (I2 = 63.15, P < 0.001) but was higher than PVB group by 1.26 mg (95% CI being 0.91–1.62) (I2 = 99.53%, P < 0.001). Two cases of pneumothorax were reported with PVB, and no complication was reported in any other group. Conclusions: Use of PECS block and its modifications with general anesthesia for breast surgery has significant opioid-sparing effect intraoperatively and during the first 24 h after surgery. It also has higher intraoperative opioid-sparing effect when compared to PVB. During the 1st postoperative day, PVB has slightly more morphine sparing potential that may however be associated with higher complication rates. The present PECS block techniques show marked interstudy variations and need standardization. PMID:29416465

Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty: A Prospective Randomized Controlled Study.

PubMed

Mei, Bin; Meng, Gaige; Xu, Guanghong; Cheng, Xinqi; Chen, Shishou; Zhang, Ye; Zhang, Ming; Liu, Xuesheng; Gu, Erwei

2018-03-09

Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium. The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of postoperative delirium. A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017. The patients were randomly assigned to receive a lumbosacral plexus plus T12 paravertebral block supplemented with propofol or dexmedetomidine for sedation. Incidence of postoperative delirium was the primary endpoint and was determined with the Confusion Assessment Method, and incidence of postoperative cognitive dysfunction was assessed with the Mini-Mental State Examination. The time of ambulation, discharge time, and complications over a 30-day post-surgery period were also recorded. 296 patients were randomly assigned to two groups. The patients sedated with dexmedetomidine had lower incidences of postoperative delirium and postoperative cognitive dysfunction and were out of bed and discharged sooner than the patients sedated with propofol. There was no difference in complications between the two groups. As a supplementary to peripheral nerve block, intraoperative sedation with dexmedetomidine could be associated with a lower incidence of POD, which may have benefits on reducing the incidence of early postoperative cognitive dysfunction and offering a better short-term recovery for elderly patients receiving hip arthroplasty.

Raman Spectroscopy Differentiates Each Tissue From the Skin to the Spinal Cord: A Novel Method for Epidural Needle Placement?

PubMed Central

Anderson, T. Anthony; Kang, Jeon Woong; Gubin, Tatyana; Dasari, Ramachandra R.; So, Peter T. C.

2016-01-01

BACKGROUND Neuraxial anesthesia and epidural steroid injection techniques require precise anatomical targeting to ensure successful and safe analgesia. Previous studies suggest that only some of the tissues encountered during these procedures can be identified by spectroscopic methods, and no previous study has investigated the use of Raman, diffuse reflectance, and fluorescence spectroscopies. The authors hypothesized that real-time needle-tip spectroscopy may aid epidural needle placement and tested the ability of spectroscopy to distinguish each of the tissues in the path of neuraxial needles. METHODS For comparison of detection methods, the spectra of individual, dissected ex vivo paravertebral and neuraxial porcine tissues were collected using Raman spectroscopy (RS), diffuse reflectance spectroscopy (DRS), and fluorescence spectroscopy (FS). Real-time spectral guidance was tested using a 2 mm inner diameter fiber optic probe-in-needle device. Raman spectra were collected during the needle’s passage through intact paravertebral and neuraxial porcine tissue and analyzed afterward. The RS tissue signatures were verified as mapping to individual tissue layers using histochemical staining and widefield microscopy. RESULTS Raman spectroscopy revealed a unique spectrum for all ex vivo paravertebral and neuraxial tissue layers; DRS and FS spectra were not distinct for all tissues. Moreover, when accounting for the expected order of tissues, real-time Raman spectra recorded during needle insertion also permitted identification of each paravertebral and neuraxial porcine tissue. CONCLUSIONS This study demonstrates Raman spectroscopy can distinguish the tissues encountered during epidural needle insertion. This technology may prove useful during needle placement by providing evidence of its anatomical localization. PMID:27466032

Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice.

PubMed

Umari, Marzia; Falini, Stefano; Segat, Matteo; Zuliani, Michele; Crisman, Marco; Comuzzi, Lucia; Pagos, Francesco; Lovadina, Stefano; Lucangelo, Umberto

2018-03-01

In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine.

Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice

PubMed Central

Falini, Stefano; Segat, Matteo; Zuliani, Michele; Crisman, Marco; Comuzzi, Lucia; Pagos, Francesco; Lovadina, Stefano; Lucangelo, Umberto

2018-01-01

In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine. PMID:29629201

Lumbar paravertebral blockade as intractable pain management method in palliative care

PubMed Central

Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; Główka, Franciszek; Łuczak, Jacek

2013-01-01

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour−1) or in boluses (10 mL of 0.125%–0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine’s side effects were absent. Coadministered drugs could mask LA’s toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine’s elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9–927.4 ng mL−1). In the case presented, lumbar PVB with bupivacaine in boluses (≤ 137.5 mg · 24 hours−1) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours−1) had an acceptable risk-benefits ratio, but was ineffective. PMID:24043944

Lumbar paravertebral blockade as intractable pain management method in palliative care.

PubMed

Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; Główka, Franciszek; Luczak, Jacek

2013-01-01

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour(-1)) or in boluses (10 mL of 0.125%-0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine's side effects were absent. Coadministered drugs could mask LA's toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine's elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9-927.4 ng mL(-1)). In the case presented, lumbar PVB with bupivacaine in boluses (≤ 137.5 mg · 24 hours(-1)) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours(-1)) had an acceptable risk-benefits ratio, but was ineffective.

TARGETED STELLATE DECENTRALIZATION: IMPLICATIONS FOR SYMPATHETIC CONTROL OF VENTRICULAR ELECTROPHYSIOLOGY

PubMed Central

Buckley, Una; Yamakawa, Kentaro; Takamiya, Tatsuo; Armour, J. Andrew; Shivkumar, Kalyanam; Ardell, Jeffrey L.

2015-01-01

Background Selective, bilateral cervicothoracic sympathectomy has proven to be effective for managing ventricular arrhythmias in the setting of structural heart disease. The procedure currently employed removes the caudal portions of both stellate ganglia, along with thoracic chain ganglia down to T4 ganglia. Objective To define the relative contributions of T1-T2 and the T3-T4 paravertebral ganglia in modulating ventricular electrical function. Methods In anesthetized vagotomised porcine subjects (n=8), the heart was exposed via sternotomy along with right and left paravertebral sympathetic ganglia to the T4 level. A 56-electrode epicardial sock was placed over both ventricles to assess epicardial activation recovery intervals (ARI) in response to individually stimulating right and left stellate vs T3 paravertebral ganglia. Responses to T3 stimuli were repeated following surgical removal of the caudal portions of stellate ganglia and T2 bilaterally. Results In intact preparations, stellate ganglion vs T3 stimuli (4Hz, 4ms duration) were titrated to produce equivalent decreases in global ventricular ARIs (right-side 85±6 vs 55±10 ms; left-side 24±3 vs 17±7 ms). Threshold of stimulus intensity applied to T3 ganglia to achieve threshold was 3 times that of T1 threshold. ARIs in unstimulated states were unaffected by bilateral stellate-T2 ganglion removal. Following acute decentralization, T3 stimulation failed to change ARIs. Conclusion Preganglionic sympathetic efferents arising from the T1-T4 spinal cord that project to the heart transit through stellate ganglia via the paravertebral chain. T1-T2 surgical excision is thus sufficient to functionally interrupt central control of peripheral sympathetic efferent activity. PMID:26282244

Differential block of nicotinic synapses on B versus C neurones in sympathetic ganglia of frog by alpha-conotoxins MII and ImI.

PubMed

Tavazoie, S F; Tavazoie, M F; McIntosh, J M; Olivera, B M; Yoshikami, D

1997-03-01

1. The effects of two new acetylcholine receptor antagonists, alpha-conotoxin MII and alpha-conotoxin ImI, on nicotinic synaptic transmission in the 10th paravertebral sympathetic ganglion of the leopard frog (Rana pipiens) were examined. The preganglionic nerve was electrically stimulated (at low frequency, < or = 1 min-1, to avoid use-dependent changes) while compound action potentials of B and C neurones were monitored from the postganglionic nerve. 2. alpha-Conotoxins MII and ImI, at low micromolar concentrations, reversibly blocked both B and C waves, alpha-Conotoxin MII blocked the C wave more effectively than the B wave, whereas the potency of alpha-conotoxin ImI was opposite that of MII. The observation that nicotinic antagonists can differentially block synaptic transmission of B versus C neurones with opposite selectivities strongly suggests that these neurones possess distinct nicotinic receptors. 3. In addition to fast and slow B waves described by others. C waves with two temporally distinguishable components were present in our recordings. Each alpha-conotoxin affected fast and slow B waves similarly. Likewise, toxins did not discriminate between the two components of C waves. This suggests that all neurones within each major class (B or C) may have the same nicotinic receptors. 4. Synthetic forms of alpha-conotoxins MII and ImI were used in the present study. Their ease of synthesis and their specificities should make these toxins useful probes to investigate the various subtypes of neuronal nicotinic acetylcholine receptors.

Thoracic epidural steroid injection for rib fracture pain.

PubMed

Rauchwerger, Jacob J; Candido, Kenneth D; Deer, Timothy R; Frogel, Jonathan K; Iadevaio, Robert; Kirschen, Neil B

2013-06-01

Treatment for rib fracture pain can be broadly divided into pharmacologic approaches with oral and/or parenteral medication and interventional approaches utilizing neuraxial analgesia or peripheral nerve blocks to provide pain relief. Both approaches attempt to control nociceptive and neuropathic pain secondary to osseous injury and nerve insult, respectively. Success of treatment is ultimately measured by the ability of the selected modality to decrease pain, chest splinting, and to prevent sequelae of injury, such as pneumonia. Typically, opioids and NSAIDs are the drugs of first choice for acute pain because of ease of administration, immediate onset of action, and rapid titration to effect. In contrast, neuropathic pain medications have a slower onset of action and are more difficult to titrate to therapeutic effect. Interventional approaches include interpleural catheters, intercostal nerve blocks, paravertebral nerve blocks, and thoracic and lumbar epidural catheters. Each intervention has its own inherent advantages, disadvantages, and success rates. Rib fracture pain management practice is founded on the thoracic surgical and anesthesiology literature. Articles addressing rib fracture pain are relatively scarce in the pain medicine literature. As life expectancy increases, and as healthcare system modifications are implemented, pain medicine physicians may be consulted to treat increasing number of patients suffering rib fracture pain and may need to resort to novel therapeutic measures because of financial constraints imposed by those changes. Here we present the first published case series of thoracic epidural steroid injections used for management of rib fracture pain. © 2012 The Authors Pain Practice © 2012 World Institute of Pain.

Midstream clean-catch urine collection in newborns: a randomized controlled study.

PubMed

Altuntas, Nilgun; Tayfur, Asli Celebi; Kocak, Mesut; Razi, Hasan Cem; Akkurt, Serpil

2015-05-01

We aimed to evaluate a recently defined technique based on bladder stimulation and paravertebral lumbar massage maneuvers in collecting a midstream clean-catch urine sample in newborns. A total of 127 term newborns were randomly assigned either to the experimental group or the control group. Twenty-five minutes after feeding, the genital and perineal areas of the babies were cleaned. The babies were held under the armpits with legs dangling. Bladder stimulation and lumbar paravertebral massage maneuvers were only applied to the babies in the experimental group. Success was defined as collection of a urine sample within 5 min of starting the stimulation maneuvers in the experimental group and of holding under the armpits in the control group. The success rate of urine collection was significantly higher in the experimental group (78%) than in the control group (33%; p < 0.001). The median time (interquartile range) for sample collection was 60 s (64.5 s) in the experimental group and 300 s (95 s) in the control group (p < 0.0001). Contamination rates were similar in both groups (p = 0.770). We suggest that bladder stimulation and lumbar paravertebral massage is a safe, quick, and effective way of collecting midstream clean-catch urine in newborns.

Case Report of Serratus Plane Catheter for Pain Management in a Patient With Multiple Rib Fractures and an Inferior Scapular Fracture.

PubMed

Fu, Peter; Weyker, Paul D; Webb, Christopher A J

2017-03-15

We placed a superficial serratus anterior plane catheter in an elderly woman with dementia and elevated clotting times who presented with multiple rib fractures after a mechanical fall. She was not a surgical candidate, and treatment consisted of conservative management with physical therapy and pain control. She was not a candidate for a patient-controlled analgesia regimen because of her dementia. Given her elevated international normalized ratio, thoracic epidural and paravertebral analgesia was also contraindicated. We placed an ultrasound-guided serratus anterior plane catheter, allowing titratable continuous infusion in a trauma patient, resulting in excellent analgesia without adverse effects.

Transforming Growth Factor-Beta (TGF-β) Signaling in Paravertebral Muscles in Juvenile and Adolescent Idiopathic Scoliosis

PubMed Central

Kwiecien, Magdalena

2014-01-01

Most researchers agree that idiopathic scoliosis (IS) is a multifactorial disease influenced by complex genetic and environmental factors. The onset of the spinal deformity that determines the natural course of the disease, usually occurs in the juvenile or adolescent period. Transforming growth factors β (TGF-βs) and their receptors, TGFBRs, may be considered as candidate genes related to IS susceptibility and natural history. This study explores the transcriptional profile of TGF-βs, TGFBRs, and TGF-β responsive genes in the paravertebral muscles of patients with juvenile and adolescent idiopathic scoliosis (JIS and AIS, resp.). Muscle specimens were harvested intraoperatively and grouped according to the side of the curve and the age of scoliosis onset. The results of microarray and qRT-PCR analysis confirmed significantly higher transcript abundances of TGF-β2, TGF-β3, and TGFBR2 in samples from the curve concavity of AIS patients, suggesting a difference in TGF-β signaling in the pathogenesis of juvenile and adolescent curves. Analysis of TGF-β responsive genes in the transcriptomes of patients with AIS suggested overrepresentation of the genes localized in the extracellular region of curve concavity: LTBP3, LTBP4, ITGB4, and ITGB5. This finding suggests the extracellular region of paravertebral muscles as an interesting target for future molecular research into AIS pathogenesis. PMID:25313366

Preemptive, preventive, multimodal analgesia: what do they really mean?

PubMed

Rosero, Eric B; Joshi, Girish P

2014-10-01

To improve postoperative pain management, several concepts have been developed, including preemptive analgesia, preventive analgesia, and multimodal analgesia. This article will discuss the role of these concepts in improving perioperative pain management. Preemptive analgesia refers to the administration of an analgesic treatment before the surgical insult or tissue injury. Several randomized clinical trials have, however, provided equivocal evidence regarding the benefits of preincisional compared with postincisional analgesic administration. Current general consensus, therefore, indicates that use of preemptive analgesia does not translate into consistent clinical benefits after surgery. Preventive analgesia is a wider concept where the timing of analgesic administration in relation to the surgical incision is not critical. The aim of preventive analgesia is to minimize sensitization induced by noxious stimuli arising throughout the perioperative period. Multimodal analgesia consists of the administration of 2 or more drugs that act by different mechanisms for providing analgesia. These drugs may be administered via the same route or by different routes. Thus, the aim of multimodal analgesia is to improve pain relief while reducing opioid requirements and opioid-related adverse effects. Analgesic modalities currently available for postoperative pain control include opioids, local anesthetic techniques [local anesthetic infiltration, peripheral nerve blocks, and neuraxial blocks (epidural and paravertebral)], acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2-specific inhibitors as well as analgesic adjuncts such as steroids, ketamine, α-2 agonists, and anticonvulsants.

Paravertebral masses in blue-tailed monitor, Varanus dorianus, indicative of soft-tissue infection with associated osteomyelitis.

PubMed

Rothschild, Bruce M

2014-03-01

Paravertebral osseous masses in reptiles have been attributed to Paget's disease on the basis of histology. Histologically recognized mosaic architecture and cement lines, however, lack specificity. A Varanus dorianus with this condition was subjected to standard and computerized tomography. Because the masses were extraskeletal in nature, Paget's disease could be excluded. Although interpretation of the computed tomography suggested the process to be entirely extraskeletal, standard radiographs revealed disorganized vertebral architecture characteristic of osteomyelitis, crossing intervertebral spaces. Posttraumatic myositis ossificans and calcified hematoma were confidently excluded as diagnoses. The etiology of paraspinal masses in this V. dorianus appears attributable to infection, with infection of a puncture wound hypothesized as the underlying process. If one extrapolates the findings in this one animal, it seems reasonable to suggest that consideration be given to investigating the possibility of an infectious origin when similar masses are recognized in other reptiles.

Aggressive vertebral hemangioma of the thoracic spine without typical radiological appearance.

PubMed

Dang, Lei; Liu, Chen; Yang, Shao Min; Jiang, Liang; Liu, Zhong Jun; Liu, Xiao Guang; Yuan, Hui Shu; Wei, Feng; Yu, Miao

2012-10-01

Vertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported treatments include radiotherapy, vertebroplasty, direct alcohol injection, embolization, surgery and a combination of these modalities. A 41-year-old lady was presented with 18 month history of intermittent back pain. CT revealed T5 osteolytic lesion with epidural and paravertebral extension. The first CT guided biopsy yielded little information. Histopathological diagnosis of the second biopsy was VH. Vertebroplasty, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately after the operation. At 12 months follow-up, no recurrence was detected by CT with contrast enhancement. Surgical decompression, vertebroplasty and fixation are safe and effective for aggressive VH. More attention is needed in determining the algorithm for the diagnosis and treatment of aggressive VH.

The fourth Bent-toed Gecko of the genus Cyrtodactylus (Squamata: Gekkonidae) from Java, Indonesia.

PubMed

Riyanto, Awal; Grismer, L Lee; Wood, Perry L

2015-12-22

Cyrtodactylus petani sp. nov. is a new species of Bent-toed Gecko from Java, Indonesia that had been masquerading under the name C. fumosus (Müller, 1895). The new species is differentiated from C. fumosus and all its Sundaland congeners by having the following combination of morphological characters: a maximum SVL of 57.2 mm; nine or ten supralabials; seven or eight infralabials; strongly tuberculate body and limbs; 20-25 paravertebral tubercles; 30-35 ventral scales; enlarged precloacal scales; enlarged femoral scales; 17-18 subdigital lamellae on the fourth toe; 31-35 continuous precloacal and femoral pores in males, pores absent in females; no precloacal groove; no enlarged median subcaudals; tubercles on anterior portion of tail; no reticulated pattern on top of head; a blotched dorsal pattern; and no paired, dark, semi-lunar shaped blotches on the nape.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Urman, M.; O'Sullivan, R.A.; Nugent, R.A.

This case concerns a patient with intracranial extramedullary hematopoiesis (EH) suspected on a CT scan and subsequently confirmed with In-111 chloride and Tc-99m SC bone marrow scans. The bone marrow scans also provided additional information by demonstrating other sites of EH in the paravertebral tissues and bone marrow expansion into the distal extremities.

Spinal Cord Injury-Induced Dysautonomia via Plasticity in Paravertebral Sympathetic Postganglionic

DTIC Science & Technology

2016-10-01

sympathetic chain of the guinea - pig . J Physiol 203:173-198. Bratton B, Davies P, Janig W, McAllen R (2010) Ganglionic transmission in a vasomotor...sympathetic neurons. Journal of neurophysiology 82:2747-2764. Lichtman JW, Purves D, Yip JW (1980) Innervation of sympathetic neurones in the guinea - pig ...10 6. PRODUCTS

An elderly-onset limb girdle muscular dystrophy type 1B (LGMD1B) with pseudo-hypertrophy of paraspinal muscles.

PubMed

Furuta, Mitsuru; Sumi-Akamaru, Hisae; Takahashi, Masanori P; Hayashi, Yukiko K; Nishino, Ichizo; Mochizuki, Hideki

2016-09-01

Mutations in LMNA, encoding A-type lamins, lead to diverse disorders, collectively called "laminopathies," which affect the striated muscle, cardiac muscle, adipose tissue, skin, peripheral nerve, and premature aging. We describe a patient with limb-girdle muscular dystrophy type 1B (LGMD1B) carrying a heterozygous p.Arg377His mutation in LMNA, in whom skeletal muscle symptom onset was at the age of 65 years. Her weakness started at the erector spinae muscles, which showed marked pseudo-hypertrophy even at the age of 72 years. Her first episode of syncope was at 44 years; however, aberrant cardiac conduction was not revealed until 60 years. The p.Arg377His mutation has been previously reported in several familial LMNA-associated myopathies, most of which showed muscle weakness before the 6th decade. This is the first report of pseudo-hypertrophy of paravertebral muscles in LMNA-associated myopathies. The pseudo-hypertrophy of paravertebral muscles and the elderly-onset of muscle weakness make this case unique and reportable. Copyright © 2016 Elsevier B.V. All rights reserved.

Frequency of Magnetic Resonance Imaging patterns of tuberculous spondylitis in a public sector hospital.

PubMed

Tabassum, Sumera; Haider, Shahbaz

2016-01-01

To determine frequencies of different MRI patterns of tuberculous spondylitisin a public sector hospital in Karachi. This descriptive multidisciplinary case series study was done from October 25, 2011 to May 28, 2012 in Radiology Department and Department of Medicine in the Jinnah Postgraduate Medical Center Karachi. MRI scans (dorsal / lumbosacral spine) of the Patients presenting with backache in Medical OPD, were performed in Radiology Department. Axial and sagittal images of T1 weighted, T2 weighted and STIR sequences of the affected region were taken. A total of 140 patients who were diagnosed as having tuberculous spondylitis were further evaluated and analyzed for having different patterns of involvement of the spine and compared with similar studies. Among frequencies of different MRI pattern of tuberculous spondylitis, contiguous vertebral involvement was 100%, discal involvement 98.6%, paravertebral abscess 92.1% cases, epidural abscess 91.4%, spinal cord / thecal sac compression 89.3%, vertebral collapse 72.9%, gibbus deformity 42.9% and psoas abscess 36.4%. Contiguous vertebral involvement was commonest MRI pattern, followed by disk involvement, paravertebral & epidural abscesses, thecal sac compression and vertebral collapse.

Open versus percutaneous instrumentation in thoracolumbar fractures: magnetic resonance imaging comparison of paravertebral muscles after implant removal.

PubMed

Ntilikina, Yves; Bahlau, David; Garnon, Julien; Schuller, Sébastien; Walter, Axel; Schaeffer, Mickaël; Steib, Jean-Paul; Charles, Yann Philippe

2017-08-01

OBJECTIVE Percutaneous instrumentation in thoracolumbar fractures is intended to decrease paravertebral muscle damage by avoiding dissection. The aim of this study was to compare muscles at instrumented levels in patients who were treated by open or percutaneous surgery. METHODS Twenty-seven patients underwent open instrumentation, and 65 were treated percutaneously. A standardized MRI protocol using axial T1-weighted sequences was performed at a minimum 1-year follow-up after implant removal. Two independent observers measured cross-sectional areas (CSAs, in cm 2 ) and region of interest (ROI) signal intensity (in pixels) of paravertebral muscles by using OsiriX at the fracture level, and at cranial and caudal instrumented pedicle levels. An interobserver comparison was made using the Bland-Altman method. Reference ROI muscle was assessed in the psoas and ROI fat subcutaneously. The ratio ROI-CSA/ROI-fat was compared for patients treated with open versus percutaneous procedures by using a linear mixed model. A linear regression analyzed additional factors: age, sex, body mass index (BMI), Pfirrmann grade of adjacent discs, and duration of instrumentation in situ. RESULTS The interobserver agreement was good for all CSAs. The average CSA for the entire spine was 15.7 cm 2 in the open surgery group and 18.5 cm 2 in the percutaneous group (p = 0.0234). The average ROI-fat and ROI-muscle signal intensities were comparable: 497.1 versus 483.9 pixels for ROI-fat and 120.4 versus 111.7 pixels for ROI-muscle in open versus percutaneous groups. The ROI-CSA varied between 154 and 226 for open, and between 154 and 195 for percutaneous procedures, depending on instrumented levels. A significant difference of the ROI-CSA/ROI-fat ratio (0.4 vs 0.3) was present at fracture levels T12-L1 (p = 0.0329) and at adjacent cranial (p = 0.0139) and caudal (p = 0.0100) instrumented levels. Differences were not significant at thoracic levels. When adjusting based on age, BMI, and Pfirrmann grade, a significant difference between open and percutaneous procedures regarding the ROI-CSA/ROI-fat ratio was present in the lumbar spine (p < 0.01). Sex and duration of instrumentation had no significant influence. CONCLUSIONS Percutaneous instrumentation decreased muscle atrophy compared with open surgery. The MRI signal differences for T-12 and L-1 fractures indicated less fat infiltration within CSAs in patients who received percutaneous treatment. Differences were not evidenced at thoracic levels, where CSAs were smaller. Fat infiltration was not significantly different at lumbar levels with either procedure in elderly patients with associated discopathy and higher BMI. In younger patients, there was less fat infiltration of lumbar paravertebral muscles with percutaneous procedures.

Long-term use of nerve block catheters in paediatric patients with cancer related pathologic fractures

PubMed Central

BURGOYNE, L. L.; PEREIRAS, L. A.; BERTANI, L. A.; KADDOUM, R. N.; NEEL, M.; FAUGHNAN, L. G.; ANGHELESCU, D. L.

2013-01-01

SUMMARY We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control. PMID:22813501

Retrieval of Cement Embolus from Inferior Vena Cava After Percutaneous Vertebroplasty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Athreya, S., E-mail: sathreya@stjoes.c; Mathias, N.; Rogers, P.

Percutaneous vertebroplasty is an accepted treatment for painful vertebral compression fractures caused by osteoporosis and malignant disease. Venous leakage of cement and pulmonary cement embolism have been reported complications. We describe a paravertebral venous cement leak resulting in the deposition of a cement cast in the inferior vena cava and successful retrieval of the cement embolus.

Calcium channel subtypes differ at two types of cholinergic synapse in lumbar sympathetic neurones of guinea-pigs.

PubMed

Ireland, D R; Davies, P J; McLachlan, E M

1999-01-01

1. The involvement of different presynaptic Ca2+ channels in transmission at 'weak' (subthreshold) and 'strong' (suprathreshold) synapses was investigated in guinea-pig paravertebral ganglia isolated in vitro. Selective Ca2+ channel antagonists were used to block excitatory synaptic currents evoked by stimulating single preganglionic axons. 2. The N-type Ca2+ channel blocker, omega-conotoxin GVIA (100 nM), reduced peak synaptic conductance by similar amounts at weak synapses (by 39 +/- 6 %) and strong synapses (34 +/- 6 %). 3. The P-type Ca2+ channel blocker, omega-agatoxin IVA (40 nM), significantly reduced transmitter release at weak synapses (by 42 +/- 6 %) but had only a small effect at strong synapses (reduced by 6 +/- 2 %). 4. Blockers of Q-, L- or T-type Ca2+ channels had no significant effects on peak synaptic conductance at either type of synapse. 5. We conclude that the two functionally distinct types of preganglionic terminal in sympathetic ganglia which synapse on the same neurone differ in their expression of particular types of voltage-dependent Ca2+ channels. Both types utilize N-type channels and channels resistant to blockade by specific antagonists, but Ca2+ entry through P-type channels makes a substantial contribution to acetylcholine release only at weak synapses.

Calcium channel subtypes differ at two types of cholinergic synapse in lumbar sympathetic neurones of guinea-pigs

PubMed Central

Ireland, David R; Davies, Philip J; McLachlan, Elspeth M

1999-01-01

The involvement of different presynaptic Ca2+ channels in transmission at ‘weak’ (subthreshold) and ‘strong’ (suprathreshold) synapses was investigated in guinea-pig paravertebral ganglia isolated in vitro. Selective Ca2+ channel antagonists were used to block excitatory synaptic currents evoked by stimulating single preganglionic axons.The N-type Ca2+ channel blocker, ω-conotoxin GVIA (100 nm), reduced peak synaptic conductance by similar amounts at weak synapses (by 39 ± 6%) and strong synapses (34 ± 6%).The P-type Ca2+ channel blocker, ω-agatoxin IVA (40 nm), significantly reduced transmitter release at weak synapses (by 42 ± 6%) but had only a small effect at strong synapses (reduced by 6 ± 2%).Blockers of Q-, L- or T-type Ca2+ channels had no significant effects on peak synaptic conductance at either type of synapse.We conclude that the two functionally distinct types of preganglionic terminal in sympathetic ganglia which synapse on the same neurone differ in their expression of particular types of voltage-dependent Ca2+ channels. Both types utilize N-type channels and channels resistant to blockade by specific antagonists, but Ca2+ entry through P-type channels makes a substantial contribution to acetylcholine release only at weak synapses. PMID:9831716

Nano-structured polymer composites and process for preparing same

DOEpatents

Hillmyer, Marc; Chen, Liang

2013-04-16

A process for preparing a polymer composite that includes reacting (a) a multi-functional monomer and (b) a block copolymer comprising (i) a first block and (ii) a second block that includes a functional group capable of reacting with the multi-functional monomer, to form a crosslinked, nano-structured, bi-continuous composite. The composite includes a continuous matrix phase and a second continuous phase comprising the first block of the block copolymer.

Recurrent spontaneous massive hemothorax from intrathoracic extramedullary hematopoiesis resulting in respiratory failure.

PubMed

Chu, Kuo-An; Hsu, Chien-Wei; Lin, Min-Hsi; Lin, Shyh-Jer; Huang, Yi-Luan

2015-03-01

Extramedullary hematopoiesis (EMH) is a compensatory response to many chronic anemic disorders. Intrathoracic EMH, usually presenting as paravertebral masses over the posterior mediastinum, is a rare entity and is usually asymptomatic. Hemothorax is a rare but possibly fatal complication. Local radiation for intrathoracic EMH is considered effective in preventing its recurrence. Here we describe a patient who had had α-thalassemia for many years and developed a spontaneous left-sided hemothorax from EMH. A chest film and a chest computed tomography (CT) scan had showed multiple paravertebral masses over the lower thoracic spine with left-sided pleural effusion. A pathological diagnosis of EMH was made by video-assisted thoracoscopic surgery. The patient had not received preventive local chest radiation. Ten years later, he suffered from a life-threatening hemothorax complicated by acute respiratory failure without traumatic history. A CT scan showed posterior mediastinal masses over the lower thoracic spine with right-sided pleural effusion. Thoracoscopy was performed to remove the blood clot in the pleural space for successful weaning from mechanical ventilation. This is the first case of intrathoracic EMH to have recurrent hemothorax associated with acute respiratory failure. Copyright © 2012. Published by Elsevier B.V.

Frequency of Magnetic Resonance Imaging patterns of tuberculous spondylitis in a public sector hospital

PubMed Central

Tabassum, Sumera; Haider, Shahbaz

2016-01-01

Objective: To determine frequencies of different MRI patterns of tuberculous spondylitisin a public sector hospital in Karachi. Methods: This descriptive multidisciplinary case series study was done from October 25, 2011 to May 28, 2012 in Radiology Department and Department of Medicine in the Jinnah Postgraduate Medical Center Karachi. MRI scans (dorsal / lumbosacral spine) of the Patients presenting with backache in Medical OPD, were performed in Radiology Department. Axial and sagittal images of T1 weighted, T2 weighted and STIR sequences of the affected region were taken. A total of 140 patients who were diagnosed as having tuberculous spondylitis were further evaluated and analyzed for having different patterns of involvement of the spine and compared with similar studies. Results: Among frequencies of different MRI pattern of tuberculous spondylitis, contiguous vertebral involvement was 100%, discal involvement 98.6%, paravertebral abscess 92.1% cases, epidural abscess 91.4%, spinal cord / thecal sac compression 89.3%, vertebral collapse 72.9%, gibbus deformity 42.9% and psoas abscess 36.4%. Conclusion: Contiguous vertebral involvement was commonest MRI pattern, followed by disk involvement, paravertebral & epidural abscesses, thecal sac compression and vertebral collapse. PMID:27022369

Continuous PECS II block for postoperative analgesia in patients undergoing transapical transcatheter aortic valve implantation.

PubMed

Shakuo, Tomoharu; Kakumoto, Shinichi; Kuribayashi, Junya; Oe, Katsunori; Seo, Katsuhiro

2017-01-01

It has been reported that PECS II block can alleviate postoperative pain following transapical transcatheter aortic valve implantation (TA-TAVI). However, the effectiveness of continuous PECS II block with catheterization has not yet been reported on the postoperative pain in patients undergoing TA-TAVI. We experienced two cases of TA-TAVI who received PECS II block with catheterization to manage postoperative pain. In the first case, a bolus injection for intraoperative pain and subsequent catheterization were performed before the implantation. However, the patient developed severe pain postoperatively in spite of the continuous block due to displacement of the catheter. In the second case, a bolus injection and the catheterization for the continuous block were performed before and after the implantation, respectively, which provided high-quality pain control. Continuous PECS II block may be useful to control perioperative pain associated with TA-TAVI. The insertion of the catheter after the implantation could be useful to avoid its displacement during the surgery.

[Dosimetry verification of radioactive seed implantation with 3D printing template and CT guidance for paravertebral/retroperitoneal malignant tumor].

PubMed

Ji, Z; Jiang, Y L; Guo, F X; Peng, R; Sun, H T; Fan, J H; Wang, J J

2017-04-04

Objective: To compare the dose distributions of postoperative plans with preoperative plans for seeds implantations of paravertebral/retroperitoneal tumors assisted by 3D printing guide template and CT guidance, explore the effects of the technology for seeds implantations in dosimetry level and provide data support for the optimization and standardization in seeds implantation. Methods: Between December 2015 and July 2016, a total of 10 patients with paravertebral/retroperitoneal tumors (12 lesions) received 3D printing template assist radioactive seeds implantations in department of radiation oncology of Peking University Third Hospital, and included in the study. The diseases included cervical cancer, kidney cancer, abdominal stromal tumor, leiomyosarcoma of kidney, esophageal cancer and carcinoma of ureter. The prescribed doses was 110-150 Gy. All patients received preoperative planning design, individual template design and production, and the dose distribution of postoperative plan was compared with preoperative plan. Dose parameters including D(90), MPD, V(100), V(150,)conformal index(CI), EI of target volume and D(2cc) of organs at risk (spinal cord, aorta, kidney). Statistical software was SPSS 19.0 and statistical method was non-parameters Wilcoxon symbols test. Results: A total of 10 3D printing templates were designed and produced which were including 12 treatment areas.The mean D(90) of postoperative target area (GTV) was 131.1 (97.8-167.4 Gy) Gy. The actual seeds number of post operation increased by 3 to 12 in 5 cases (42.0%). The needle was well distributed. For postoperative plans, the mean D(90,)MPD, V(100,)V(150) was 131.1 Gy, 69.3 Gy, 90.2% and 65.2%, respectively, and which was 140.2 Gy, 65.6 Gy, 91.7% and 26.8%, respectively, in preoperative plans. This meant that the actual dose of target volume was slightly lower than preplanned dose, and the high dose area of target volume was larger than preplanned range, but there was no statistical difference in P value between the two groups except V(150)( P =0.004). The actual dose conformity of target volume was worse than preplanned (CI was 0.58 and 0.62, respectively) and the difference was statistically significant( P =0.019). The actual dose of external target volume was higher than preplanned (EI was 55% and 45.9%, respectively) and the difference had no significance. For organs at risk, the actual mean D(2cc) of spinal cord, aorta and kidney was 24.7, 54.4 and 29.7 Gy, respectively, which was higher than preplanned(20.6, 51.6 and 28.6 Gy, respectively), and there was no significant difference in two groups. Conclusions: Most parameters of postoperative validations for 3D printing template assisted seeds implantation in paravertebral/retroperitoneal are closed to the expectations of preoperative plans which means the improvement of accuracy in treatment.

Randomised controlled pilot study to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain: TOPIC feasibility study protocol.

PubMed

Yeung, Joyce; Melody, Teresa; Kerr, Amy; Naidu, Babu; Middleton, Lee; Tryposkiadis, Kostas; Daniels, Jane; Gao, Fang

2016-12-01

Open chest surgery (thoracotomy) is considered the most painful of surgical procedures. Forceful wound retraction, costochondral dislocation, posterior costovertebral ligament disruption, intercostal nerve trauma and wound movement during respiration combine to produce an acute, severe postoperative pain insult and persistent chronic pain many months after surgery is common. Three recent systematic reviews conclude that unilateral continuous paravertebral blockade (PVB) provides analgesia at least equivalent to thoracic epidural blockade (TEB) in the postoperative period, has a lower failure rate, and symptom relief that lasted months. Crucially, PVB may reduce the development of subsequent chronic pain by intercostal nerve protection or decreased nociceptive input. The overall aim is to determine in patients who undergo thoracotomy whether perioperative PVB results in reducing chronic post-thoracotomy pain (CPTP) compared with TEB. This pilot study will evaluate feasibility of a substantive trial. TOPIC is a randomised controlled trial comparing the effectiveness of TEB and PVB in reducing CPTP. This is a pilot study to evaluate feasibility of a substantive trial and study processes in 2 adult thoracic centres, Heart of England NHS Foundation Trust (HEFT) and University Hospital of South Manchester NHS Foundation Trust (UHSM). The primary objective is to establish the number of patients randomised as a proportion of those eligible. Secondary objectives include evaluation of study processes. Analyses of feasibility and patient-reported outcomes will primarily take the form of simple descriptive statistics and where appropriate, point estimates of effects sizes and associated 95% CIs. The study has obtained ethical approval from NHS Research Ethics Committee (REC number 14/EM/1280). Dissemination plan includes: informing patients and health professionals; engaging multidisciplinary professionals to support a proposal of a definitive trial and submission for a full HTA application dependent on the success of the study. ISRCTN45041624; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Spinal Cord Injury-Induced Dysautonomia via Plasticity in Paravertebral Sympathetic Postganglionic

DTIC Science & Technology

2015-10-01

for future study Data analysis and publications Major Task 3: Data analysis and publications months % completion/ Completion dates Subtask 1...Data analysis 6-36 25% Subtask 2: Manuscript writing and submission 24-36 10% Milestone(s) Achieved: Dissemination of scientific results. b. What...ganglia by computational simulation and dynamic-clamp analysis . Journal of neurophysiology 92, 2659- 2671, doi:10.1152/jn.00470.2004 (2004). 14 Llewellyn

Non-Traumatic Myositis Ossificans in the Lumbosacral Paravertebral Muscle

PubMed Central

Jung, DaeYoung; Roh, Ji Hyeon

2013-01-01

Myositis ossificans (MO) is a benign condition of non-neoplastic heterotopic bone formation in the muscle or soft tissue. Trauma plays a role in the development of MO, thus, non-traumatic MO is very rare. Although MO may occur anywhere in the body, it is rarely seen in the lumbosacral paravertebral muscle (PVM). Herein, we report a case of non-traumatic MO in the lumbosacral PVM. A 42-year-old man with no history of trauma was referred to our hospital for pain in the low back, left buttock, and left thigh. On physical examination, a slightly tender, hard, and fixed mass was palpated in the left lumbosacral PVM. Computed tomography showed a calcified mass within the left lumbosacral PVM. Magnetic resonance imaging (MRI) showed heterogeneous high signal intensity in T1- and T2-weighted image, and no enhancement of the mass was found in the postcontrast T1-weighted MRI. The lack of typical imaging features required an open biopsy, and MO was confirmed. MO should be considered in the differential diagnosis when the imaging findings show a mass involving PVM. When it is difficult to distinguish MO from soft tissue or bone malignancy by radiology, it is necessary to perform a biopsy to confirm the diagnosis. PMID:23908707

Neisseria gonorrhoeae paravertebral abscess.

PubMed

Low, Sharon Y Y; Ong, Catherine W M; Hsueh, Po-Ren; Tambyah, Paul Ananth; Yeo, Tseng Tsai

2012-07-01

The authors present the case of an isolated gonococcal paravertebral abscess with an epidural component in a 42-year-old man. A primary epidural abscess of the spine is a rare condition and is most commonly caused by Staphylococcus aureus. In this report, the authors present their therapeutic decisions and review the relevant literature on disseminated gonococcal infection in a patient presenting with an epidural abscess. A 42-year-old Indonesian man was admitted with symptoms of neck and upper back pain and bilateral lower-limb weakness. Clinical examination was unremarkable apart from tenderness over the lower cervical spine. Postgadolinium T1-weighted MRI of the cervical and thoracic spine demonstrated an enhancing lesion in the right paraspinal and epidural soft tissue at C-6 to T1-2, in keeping with a spinal epidural abscess. The patient underwent laminectomy of C-7 and T-1 with abscess drainage. Tissue cultures subsequently grew Neisseria gonorrhoeae that was resistant to quinolones by genotyping. Upon further questioning, the patient admitted to unprotected sexual intercourse with commercial sex workers. Further investigations showed that he was negative for other sexually transmitted infections. Postoperatively, he received a course of beta-lactam antibiotics with good recovery. Clinicians should be aware of this unusual disseminated gonococcal infection manifested in any patient with the relevant risk factors.

Continuous femoral nerve block using 0.125% bupivacaine does not prevent early ambulation after total knee arthroplasty.

PubMed

Beebe, Michael J; Allen, Rachel; Anderson, Mike B; Swenson, Jeffrey D; Peters, Christopher L

2014-05-01

Continuous femoral nerve block has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay. However, several studies have raised the concern that continuous femoral nerve block may delay patient ambulation and increase the risk of falls during the postoperative period. This study sought to determine whether continuous femoral nerve block with a single-shot sciatic block prevented early ambulation after total knee arthroplasty (TKA) and whether the technique was associated with adverse effects. Between January 2011 and January 2013, 77 consecutive patients undergoing primary TKAs at an orthopaedic specialty hospital received a continuous femoral nerve block for perioperative analgesia. The femoral block was placed preoperatively with an initial bolus and 76 (99%) patients received a single-shot sciatic nerve block performed at the same time. Fifty-eight percent (n = 45) received an initial bolus of 0.125% bupivacaine and 42% (n = 32) received 0.25% bupivacaine. All 77 patients received 0.125% bupivacaine infusion postoperatively with the continuous femoral nerve block. All patients were provided a knee immobilizer that was worn while they were out of bed and was used until 24 hours after removal of the block. All patients also used a front-wheeled walker to assist with ambulation. All 77 patients had complete records for assessing the end points of interest in this retrospective case series, including distance ambulated each day and whether in-hospital complications could be attributed to the patients' nerve blocks. Thirty-five patients (45%) ambulated for a mean distance of 19 ± 22 feet on the day of surgery. On postoperative Days 1 and 2, all 77 patients successfully ambulated a mean of 160 ± 112 and 205 ± 123 feet, respectively. Forty-eight patients (62%) had documentation of ascending/descending stairs during their hospital stay. No patient fell during the postoperative period, required return to the operating room, or readmission within 90 days of surgery. One patient experienced a transient foot drop related to the sciatic nerve block, which resolved by postoperative Day 1. Continuous femoral nerve block with dilute bupivacaine (0.125%) can be successfully used after TKA without preventing early ambulation. By taking active steps to prevent in-hospital falls, including the use of a knee immobilizer for ambulation while the block is in effect, patients can benefit from the analgesia provided by the block and still ambulate early after TKA. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Merging Bottom-Up with Top-Down: Continuous Lamellar Networks and Block Copolymer Lithography

NASA Astrophysics Data System (ADS)

Campbell, Ian Patrick

Block copolymer lithography is an emerging nanopatterning technology with capabilities that may complement and eventually replace those provided by existing optical lithography techniques. This bottom-up process relies on the parallel self-assembly of macromolecules composed of covalently linked, chemically distinct blocks to generate periodic nanostructures. Among the myriad potential morphologies, lamellar structures formed by diblock copolymers with symmetric volume fractions have attracted the most interest as a patterning tool. When confined to thin films and directed to assemble with interfaces perpendicular to the substrate, two-dimensional domains are formed between the free surface and the substrate, and selective removal of a single block creates a nanostructured polymeric template. The substrate exposed between the polymeric features can subsequently be modified through standard top-down microfabrication processes to generate novel nanostructured materials. Despite tremendous progress in our understanding of block copolymer self-assembly, continuous two-dimensional materials have not yet been fabricated via this robust technique, which may enable nanostructured material combinations that cannot be fabricated through bottom-up methods. This thesis aims to study the effects of block copolymer composition and processing on the lamellar network morphology of polystyrene-block-poly(methyl methacrylate) (PS-b-PMMA) and utilize this knowledge to fabricate continuous two-dimensional materials through top-down methods. First, block copolymer composition was varied through homopolymer blending to explore the physical phenomena surrounding lamellar network continuity. After establishing a framework for tuning the continuity, the effects of various processing parameters were explored to engineer the network connectivity via defect annihilation processes. Precisely controlling the connectivity and continuity of lamellar networks through defect engineering and optimizing the block copolymer lithography process thus enabled the top-down fabrication of continuous two-dimensional gold networks with nanoscale properties. The lamellar structure of these networks was found to confer unique mechanical properties on the nanowire networks and suggests that materials templated via this method may be excellent candidates for integration into stretchable and flexible devices.

Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only.

PubMed

Tang, Ming-xing; Zhang, Hong-qi; Wang, Yu-xiang; Guo, Chao-feng; Liu, Jin-yang

2016-02-01

Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting, and internal fixation can be completed with only one incision and surgical position, and the deformity correction efficiency is higher than anterior surgery. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

31 CFR 510.301 - Blocked account; blocked property.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

31 CFR 510.301 - Blocked account; blocked property.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

31 CFR 510.301 - Blocked account; blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

Spinal Epidural Haemangioma Associated with Extensive Gastrointestinal Haemangiomas

PubMed Central

Cheng, L.T.E.; Lim, W.E.H.

2005-01-01

Summary A case of spinal epidural cavernous haemangioma associated with gastrointestinal haemangiomas is discussed. The patient was a young Chinese female presenting with chronic lower back pain. She had a history of extensive gastric and small bowel haemangiomas. Lumbar spine MRI showed a heterogeneously enhancing epidural mass infiltrating the paravertebral muscles. Open biopsy confirmed an epidural cavernous haemangioma. To our knowledge, an association between spinal epidural cavernous haemangiomas and gastrointestinal haemangiomas has not been reported. PMID:20584496

Hypoplastic left heart syndrome and pulmonary veno-occlusive disease in an infant.

PubMed

D'Souza, Marise; Vergales, Jeffrey; Jayakumar, K Anitha

2013-01-01

This report describes an infant with heterotaxy syndrome and severe hypoplasia of the left heart who presented with profound cyanosis at birth despite a large patent ductus arteriosus. Pulmonary venous return was difficult to demonstrate by echocardiography. Angiography showed total anomalous pulmonary venous return via a plexus that drained through the paravertebral veins and bilateral superior vena cavae. Autopsy confirmed these findings, and histopathology demonstrated severe occlusive changes within the pulmonary veins.

The role of the paravertebral muscles in adolescent idiopathic scoliosis evaluated by temporary paralysis.

PubMed

Wong, Christian; Gosvig, Kasper; Sonne-Holm, Stig

2017-01-01

Muscle imbalance has been suggested as implicated in the pathology of adolescent idiopathic scoliosis (AIS). The specific "pathomechanic" role of the paravertebral muscles as being scoliogenic (inducing scoliosis) or counteracting scoliosis in the initial development and maintenance of this spinal deformity has yet to be clarified in humans. In the present study, we investigated the radiographic changes of temporal paralysis using botulinum toxin A as localized injection therapy (ITB) in the psoas major muscle in AIS patients. Nine patients with AIS were injected one time with ITB using ultrasonic and EMG guidance in the selected spine muscles. Radiographic and clinical examinations were performed before and 6 weeks after the injection. Primary outcome parameters of radiological changes were analyzed using Wilcoxon signed-rank test and binomial test, and secondary outcome parameters of short- and long-term clinical effects were obtained. Significant radiological corrective changes were seen in the frontal plane in the thoracic and lumbar spine as well as significant derotational corrective change in the lumbar spine according to Cobb's angle measurements and to Nash and Moe's classification, respectively. No serious adverse events were detected at follow-up. In conclusion, this study demonstrated that the psoas major muscle do play a role into the pathology in adolescent idiopathic scoliosis by maintaining the curvature of the lumbar spine and thoracic spine. EudraCT number 2008-004584-19.

31 CFR 598.301 - Blocked account; blocked property.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

31 CFR 598.301 - Blocked account; blocked property.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

31 CFR 598.301 - Blocked account; blocked property.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

31 CFR 598.301 - Blocked account; blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

Comparison of Continuous Femoral Nerve Block with and Without Combined Sciatic Nerve Block after Total Hip Arthroplasty: A Prospective Randomized Study.

PubMed

Nishio, Shoji; Fukunishi, Shigeo; Fukui, Tomokazu; Fujihara, Yuki; Okahisa, Shohei; Takeda, Yu; Yoshiya, Shinichi

2017-06-23

In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery.

PubMed

Kim, Eun Soo; Kim, Hae Kyu; Baik, Ji Seok; Ji, Young Tae

2016-07-01

Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants.

Melorheostosis involving the cervical and upper thoracic spine: radiographic, CT, and MR imaging findings.

PubMed

Motimaya, A M; Meyers, S P

2006-01-01

Melorheostosis, an uncommon mesenchymal dysplasia, rarely affects the axial skeleton. We describe the imaging findings of melorheostosis involving the cervical and upper thoracic spine. Radiographs and CT showed unilateral well-marginated undulating zones of cortical hyperostosis involving multiple vertebrae that were contiguous with a coalescent ossified right paravertebral mass. MR imaging showed zones of signal intensity void on all pulse sequences without contrast enhancement. Conservative management was elected because of lack of interval clinical and imaging changes for 8 years.

[Case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by transversus abdominis plane block, rectus sheath block, and continuous wound infusion with ropivacaine].

PubMed

Hotta, Arisa; Yagi, Yuuki; Hakata, Saaya; Tsumura, Yae; Shimizu, Motoko; Kukida, Ayako; Nakamoto, Ai; Yoshikawa, Noriko; Oohira, Naoko; Tatekawa, Shigeki

2013-12-01

Ultrasound-guided peripheral nerve blocks in the abdominal wall, such as transversus abdominis plane block (TAP block) and rectus sheath block, are now widely used. We report a case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by abdominal wall block and continuous infusion. A 61-year-old man diagnosed with Leriche's syndrome underwent Y-graft replacement for an abdominal aortic aneurysm. Preoperative enhanced and 3-dimensional CTs showed many collateral arterial systems, especially in the right abdominal wall. It was suggested that the right internal iliac artery had been completely occluded, and the left one showed severe stenosis. After the induction of general anesthesia, we recognized collateral arteries through an ultrasound view as on preoperative CTs. We lowered the pulse repetition frequency more than usual in order not to injure them. We injected 0.1875% ropivacaine 60 ml as TAP block, and 20 ml as rectus sheath block. When the wound was closed, a catheter was passed through an 18-gauge Tuohy needle placed above the fascia along the supraumbilical site. After the operation, 0.2% ropivacaine was continuously delivered at a rate of 6 ml hr-1 through the catheter. We could provide the patient with effective analgesia after surgery.

[Role of percutaneous vertebroplasty and kyphoplasty in the treatment of oncology disorders of the spine].

PubMed

Ryska, P; Rehák, S; Odráka, K; Maisnar, V; Raupach, J; Málek, V; Renc, O; Kaltofen, K

2006-01-01

The aim of the study is to present results of a prospective uncontrolled clinical study. Percutaneous vertebroplasty or kyphoplasty are minimally invasive methods based on polymethylmethacrylate (PMMA) bone cement application into the damaged vertebra. This leads to decrease of the pain and vertebral body stabilisation. Oncology disorders of the spine are relatively common, having a wide alternative of various methods of treatment. Patients, according to their findings and indication criteria, are treated surgically or conservatively, oncological treatment is usually based on radiotherapy. Authors discuss the role of these invasive procedures in the treating algorithm of patients with spinal metasthases and multiple myeloma. From September 2003 to December 2005, 21 percutaneous vertebroplasties in 14 patients, mean age 68.7 (47-80) year, were performed in our department. During one treatment session 1-2 vertebrae (total of 21 vertebrae) in level Th9 - L5 were treated. Vertebroplasties and kyphoplasty were performed under fluoroscopy guidance. Transpedicular acces was used. Totally, 3 asymptomatic complications were proved. As first, a bone cement leaked paravertebrally during L5 body treatment, as second, a bone cement leaked into paravertebral veins, and as third, a bone cement leaked into the intervertebral space. Visual analog scale (VAS) was 8.9 points before procedure, 1.9 point 3 months after procedure and 2.6 points 6 months after procedure. We did not prove a symptomatic or total complication. According to our experience, percutaneous vertebroplasty is an effective alternative treatment of painful oncologic spine disease.

Has the percutaneous vertebroplasty a role to prevent progression or local recurrence in spinal metastases of breast cancer?

PubMed

Roedel, Beatriz; Clarençon, Frédéric; Touraine, Sébastien; Cormier, Evelyne; Molet-Benhamou, Luc; Le Jean, Lise; Brisse, Hervé; Neuenschwander, Sylvia; Chiras, Jacques

2015-07-01

To evaluate the effectiveness of percutaneous vertebroplasty (PV) on the prevention of progression or local recurrence in patients with spinal metastases from breast cancer. Retrospective study on 55 patients between 27-78 years of age (mean age: 55 years) treated for metastatic breast cancer in the same institution (Curie institute, Paris, France), who underwent percutaneous vertebroplasty (PV) (number of vertebrae treated=137) for spinal metastases from January 2000 to December 2009 at the Pitié-Salpêtrière hospital. Statistical correlation between the local tumor progression/recurrence, and the presence of an epidural or a paravertebral metastatic extension at diagnosis, the rate of cement filling the lesion (<50%, ≥50% but incomplete, complete/almost complete) and radiotherapy was evaluated using Chi(2) and Fisher's exact test. The rate of local tumor progression/recurrence of the vertebrae treated by vertebroplasty was 14% (19/137). No statistically significant correlation between either the rate of cement filling of the lesion, or the presence of an epidural or paravertebral metastatic extension, and progression/local recurrence after vertebroplasty was found. No influence of radiotherapy in preventing local progression/recurrence was noted. Distant new bone metastases were observed in 47 out of 55 patients (86%). The low rate of local tumor progression/recurrence after a vertebroplasty may support the hypothesis of an antitumor effect of the cement. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Spectrum of intra-thoracic lesion detected by computed tomography guided fine needle aspiration biopsy.

PubMed

Naqvi, Hanna; Edhi, Muhammad Muzzammil; Aslam, Hafiz Muhammad; Faridi, Naveen

2013-02-12

Fine needle aspiration biopsy (FNAB) is a rapid, sensitive and inexpensive procedure for diagnosing benign and malignant palpable lesions. For lesions that are not palpable or deep seated, FNAB can be performed under the guidance of radiological imaging. Our basic objective was to evaluate the spectrum of intrathoracic lesions by using Computed Tomography guided fine needle aspiration biopsy and evaluate its diagnostic yield. It was a retrospective study carried out in the Department of Histopathology, Liaquat National Hospital and Medical College, during the months of August 2011 and August 2012. All patients with pulmonary, mediastinal or paravertebral mass who underwent CT guided intrathoracic biopsy were included in this study. Fine needle aspiration biopsies were performed in the Radiology Department and specimen retrieved was sent in 10% buffered Formalin to the Histopathology Department. All the data was entered and analyzed through SPSS 19.0. A total of 130 cases were evaluated, out of which 108 (83.1%) were pulmonary, 16 (12.3%) were mediastinal and 6 (4.6%) were paravertebral. Conclusive biopsies were possible in 113 cases, while 17 biopsies were inconclusive. In those that showed a conclusive diagnosis, 83.1% were neoplastic and 16.9% were non neoplastic. Of the neoplastic cases, 27 (20.8%) were adenocarcinomas, followed by squamous cell carcinomas (15.4%) and large cell carcinoma, not otherwise specified, (12.3%). CT guided fine needle aspiration biopsy is a reliable tool for examination of intrathoracic lesions, with a high rate of conclusive diagnosis.

Spine Topographical Distribution of Skin α-Synuclein Deposits in Idiopathic Parkinson Disease.

PubMed

Donadio, Vincenzo; Incensi, Alex; Rizzo, Giovanni; Scaglione, Cesa; Capellari, Sabina; Fileccia, Enrico; Avoni, Patrizia; Liguori, Rocco

2017-05-01

Phosphorylated α-synuclein (p-syn) in skin nerves mainly in the proximal sites is a promising neurodegenerative biomarker for idiopathic Parkinson disease (IPD). However, the p-syn spine distribution particularly in patients with unilateral motor dysfunctions remains undefined. This study aimed to investigate in IPD p-syn differences between left and right cervical spine sites in patients with prevalent unilateral motor symptoms, and cervical and thoracic spine sites in patients with bilateral motor symptoms. We enrolled 28 IPD patients fulfilling clinical diagnostic criteria associated with abnormal nigro-striatal DatScan and cardiac MIBG: 15 with prevalently unilateral motor symptoms demonstrated by DatScan; 13 with bilateral motor symptoms and DatScan abnormalities. Patients underwent skin biopsy searching for intraneural p-syn deposits: skin samples were taken from C7 paravertebral left and right sites in unilateral patients and from cervical (C7) and thoracic (Th12) paravertebral spine regions in bilateral patients. Unilateral patients displayed 20% of abnormal p-syn deposits in the affected motor site, 60% in both sites and 20% only in the non-affected site. P-syn was found in all patients in C7 but in only 62% of patients in Th12. Our data showed that cervical p-syn deposits displayed a uniform distribution between both sides not following the motor dysfunction in unilateral patients, and skin nerve p-syn deposits demonstrated a spine gradient with the cervical site expressing the highest positivity. © 2017 American Association of Neuropathologists, Inc. All rights reserved.

Trial-dependent psychometric functions accounting for perceptual learning in 2-AFC discrimination tasks.

PubMed

Kattner, Florian; Cochrane, Aaron; Green, C Shawn

2017-09-01

The majority of theoretical models of learning consider learning to be a continuous function of experience. However, most perceptual learning studies use thresholds estimated by fitting psychometric functions to independent blocks, sometimes then fitting a parametric function to these block-wise estimated thresholds. Critically, such approaches tend to violate the basic principle that learning is continuous through time (e.g., by aggregating trials into large "blocks" for analysis that each assume stationarity, then fitting learning functions to these aggregated blocks). To address this discrepancy between base theory and analysis practice, here we instead propose fitting a parametric function to thresholds from each individual trial. In particular, we implemented a dynamic psychometric function whose parameters were allowed to change continuously with each trial, thus parameterizing nonstationarity. We fit the resulting continuous time parametric model to data from two different perceptual learning tasks. In nearly every case, the quality of the fits derived from the continuous time parametric model outperformed the fits derived from a nonparametric approach wherein separate psychometric functions were fit to blocks of trials. Because such a continuous trial-dependent model of perceptual learning also offers a number of additional advantages (e.g., the ability to extrapolate beyond the observed data; the ability to estimate performance on individual critical trials), we suggest that this technique would be a useful addition to each psychophysicist's analysis toolkit.

49 CFR 236.804 - Signal, block.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Signal, block. 236.804 Section 236.804 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Signal, block. A roadway signal operated either automatically or manually at the entrance to a block. ...

Fluorescence Lifetime Study of Cyclodextrin Complexes of Substituted Naphthalenes.

DTIC Science & Technology

1987-08-15

Spectroscopy iip 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse If necessary and identify by block number) FIELD GROUP SUB-GROUP fluorescence lifetime...measurements cyclodextrins spectroscopic techniques 19. TRACT (Continue on revere if necsary and identify by block number

47 CFR 64.1508 - Blocking access to 900 service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Blocking access to 900 service. 64.1508 Section 64.1508 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS RULES RELATING TO COMMON CARRIERS Interstate Pay-Per-Call and Other Information...

Repair, Evaluation, Maintenance, and Rehabilitation Research Program: Case Histories of Corps Breakwater and Jetty Structures. Report 5. North Atlantic Division

DTIC Science & Technology

1988-11-01

TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP Breakwater REMR (Repair, Evaluation, Concrete armor units...Maintenance, and Rehabilitation) Jetty Rubble-mound structures 19. ABSTRACT (Continue on reverse if necessary and identify by block number) :-This...have been repaired since construction. Other construction materials that have been used include steel, dolosse, concrete cap, concrete block , and

49 CFR 236.709 - Block, absolute.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Block, absolute. 236.709 Section 236.709 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Block, absolute. A block in which no train is permitted to enter while it is occupied by another train. ...

31 CFR 594.301 - Blocked account; blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS...

31 CFR 545.301 - Blocked account; blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 545.301 Section 545.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TALIBAN (AFGHANISTAN) SANCTIONS...

49 CFR 236.709 - Block, absolute.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Block, absolute. 236.709 Section 236.709 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Block, absolute. A block in which no train is permitted to enter while it is occupied by another train. ...

31 CFR 551.301 - Blocked account; blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 551.301 Section 551.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY SOMALIA SANCTIONS REGULATIONS...

Self-doped microphase separated block copolymer electrolyte

DOEpatents

Mayes, Anne M.; Sadoway, Donald R.; Banerjee, Pallab; Soo, Philip; Huang, Biying

2002-01-01

A polymer electrolyte includes a self-doped microphase separated block copolymer including at least one ionically conductive block and at least one second block that is immiscible in the ionically conductive block, an anion immobilized on the polymer electrolyte and a cationic species. The ionically conductive block provides a continuous ionically conductive pathway through the electrolyte. The electrolyte may be used as an electrolyte in an electrochemical cell.

47 CFR 64.1512 - Involuntary blocking of pay-per-call services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Involuntary blocking of pay-per-call services. 64.1512 Section 64.1512 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS RULES RELATING TO COMMON CARRIERS Interstate Pay-Per-Call and...

40 CFR 63.482 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... operation operated in a batch mode. Block polymer means a polymer where the polymerization is controlled... frequent block average values. Continuous unit operation means a unit operation operated in a continuous... (EPM) result from the polymerization of ethylene and propylene and contain a saturated chain of the...

40 CFR 63.482 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... operation operated in a batch mode. Block polymer means a polymer where the polymerization is controlled... frequent block average values. Continuous unit operation means a unit operation operated in a continuous... (EPM) result from the polymerization of ethylene and propylene and contain a saturated chain of the...

40 CFR 63.482 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... operation operated in a batch mode. Block polymer means a polymer where the polymerization is controlled... frequent block average values. Continuous unit operation means a unit operation operated in a continuous... (EPM) result from the polymerization of ethylene and propylene and contain a saturated chain of the...

Clustering of GPS velocities in the Mojave Block, southeastern California

USGS Publications Warehouse

Savage, James C.; Simpson, Robert W.

2013-01-01

We find subdivisions within the Mojave Block using cluster analysis to identify groupings in the velocities observed at GPS stations there. The clusters are represented on a fault map by symbols located at the positions of the GPS stations, each symbol representing the cluster to which the velocity of that GPS station belongs. Fault systems that separate the clusters are readily identified on such a map. The most significant representation as judged by the gap test involves 4 clusters within the Mojave Block. The fault systems bounding the clusters from east to west are 1) the faults defining the eastern boundary of the Northeast Mojave Domain extended southward to connect to the Hector Mine rupture, 2) the Calico-Paradise fault system, 3) the Landers-Blackwater fault system, and 4) the Helendale-Lockhart fault system. This division of the Mojave Block is very similar to that proposed by Meade and Hager. However, no cluster boundary coincides with the Garlock Fault, the northern boundary of the Mojave Block. Rather, the clusters appear to continue without interruption from the Mojave Block north into the southern Walker Lane Belt, similar to the continuity across the Garlock Fault of the shear zone along the Blackwater-Little Lake fault system observed by Peltzer et al. Mapped traces of individual faults in the Mojave Block terminate within the block and do not continue across the Garlock Fault [Dokka and Travis, ].

29 CFR 1919.32 - Specially designed blocks and components.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Specially designed blocks and components. 1919.32 Section 1919.32 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... Treatment; Competent Persons § 1919.32 Specially designed blocks and components. (a) Blocks and connecting...

31 CFR 594.301 - Blocked account; blocked property.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS...

31 CFR 594.301 - Blocked account; blocked property.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS...

31 CFR 594.301 - Blocked account; blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS...

31 CFR 546.302 - Blocked account; blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 546.302 Section 546.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DARFUR SANCTIONS REGULATIONS General...

31 CFR 593.301 - Blocked account; blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES...

31 CFR 510.301 - Blocked account; blocked property.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY NORTH KOREA SANCTIONS REGULATIONS General...

31 CFR 547.302 - Blocked account; blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO...

A randomized comparison of ropivacaine 0.1% and 0.2% for continuous interscalene block after shoulder surgery.

PubMed

Yang, Chun Woo; Jung, Sung Mee; Kang, Po Soon; Kwon, Hee Uk; Cho, Choon Kyu; Lee, Younsuk; Kim, Chul Woung; Kim, Su Young

2013-03-01

The optimal concentration of ropivacaine for continuous interscalene block after shoulder surgery is currently unknown. Fifty-six patients received a perineural infusion of either ropivacaine 0.1% or 0.2% for 48 hours after shoulder surgery. We assessed pain scores as primary end points and supplemental analgesia, ropivacaine consumption, motor block, side effects, and patient satisfaction as secondary end points. Pain scores were not statistically different during the infusion periods; however, supplemental analgesia consumption was higher in the group receiving ropivacaine 0.1% during the first 24 hours (64% vs 28%, P = 0.022). Other secondary end points were statistically inconclusive. These results suggest that ropivacaine 0.2% provides more effective analgesia than ropivacaine 0.1% during the first 24 hours for continuous interscalene block after shoulder surgery.

47 CFR 24.716 - Installment payments for licenses for frequency Block F.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Block F. 24.716 Section 24.716 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON....716 Installment payments for licenses for frequency Block F. Installment Payments. Each eligible licensee of frequency Block F may pay the remaining 80 percent of the net auction price for the license in...

49 CFR 236.504 - Operation interconnected with automatic block-signal system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Operation interconnected with automatic block... Operation interconnected with automatic block-signal system. (a) A continuous inductive automatic train stop or train control system shall operate in connection with an automatic block signal system and shall...

47 CFR 24.711 - Installment payments for licenses for frequency Block C.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Block C. 24.711 Section 24.711 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON....711 Installment payments for licenses for frequency Block C. Installment payments. Each eligible licensee of frequency Block C may pay the remaining 90 percent of the net auction price for the license in...

21 CFR 882.5070 - Bite block.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bite block. 882.5070 Section 882.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5070 Bite block. (a) Identification. A bite block...

21 CFR 882.5070 - Bite block.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Bite block. 882.5070 Section 882.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5070 Bite block. (a) Identification. A bite block...

21 CFR 892.5710 - Radiation therapy beam-shaping block.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Radiation therapy beam-shaping block. 892.5710... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5710 Radiation therapy beam-shaping block. (a) Identification. A radiation therapy beam-shaping block is a device made of a highly...

31 CFR 593.301 - Blocked account; blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

31 CFR 593.301 - Blocked account; blocked property.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

31 CFR 593.301 - Blocked account; blocked property.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

31 CFR 593.301 - Blocked account; blocked property.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

21 CFR 892.5710 - Radiation therapy beam-shaping block.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Radiation therapy beam-shaping block. 892.5710... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5710 Radiation therapy beam-shaping block. (a) Identification. A radiation therapy beam-shaping block is a device made of a highly...

21 CFR 892.5710 - Radiation therapy beam-shaping block.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Radiation therapy beam-shaping block. 892.5710... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5710 Radiation therapy beam-shaping block. (a) Identification. A radiation therapy beam-shaping block is a device made of a highly...

21 CFR 892.5710 - Radiation therapy beam-shaping block.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Radiation therapy beam-shaping block. 892.5710... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5710 Radiation therapy beam-shaping block. (a) Identification. A radiation therapy beam-shaping block is a device made of a highly...

47 CFR 52.20 - Thousands-block number pooling.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Thousands-block number pooling. 52.20 Section... (CONTINUED) NUMBERING Number Portability § 52.20 Thousands-block number pooling. (a) Definition. Thousands-block number pooling is a process by which the 10,000 numbers in a central office code (NXX) are...

31 CFR 547.302 - Blocked account; blocked property.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

31 CFR 547.302 - Blocked account; blocked property.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

31 CFR 547.302 - Blocked account; blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

31 CFR 547.302 - Blocked account; blocked property.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

Precomplexation and Activation of Carboxylate and Phosphate Esters

DTIC Science & Technology

1992-03-02

SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP 07 03 19 ABSTRACT (Continue on reverse if...necessary and identify by block number) This is the final report for contract N00014-88-K-0309. It summarizes our previously submitted Technical Reports #1

Inclusion Complexes of Diisopropyl Fluorophosphate with Cyclodextrins.

DTIC Science & Technology

1987-09-01

SUPPLEMENTARY NOTATION For Submission to Journal of Catalysis. 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block...number) FIELD GROUP SUB-GROUP 19. ABSTRACT (Continue on reverse if necessary and identify by block number) See Attached DTIC S ELECTESNOV 2 3 1987D 20

X-Ray Diagnostics of Laser-Produced Aluminum Plasmas

DTIC Science & Technology

1976-06-01

n.n g (E /kT ) ’ (24) ff r l e ff H e but shoys re spectral dependence on T [29]. Thus in the e visible region, electron density can be extracted...abetract entered In Block 20, It different from Report) 18. SUPPLEMENTARY NOTES 19. KEY WORDS ’Continue on reveree aide it neceaaary and Identity by block...Continue on reveree tide It naceeeary and identity by block number) Electron temperatures have been evaluated using the x-ray emission from plasmas

Prevalence of extravertebral cement leakage after vertebroplasty: procedural documentation versus CT detection.

PubMed

Martin, Douglas J; Rad, Arash Ehteshami; Kallmes, David F

2012-06-01

Reported incidence of extravertebral cement leakage after vertebroplasty varies widely across studies. To retrospectively compare the relative detection rates of extravertebral leakage noted under intra-procedural fluoroscopic surveillance, postprocedure plain radiographs, and postprocedure computed tomography (CT) in a cohort of patients undergoing vertebroplasty. With IRB approval, we retrospectively identified 181 patients with 277 levels treated with percutaneous vertebroplasty among a total of 1255 patients undergoing vertebroplasty between 1999 and 2010 who had subsequently undergone a CT examination that included the treated level(s). Categories of leakage were paravertebral, end plate, epidural, and prevertebral venous leakage. CT-detected leak rates were then compared to those noted on the vertebroplasty procedure reports and the archived fluoroscopic images for this same cohort using Pearson's χ(2) test. One hundred and forty-nine (82%, 95% CI 76-87%) of 181 patients demonstrated evidence of some type of leakage on CT at one or more treated levels. Sixty-two (34%, 95% CI 28-42%) and seventy-seven (50%, 95% CI 43-57%) of 149 CT-detected leaks were reported in the procedural dictation or detected on plain radiography (P = 0.01 and 0.006, respectively). The most common type of leakage noted on CT was end plate (n = 81, 45%, 95% CI 38-52%), followed by paravertebral (n = 64, 35%, 95% CI 29-43%), epidural (n = 36, 20%, 95% CI 15-26%), and prevertebral venous (n = 32, 18%, 95% CI 13-24%). Cement leakage after vertebroplasty is common and is often not reported by operators in procedural dictations. CT detects substantially more leaks than plain radiography.

Venous air embolism in consecutive balloon kyphoplasties visualised on CT imaging.

PubMed

Tins, Bernhard J; Cassar-Pullicino, Victor N; Lalam, Radhesh; Haddaway, Mike

2012-09-01

We noted a large amount of intravenous gas during balloon kyphoplasty on CT imaging. Formal assessment to understand the extent, possible causes and implications was undertaken. Ten consecutive cases of balloon kyphoplasty were performed under general anaesthesia in the prone position, on a single vertebral level using a two-step technique under combined fluoroscopic and CT guidance. CT of the affected vertebra was performed before, after, and intermittently during the procedure. In 2 cases delayed CT was carried out in the supine position. Gas was seen on CT imaging, but not on conventional fluoroscopy. The gas is most likely to be air introduced during the procedure and was seen in the epidural and paravertebral venous plexus, posterior intercostal veins, renal veins, IVC and azygos vein. The average measured volume of gas seen on the post-procedure CT imaging was 1.07 mL, range 0.16-3.97 mL. There was no correlation of the measured amount of gas to the procedure duration or location, the use of a curette or the injected cement volume. Delayed CT in the supine position no longer showed air in the local venous system. Balloon kyphoplasty is associated with the fluoroscopically invisible introduction of air into the vertebral and paravertebral veins and deep systemic veins and is likely to be much more extensive than identified on CT imaging. There is potential for serious air embolism in kyphoplasty and if there is a sudden deterioration in patient condition during the procedure the possibility of this complication needs to be considered.

Long constructs in the thoracic and lumbar spine with a minimally invasive technique.

PubMed

Roldan, H; Perez-Orribo, L; Spreafico, M; Ginoves-Sierra, M

2011-04-01

Literature about long implants used together with a minimally invasive spine surgery (MISS) technique is scarce. Our objective is to contribute our surgical experience in this field and to specifically focus on several technical details. A digitally-dissected canal along the paravertebral muscles was created linking the stab wounds on each side in relation with the pedicles to be cannulated. Screws were inserted following the percutaneous technique. Long rods were modelled, threaded through the extender sleeves along the paravertebral canal and pushed into the screw heads with the reduction forceps. When fusion was needed, the facet complex was decorticated with a drill. To insert a cross-link, a canal between the 2 rods was digitally created and the spinous process was drilled. 8 patients underwent surgery (age range: 25-77 years). Indications were postosteomyelitis kyphosis in 3 patients, bone tumor in 3, and spine fracture in 2. No blood transfusions were necessary during or after surgery. A cross-link was inserted in 2 patients. Posterolateral bone fusion was attempted in 4, but radiologically identifiable in none. In one patient a cantilever manoeuvre was done to correct kyphosis. Mean duration of surgery was 4 h. There were no clinical complications related to the operation or the hardware (mean follow-up of 7.14 months, range: 1-15 months). The application of MISS techniques can be broadened to long spinal constructs to assess fractures, tumors or deformity, especially in elderly or debilitated patients. Nevertheless, posterolateral fusion is still a challenge through these limited exposures. © Georg Thieme Verlag KG Stuttgart · New York.

Spectrum of intra-thoracic lesion detected by computed tomography guided fine needle aspiration biopsy

PubMed Central

2013-01-01

Background Fine needle aspiration biopsy (FNAB) is a rapid, sensitive and inexpensive procedure for diagnosing benign and malignant palpable lesions. For lesions that are not palpable or deep seated, FNAB can be performed under the guidance of radiological imaging. Our basic objective was to evaluate the spectrum of intrathoracic lesions by using Computed Tomography guided fine needle aspiration biopsy and evaluate its diagnostic yield. Methodology It was a retrospective study carried out in the Department of Histopathology, Liaquat National Hospital and Medical College, during the months of August 2011 and August 2012. All patients with pulmonary, mediastinal or paravertebral mass who underwent CT guided intrathoracic biopsy were included in this study. Fine needle aspiration biopsies were performed in the Radiology Department and specimen retrieved was sent in 10% buffered Formalin to the Histopathology Department. All the data was entered and analyzed through SPSS 19.0. Results A total of 130 cases were evaluated, out of which 108 (83.1%) were pulmonary, 16 (12.3%) were mediastinal and 6 (4.6%) were paravertebral. Conclusive biopsies were possible in 113 cases, while 17 biopsies were inconclusive. In those that showed a conclusive diagnosis, 83.1% were neoplastic and 16.9% were non neoplastic. Of the neoplastic cases, 27 (20.8%) were adenocarcinomas, followed by squamous cell carcinomas (15.4%) and large cell carcinoma, not otherwise specified, (12.3%). Conclusion CT guided fine needle aspiration biopsy is a reliable tool for examination of intrathoracic lesions, with a high rate of conclusive diagnosis. PMID:23402220

Effect of vibratory soldier alarm signals on the foraging behavior of subterranean termites (Isoptera: Rhinotermitidae).

PubMed

Inta, R; Evans, T A; Lai, J C S

2009-02-01

Termite soldiers produce a vibratory alarm signal to warn conspecific workers. This study recorded and characterized the alarm signals of Coptotermes acinaciformis (Froggatt) (Isoptera: Rhinotermitidae) and then investigated the effect of playing these recorded alarm signals on C. acinaciformis feeding activity. Foraging groups of termites were offered paired wooden blocks: either one block, continuously stimulated with a vibratory alarm signal, paired with a nonstimulated block (the alarm treatment), continuously stimulated with a pink noise signal, paired with a nonstimulated block (control for nonspecific vibrations) or two nonstimulated blocks (control for environmental effects), for 4 wk. The amount of wood eaten in the blocks stimulated by the alarm signals was significantly less than the paired nonstimulated blocks, while there seemed to be no preference in the case of the pink noise playback or control for direction. Importantly, the termites seemed not to have adapted to the recorded alarm signal over the 4-wk duration of the experiment, unlike previous studies using nonbiologically derived signals.

Four quadrant transversus abdominis plane block and continuous transversus abdominis plane analgesia: a 3-year prospective audit in 124 patients.

PubMed

Niraj, G; Kelkar, Aditi; Hart, Elaine; Kaushik, Vipul; Fleet, Danny; Jameson, John

2015-11-01

Transversus abdominis plane (TAP) blocks have been reported to be an effective method of providing analgesia after abdominal surgery. To perform a prospective audit on the effectiveness of a novel technique of providing continuous transversus abdominis plane (TAP) analgesia in patients undergoing emergency and elective abdominal surgery. Prospective single center audit over a 3-year period. University hospital. One hundred twenty-four American Society of Anesthesiologists I to IV adult patients presenting for elective as well as emergency abdominal surgery in whom epidural analgesia was contraindicated or refused. Four quadrant TAP blocks and continuous TAP analgesia. Numerical rating scale pain scores at rest and on coughing, nausea scores, satisfaction scores, complications, frequency of analgesia failure, therapeutic failure with continuous TAP analgesia and opioid consumption. One hundred twenty-four patients who received continuous TAP analgesia were audited. This included 34 patients for elective open surgery, 36 patients for emergency laparotomy, and 54 patients who underwent elective laparoscopic colorectal surgery. Surgical incision was within the dermatomal limit of the block in 70% of the patients (88/124). Therapeutic failure with the technique was 10%. Frequency of analgesic failure over the 48-hour period was none in 39% and below 5 episodes in 57%. Four quadrant transversus abdominis plane blocks and continuous TAP analgesia is an effective technique for providing postoperative analgesia after abdominal surgery. It has the potential to be used as a sole analgesic technique when the surgical incision is within its dermatomal limit. Copyright © 2015 Elsevier Inc. All rights reserved.

14 CFR 156.7 - Enforcement of State block grant agreements and other related grant assurances.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Enforcement of State block grant agreements... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS STATE BLOCK GRANT PILOT PROGRAM § 156.7 Enforcement of State block grant agreements and other related grant assurances. The Administrator may take any...

Block Play: Practical Suggestions for Common Dilemmas

ERIC Educational Resources Information Center

Tunks, Karyn Wellhousen

2009-01-01

Learning materials and teaching methods used in early childhood classrooms have fluctuated greatly over the past century. However, one learning tool has stood the test of time: Wood building blocks, often called unit blocks, continue to be a source of pleasure and learning for young children at play. Wood blocks have the unique capacity to engage…

46 CFR 42.20-25 - Correction for block coefficient.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Correction for block coefficient. 42.20-25 Section 42.20-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) LOAD LINES DOMESTIC AND FOREIGN VOYAGES BY SEA Freeboards § 42.20-25 Correction for block coefficient. If the block coefficient (Cb...

31 CFR 537.209 - Expenses of maintaining blocked property; liquidation of blocked account.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Expenses of maintaining blocked property; liquidation of blocked account. 537.209 Section 537.209 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY...

31 CFR 537.209 - Expenses of maintaining blocked property; liquidation of blocked account.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Expenses of maintaining blocked property; liquidation of blocked account. 537.209 Section 537.209 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY...

Clustering of GPS velocities in the Mojave Block, southeastern California

NASA Astrophysics Data System (ADS)

Savage, J. C.; Simpson, R. W.

2013-04-01

find subdivisions within the Mojave Block using cluster analysis to identify groupings in the velocities observed at GPS stations there. The clusters are represented on a fault map by symbols located at the positions of the GPS stations, each symbol representing the cluster to which the velocity of that GPS station belongs. Fault systems that separate the clusters are readily identified on such a map. The most significant representation as judged by the gap test involves 4 clusters within the Mojave Block. The fault systems bounding the clusters from east to west are 1) the faults defining the eastern boundary of the Northeast Mojave Domain extended southward to connect to the Hector Mine rupture, 2) the Calico-Paradise fault system, 3) the Landers-Blackwater fault system, and 4) the Helendale-Lockhart fault system. This division of the Mojave Block is very similar to that proposed by Meade and Hager []. However, no cluster boundary coincides with the Garlock Fault, the northern boundary of the Mojave Block. Rather, the clusters appear to continue without interruption from the Mojave Block north into the southern Walker Lane Belt, similar to the continuity across the Garlock Fault of the shear zone along the Blackwater-Little Lake fault system observed by Peltzer et al. []. Mapped traces of individual faults in the Mojave Block terminate within the block and do not continue across the Garlock Fault [Dokka and Travis, ].

Management of complex regional pain syndrome type I in upper extremity-evaluation of continuous stellate ganglion block and continuous infraclavicular brachial plexus block: a pilot study.

PubMed

Toshniwal, Gokul; Sunder, Rani; Thomas, Ronald; Dureja, G P

2012-01-01

Interventional pain management techniques play an important role in the multidisciplinary approach to management of complex regional pain syndrome (CRPS). In this preliminary study we compared the efficacy of continuous stellate ganglion (CSG) block with that of continuous infraclavicular brachial plexus (CIBP) block in management of CRPS type I of upper extremity. Thirty-three patients with CRPS type I of upper extremity were randomly assigned to either CSG or CIBP group. Patients were treated for 1 week with continuous infusion of 0.125% bupivacaine at 2and 5mL/h, respectively. Catheter was removed at 1 week and patients were followed up for 4 weeks. The outcome was evaluated in terms of neuropathic pain scale score (NPSS), edema scores (Grades 0-2), and range of motion (ROM) of all upper extremity joints (Grades 0-2). CIBP group showed statistically significant improvement in NPSS compared with CSG group during the first 12 hours after the procedures (P value <0.05). After 12 hours, the NPSS was comparable between the groups. At 4 weeks, both groups showed clinically significant improvement in edema score and ROM of all upper extremity joints when compared with the baseline. This preliminary study suggests that CIBP block and CSG block may be feasible and effective interventional techniques for the management of CRPS type I of upper extremities. Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration. Wiley Periodicals, Inc.

29 CFR 1919.32 - Specially designed blocks and components.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 7 2011-07-01 2011-07-01 false Specially designed blocks and components. 1919.32 Section 1919.32 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) GEAR CERTIFICATION Certification of Vessels: Tests and Proof Loads; Heat Treatment; Competent Persons § 1919.32...

Radiating leg pain and positive straight leg raising in spondylolysis in children.

PubMed

Halperin, N; Copeliovitch, L; Schachner, E

1983-09-01

Three children presented with low back pain radiating to the leg and with spasm of the hamstring and paravertebral muscles. Since the pain could not be ascribed to trauma, it was necessary to exclude the presence of infection or tumors. All the signs--localization of the pain, tenderness on one side of the back, X-ray film findings of unilateral or bilateral spondylolysis, and localized positive bone scan--pointed to spondylolysis as the cause of pain. All three children exhibited symptoms resembling those found in the facet syndrome described by Mooney and Robertson.

Extremely rare coincidence of non-radiographic axial spondyloarthropathy HLA-B27 positive and Stiff Person Syndrome--rheumatologist point of view.

PubMed

Marinović, Ivanka; Pivalica, Dinko; Aljinović, Jure; Vlak, Tonko; Škorić, Ela; Martinović Kaliterna, Dušanka

2016-01-01

Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder characterized by progressive stiffness and rigidity of truncal muscles accompanied with co-contraction of agonist-antagonist muscles. Our 51-year-old female patient was presented for the first time to physiatrists in 2006 and diagnosed with axial-spondyloarthropathy (SpA) HLA-B27 positive. SPS was diagnosed 7 years after initial symptoms. SPS should be taken into consideration in HLA-B27 positive patients if stiffness of paravertebral and abdominal muscles progresses during SpA therapy.

Spondylodiscitis revisited

PubMed Central

Mavrogenis, Andreas F.; Megaloikonomos, Panayiotis D.; Igoumenou, Vasileios G.; Panagopoulos, Georgios N.; Giannitsioti, Efthymia; Papadopoulos, Antonios; Papagelopoulos, Panayiotis J.

2017-01-01

Spondylodiscitis may involve the vertebral bodies, intervertebral discs, paravertebral structures and spinal canal, with potentially high morbidity and mortality rates. A rise in the susceptible population and improved diagnosis have increased the reported incidence of the disease in recent years. Blood cultures, appropriate imaging and biopsy are essential for diagnosis and treatment. Most patients are successfully treated by conservative means; however, some patients may require surgical treatment. Surgical indications include doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain. Cite this article: EFORT Open Rev 2017;2:447–461. DOI: 10.1302/2058-5241.2.160062 PMID:29218230

49 CFR 236.710 - Block, latch.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Block, latch. 236.710 Section 236.710 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Block, latch. The lower extremity of a latch rod which engages with a square shoulder of the segment or...

Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block.

PubMed

Kollmann-Camaiora, A; Brogly, N; Alsina, E; Gilsanz, F

2017-10-01

Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Comparative Analysis of the Paravertebral Analgesic Pump Catheter with the Epidural Catheter in Elderly Trauma Patients with Multiple Rib Fractures.

PubMed

Shapiro, Brian S; Wasfie, Tarik; Chadwick, Mathew; Barber, Kimberly R; Yapchai, Raquel

2017-04-01

Presently, trauma guidelines recommend epidural analgesia as the optimal modality of pain relief from rib fractures. They are not ideally suited for elderly trauma patients and have disadvantages including bleeding risk. The paravertebral analgesic pump (PVP) eliminates such disadvantages and includes ease of placement in the trauma setting. This study compares pain control in patients treated by EPI versus PVP. This is a retrospective, historical cohort study comparing two methods of pain management in the trauma setting. Before 2010, patients who had epidural catheters (EPI) placed for pain control were compared with patients after 2010 in which the PVP was used. All patients had multiple rib fractures as diagnosed by CT scan. Analysis was adjusted for age, number of fractures, and comorbid conditions. Multiple linear regression analysis was conducted to compare average reported pain. A total of 110 patients, 31 PVP and 79 epidural catheters, were included in the study. Overall mean age was 65 years. The mean Injury Severity Score was 12.0 (EPI) and 11.1 (PVP). Mean number rib fractures was 4.29 (EPI) and 4.71 (PVP). PVP was associated with a 30 per cent greater decrease in pain than that seen with EPI (6.0-1.9 vs 6.4-3.4). After controlling for age, Injury Severity Score, and number of rib fractures, there were no differences in intensive care unit or total length of stay (P = 0.35) or in pain score (3.76 vs 3.56, P = 0.64). In conclusion, the PVP compares well with epidural analgesia in older trauma patients yet is safe, well tolerated, and easily inserted.

Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kirova, Youlia M., E-mail: youlia.kirova@curie.net; Menard, Jean; Chargari, Cyrus

2012-07-01

To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. Themore » dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.« less

21 CFR 177.1810 - Styrene block polymers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Styrene block polymers. 177.1810 Section 177.1810... FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: POLYMERS Substances for Use as Basic Components of Single and Repeated Use Food Contact Surfaces § 177.1810 Styrene block polymers. The styrene...

31 CFR 598.202 - Blocking of assets.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocking of assets. 598.202 Section 598.202 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Prohibitions § 598.202 Blocking of assets. Except to the extent provided in regulations, orders, instructions...

31 CFR 598.202 - Blocking of assets.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocking of assets. 598.202 Section 598.202 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Prohibitions § 598.202 Blocking of assets. Except to the extent provided in regulations, orders, instructions...

31 CFR 598.202 - Blocking of assets.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocking of assets. 598.202 Section 598.202 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Prohibitions § 598.202 Blocking of assets. Except to the extent provided in regulations, orders, instructions...

31 CFR 598.202 - Blocking of assets.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocking of assets. 598.202 Section 598.202 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Prohibitions § 598.202 Blocking of assets. Except to the extent provided in regulations, orders, instructions...

31 CFR 598.202 - Blocking of assets.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocking of assets. 598.202 Section 598.202 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Prohibitions § 598.202 Blocking of assets. Except to the extent provided in regulations, orders, instructions...

21 CFR 177.1810 - Styrene block polymers.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 3 2011-04-01 2011-04-01 false Styrene block polymers. 177.1810 Section 177.1810... FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: POLYMERS Substances for Use as Basic Components of Single and Repeated Use Food Contact Surfaces § 177.1810 Styrene block polymers. The styrene...

21 CFR 177.1810 - Styrene block polymers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 3 2012-04-01 2012-04-01 false Styrene block polymers. 177.1810 Section 177.1810... FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: POLYMERS Substances for Use as Basic Components of Single and Repeated Use Food Contact Surfaces § 177.1810 Styrene block polymers. The styrene...

21 CFR 177.1810 - Styrene block polymers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 3 2013-04-01 2013-04-01 false Styrene block polymers. 177.1810 Section 177.1810... FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: POLYMERS Substances for Use as Basic Components of Single and Repeated Use Food Contact Surfaces § 177.1810 Styrene block polymers. The styrene...

Simulant Gas Test Technique Feasibility

DTIC Science & Technology

1990-05-01

DY’NAMICS LABORATORY WRIGHT RESEARCH AND DEVELOPMENT CENTER AIR FORCE SYSTEMS COMMAND WRIGHT-PATTERSON AIR FORCE BASE, OHIO 45433-6553 NOTIr’ When...TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP Hypersonic-test Air -chemistry Non-equilibrium-flow 0g...ABSTRACT (Continue on reverse if necessary and identify by block number) ’[lie Ulcertaillty engendered by non-equilibrium air effects on hypersonic

Synthetic Helizyme Enzymes.

DTIC Science & Technology

1987-08-18

NOTATION 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP I Synthetic enzymes...chymotrypsin; molecular modeling; 03 peptide synthesis 19. ABSTRACT (Continue on reverse if necessary and identify by block number) The object of this...for AChE. Additionally, synthetic models ofcL- chymotrypsin built using cyclo- dextrins show catalytic activity over a limited pH range.2 Using L

Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial.

PubMed

Choi, Yun-Mi; Byeon, Gyeong-Jo; Park, Soon-Ji; Ok, Young-Min; Shin, Sang-Wook; Yang, Kwangho

2017-06-01

To compare the analgesic efficacy of ultrasound-guided single-shot and continuous transversus abdominis plane (TAP) block to that of IV-PCA in patients undergoing laparoscopic cholecystectomy. Prospective randomized controlled trial. Post-anesthesia care unit and General ward. 108 American Society of Anesthesiologist (ASA) physical status I-II patients undergoing laparoscopic cholecystectomy. Group A received IV-PCA; group B received both ultrasound-guided single-shot TAP block with 0.2% ropivacaine (20mL) and IV-PCA; and group C received continuous TAP block using an ultrasound-guidance-inserted indwelling catheter. In group C, infusion of 0.2% ropivacaine at a basal rate of 3mL/h, bolus dose of 4mL, and a lockout interval of 30min was maintained for 48h postoperatively. The primary outcome was evaluated analgesic efficacy using the numeric rating scale (NRS) for 48h postoperatively. Other outcomes included the number of patients requiring additional analgesics, patient satisfaction with postoperative pain control, and incidence of postoperative adverse events. Compared to other groups, group C had higher deep abdominal NRS at 1h postoperatively (P<0.05), and lower incidence of postoperative urinary retention (P<0.05). There were no significant intergroup differences in the number of patients requiring additional analgesics, and patient satisfaction with postoperative pain control. Compared to IV-PCA with or without single-shot TAP block, ultrasound-guided continuous TAP block provided similar analgesia in somatic pain and less analgesia in visceral pain. Moreover, the latter resulted in a lower incidence of postoperative urinary retention. Copyright © 2017 Elsevier Inc. All rights reserved.

Continuity Clinic Model and Diabetic Outcomes in Internal Medicine Residencies: Findings of the Educational Innovations Project Ambulatory Collaborative

PubMed Central

Francis, Maureen D.; Julian, Katherine A.; Wininger, David A.; Drake, Sean; Bollman, KeriLyn; Nabors, Christopher; Pereira, Anne; Rosenblum, Michael; Zelenski, Amy B.; Sweet, David; Thomas, Kris; Varney, Andrew; Warm, Eric; Francis, Mark L.

2016-01-01

Background Efforts to improve diabetes care in residency programs are ongoing and in the midst of continuity clinic redesign at many institutions. While there appears to be a link between resident continuity and improvement in glycemic control for diabetic patients, it is uncertain whether clinic structure affects quality measures and patient outcomes. Methods This multi-institutional, cross-sectional study included 12 internal medicine programs. Three outcomes (glycemic control, blood pressure control, and achievement of target low-density lipoprotein [LDL]) and 2 process measures (A1C and LDL measurement) were reported for diabetic patients. Traditional, block, and combination clinic models were compared using analysis of covariance (ANCOVA). Analysis was adjusted for continuity, utilization, workload, and panel size. Results No significant differences were found in glycemic control across clinic models (P = .06). The percentage of diabetic patients with LDL < 100 mg/dL was 60% in block, compared to 54.9% and 55% in traditional and combination models (P = .006). The percentage of diabetic patients with blood pressure < 130/80 mmHg was 48.4% in block, compared to 36.7% and 36.9% in other models (P < .001). The percentage of diabetic patients with HbA1C measured was 92.1% in block compared to 75.2% and 82.1% in other models (P < .001). Also, the percentage of diabetic patients with LDL measured was significantly different across all groups, with 91.2% in traditional, 70.4% in combination, and 83.3% in block model programs (P < .001). Conclusions While high scores on diabetic quality measures are achievable in any clinic model, the block model design was associated with better performance. PMID:26913099

Paravertebral Spinal Injection for the Treatment of Patients with Degenerative Facet Osteoarthropathy: Evidence of Motor Performance Improvements based on Objective Assessments

PubMed Central

Toosizadeh, Nima; Harati, Homayoon; Yen, Tzu-Chuan; Fastje, Cindy; Mohler, Jane; Najafi, Bijan; Dohm, Michael

2016-01-01

Background This study examined short- and long-term improvements in motor performance, quantified using wearable sensors, in response to facet spine injection in degenerative facet osteoarthropathy patients. Methods Adults with confirmed degenerative facet osteoarthropathy were recruited and were treated with medial or intermediate branch block injection. Self-report pain, health condition, and disability (Oswestry), as well as objective motor performance measures (gait, balance, and timed-up-and-go) were obtained in five sessions: pre-surgery (baseline), immediately after the injection, one-month, three-month, and 12-month follow-ups. Baseline motor performance parameters were compared with 10 healthy controls. Findings Thirty patients (age=50(14) years) and 10 controls (age=46(15) years) were recruited. All motor performance parameters were significantly different between groups. Results showed that average pain and Oswestry scores improved by 51% and 24%, respectively among patients, only one month after injection. Similarly, improvement in motor performance was most noticeable in one-month post-injection measurements; most improvements were observed in gait speed (14% normal walking, P<0.02), hip sway within balance tests (63% eyes-open P<0.01), and turning velocity within the timed-up-and-go test (28%, P<0.02). Better baseline motor performance led to better outcomes in terms of pain relief; baseline turning velocity was 18% faster among the responsive compared to the non-responsive patients. Interpretations Spinal injection can temporarily (one to three months) improve motor performance in degenerative facet osteoarthropathy patients. Successful pain relief in response to treatment is independent of demographic characteristics and initial pain but dependent on baseline motor performance. Immediate self-reported pain relief is unrelated to magnitude of gradual improvement in motor performance. PMID:27744005

Minimum cause--maximum effect: the travelogue of a bullet.

PubMed

Hartert, Marc; Dahm, Manfred; Neufang, Achim; Vahl, Christian-Friedrich

2010-11-01

This case report involves a 57-year-old male, accidentally shot in the chest with a small bore firearm. The bullet entered the left hemithorax, disrupting the left internal mammarian artery. It then penetrated the anterior wall of the right ventricle causing a pericardial tamponade. After leaving the base of the right heart it perforated the diaphragm, the liver, the spleen and the pancreas. Finally, it penetrated the abdominal aorta 3 cm proximally to the coeliac trunk and reached its final position paravertebrally. This case report illustrates that the management of even minimum gunshot wounds requires a maximum variety of surgical skills.

Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

PubMed Central

Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

2014-01-01

Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis. PMID:24782978

High-efficiency Gaussian key reconciliation in continuous variable quantum key distribution

NASA Astrophysics Data System (ADS)

Bai, ZengLiang; Wang, XuYang; Yang, ShenShen; Li, YongMin

2016-01-01

Efficient reconciliation is a crucial step in continuous variable quantum key distribution. The progressive-edge-growth (PEG) algorithm is an efficient method to construct relatively short block length low-density parity-check (LDPC) codes. The qua-sicyclic construction method can extend short block length codes and further eliminate the shortest cycle. In this paper, by combining the PEG algorithm and qua-si-cyclic construction method, we design long block length irregular LDPC codes with high error-correcting capacity. Based on these LDPC codes, we achieve high-efficiency Gaussian key reconciliation with slice recon-ciliation based on multilevel coding/multistage decoding with an efficiency of 93.7%.

Report on: Connecticut River Streambank Erosion Study, Massachusetts, New Hampshire and Vermont

DTIC Science & Technology

1979-11-01

Plastic filter cloths are used with considerable success beneath tiprap and other revetment materials such as articulated concrete blocks . The...rihutior unlimited II. SUPPLEMENTARY NOTES It. KEY WORDS (Continue on fever&e elde ifneceeeery and identify by block number). alluvial channel...erosion boat waves shear stress rock riprap lower bank erosion revetments flow control vegetation 20. ABSTRACT (Continue on reverse aide if neceesary and

Pharmacokinetics and Pharmacodynamics of Oximes in Unanesthetized Pigs

DTIC Science & Technology

1991-04-01

D-A234 036 U.S. ARMY MEDICAL RESEARCH p INSTITUTE OF CHEMICAL DEFENSE USAMRICD-TR-91-07 PHARMACOKINETICS AND PHARMACODYNAMICS OF OXIMES IN...SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP 2-PAM Cl, ICD 467, MMB-4, Pharmacokinetics ...Cardiovascular 06 15 Pharmacodynamics, Oximes06 15 19. ABSTRACT (Continue on reverse if necessary and identify by block number) The pharmacokinetics and

Communication Module for the Micro-Based Small Purchase Contracting Program

DTIC Science & Technology

1992-03-01

SUISISTUCI 2 3 SANDWICH COOKIES 3 CREAM FILLING, CHOCOLATE FLAVOR, VANILLA FLAVOR, OR 3 COM INATION BASE CAKES , ADCOP. 2 2 VARIATION PROVISIONS SAE AS CLII...SUBJECT TERMS (continue on reverse if necessary and identify by block number) FIELD I GROUP SUBGROUP Procurement Automation Telecommunications System...Information Management System 19 ABSTRACT (continue on reverse if necessary and identify by block number) This thesis conducted research and development of

Tissue Distribution, Excretion, and Hepatic Biotransformation of Microcystin-LR in Mice

DTIC Science & Technology

1990-07-09

TO 900709 43 16. SUPPLEMENTARY NOTATION 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD...GROUP SUB-GROUP Imicrocystin-LR, pharmacokinetics, biotransformation, protein binding 19, ABSTRACT (Continue on reverse if necessary and identify by block...the column measured with blue dextrin . Fig. 6. Econo-Pac 1ODG desalting column profile of hepatic- cytosolic radiolabel under denaturing conditions

Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative.

PubMed

Francis, Maureen D; Wieland, Mark L; Drake, Sean; Gwisdalla, Keri Lyn; Julian, Katherine A; Nabors, Christopher; Pereira, Anne; Rosenblum, Michael; Smith, Amy; Sweet, David; Thomas, Kris; Varney, Andrew; Warm, Eric; Wininger, David; Francis, Mark L

2015-03-01

Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear. This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity. UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY. Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model.

Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

PubMed Central

Francis, Maureen D.; Wieland, Mark L.; Drake, Sean; Gwisdalla, Keri Lyn; Julian, Katherine A.; Nabors, Christopher; Pereira, Anne; Rosenblum, Michael; Smith, Amy; Sweet, David; Thomas, Kris; Varney, Andrew; Warm, Eric; Wininger, David; Francis, Mark L.

2015-01-01

Background Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear. Methods This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity. Results UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY. Conclusions Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model. PMID:26217420

Continuous vs. blocks of physiotherapy for motor development in children with cerebral palsy and similar syndromes: A prospective randomized study.

PubMed

Brunner, Anne-Louise; Rutz, Erich; Juenemann, Stephanie; Brunner, Reinald

2014-12-01

To determine whether physiotherapy is more effective when applied in blocks or continuously in children with cerebral palsy (CP). A prospective randomized cross-over design study compared the effect of regular physiotherapy (baseline) with blocks of physiotherapy alternating with no physiotherapy over one year. Thirty-nine institutionalized children with CP and clinically similar syndromes (6-16 years old, Gross Motor Function Classification Scale II-IV) were included. During the first scholastic year, group A received regular physiotherapy, group B blocks of physiotherapy and vice versa in the second year. The Gross Motor Function Measure 66 (GMFM-66) was the outcome measure. Thirteen children in each group completed the study. GMFM-66 improved (p < 0.05) over the study period in both groups in total; changes (p < 0.05) were seen only in dimension D (group B) and E (both groups) during regular therapy. Physiotherapy may be more effective when provided regularly rather than in blocks.

Carbon dioxide laser ablation with immediate autografting in a full-thickness porcine burn model.

PubMed Central

Glatter, R D; Goldberg, J S; Schomacker, K T; Compton, C C; Flotte, T J; Bua, D P; Greaves, K W; Nishioka, N S; Sheridan, R L

1998-01-01

OBJECTIVE: To compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high-power continuous-wave CO2 laser to sharply débrided wounds in a porcine model. SUMMARY BACKGROUND DATA: Continuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting. METHODS: Full-thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 150-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 microm of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days. RESULTS: The laser-treated sites were nearly bloodless. The mean residual thermal damage was 0.18+/-0.05 mm. The mean graft take was 96+/-11% in manual sites and 93+/-8% in laser sites. On postoperative day 7, the thickness of granulation tissue at the graft-wound bed interface was greater in laser-debrided sites. By postoperative day 180, the manual and laser sites were histologically identical. Vancouver scar assessment revealed no differences in scarring at postoperative day 180. CONCLUSIONS: Long-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laser-ablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long-term outcome. Images Figure 1. Figure 2. Figure 3. Figure 4. PMID:9712572

15 CFR Supplement No. 2 to Part 752 - Instructions for Completing Form BIS-748P-A, “Item Annex”

Code of Federal Regulations, 2014 CFR

2014-01-01

... within the lines for each block or box. Block 1: Application Control No. Enter the application control... or reexport a computer or equipment that contains a computer. Instructions on calculating the APP are... processing of your application. Block 24: Continuation of Additional Information. Enter any identifying...

15 CFR Supplement No. 2 to Part 752 - Instructions for Completing Form BIS-748P-B, “Item Annex”

Code of Federal Regulations, 2012 CFR

2012-01-01

... within the lines for each block or box. Block 1: Application Control No. Enter the application control... or reexport a computer or equipment that contains a computer. Instructions on calculating the APP are... processing of your application. Block 24: Continuation of Additional Information. Enter any identifying...

15 CFR Supplement No. 2 to Part 752 - Instructions for Completing Form BIS-748P-B, “Item Annex”

Code of Federal Regulations, 2013 CFR

2013-01-01

... within the lines for each block or box. Block 1: Application Control No. Enter the application control... or reexport a computer or equipment that contains a computer. Instructions on calculating the APP are... processing of your application. Block 24: Continuation of Additional Information. Enter any identifying...

15 CFR Supplement No. 2 to Part 752 - Instructions for Completing Form BIS-748P-B, “Item Annex”

Code of Federal Regulations, 2011 CFR

2011-01-01

... within the lines for each block or box. Block 1: Application Control No. Enter the application control... or reexport a computer or equipment that contains a computer. Instructions on calculating the APP are... processing of your application. Block 24: Continuation of Additional Information. Enter any identifying...

Borehole Tilt Measurements at the Charlevoix Observatory, Quebec.

DTIC Science & Technology

1983-01-31

1q. KEY WORDS (Continue on reverse side it necessary end identify by block number) Borehole tiltmeter Earthquakes Tidal, secular and transient tilts 20...ABSTRACT (Continue on reverse side If necessary and Identify by block number) An array of three Bodenseewerk Gbp borehole tiltmeters has been...established to measure tidal, transient and secular tilting of the Earth’s surface in the Charlevoix region of Quebec. Two of the tiltmeters operate at a

A Comparison of Reliability Measures for Continuous and Discontinuous Recording Methods: Inflated Agreement Scores with Partial Interval Recording and Momentary Time Sampling for Duration Events

ERIC Educational Resources Information Center

Rapp, John T.; Carroll, Regina A.; Stangeland, Lindsay; Swanson, Greg; Higgins, William J.

2011-01-01

The authors evaluated the extent to which interobserver agreement (IOA) scores, using the block-by-block method for events scored with continuous duration recording (CDR), were higher when the data from the same sessions were converted to discontinuous methods. Sessions with IOA scores of 89% or less with CDR were rescored using 10-s partial…

BlockLogo: visualization of peptide and sequence motif conservation

PubMed Central

Olsen, Lars Rønn; Kudahl, Ulrich Johan; Simon, Christian; Sun, Jing; Schönbach, Christian; Reinherz, Ellis L.; Zhang, Guang Lan; Brusic, Vladimir

2013-01-01

BlockLogo is a web-server application for visualization of protein and nucleotide fragments, continuous protein sequence motifs, and discontinuous sequence motifs using calculation of block entropy from multiple sequence alignments. The user input consists of a multiple sequence alignment, selection of motif positions, type of sequence, and output format definition. The output has BlockLogo along with the sequence logo, and a table of motif frequencies. We deployed BlockLogo as an online application and have demonstrated its utility through examples that show visualization of T-cell epitopes and B-cell epitopes (both continuous and discontinuous). Our additional example shows a visualization and analysis of structural motifs that determine specificity of peptide binding to HLA-DR molecules. The BlockLogo server also employs selected experimentally validated prediction algorithms to enable on-the-fly prediction of MHC binding affinity to 15 common HLA class I and class II alleles as well as visual analysis of discontinuous epitopes from multiple sequence alignments. It enables the visualization and analysis of structural and functional motifs that are usually described as regular expressions. It provides a compact view of discontinuous motifs composed of distant positions within biological sequences. BlockLogo is available at: http://research4.dfci.harvard.edu/cvc/blocklogo/ and http://methilab.bu.edu/blocklogo/ PMID:24001880

Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society.

PubMed

Galvagno, Samuel Michael; Smith, Charles E; Varon, Albert J; Hasenboehler, Erik A; Sultan, Shahnaz; Shaefer, Gregory; To, Kathleen B; Fox, Adam D; Alley, Darrell E R; Ditillo, Michael; Joseph, Bellal A; Robinson, Bryce R H; Haut, Elliot R

2016-11-01

Thoracic trauma is the second most prevalent nonintentional injury in the United States and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework recently adopted by EAST are presented. Five systematic reviews were conducted using multiple databases. The search retrieved articles regarding analgesia for blunt thoracic trauma from January1967 to August 2015. Critical outcomes of interest were analgesia, postoperative pulmonary complications, changes in pulmonary function tests, need for endotracheal intubation, and mortality. Important outcomes of interest examined included hospital and intensive care unit length of stay. Seventy articles were identified. Of these, 28 articles were selected to construct the guidelines. The overall risk of bias for all studies was high. The majority of included studies examined epidural analgesia. Epidural analgesia was associated with lower short-term pain scores in most studies, but the quality and quantity of evidence were very low, and no firm evidence of benefit or harm was found when this modality was compared with other analgesic interventions. The quality of evidence for paravertebral block, intrapleural analgesia, multimodal analgesia, and intercostal nerve blocks was very low as assessed by GRADE. The limitations with the available literature precluded the formulation of strong recommendations by our panel. We propose two evidence-based recommendations regarding analgesia for patients with blunt thoracic trauma. The overall risk of bias for all studies was high. The limitations with the available literature precluded the formulation of strong recommendations by our panel. We conditionally recommend epidural analgesia and multimodal analgesia as options for patients with blunt thoracic trauma, but the overall quality of evidence supporting these modalities is low in trauma patients. These recommendations are based on very low-quality evidence but place a high value on patient preferences for analgesia. These recommendations are in contradistinction to the previously published Practice Management Guideline published by EAST.

Development of extracellular matrix in chick paravertebral sympathetic ganglia.

PubMed

Luckenbill-Edds, L

1986-08-01

Alcian blue staining coupled with enzyme digestion or critical electrolyte staining revealed differences in the development of extracellular matrix (ECM) within sympathetic ganglia compared with the surrounding capsule. On day 5 of chick development (Hamburger-Hamilton stage 26) only hyaluronic acid (HA) could be detected in the ECM surrounding condensing primary ganglia. By day 7 (st 30) the ganglionic capsule contained HA, as well as sulfated glycosaminoglycans (GAGs), and this pattern continued into the adult stage. During the later stages of embryonic life (st 41-45) satellite cells appear, showing fine structural characteristics that point to their role in the secretion of intraganglionic ECM. Only during these stages could ECM be detected histochemically within ganglia, the same stages (days 15-19) when routine electron microscopic methods reveal collagen fibrils embedded in a granular ground substance. Thus, the intraganglionic environment appears as a separate compartment free of detectable amounts of GAG until late embryonic stages when ECM is secreted around satellite cells. This developmental pattern could represent a role of ECM in the histological stabilization of ganglia during the late stages of differentiation, since the appearance of intraganglionic ECM is correlated with the appearance of small dense-cored vesicles characteristic of adult neurons. The developmental pattern of ECM in differentiating sympathetic ganglia is compared with that of other tissues that undergo condensation and morphogenesis.

Temporary persistence of conduction block after prolonged kilohertz frequency alternating current on rat sciatic nerve

NASA Astrophysics Data System (ADS)

Bhadra, Narendra; Foldes, Emily; Vrabec, Tina; Kilgore, Kevin; Bhadra, Niloy

2018-02-01

Objective. Application of kilohertz frequency alternating current (KHFAC) waveforms can result in nerve conduction block that is induced in less than a second. Conduction recovers within seconds when KHFAC is applied for about 5-10 min. This study investigated the effect of repeated and prolonged application of KHFAC on rat sciatic nerve with bipolar platinum electrodes. Approach. Varying durations of KHFAC at signal amplitudes for conduction block with intervals of no stimulus were studied. Nerve conduction was monitored by recording peak Gastrocnemius muscle force utilizing stimulation electrodes proximal (PS) and distal (DS) to a blocking electrode. The PS signal traveled through the block zone on the nerve, while the DS went directly to the motor end-plate junction. The PS/DS force ratio provided a measure of conduction patency of the nerve in the block zone. Main results. Conduction recovery times were found to be significantly affected by the cumulative duration of KHFAC application. Peak stimulated muscle force returned to pre-block levels immediately after cessation of KHFAC delivery when it was applied for less than about 15 min. They fell significantly but recovered to near pre-block levels for cumulative stimulus of 50  ±  20 min, for the tested On/Off times and frequencies. Conduction recovered in two phases, an initial fast one (60-80% recovery), followed by a slower phase. No permanent conduction block was seen at the end of the observation period during any experiment. Significance. This carry-over block effect may be exploited to provide continuous conduction block in peripheral nerves without continuous application of KHFAC.

76 FR 50276 - Self-Regulatory Organizations; OneChicago, LLC; Notice of Filing and Immediate Effectiveness of a...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... for Four Decimal Point Pricing for Block and Exchange for Physical (``EFPs'') Trades August 8, 2011... block trades and the futures component of EFP trades to be traded/priced in four decimals points. Regular trades (non-block or non EFP) will continue to trade in only two decimal points. The text of the...

40 CFR Table 8 to Subpart Sssss of... - Continuous Compliance with Operating Limits

Code of Federal Regulations, 2010 CFR

2010-07-01

... subpart; andii. Reducing the scrubber pressure drop data to 1-hour and 3-hour block averages; and iii.... Reducing the scrubber liquid pH data to 1-hour and 3-hour block averages; and iii. Maintaining the 3-hour... subpart; andii. Reducing the scrubber liquid flow rate data to 1-hour and 3-hour block averages; and iii...

Development and validation of fuel height models for terrestrial lidar - RxCADRE 2012

Treesearch

Eric M. Rowell; Carl A. Seielstad; Roger D. Ottmar

2016-01-01

Terrestrial laser scanning (TLS) was used to collect spatially continuous measurements of fuelbed characteristics across the plots and burn blocks of the 2012 RxCADRE experiments in Florida. Fuelbeds were scanned obliquely from plot/block edges at a height of 20 m above ground. Pre-fire blocks were scanned from six perspectives and four perspectives for post-...

The Ambulatory Long-Block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP)

PubMed Central

Schauer, Daniel P.; Diers, Tiffiny; Mathis, Bradley R.; Neirouz, Yvette; Boex, James R.; Rouan, Gregory W.

2008-01-01

Introduction Historical bias toward service-oriented inpatient graduate medical education experiences has hindered both resident education and care of patients in the ambulatory setting. Aim Describe and evaluate a residency redesign intended to improve the ambulatory experience for residents and patients. Setting Categorical Internal Medicine resident ambulatory practice at the University of Cincinnati Academic Health Center. Program Description We created a year-long continuous ambulatory group-practice experience separated from traditional inpatient responsibilities called the long block as an Accreditation Council for Graduate Medical Education Educational Innovations Project. The practice adopted the Chronic Care Model and residents received extensive instruction in quality improvement and interprofessional teams. Program Evaluation The long block was associated with significant increases in resident and patient satisfaction as well as improvement in multiple quality process and outcome measures. Continuity and no-show rates also improved. Discussion An ambulatory long block can be associated with improvements in resident and patient satisfaction, quality measures, and no-show rates. Future research should be done to determine effects of the long block on education and patient care in the long term, and elucidate which aspects of the long block most contribute to improvement. PMID:18612718

Supplemental Cultural Resources Investigations and Site Testing for the Pointe Coupee to Arbroth Levee Enlargement and Seepage Control Project, West Baton Rouge Parish, Louisiana

DTIC Science & Technology

1993-07-01

July 316 16. SUPPLEMENTARY NOTATION 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) Bayou Plantation...Archeology Tenements Yatton Plantation 19. ABSTRACT (Continue on reverse if necessary and identify by block number) This report presents the results of Phase 1... Revetment Projects, M-270.2 to 246.0-R ........................................................... 21 Previously Recorded Archeological Sites in the

Role of Interfaces and Interphases in the Evolution Mechanics of Material Systems

DTIC Science & Technology

1992-03-26

K. REIFSNIDER, W. STINCHCOMB, D. DILLARD, R. SWAIN, K. JAYARAMAN, Y. CHlANG J. LESKO, M. ELAHI, Z. GAO, A. RAZVAN Nlatcrials Response Group 92- 12953...1/91 1 26 March 1992 SUPPLEMENTARY NOTATION COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP ...SUB- GROUP ABSTRACT (Continue on reverse if necessary and identify by block number) This final report summarizes the activities conducted under this

Effect of PFDA on Cardiac Membrane Function.

DTIC Science & Technology

1983-03-01

NO. 3. RECIPIENT’S CATALOG NUMBER AFOS-TR - / .... 4. TITLE (and Subtitle) 5. TVPF nF REPORT & PERIOD COVERED EFFECT OF PFDA ON CARDIAC MEMBRANE...Continue on reverse side II necessary and Identify by block number) Heart, Thyroxine, Triiodothyronine, PFDA 0t C) 20, ABSTRACT (Continue on revereD...eide If neceesary and Identify by block number) LTJ "Yihe in vivo and in vitro heart rates of rats treated with 75 mg/kg PFDA was __j significantly

40 CFR 63.961 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission... air emissions to the atmosphere by blocking an opening to the individual drain system. Closure devices...

Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.

2013-04-15

We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease,more » we reviewed the literature for similar cases.« less

Sudden Death: An Uncommon Occurrence in Dementia with Lewy Bodies.

PubMed

Molenaar, Joery P; Wilbers, Joyce; Aerts, Marjolein B; Leijten, Quinten H; van Dijk, Jan G; Esselink, Rianne A; Bloem, Bastiaan R

2016-01-01

We present a 75-year-old woman with dementia and parkinsonism who developed severe orthostatic hypotension and eventually died. Autopsy revealed extensive Lewy body formation in the midbrain, limbic system, intermediate spinal cord, and medulla oblongata. Furthermore, a vast amount of Lewy bodies was seen in the paravertebral sympathetic ganglia which likely explained the severe autonomic failure. We speculate that this autonomic failure caused sudden death through dysregulation of respiration or heart rhythm, reminiscent of sudden death in multiple system atrophy (MSA). Clinicians should be aware of this complication in patients presenting with parkinsonism and autonomic dysfunction, and that sudden death may occur in dementia with Lewy bodies (DLB) as it does in MSA.

Truncal blocks for perioperative pain management: a review of the literature and evolving techniques.

PubMed

Go, Ramon; Huang, Yolanda Y; Weyker, Paul D; Webb, Christopher Aj

2016-10-01

As the American healthcare system continues to evolve and reimbursement becomes tied to value-based incentive programs, perioperative pain management will become increasingly important. Regional anesthetic techniques are only one component of a successful multimodal pain regimen. In recent years, the use of peripheral and paraneuraxial blocks to provide chest wall and abdominal analgesia has gained popularity. When used within a multimodal regimen, truncal blocks may provide similar analgesia when compared with other regional anesthetic techniques. While there are other reviews that cover this topic, our review will also highlight the emerging role for serratus plane blocks, pectoral nerve blocks and quadratus lumborum blocks in providing thoracic and abdominal analgesia.

Continuous recording and interobserver agreement algorithms reported in the Journal of Applied Behavior Analysis (1995-2005).

PubMed

Mudford, Oliver C; Taylor, Sarah Ann; Martin, Neil T

2009-01-01

We reviewed all research articles in 10 recent volumes of the Journal of Applied Behavior Analysis (JABA): Vol. 28(3), 1995, through Vol. 38(2), 2005. Continuous recording was used in the majority (55%) of the 168 articles reporting data on free-operant human behaviors. Three methods for reporting interobserver agreement (exact agreement, block-by-block agreement, and time-window analysis) were employed in more than 10 of the articles that reported continuous recording. Having identified these currently popular agreement computation algorithms, we explain them to assist researchers, software writers, and other consumers of JABA articles.

31 CFR 543.407 - Payments from blocked accounts to satisfy obligations prohibited.

Code of Federal Regulations, 2012 CFR

2012-07-01

... to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY CôTE D... obligations prohibited. Pursuant to § 543.201, no debits may be made to a blocked account to pay obligations...

31 CFR 543.407 - Payments from blocked accounts to satisfy obligations prohibited.

Code of Federal Regulations, 2011 CFR

2011-07-01

... to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY CôTE D... obligations prohibited. Pursuant to § 543.201, no debits may be made to a blocked account to pay obligations...

Strategies for Teaching in a Block-of-Time Schedule.

ERIC Educational Resources Information Center

Hackmann, Donald G.; Schmitt, Donna M.

1997-01-01

Offers suggestions for developing creative instructional approaches in time-blocked classes. Teachers should continuously engage students in active learning, include group activities to encourage student participation, incorporate activities addressing multiple intelligences, use creative thinking activities, move outside the classroom, employ…

Two-Dimensional Electrophoretic Analysis of Subcellular Liver Fractions and Isolated Hepatocytes from Normal and PFDA Treated Rats

DTIC Science & Technology

1990-05-28

Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP perfluoro.n-decanoic acid ; two-dimensional electrophoresis...hepatotoxicity; cell fractions; liver 1 t ABSTRACT (Continue on reverse if necessary and identify by block number) Perfluoro-n-decanoic acid (PFDA) effects...Unu::’-. ’. I AFOSR Ju .T , Building 410 Bolling AFB, DC 20332-6448 By Dist V’ lml mm mm i INTRODUCTION Perfluorocarboxylic acids and other

An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression.

PubMed

Bokov, Andrey; Isrelov, Alexey; Skorodumov, Alexander; Aleynik, Alexander; Simonov, Alexander; Mlyavykh, Sergey

2011-01-01

Despite the evident progress in treating vertebral column degenerative diseases, the rate of a so-called "failed back surgery syndrome" associated with pain and disability remains relatively high. However, this term has an imprecise definition and includes several different morbid conditions following spinal surgery, not all of which directly illustrate the efficacy of the applied technology; furthermore, some of them could even be irrelevant. To evaluate and systematize the reasons for persistent pain syndromes following surgical nerve root decompression. Prospective, nonrandomized, cohort study of 138 consecutive patients with radicular pain syndromes, associated with nerve root compression caused by lumbar disc herniation, and resistant to conservative therapy for at least one month. The minimal period of follow-up was 18 months. Hospital outpatient department, Russian Federation Pre-operatively, patients were examined clinically, applying the visual analog scale (VAS), Oswestry Disability Index (ODI), magnetic resonance imaging (MRI), discography and computed tomography (CT). According to the disc herniation morphology and applied type of surgery, all participants were divided into the following groups: for those with disc extrusion or sequester, microdiscectomy was applied (n = 65); for those with disc protrusion, nucleoplasty was applied (n = 46); for those with disc extrusion, nucleoplasty was applied (n = 27). After surgery, participants were examined clinically and the VAS and ODI were applied. All those with permanent or temporary pain syndromes were examined applying MRI imaging, functional roentgenograms, and, to validate the cause of pain syndromes, different types of blocks were applied (facet joint blocks, paravertebral muscular blocks, transforaminal and caudal epidural blocks). Group 1 showed a considerable rate of pain syndromes related to tissue damage during the intervention; the rates of radicular pain caused by epidural scar and myofascial pain were 12.3% and 26.1% respectively. Facet joint pain was found in 23.1% of the cases. Group 2 showed a significant rate of facet joint pain (16.9%) despite the minimally invasive intervention. The specificity of Group 3 was the very high rate of unresolved or recurred nerve root compression (63.0%); in other words, in the majority of cases, the aim of the intervention was not achieved. The results of the applied intervention were considered clinically significant if 50% pain relief on the VAS and a 40% decrease in the ODI were achieved. This study is limited because of the loss of participants to follow-up and because it is nonrandomized; also it could be criticized because the dynamics of numeric scores were not provided. The results of our study show that an analysis of the reasons for failures and partial effects of applied interventions for nerve root decompression may help to understand better the efficacy of the interventions and could be helpful in improving surgical strategies, otherwise the validity of the conclusion could be limited because not all sources of residual pain illustrate the applied technology efficacy. In the majority of cases, the cause of the residual or recurrent pain can be identified, and this may open new possibilities to improve the condition of patients presenting with failed back surgery syndrome.

The influence of sprint interval training on body composition, physical and metabolic fitness in adolescents and young adults with intellectual disability: a randomized controlled trial.

PubMed

Boer, Pieter-Henk; Meeus, Mira; Terblanche, Elmarie; Rombaut, Lies; Wandele, Inge De; Hermans, Linda; Gysel, Tineke; Ruige, Johannes; Calders, Patrick

2014-03-01

In this study we evaluated the effect of sprint interval training on metabolic and physical fitness in adolescents and young adults with intellectual disabilities when compared with continuous aerobic training and no training (control). Fifty-four persons with intellectual disabilities (age: 17 (3.0), body mass index: 27.7 (3.7), intelligence quotient: 59 (8.6)) were matched based on age, gender and intelligence quotient between sprint interval training (n = 17), continuous aerobic training (n = 15) and control (n = 14). Sprint interval training was composed of three blocks of 10 minutes at ventilatory threshold (blocks 1 and 3: 10 sprint bouts of 15 seconds, followed by 45 seconds relative rest; block 2: continuous training) twice a week for 15 weeks. Continuous aerobic training was composed of three blocks of 10 minutes continuous training. After eight weeks, intensity was increased to 110% of ventilatory threshold. The control group did not participate in supervised exercise training. Before and after the training period, body composition, physical and metabolic fitness were evaluated. Sprint interval training showed a significant positive evolution for waist circumference, fat%, systolic blood pressure, lipid profile, fasting insulin, homeostasis model assessment of insulin resistance, peak VO2, peak Watt, ventilatory threshold, 6-minute walk distance and muscle fatigue resistance when compared with no training (P < 0.01). The sprint interval training group demonstrated significant improvements for fat%, systolic blood pressure, low-density lipoprotein, fasting insulin, peak VO2 and peak power and ventilatory threshold (P < 0.01) when compared with continuous aerobic training. In this study we could observe that sprint interval training has stronger beneficial effects on body composition, physical fitness and metabolic fitness compared with control. Compared with continuous aerobic training, sprint interval training seems to result in better outcome.

24 CFR 570.487 - Other applicable laws and related program requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES COMMUNITY DEVELOPMENT BLOCK GRANTS State Community Development Block Grant Program § 570.487 Other applicable laws and related...

Continuous structural evolution of calcium carbonate particles: a unifying model of copolymer-mediated crystallization.

PubMed

Kulak, Alex N; Iddon, Peter; Li, Yuting; Armes, Steven P; Cölfen, Helmut; Paris, Oskar; Wilson, Rory M; Meldrum, Fiona C

2007-03-28

Two double-hydrophilic block copolymers, each comprising a nonionic block and an anionic block comprising pendent aromatic sulfonate groups, were used as additives to modify the crystallization of CaCO3. Marked morphological changes in the CaCO3 particles were observed depending on the reaction conditions used. A poly(ethylene oxide)-b-poly(sodium 4-styrenesulfonate) diblock copolymer was particularly versatile in effecting a morphological change in calcite particles, and a continuous structural transition in the product particles from polycrystalline to mesocrystal to single crystal was observed with variation in the calcium concentration. The existence of this structural sequence provides unique insight into the mechanism of polymer-mediated crystallization. We propose that it reflects continuity in the crystallization mechanism itself, spanning the limits from nonoriented aggregation of nanoparticles to classical ion-by-ion growth. The various pathways to polycrystalline, mesocrystal, and single-crystal particles, which had previously been considered to be distinct, therefore all form part of a unifying crystallization framework based on the aggregation of precursor subunits.

Feedback Effects in Computer-Based Skill Learning

DTIC Science & Technology

1989-09-12

SUPPLEMENTARY NOTATION 17 COSATI CODES 18 SUBJECT TERMS (Continue on reverse if necessary and identify by block number) r FIELD GROUP SUB-GROUP I...rather than tangible feedback ( Barringer & Gholson, 1979) and when they receive punishment (either alone or witih reward) rather than reward alone...34graphed" response latencies across the four conditions ( r = .58), indicating that subjects were sensitive to block-by-block trends in their response

Cattaraugus Creek Harbor, New York General Design Memorandum. Phase II (Detailed Design). Volume I. Main Report-GDM II.

DTIC Science & Technology

1976-03-01

of the abetract entered In Block 20, If different from Report) I$. SUPPLEMENTARY NOTES .4 19. KEY WORDS (Continue on reverse aide If neceesary and...Identify by block number) Harbors Cattaraugus Creek Flood Control 20O T’rlq 4CT Caiweut -t reverse se 0 neceeeely mid Identify by block number) The... blocked by the sand bar and lake ice at the creek mouth. During discharges developed by the com- bination of rainfall and snow melt, ice jams raise the

Influence of paravertebral muscles training on brain plasticity and postural control in chronic low back pain.

PubMed

Massé-Alarie, Hugo; Beaulieu, Louis-David; Preuss, Richard; Schneider, Cyril

2016-07-01

Isometric activation (ISOM) of deep multifidi muscles (MF) can influence postural adjustments and primary motor cortex (M1) function in chronic low back pain (CLBP). In order to better understand how ISOM impacts on CLBP condition, the present study contrasted ISOM after-effects on M1 function, MF postural activation and pain with another training, the global activation of paravertebral muscles (GLOB, hip extension). The main objective of this study was to compare the effects of ISOM and GLOB (3-week training each) on MF postural activation and M1 function in a CLBP population. Twenty-four people with CLBP were randomly allocated to ISOM and GLOB groups for a 3-week daily practice. Pre/post-training after-effects were assessed by the onset of superficial MF (MF-S) activation during ballistic limb movements (bilateral shoulder flexion in standing; unilateral hip extension in prine lying), MF-S corticomotor control tested by transcranial magnetic stimulation of M1, and assessment of pain, kinesiophobia and disability by standardized questionnaires. Both ISOM and GLOB improved pain and disability. However, only ISOM influenced M1 function (decreased corticospinal excitability and increased intracortical inhibition), fastened MF-S postural activation and decreased kinesiophobia. Changes of corticospinal excitability and of MF-S postural adjustments suggest that ISOM better influenced brain plasticity. Future studies should further test whether our novel findings relate to an influence of the exercises on the lumbopelvic control of different muscles and on cognitive function. Clinically, individual's evaluation remains warranted before prescribing one or the other of these two conventional exercises for reducing pain. This original study presents how motor control exercises can influence brain plasticity and postural control in chronic low back pain. This knowledge will impact on the decision of clinicians to prescribe specific exercises with a view of improving motor control in this musculoskeletal condition. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

CT of Patients With Hip Fracture: Muscle Size and Attenuation Help Predict Mortality

PubMed Central

Boutin, Robert D.; Bamrungchart, Sara; Bateni, Cyrus P.; Beavers, Daniel P.; Beavers, Kristen M.; Meehan, John P.; Lenchik, Leon

2018-01-01

OBJECTIVE Our objective was to determine the association between muscle cross-sectional area and attenuation, as measured on routine CT scans, and mortality in older patients with hip fracture. MATERIALS AND METHODS A retrospective 10-year study of patients with hip fracture was conducted with the following inclusion criteria: age 65 years or older, first-time hip fracture treated with surgery, and CT of the chest, abdomen, or pelvis. This yielded 274 patients (70.4% women; mean [± SD] age, 81.3 ± 8.3 years). On each CT scan, two readers independently measured the size (cross-sectional area, indexed for patient height) and attenuation of the paravertebral muscle at T12 and the psoas muscle at L4. We then determined the association between overall mortality and the muscle size and muscle attenuation, while adjusting for demographic variables (age, sex, ethnicity, and body mass index), American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index (CCI). RESULTS The overall mortality rate increased from 28.3% at 1 year to 79.5% at 5 years. Mortality was associated with decreased thoracic muscle size (odds ratio [OR], 0.66; 95% CI, 0.49–0.87). This association persisted after adjusting for demographic variables (OR, 0.69; 95% CI, 0.50–0.95), the ASA classification (OR, 0.70; CI, 0.51–0.97), and the CCI (OR, 0.72; 95% CI, 0.52–1.00). Similarly, decreased survival was associated with decreased thoracic muscle attenuation after adjusting for all of these combinations of covariates (OR, 0.67–0.72; 95% CI, 0.49–0.99). Decreased lumbar muscle size and attenuation trended with decreased survival but did not reach statistical significance. CONCLUSION In older adults with hip fractures, CT findings of decreased thoracic paravertebral muscle size and attenuation are associated with decreased overall survival. PMID:28267356

Cervical spondylodiscitis with epidural abscess after knife stab wounds to the neck: A case report.

PubMed

Voelker, Anna; von der Hoeh, Nicolas H; Gulow, Jens; Heyde, Christoph-Eckhard

2015-08-01

Cervical spondylodiscitis is usually caused by pyogenic infections, associated with retropharyngeal abscesses, or due to the swallowing of foreign bodies. No cases of cervical spondylodiscitis caused by a penetrating neck injury have been published in the literature. We describe a case of cervical spondylodiscitis after multiple knife stab wounds to the lateral soft tissue of the neck. Case report and review of the literature. A 54-year-old patient was brought to our clinic with destructive spondylodiscitis C3/4 with paravertebral and epidural abscesses. He had been involved in a fight and had suffered multiple stab wounds to his neck with a knife 1 month prior. The initial CT scan had revealed one deeper wound canal behind the sternocleidomastoid muscle on the left side without any injury to the vessels. The wound was cleaned and an antibiotic therapy with cefuroxime was given for 1 week. After an uneventful and complete healing of the wound the patient developed severe neck pain. Inflammatory laboratory parameters were elevated, and a MRI of the neck revealed a distinct spondylodiscitis C3/4 with paravertebral and epidural abscess formations. Surgery was performed and included debridement, abscess drainage, decompression of the spinal canal, fusion of the C3/4 segment using an autologous iliac crest bone graft and a plate osteosynthesis. A course of calculated antibiotic therapy was administered for 8 weeks. Normal laboratory parameters and no radiological signs of an ongoing inflammatory process were observed during follow-up examinations. The C3/4 segment was consolidated. Stab wound injuries to the neck not only bear the risk of injuries to the nerves, vessels and organs of the neck but also increase the risk of developing secondary spondylodiscitis. Specifically, cervical spondylodiscitis can result in distinct neurological symptoms, and surgical intervention should be performed in a timely manner. Copyright © 2015 Elsevier Ltd. All rights reserved.

Generation and Development of Paravertebral Ossification in Cervical Artificial Disk Replacement: A Detailed Analytic Report Using Coronal Reconstruction CT.

PubMed

Tian, Wei; Han, Xiao; Liu, Bo; He, Da; Lv, Yanwei; Yue, James

2017-04-01

A retrospective follow-up study and review of images in published papers. To determine whether true heterotopic ossification (HO) occurs in artificial disk replacement (ADR); to evaluate the incidence of paravertebral ossification (PO) and its influence on ADR. HO is typically defined as the abnormal formation of true bone within extraskeletal soft tissues. However, HO in ADR does not fit this definition precisely, as it originates from vertebral body, making it hard to distinguish radiologically from preexisting osteophytes. In this study, the term used for bone formation around ADR is PO. First, all images in the published papers were evaluated as to whether the presented PO in ADR fit the classic definition of HO or osteophytes. Second, we studied 37 consecutive patients who underwent ADR and follow-up for minimum 24 months. The preoperative and follow-up incidence of PO and its influence on range of motion were evaluated using x-ray and computed tomography. All 52 images of PO were found adjacent to the disk in 1 segment rather than entire cervical spine. Fifty (96.2%) of the POs were found to originate from the vertebral body rather than in the soft tissue. A total of 31 patients were included in the follow-up study. No significant difference was found in the incidence of PO between the follow-up and preoperation (61.29% vs. 48.39%, P>0.05). The range of motion of the ADR segment in patients with progressed PO (7.44±4.64 degrees) was significantly lower than that of patients with stable PO grade (12.13±4.42 degrees, P<0.01) at last follow-up. A proportion of HO might in fact be the natural development of preoperative osteophytes, which is unrelated to ADR; the remaining HO might be due to changes in biomechanical environment after surgery, which promotes the grade of osteophytes and affects the segment motion.

Intravenous parecoxib and continuous femoral block for postoperative analgesia after total knee arthroplasty. A randomized, double-blind, prospective trial.

PubMed

Sarridou, Despoina G; Chalmouki, Georgia; Braoudaki, Maria; Koutsoupaki, Anna; Mela, Argiro; Vadalouka, Athina

2015-01-01

Up until now, the optimal strategy for postoperative pain management after total knee arthroplasty (TKA) remains to be elucidated. The current investigation aimed to examine the analgesic efficacy and the opioid sparing effects of intravenous parecoxib in combination with continuous femoral blockade. Randomized, double-blind, prospective trial. University hospital in the United Kingdom. In total, 90 patients underwent TKA under subarachnoid anesthesia and received continuous femoral block initially as a bolus with 20 mL of ropivacaine 0.75%. Infusion of 0.2% on 10 mL/h followed. Patients were randomized into 2 groups. Group D and Group P received parecoxib and placebo, respectively at 12 hour time intervals. Visual analog scale (VAS) pain scores were obtained at different time intervals including 4, 8, 12, 24 and 36 hours. The pain scores were measured with patients in a resting position. Morphine could also be administered with a patient controlled analgesia (PCA) pump if the specified analgesia was deemed inadequate (VAS > 5). None of the patients were withdrawn from the study. Parecoxib provided greater relief than placebo following TKA. The VAS pain scores measured at rest were statistically significantly lower in parecoxib-treated patients compared to the placebo group (P = 0.007) at 4 (P = 0.044), 12 (P = 0.001), and 24 hours (P = 0.012), postoperatively. Patients receiving parecoxib consumed less morphine at all time intervals than patients receiving placebo, with borderline statistical significance (P = 0.054). In each time period, all patients receiving continuous femoral block irrespectively of the treatment group, required low morphine doses. Current protocol did not answer question as to functional recovery. According to our findings intravenous parecoxib in combination with continuous femoral block provided superior analgesic efficacy and opioid sparing effects in patients undergoing TKA.

Commencement Bay Studies Phase II, Environmental Impacts Assessment.

DTIC Science & Technology

1983-10-01

Approved for public release, distribution unlimited. 17. DISTRIBUTION STATEMENT (of the absirct entered In Block 20. If dlfforent from Report) IS...Matrix (Appendix D). 19. KEY WORDS (Continue n reveres side itnecsewy and identify by block number) Salmonids Wetlands Aesthetics City of Tacoma Marine...Water Quality Land and Water Use Port of Tacoma t AEINACr (Cm as ,.verem ebb N c evesey a - fdoswif by block n mbs) ames and Moore assessed the

21 CFR 882.1925 - Ultrasonic scanner calibration test block.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ultrasonic scanner calibration test block. 882.1925 Section 882.1925 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Diagnostic Devices § 882.1925...

On the Road to Quality: Turning Stumbling Blocks into Stepping Stones.

ERIC Educational Resources Information Center

Bonstingl, John Jay

1996-01-01

W. Edwards Deming's quality philosophy can help organizations develop collaborative, community-building leadership practices. This article outlines five personal practices of quality based on personal leadership, partnerships, a systems focus, a process orientation, and constant dedication to continuous improvement. Stumbling blocks can be…

31 CFR 598.404 - Setoffs prohibited.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Setoffs prohibited. 598.404 Section 598.404 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.404 Setoffs prohibited. A setoff against blocked property (including a blocked account...

31 CFR 598.404 - Setoffs prohibited.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Setoffs prohibited. 598.404 Section 598.404 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.404 Setoffs prohibited. A setoff against blocked property (including a blocked account...

31 CFR 598.404 - Setoffs prohibited.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Setoffs prohibited. 598.404 Section 598.404 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.404 Setoffs prohibited. A setoff against blocked property (including a blocked account...

31 CFR 598.404 - Setoffs prohibited.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Setoffs prohibited. 598.404 Section 598.404 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.404 Setoffs prohibited. A setoff against blocked property (including a blocked account...

31 CFR 598.404 - Setoffs prohibited.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Setoffs prohibited. 598.404 Section 598.404 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.404 Setoffs prohibited. A setoff against blocked property (including a blocked account...

31 CFR 595.201 - Prohibited transactions involving blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Prohibited transactions involving blocked property. 595.201 Section 595.201 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM SANCTIONS...

31 CFR 594.201 - Prohibited transactions involving blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Prohibited transactions involving blocked property. 594.201 Section 594.201 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM...

31 CFR 538.201 - Prohibited transactions involving blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Prohibited transactions involving blocked property. 538.201 Section 538.201 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY SUDANESE SANCTIONS...

31 CFR 545.201 - Prohibited transactions involving blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Prohibited transactions involving blocked property. 545.201 Section 545.201 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TALIBAN (AFGHANISTAN...

31 CFR 537.201 - Prohibited transactions involving certain blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Prohibited transactions involving certain blocked property. 537.201 Section 537.201 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY BURMESE...

Organic Coatings to Improve the Storageability and Safety of Pyrotechnic Compositions.

DTIC Science & Technology

1987-11-01

TERMS (CONTINUE ON REVERSE IF NECESSARY AND IDENTIFY BY BLOCK NUMBER) FIELD GROUP sue-oRouP Organic coatings Pyrotechnic compositions Magnesium coatings...Storageability Hydrogen gassing \\ ABSTRACT (CONTINUE ON REVERSE IF NECESSARY AND IDENTIFY BY BLOCK NUMBER) study was conducted to find organic...composition 52% KC10 3, 31% S2S31 17% dextrin Impact = (14 cm Coated with 5% Elvax-360 Impact = 16 cm in Ln cn- -T 01 LA 1C) -l4 -t, 0 14-1 0 toJ 0 0 110

Continuous air monitor filter changeout apparatus

DOEpatents

Rodgers, John C [Santa Fe, NM

2008-07-15

An apparatus and corresponding method for automatically changing out a filter cartridge in a continuous air monitor. The apparatus includes: a first container sized to hold filter cartridge replacements; a second container sized to hold used filter cartridges; a transport insert connectively attached to the first and second containers; a shuttle block, sized to hold the filter cartridges that is located within the transport insert; a transport driver mechanism means used to supply a motive force to move the shuttle block within the transport insert; and, a control means for operating the transport driver mechanism.

Unique Phrenic Nerve-Sparing Regional Anesthetic Technique for Pain Management after Shoulder Surgery

PubMed Central

Olsen, David A.; Amundson, Adam W.

2017-01-01

Background Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement. Conclusion This case report briefly reviews the important innervations to the shoulder joint and examines the utility of the infraclavicular brachial plexus block for postoperative pain management. PMID:29410922

Cervical spondylitis and spinal abscess due to Actinomyces meyeri.

PubMed

Duvignaud, Alexandre; Ribeiro, Emmanuel; Moynet, Daniel; Longy-Boursier, Maïté; Malvy, Denis

2014-01-01

Human actinomycosis with involvement of the spine is a rare condition although it has been first described a long time ago. It is probably underrecognized since its clinical presentation is often misleading and accurate bacteriological diagnosis is challenging. We herein report a rare case of cervical actinomycosis with paravertebral abscess and spondylitis imputed to an infection by Actinomyces meyeri in a 52-year-old immunocompetent Caucasian man. A. meyeri should be considered as a potential cause for subacute or chronic spondylitis, even in immunocompetent subjects. Modern diagnostic tools such as Matrix-Assisted Laser Desorption-Ionization Time of Flight mass spectrometry and 16S rRNA sequencing are efficient for accurate microbiological identification. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

[Carcinosarcoma of the urinary bladder and renal metastasis].

PubMed

Jlidi, R; Remadi, S; Gloor, J; Chatelanat, F

1991-01-01

A 74 year-old woman developed a polypoid tumor of the bladder which was discovered by hematuria. Upon histological examination, the tumor was shown to be a carcinosarcoma with a weak epithelial composition confirmed by immunolabelling with keratin and was composed essentially of chondrosarcomatous material. Six months later, the patient developed metastases in the kidney, in the paravertebral muscles, and in the right para-ureteral lymph nodes. There are 55 cases of carcinosarcoma of the bladder described in the literature [3, 20, 22]. It is a tumor found more frequently in men than in women, between the ages of 33 to 83. The prognosis is very gloomy .70% death rate within 2 years), but it seems to be improved by radical cystectomy and adjuvant therapy.

Intrathoracic extramedullary haematopoiesis complicated by massive haemothorax in alpha-thalassaemia

PubMed Central

Chu, K.; Lai, R.; Lee, C.; Lu, J.; Chang, H.; Chiang, H.

1999-01-01

Intrathoracic extramedullary haematopoiesis (EMH) is a rare entity that is usually asymptomatic. A 44 year old man with alpha-thalassaemia is described who developed dyspnoea and massive left sided haemothorax. The haemoglobin disorder was established by Hgb H staining and haemoglobin electrophoretic studies. The DNA analysis revealed it to be a case of double heterozygous terminal codon mutation with the genotype ααCS/ααT. Computed tomographic scanning and magnetic resonance imaging of the thorax showed multiple paravertebral masses which were found by thoracoscopic biopsy to be extramedullary haematopoiesis. Although no additional sclerosing pleurodesis or low dose radiation therapy was given, the lung expanded well and there has been no recurrence of haemothorax to date.

 PMID:10212116

Peripheral ganglia supplying the genital smooth musculature in the female pig: an experimental study

PubMed Central

PANU, RINO; BO MINELLI, LUISA; BOTTI, MADDALENA; GAZZA, FERDINANDO; ACONE, FRANCA; PALMIERI, GIOVANNI

2001-01-01

The aim of the present study was to locate the sensory and autonomic ganglia innervating the female genital musculature in pigs. The retrograde neuronal tracers horseradish peroxidase (HRP) or fast blue (FB) were injected into the left retractor clitoridis muscle (RCM), which was treated as a typical model of the genital smooth musculature. Labelled cells were found in ipsilateral dorsal root ganglia Sl–S4, in bilateral sympathetic paravertebral ganglia from L5–L6 or L6–L7 to S3 and in the left and right caudal mesenteric ganglion. In two of the five animals treated, presumably preganglionic parasympathetic cells were labelled in the ipsilateral intermediate grey substance of the segments Sl–S2. PMID:11554508

Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Scheffer, Hester J., E-mail: hj.scheffer@vumc.nl; Melenhorst, Marleen C. A. M., E-mail: m.melenhorst@vumc.nl; Vogel, Jantien A., E-mail: j.a.vogel@amc.uva.nl

Irreversible electroporation (IRE) is a novel image-guided ablation technique that is increasingly used to treat locally advanced pancreatic carcinoma (LAPC). We describe a 67-year-old male patient with a 5 cm stage III pancreatic tumor who was referred for IRE. Because the ventral approach for electrode placement was considered dangerous due to vicinity of the tumor to collateral vessels and duodenum, the dorsal approach was chosen. Under CT-guidance, six electrodes were advanced in the tumor, approaching paravertebrally alongside the aorta and inferior vena cava. Ablation was performed without complications. This case describes that when ventral electrode placement for pancreatic IRE is impaired,more » the dorsal approach could be considered alternatively.« less

Tissue biocompatibility of kevlar aramid fibers and polymethylmethacrylate, composites in rabbits.

PubMed

Henderson, J D; Mullarky, R H; Ryan, D E

1987-01-01

Two groups of female NZW rabbits were implanted in the paravertebral muscles with aramid (du Pont Kevlar aramid 49) fibers and aramid-polymethylmethacrylate (PMMA) composites for 14 and 28 days. Rabbits were killed at these times periods, necropsies performed, sites scored for gross tissue response, and tissue specimens containing the implants removed for histopathological evaluation. A mild fibrous tissue reaction was observed around all implants containing aramid fiber similar to that observed around the silicone control implant. Some foreign body giant cells were also present adjacent to the fibers. An intense necrotic inflammatory reaction was present around the positive control material (PVC Y-78). The tissue response to implantation of aramid fiber and fiber-PMMA composites indicates that aramid is a biocompatible material.

A new blind snake (Serpentes: Typhlopidae) from an endangered habitat in south-eastern Queensland, Australia.

PubMed

Venchi, Alberto; Wilson, Steve K; Borsboom, Adrian C

2015-07-24

A new species of blind snake is described from south-eastern Queensland, eastern Australia. Anilios insperatus sp. nov. differs from all of its congeners in having:16 scales around the body; 442 paravertebral scales; snout slightly trilobed from above and bluntly angular in profile; small, inconspicuous eyes, located within the ocular scale at its junction with the preocular and the supraocular scales; and uniform light colouration. The unique specimen was collected from pasture that was formally Queensland regional ecosystem 12.8.24, a eucalypt dominated ecosystem currently listed as endangered. The site is less than 100 km from Queensland's capital, Brisbane. Given the locality, habitat and absence of additional specimens, the species is probably of conservation concern.

Optimized collectives using a DMA on a parallel computer

DOEpatents

Chen, Dong [Croton On Hudson, NY; Gabor, Dozsa [Ardsley, NY; Giampapa, Mark E [Irvington, NY; Heidelberger,; Phillip, [Cortlandt Manor, NY

2011-02-08

Optimizing collective operations using direct memory access controller on a parallel computer, in one aspect, may comprise establishing a byte counter associated with a direct memory access controller for each submessage in a message. The byte counter includes at least a base address of memory and a byte count associated with a submessage. A byte counter associated with a submessage is monitored to determine whether at least a block of data of the submessage has been received. The block of data has a predetermined size, for example, a number of bytes. The block is processed when the block has been fully received, for example, when the byte count indicates all bytes of the block have been received. The monitoring and processing may continue for all blocks in all submessages in the message.

47 CFR 24.717 - Bidding credits for licenses for frequency Block F.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Block F. 24.717 Section 24.717 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Competitive Bidding Procedures for Broadband PCS § 24... closed bidding in auctions that begin after March 23, 1999, a winning bidder that qualifies as a small...

47 CFR 24.712 - Bidding credits for licenses won for frequency Block C.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Block C. 24.712 Section 24.712 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Competitive Bidding Procedures for Broadband PCS § 24... closed bidding in auctions that begin after March 23, 1999, a winning bidder that qualifies as a small...

An Airborne Programmable Digital to Video Converter Interface and Operation Manual.

DTIC Science & Technology

1981-02-01

Identify by block number) SCAN CONVERTER VIDEO DISPLAY TELEVISION DISPLAY 20. ABSTRACT (Continue on reverse oide If necessary and Identify by block...programmable cathode ray tube (CRT) controller which is accessed by the CPU to permit operation in a wide variety of modes. The Alphanumeric Generator

31 CFR 594.408 - Payments from blocked accounts to satisfy obligations prohibited.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Payments from blocked accounts to satisfy obligations prohibited. 594.408 Section 594.408 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL...

31 CFR 594.408 - Payments from blocked accounts to satisfy obligations prohibited.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Payments from blocked accounts to satisfy obligations prohibited. 594.408 Section 594.408 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL...

31 CFR 546.407 - Payments from blocked accounts to satisfy obligations prohibited.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Payments from blocked accounts to satisfy obligations prohibited. 546.407 Section 546.407 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DARFUR...

31 CFR 537.407 - Payments from blocked accounts to satisfy obligations prohibited.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Payments from blocked accounts to satisfy obligations prohibited. 537.407 Section 537.407 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY BURMESE...

14 CFR 156.4 - Airport and project eligibility.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Airport and project eligibility. 156.4... (CONTINUED) AIRPORTS STATE BLOCK GRANT PILOT PROGRAM § 156.4 Airport and project eligibility. (a) A participating State shall use monies distributed pursuant to a State block grant agreement for airport...

14 CFR 156.4 - Airport and project eligibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Airport and project eligibility. 156.4... (CONTINUED) AIRPORTS STATE BLOCK GRANT PILOT PROGRAM § 156.4 Airport and project eligibility. (a) A participating State shall use monies distributed pursuant to a State block grant agreement for airport...

14 CFR 156.4 - Airport and project eligibility.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Airport and project eligibility. 156.4... (CONTINUED) AIRPORTS STATE BLOCK GRANT PILOT PROGRAM § 156.4 Airport and project eligibility. (a) A participating State shall use monies distributed pursuant to a State block grant agreement for airport...

14 CFR 156.4 - Airport and project eligibility.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Airport and project eligibility. 156.4... (CONTINUED) AIRPORTS STATE BLOCK GRANT PILOT PROGRAM § 156.4 Airport and project eligibility. (a) A participating State shall use monies distributed pursuant to a State block grant agreement for airport...

14 CFR 156.4 - Airport and project eligibility.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Airport and project eligibility. 156.4... (CONTINUED) AIRPORTS STATE BLOCK GRANT PILOT PROGRAM § 156.4 Airport and project eligibility. (a) A participating State shall use monies distributed pursuant to a State block grant agreement for airport...

31 CFR 515.508 - Payments to blocked accounts in domestic banks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Payments to blocked accounts in domestic banks. 515.508 Section 515.508 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY CUBAN ASSETS CONTROL...

31 CFR 500.508 - Payments to blocked accounts in domestic banks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Payments to blocked accounts in domestic banks. 500.508 Section 500.508 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FOREIGN ASSETS CONTROL...

21 CFR 892.5710 - Radiation therapy beam-shaping block.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiation therapy beam-shaping block. 892.5710 Section 892.5710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5710 Radiation therapy beam-shaping...

Long Range Spoil Disposal Study. Part 3. Sub-Study 2. Nature, Source, and Cause of Shoal

DTIC Science & Technology

1973-09-01

Report) Prepared for public release; distribution unlimited 17. DISTRIBUTION STATEMENT (of the abetract entered In Block 20, if different from Report) IS...SUPPLEMENTARY NOTES 19. KEY WORDS (Continue on reverse side if necseseey and identify by block number) Delaware River River Channel Delaware Estuary...Marcus Hook, Pa. Dredging Hydraulic Dredge Spoil Disposal Sediment transport 2o ABSTRACT r -ciftue a r verse - i- - n a eay amd ideai fy by block

Development of a blunt chest injury care bundle: An integrative review.

PubMed

Kourouche, Sarah; Buckley, Thomas; Munroe, Belinda; Curtis, Kate

2018-06-01

Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes. To review and integrate the BCI management interventions to inform the development of a BCI care bundle. A structured search of the literature was conducted to identify studies evaluating interventions for patients with BCI. Databases MEDLINE, CINAHL, PubMed and Scopus were searched from 1990-April 2017. A two-step data extraction process was conducted using pre-defined data fields, including research quality indicators. Each study was appraised using a quality assessment tool, scored for level of evidence, then data collated into categories. Interventions were also assessed using the APEASE criteria then integrated to develop a BCI care bundle. Eighty-one articles were included in the final analysis. Interventions that improved BCI outcomes were grouped into three categories; respiratory intervention, analgesia and surgical intervention. Respiratory interventions included continuous positive airway pressure and high flow nasal oxygen. Analgesia interventions included regular multi-modal analgesia and paravertebral or epidural analgesia. Surgical fixation was supported for use in moderate to severe rib fractures/BCI. Interventions supported by evidence and that met APEASE criteria were combined into a BCI care bundle with four components: respiratory adjuncts, analgesia, complication prevention, and surgical fixation. The key components of a BCI care bundle are respiratory support, analgesia, complication prevention including chest physiotherapy and surgical fixation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Rockslide-debris avalanche of May 18, 1980, Mount St. Helens Volcano, Washington

USGS Publications Warehouse

Glicken, Harry

1996-01-01

This report provides a detailed picture of the rockslide-debris avalanche of the May 18, 1980, eruption of Mount St. Helens volcano. It provides a characterization of the deposit, a reinterpretation of the details of the first minutes of the eruption of May 18, and insight into the transport mechanism of the mass movement. Details of the rockslide event, as revealed by eyewitness photographs, are correlated with features of the deposit. The photographs show three slide blocks in the rockslide movement. Slide block I was triggered by a magnitude 5.1 earthquake at 8:32 a.m. Pacific Daylight Time (P.D.T.). An exploding cryptodome burst through slide block II to produce the 'blast surge.' Slide block III consisted of many discrete failures that were carried out in continuing pyroclastic currents generated from the exploding cryptodome. The cryptodome continued to depressurize after slide block III, producing a blast deposit that rests on top of the debris-avalanche deposit. The hummocky 2.5 cubic kilometer debris-avalanche deposit consists of block facies (pieces of the pre-eruption Mount St. Helens transported relatively intact) and matrix facies (a mixture of rocks from the old mountain and cryptodome dacite). Block facies is divided into five lithologic units. Matrix facies was derived from the explosively generated current of slide block III as well as from disaggregation and mixing of debris-avalanche blocks. The mean density of the old cone was measured to be abut 20 percent greater than the mean density of the avalanche deposit. Density in the deposit does not decrease with distance which suggests that debris-avalanche blocks were dilated at the mountain, rather than during transport. Various grain-size parameters that show that clast size converges about a mean with distance suggest mixing during transport. The debris-avalanche flow can be considered a grain flow, where particles -- either debris-avalanche blocks or the clasts within the blocks -- collided and created dispersive stress normal to the movement of material. The dispersive stress preserved the dilation of the material and allowed it to flow.

Navy Aegis Ballistic Missile Defense (BMD) Program: Background and Issues for Congress

DTIC Science & Technology

2010-09-28

co-development with Japan, for chemical vapor composite silicon carbide and silicon carbide corrugated mirror processes for the SM–3 Block IIA...all the more urgent in light of Iran’s continued uranium enrichment program. Iran continues to defy international obligations, and there continues to

The 10 building blocks of high-performing primary care.

PubMed

Bodenheimer, Thomas; Ghorob, Amireh; Willard-Grace, Rachel; Grumbach, Kevin

2014-01-01

Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements-engaged leadership, data-driven improvement, empanelment, and team-based care-that assist the implementation of the other 6 building blocks-patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement.

Effect of programmed intermittent epidural boluses and continuous epidural infusion on labor analgesia and obstetric outcomes: a randomized controlled trial.

PubMed

Ferrer, Leopoldo E; Romero, David J; Vásquez, Oscar I; Matute, Ednna C; Van de Velde, Marc

2017-11-01

Continuous epidural infusion and programmed intermittent epidural boluses are analgesic techniques routinely used for pain relief in laboring women. We aimed to assess both techniques and compare them with respect to labor analgesia and obstetric outcomes. After Institutional Review Board approval, 132 laboring women aged between 18 and 45 years were randomized to epidural analgesia of 10 mL of a mixture of 0.1% bupivacaine plus 2 µg/mL of fentanyl either by programmed intermittent boluses or continuous infusion (66 per group). Primary outcome was quality of analgesia. Secondary outcomes were duration of labor, total drug dose used, maternal satisfaction, sensory level, motor block level, presence of unilateral motor block, hemodynamics, side effects, mode of delivery, and newborn outcome. Patients in the programmed intermittent epidural boluses group received statistically less drug dose than those with continuous epidural infusion (24.9 vs 34.4 mL bupivacaine; P = 0.01). There was no difference between groups regarding pain control, characteristics of block, hemodynamics, side effects, and Apgar scores. Our study evidenced a lower anesthetic consumption in the programmed intermittent boluses group with similar labor analgesic control, and obstetric and newborn outcomes in both groups.

Mitigation of Shore Damage Attributed to the Federal Navigation Structures at Ludington Harbor, Michigan.

DTIC Science & Technology

1975-12-01

In Block 20, If different from Report) IS. SUPPLEMENTARY NOTES 19. KEY WORDS (Continu, on reverse aide If necesary and Identify by block number) 20...AST’R ACT (Cndbie m reverse ohb N n..e~ww and ideti fy by block number) DD JA 473 EDITION OF I NOV GS 15 OBSOLETE 4~ -i ~SECURITY CLASSIFICATION OF...and Harbor Act of 1867 provided Federal assistance for improving the harbor and channel. Revetments and channel piers were constructed under this Act

31 CFR 595.403 - Termination and acquisition of an interest in blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Termination and acquisition of an interest in blocked property. 595.403 Section 595.403 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM...

31 CFR 594.404 - Termination and acquisition of an interest in blocked property.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Termination and acquisition of an interest in blocked property. 594.404 Section 594.404 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL...

31 CFR 594.404 - Termination and acquisition of an interest in blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Termination and acquisition of an interest in blocked property. 594.404 Section 594.404 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL...

7 CFR 58.425 - Conveyor for moving and draining block or barrel cheese.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Conveyor for moving and draining block or barrel cheese. 58.425 Section 58.425 Agriculture Regulations of the Department of Agriculture (Continued... cheese. The conveyor shall be constructed so that it will not contaminate the cheese and be easily...

7 CFR 58.425 - Conveyor for moving and draining block or barrel cheese.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Conveyor for moving and draining block or barrel cheese. 58.425 Section 58.425 Agriculture Regulations of the Department of Agriculture (Continued... cheese. The conveyor shall be constructed so that it will not contaminate the cheese and be easily...

31 CFR 546.403 - Termination and acquisition of an interest in blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Termination and acquisition of an interest in blocked property. 546.403 Section 546.403 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DARFUR...

31 CFR 537.403 - Termination and acquisition of an interest in blocked property.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Termination and acquisition of an interest in blocked property. 537.403 Section 537.403 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY BURMESE...

Architecture Of A Sciencecraft To Fly Past Pluto

NASA Technical Reports Server (NTRS)

Price, Humphrey W.; Staehle, Robert L.; Alkalaj, Leon; Terrile, Richard J.; Miyake, Robert N.

1995-01-01

Two reports discuss architecture of proposed small sciencecraft carrying scientific instruments on trajectory passing near Pluto and continuing into interstellar space. Emphasizes those aspects of design pertaining to compactness, efficiency, and small mass (dry mass less than 100 kg). System block diagram of sciencecraft divided into blocks for sensors, integrated microelectronics, and motive effectors.

76 FR 29143 - Blocking Property of Senior Officials of the Government of Syria

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-20

... Order 13573 of May 18, 2011 Blocking Property of Senior Officials of the Government of Syria By the... of Syria's continuing escalation of violence against the people of Syria--including through attacks... be a senior official of the Government of Syria; (ii) to be an agency or instrumentality of the...

31 CFR 551.403 - Termination and acquisition of an interest in blocked property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Termination and acquisition of an interest in blocked property. 551.403 Section 551.403 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY SOMALIA...

75 FR 71794 - Blocking of Specially Designated Nationals Pursuant to Executive Order 13551

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-24

... 13551 of August 30, 2010, ``Blocking Property of Certain Persons With Respect to North Korea.'' DATES... President found that the continued actions and policies of the Government of North Korea, manifested most...., Potonggang District, Pyongyang, Korea, North; SWIFT/BIC KDBK KP PY (Korea, North); PHONE 850 2 381 8221...

31 CFR 510.403 - Termination and acquisition of an interest in blocked property.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Termination and acquisition of an interest in blocked property. 510.403 Section 510.403 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY NORTH KOREA...

Effects of lesions to the left lateral prefrontal cortex on task-specific top-down biases and response strategies in blocked-cyclic naming.

PubMed

Belke, Eva

Anders, Riès, van Maanen and Alario put forward evidence accumulation modelling of object naming times as an alternative to neural network models of lexical retrieval. The authors exemplify their approach using data from the blocked-cyclic naming paradigm, requiring speakers to repeatedly name small sets of related or unrelated objects. The effects observed with this paradigm are understood reasonably well within the tradition of neural network modelling. However, implemented neural network models do not specify interfaces for task-specific top-down influences and response strategies that are likely to play a role in the blocked-cyclic naming paradigm, distinguishing it from continuous, non-cyclic manipulations of the naming context. I argue that the evidence accumulation approach falls short on this account as well, as it does not specify the potential contribution of task-specific top-down processes and strategic facilitation effects to the response time distributions. Future endeavours to model or fit data from blocked-cyclic naming experiments should strive to do so by simultaneously considering data from continuous context manipulations.

Research on Disaster Early Warning and Disaster Relief Integrated Service System Based on Block Data Theory

NASA Astrophysics Data System (ADS)

Yang, J.; Zhang, H.; Wang, C.; Tang, D.

2018-04-01

With the continuous development of social economy, the interaction between mankind and nature has become increasingly evident. Disastrous global catastrophes have occurred from time to time, causing huge losses to people's lives and property. All governments recognize the importance of the establishment of disaster early warning and release mechanisms, and it is also an urgent issue to improve the comprehensive service level of emergency response and disaster relief. However, disaster early warning and emergency relief information is usually generated by different departments, and the diverse data sources, difficult integration, and limited release speed have always been difficult issues to be solved. Block data is the aggregation of various distributed (point data) and segmentation (data) big data on a specific platform and make them happen continuous polymerization effect, block data theory is a good solution to cross-sectoral, cross-platform Disaster information data sharing and integration problems. This paper attempts to discuss the integrated service mechanism of disaster information aggregation and disaster relief based on block data theory and introduces a location-based integrated service system for disaster early warning and disaster relief.

An Investigation of Cholinergic Circuitry in Cat Striate Cortex Using Acetylcholinesterase Histochemistry.

DTIC Science & Technology

1984-10-10

OF REPORT 6 PERIOD COEREC All !lVL-tiVc"lt in) 0! I ntt rcu t r, ill Cat Technical Report 00 !ti t ( lt: . ,h , -in c , I lcho l n t e ra ,- ( H iSto...8217 Report) I0 SUPPLEMENTARY NOTES 19 K EY WORDS (Continue on reveree old* it n~coeeary and Identify by block number) Ac Ltv VIc C11 i e Visual Cortex...Basal Forebrain 20. ADSTRPACT (Continue an revere. eld* it necessary and identl fy by block number) Iicor’anization of cholinergic inputs to cat striate

A Proposed Direction Finding and Polarization Sensing Scheme.

DTIC Science & Technology

1976-03-01

on ’:i J -v nor any ’.o tion 4-u rn s e c, c. in a ,y x ay su-.plie soi a. cdl nir ino g cvsci f icati o-c, in ar"r’. mnner C o the >o d r c ,,,o-,r...SUPPLEMENTARY NOTES 19. KEY WORDS (Continue on reverse aide iI necessary and identify by block number) Direction-findingi t Polarization-sensing Small...antenna array 20. ABS CT (Continue on reverse aide If necesaery and identify by block number) This report proposes and demonstrates a direction finding

Block clustering based on difference of convex functions (DC) programming and DC algorithms.

PubMed

Le, Hoai Minh; Le Thi, Hoai An; Dinh, Tao Pham; Huynh, Van Ngai

2013-10-01

We investigate difference of convex functions (DC) programming and the DC algorithm (DCA) to solve the block clustering problem in the continuous framework, which traditionally requires solving a hard combinatorial optimization problem. DC reformulation techniques and exact penalty in DC programming are developed to build an appropriate equivalent DC program of the block clustering problem. They lead to an elegant and explicit DCA scheme for the resulting DC program. Computational experiments show the robustness and efficiency of the proposed algorithm and its superiority over standard algorithms such as two-mode K-means, two-mode fuzzy clustering, and block classification EM.

Hyperalgesia and Persistent Pain after Breast Cancer Surgery: A Prospective Randomized Controlled Trial with Perioperative COX-2 Inhibition

PubMed Central

van Helmond, Noud; Steegers, Monique A.; Filippini-de Moor, Gertie P.; Vissers, Kris C.; Wilder-Smith, Oliver H.

2016-01-01

Background Persistent pain is a challenging clinical problem after breast cancer treatment. After surgery, inflammatory pain and nociceptive input from nerve injury induce central sensitization which may play a role in the genesis of persistent pain. Using quantitative sensory testing, we tested the hypothesis that adding COX-2 inhibition to standard treatment reduces hyperalgesia after breast cancer surgery. A secondary hypothesis was that patients developing persistent pain would exhibit more postoperative hyperalgesia. Methods 138 women scheduled for lumpectomy/mastectomy under general anesthesia with paravertebral block were randomized to COX-2 inhibition (2x40mg parecoxib on day of surgery, thereafter 2x200mg celecoxib/day until day five) or placebo. Preoperatively and 1, 5, 15 days and 1, 3, 6, 12 months postoperatively, we determined electric and pressure pain tolerance thresholds in dermatomes C6/T4/L1 and a 100mm VAS score for pain. We calculated the sum of pain tolerance thresholds and analyzed change in these versus preoperatively using mixed models analysis with factor medication. To assess hyperalgesia in persistent pain patients we performed an additional analysis on patients reporting VAS>30 at 12 months. Results 48 COX-2 inhibition and 46 placebo patients were analyzed in a modified intention to treat analysis. Contrary to our primary hypothesis, change in the sum of tolerance thresholds in the COX-2 inhibition group was not different versus placebo. COX-2 inhibition had an effect on pain on movement at postoperative day 5 (p<0.01). Consistent with our secondary hypothesis, change in sum of pressure pain tolerance thresholds in 11 patients that developed persistent pain was negative versus patients without pain (p<0.01) from day 5 to 1 year postoperatively. Conclusions Perioperative COX-2 inhibition has limited value in preventing sensitization and persistent pain after breast cancer surgery. Central sensitization may play a role in the genesis of persistent postsurgical pain. PMID:27935990

Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial.

PubMed

Ribeiro, Luiza Helena; Furtado, Rita Nely Vilar; Konai, Monique Sayuri; Andreo, Ana Beatriz; Rosenfeld, Andre; Natour, Jamil

2013-11-01

Randomized clinical trial. To compare the effectiveness of facet joint injection versus systemic steroid in patients with a diagnosis of facet joint syndrome. The term facet joint syndrome has been used to define back pain originating from the facet joints. Treatment is mainly conservative, although interventions, including intra-articular injections and medial branch nerve blocks are used to manage facet-mediated pain. Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting. Sixty subjects with a diagnosis of facet joint syndrome were enrolled in the study. They were randomized into experimental and control groups. The experimental group was administered with intra-articular injection of 6 lumbar facet joints with triamcinolone hexacetonide; the control group was administered with triamcinolone acetonide intramuscular injection of 6 lumbar paravertebral points. Visits were taken at baseline and at 1, 4, 12, and 24 weeks after interventions. Outcome measures were used: pain visual analogue scale, pain visual analogue scale during extension of the spine, Likert scale, improvement percentage scale, Roland-Morris, 36-Item Short Form Health Survey, and accountability of medications taken.Homogeneity was tested using the Student t, Pearson χ, and Mann-Whitney tests. Analysis of variance was used to analyze differences in the groups over time and the Student t test to analyze differences between groups at each time evaluation. The groups were similar at baseline. Comparisons between the groups showed, in analysis of variance analysis, an improvement in the experimental group regarding diclofenac intake and quality of life, in the "role physical" profile, assessed by 36-Item Short Form Health Survey.In the analysis at each time point, an improvement in the experimental group was also found in the Roland-Morris questionnaire, in the improvement percentage scale and in the response to treatment, assessed by the Likert scale. Both treatments were effective, with a slight superiority of the intra-articular injection of steroids over intramuscular injection.

40 CFR Table 5 to Subpart Hhhhhhh... - Operating Parameters, Operating Limits and Data Monitoring, Recording and Compliance Frequencies...

Code of Federal Regulations, 2013 CFR

2013-07-01

... conductivity Continuous Every 15 minutes 3-hour block average. Regenerative Adsorber Regeneration stream flow. Minimum total flow per regeneration cycle Continuous N/A Total flow for each regeneration cycle. Adsorber bed temperature. Maximum temperature Continuously after regeneration and within 15 minutes of...

40 CFR Table 5 to Subpart Hhhhhhh... - Operating Parameters, Operating Limits and Data Monitoring, Recording and Compliance Frequencies...

Code of Federal Regulations, 2014 CFR

2014-07-01

... conductivity Continuous Every 15 minutes 3-hour block average. Regenerative Adsorber Regeneration stream flow. Minimum total flow per regeneration cycle Continuous N/A Total flow for each regeneration cycle. Adsorber bed temperature. Maximum temperature Continuously after regeneration and within 15 minutes of...

Influence of micromixer characteristics on polydispersity index of block copolymers synthesized in continuous flow microreactors.

PubMed

Rosenfeld, Carine; Serra, Christophe; Brochon, Cyril; Hadziioannou, Georges

2008-10-01

The influence of interdigital multilamination micromixer characteristics on monomer conversions, molecular weights and especially on the polydispersity index of block copolymers synthesized continuously in two microtube reactors is investigated. The micromixers are used to mix, before copolymerization, a polymer solution with different viscosities and the second monomer. Different geometries of micromixer (number of microchannels, characteristic lengths) have been studied. It was found that polydispersity indices of the copolymers follow a linear relationship with the Reynolds number in the micromixer, represented by a form factor. Thus, beside the operating conditions (nature of the first block and comonomer flow rate), the choice of the micromixer geometry and dimension is essential to control the copolymerization in terms of molecular weights and polydispersity indices. This linear correlation allows the prediction of copolymer features. It can also be a new method to optimize existing micromixers or design other geometries so that mixing could be more efficient.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khin, J.A.

Since reopening to foreign operators in 1989, companies have secured concessions and begun active exploration programs. This paper reports on: Yukong Oil (Block C) spudded well Indaw YK-1 last December and continued drilling below 8,500 ft. Well encountered frequent gas cut mud as well as lost circulation. BHP (Block H) spudded the Kawliya-1 in March this year and drilled to 6,500 ft. The well was dry and abandoned BHP plans to drill another well this year. Unocal (Block F) spudded its first well, the Kandaw-1, in May and plans to drill to 14,500 ft. Shell (Block G) began its firstmore » well in June. Shell's drilling program will consist of drilling four to six wells. Idemitsu (Block D) also spudded its first well in June. PetroCanada (Block E) plans to spud a well by December. Target depth is 12,000 ft.« less

Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation.

PubMed

Fujiwara, Atsushi; Komasawa, Nobuyasu; Minami, Toshiaki

2014-01-01

A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered risky, monitored anesthesia care utilizing peripheral nerve block and slight sedation was scheduled. Pectoral nerves (PECS) block and intercostal block was performed under ultrasonography with ropivacaine. For sedation during the procedure, continuous infusion of dexmedetomidine without a loading dose was performed. The procedure lasted about 3 hours, but the patient showed no pain or restlessness. Combination of PECS block and intercostal block may provide effective analgesia for CRTD implantation.

Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report.

PubMed

Lee, Susan C; Geannette, Christian; Wolfe, Scott W; Feinberg, Joseph H; Sneag, Darryl B

2017-08-01

This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed-and consequently scar tethered-the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy.

Method and apparatus for conducting variable thickness vapor deposition

DOEpatents

Nesslage, G.V.

1984-08-03

A method of vapor depositing metal on a substrate in variable thickness comprises conducting the deposition continuously without interruption to avoid formation of grain boundaries. To achieve reduced deposition in specific regions a thin wire or ribbon blocking body is placed between source and substrate to partially block vapors from depositing in the region immediately below.

76 FR 52209 - Blocking Property of the Government of Syria and Prohibiting Certain Transactions With Respect to...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-22

... Order 13582 of August 17, 2011 Blocking Property of the Government of Syria and Prohibiting Certain Transactions With Respect to Syria By the authority vested in me as President by the Constitution and the laws... additional steps with respect to the Government of Syria's continuing escalation of violence against the...

31 CFR 586.513 - Certain transactions with respect to trade with blocked persons authorized.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Certain transactions with respect to trade with blocked persons authorized. 586.513 Section 586.513 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FEDERAL REPUBLIC OF YUGOSLAVIA (SERBIA &...

Child Care and Development Block Grant (CCDBG) Participation Continues to Fall

ERIC Educational Resources Information Center

Matthews, Hannah; Schmit, Stephanie

2014-01-01

Child care subsidies help make quality child care affordable for low-income parents, allowing them to attend work or school to support their families while ensuring their children's healthy development. The Child Care and Development Block Grant (CCDBG) is the primary source of federal funding for child care subsidies for low-income working…

Spontaneously Combustible Solids -- A Literature Search

DTIC Science & Technology

1975-05-01

Wasahizeon, D.* C. It. K(EY WORDS (Continue on reviers side It necesary and Identify by block number) Pyrophoric Materials Hazardous Materials...and Identify by block number) Existing information on spontaneously combustible solids including pyrophoric - air hazardous materials and water... pyrophoric -air hazardous and water reactive materials. All available hazard classification systems and test methods releting to spontaneous combustion have

31 CFR 500.327 - Blocked estate of a decedent.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked estate of a decedent. 500.327 Section 500.327 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... interest in a decedent's estate if he: (a) Was the decedent; (b) Is a personal representative; or (c) Is a...

31 CFR 515.327 - Blocked estate of a decedent.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked estate of a decedent. 515.327 Section 515.327 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... interest in a decedent's estate if he: (a) Was the decedent; (b) Is a personal representative; or (c) Is a...

31 CFR 515.327 - Blocked estate of a decedent.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked estate of a decedent. 515.327 Section 515.327 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... interest in a decedent's estate if he: (a) Was the decedent; (b) Is a personal representative; or (c) Is a...

31 CFR 515.327 - Blocked estate of a decedent.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked estate of a decedent. 515.327 Section 515.327 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... interest in a decedent's estate if he: (a) Was the decedent; (b) Is a personal representative; or (c) Is a...

31 CFR 515.327 - Blocked estate of a decedent.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked estate of a decedent. 515.327 Section 515.327 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... interest in a decedent's estate if he: (a) Was the decedent; (b) Is a personal representative; or (c) Is a...

31 CFR 515.327 - Blocked estate of a decedent.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked estate of a decedent. 515.327 Section 515.327 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... interest in a decedent's estate if he: (a) Was the decedent; (b) Is a personal representative; or (c) Is a...

Real alerts and artifact classification in archived multi-signal vital sign monitoring data: implications for mining big data.

PubMed

Hravnak, Marilyn; Chen, Lujie; Dubrawski, Artur; Bose, Eliezer; Clermont, Gilles; Pinsky, Michael R

2016-12-01

Huge hospital information system databases can be mined for knowledge discovery and decision support, but artifact in stored non-invasive vital sign (VS) high-frequency data streams limits its use. We used machine-learning (ML) algorithms trained on expert-labeled VS data streams to automatically classify VS alerts as real or artifact, thereby "cleaning" such data for future modeling. 634 admissions to a step-down unit had recorded continuous noninvasive VS monitoring data [heart rate (HR), respiratory rate (RR), peripheral arterial oxygen saturation (SpO 2 ) at 1/20 Hz, and noninvasive oscillometric blood pressure (BP)]. Time data were across stability thresholds defined VS event epochs. Data were divided Block 1 as the ML training/cross-validation set and Block 2 the test set. Expert clinicians annotated Block 1 events as perceived real or artifact. After feature extraction, ML algorithms were trained to create and validate models automatically classifying events as real or artifact. The models were then tested on Block 2. Block 1 yielded 812 VS events, with 214 (26 %) judged by experts as artifact (RR 43 %, SpO 2 40 %, BP 15 %, HR 2 %). ML algorithms applied to the Block 1 training/cross-validation set (tenfold cross-validation) gave area under the curve (AUC) scores of 0.97 RR, 0.91 BP and 0.76 SpO 2 . Performance when applied to Block 2 test data was AUC 0.94 RR, 0.84 BP and 0.72 SpO 2 . ML-defined algorithms applied to archived multi-signal continuous VS monitoring data allowed accurate automated classification of VS alerts as real or artifact, and could support data mining for future model building.

Real Alerts and Artifact Classification in Archived Multi-signal Vital Sign Monitoring Data—Implications for Mining Big Data — Implications for Mining Big Data

PubMed Central

Hravnak, Marilyn; Chen, Lujie; Dubrawski, Artur; Bose, Eliezer; Clermont, Gilles; Pinsky, Michael R.

2015-01-01

PURPOSE Huge hospital information system databases can be mined for knowledge discovery and decision support, but artifact in stored non-invasive vital sign (VS) high-frequency data streams limits its use. We used machine-learning (ML) algorithms trained on expert-labeled VS data streams to automatically classify VS alerts as real or artifact, thereby “cleaning” such data for future modeling. METHODS 634 admissions to a step-down unit had recorded continuous noninvasive VS monitoring data (heart rate [HR], respiratory rate [RR], peripheral arterial oxygen saturation [SpO2] at 1/20Hz., and noninvasive oscillometric blood pressure [BP]) Time data were across stability thresholds defined VS event epochs. Data were divided Block 1 as the ML training/cross-validation set and Block 2 the test set. Expert clinicians annotated Block 1 events as perceived real or artifact. After feature extraction, ML algorithms were trained to create and validate models automatically classifying events as real or artifact. The models were then tested on Block 2. RESULTS Block 1 yielded 812 VS events, with 214 (26%) judged by experts as artifact (RR 43%, SpO2 40%, BP 15%, HR 2%). ML algorithms applied to the Block 1 training/cross-validation set (10-fold cross-validation) gave area under the curve (AUC) scores of 0.97 RR, 0.91 BP and 0.76 SpO2. Performance when applied to Block 2 test data was AUC 0.94 RR, 0.84 BP and 0.72 SpO2). CONCLUSIONS ML-defined algorithms applied to archived multi-signal continuous VS monitoring data allowed accurate automated classification of VS alerts as real or artifact, and could support data mining for future model building. PMID:26438655

Test Excavations at 3LA128. An Early Caddo Occupation on the Red River.

DTIC Science & Technology

1982-04-15

aberact entered in Block 20, It different frot Report) IS. SUPPLEMENTARY NOTES It. KEY WORDS (Continue on reverse side It necessary end Identify by... block number) ! l SITNT’ (CCOlMnue as reverse shb N ne"myaj dad identify by block nmbet) t7The Arkansas Acheological Survey tested site 37.A128 under...Purchase Order DACW29-81-M-0165 on the Field Revetment for the New Orleans District Office of the U.S. Army Corps of Engineers to gather data for

Best multimodal analgesic protocol for total knee arthroplasty.

PubMed

Webb, Christopher A J; Mariano, Edward R

2015-01-01

Total knee arthroplasty is one of the most commonly performed operations in the USA. As with any elective joint surgery, the primary goal includes functional restoration that is not limited by pain. The use of peripheral nerve blocks for patients undergoing knee arthroplasty has resulted in decreased pain scores, improved early ambulation and decreased time to achieve hospital discharge criteria. Concern has been raised over the potential risks of femoral nerve block, and there has been growing support for the adductor canal block. It is the author's opinion that when not contraindicated, intraoperative neuraxial anesthesia combined with a continuous adductor canal block and a multimodal medication regimen for postoperative pain control is the best analgesic protocol for knee arthroplasty.

Chimeric Plastics : a new class of thermoplastic

NASA Astrophysics Data System (ADS)

Sonnenschein, Mark

A new class of thermoplastics (dubbed ``Chimerics'') is described that exhibits a high temperature glass transition followed by high performance elastomer properties, prior to melting. These transparent materials are comprised of co-continuous phase-separated block copolymers. One block is an amorphous glass with a high glass transition temperature, and the second is a higher temperature phase transition block creating virtual thermoreversible crosslinks. The material properties are highly influenced by phase separation on the order of 10-30 nanometers. At lower temperatures the polymer reflects the sum of the block copolymer properties. As the amorphous phase glass transition is exceeded, the virtual crosslinks of the higher temperature second phase dominate the plastic properties, resulting in rubber-like elasticity.

FLOWCHART; a computer program for plotting flowcharts

USGS Publications Warehouse

Bender, Bernice

1982-01-01

The computer program FLOWCHART can be used to very quickly and easily produce flowcharts of high quality for publication. FLOWCHART centers each element or block of text that it processes on one of a set of (imaginary) vertical lines. It can enclose a text block in a rectangle, circle or other selected figure. It can draw a 'line connecting the midpoint of any side of any figure with the midpoint of any side of any other figure and insert an arrow pointing in the direction of flow. It can write 'yes' or 'no' next to the line joining two figures. FLOWCHART creates flowcharts using some basic plotting subroutine* which permit plots to be generated interactively and inspected on a Tektronix compatible graphics screen or plotted in a deferred mode on a Houston Instruments 42' pen plotter. The size of the plot, character set and character height in inches are inputs to the program. Plots generated using the pen plotter can be up to 42' high--the larger size plots being directly usable as visual aids in a talk. FLOWCHART centers each block of text on an imaginary column line. (The number of columns and column width are specified as input.) The midpoint of the longest line of text within the block is defined to be the center of the block and is placed on the column line. The spacing of individual words within the block is not altered when the block is positioned. The program writes the first block of text in a designated column and continues placing each subsequent block below the previous block in the same column. A block of text may be placed in a different column by specifying the number of the column and an earlier block of text with which the new block is to be aligned. If block zero is given as the earlier block, the new text is placed in the new column continuing down the page below the previous block. Optionally a column and number of inches from the top of the page may be given for positioning the next block of text. The program will normally draw one of five types of figure to enclose a block of text: a rectangle, circle, diamond, eight sided figure or figure with parallel sides and rounded ends. It can connect the figure with a line to the preceding figure, and place an arrow pointing toward the second figure. Text blocks not in sequence can also be connected and 'yes' or 'no' written next to any line to indicate branching. Figure 1 illustrates the various types of figures that can be drawn, spacings, connecting lines and the like. * The plotting package employed is Buplot available on the VAX and PDP-1170 computers at the USGS Office of Earthquake Studies, Golden, Colo. Calls to the plotting subroutines must be adjusted if some other plotting package is used.

Ultrasound-guided continuous interscalene block: the influence of local anesthetic background delivery method on postoperative analgesia after shoulder surgery: a randomized trial.

PubMed

Hamdani, Mehdi; Chassot, Olivier; Fournier, Roxane

2014-01-01

Automated bolus delivery has recently been shown to reduce local anesthetic consumption and improve analgesia, compared with continuous infusion, in continuous sciatic and epidural block. However, there are few data on the influence of local anesthetic delivery method on local anesthetic consumption following interscalene blockade. This randomized, double-blind trial was designed to determine whether hourly automated perineural boluses (4 mL) of local anesthesia delivered with patient-controlled pro re nata (PRN, on demand) boluses would result in a reduction in total local anesthesia consumption during continuous interscalene blockade after shoulder surgery compared with continuous perineural infusion (4 mL/h) plus patient-controlled PRN boluses. One hundred one patients undergoing major shoulder surgery under general anesthesia with ultrasound-guided continuous interscalene block were randomly assigned to receive 0.2% ropivacaine via interscalene end-hole catheter either by continuous infusion 4 mL/h (n = 50) or as automated bolus 4 mL/h (n = 51). Both delivery methods were combined with 5 mL PRN boluses of 0.2% ropivacaine with a lockout time of 30 minutes. Postoperative number of PRN boluses, 24- and 48-hour local anesthetic consumption, pain scores, rescue analgesia (morphine), and adverse events were recorded. There were no significant differences in either the number of PRN ropivacaine boluses or total 48 hour local anesthetic consumption between the groups (18.5 [11-25.2] PRN boluses in the continuous infusion group vs 17 [8.5-29] PRN boluses in the automated bolus group). Postoperative pain was similar in both groups; on day 2, the median average pain score was 4 (2-6) in the continuous infusion group versus 3 (2-5) in the automated bolus group (P = 0.54). Nor were any statistically significant intergroup differences observed with respect to morphine rescue, incidence of adverse events, or patient satisfaction. In continuous interscalene blockade under ultrasound guidance after shoulder surgery, automated boluses of local anesthetic combined with PRN boluses did not provide any reduction in local anesthetic consumption or rescue analgesia, compared with continuous infusion combined with PRN boluses.

Paroxysmal atrioventricular block: Electrophysiological mechanism of phase 4 conduction block in the His-Purkinje system: A comparison with phase 3 block.

PubMed

Shenasa, Mohammad; Josephson, Mark E; Wit, Andrew L

2017-11-01

Paroxysmal atrioventricular (A-V) block is relatively rare, and due to its transient nature, it is often under recognized. It is often triggered by atrial, junctional, or ventricular premature beats, and occurs in the presence of a diseased His-Purkinje system (HPS). Here, we present a 45-year-old white male who was admitted for observation due to recurrent syncope and near-syncope, who had paroxysmal A-V block. The likely cellular electrophysiological mechanisms(s) of paroxysmal A-V block and its differential diagnosis and management are discussed. Continuous electrocardiographic monitoring was done while the patient was in the cardiac unit. Multiple episodes of paroxysmal A-V block were documented in this case. All episodes were initiated and terminated with atrial/junctional premature beats. The patient underwent permanent pacemaker implantation and has remained asymptomatic since then. Paroxysmal A-V block is rare and often causes syncope or near-syncope. Permanent pacemaker implantation is indicated according to the current guidelines. Paroxysmal A-V block occurs in the setting of diseased HPS and is bradycardia-dependent. The detailed electrophysiological mechanisms, which involve phase 4 diastolic depolarization, and differential diagnosis are discussed. © 2017 Wiley Periodicals, Inc.

Multi-blocking strategies for the INS3D incompressible Navier-Stokes code

NASA Technical Reports Server (NTRS)

Gatlin, Boyd

1990-01-01

With the continuing development of bigger and faster supercomputers, computational fluid dynamics (CFD) has become a useful tool for real-world engineering design and analysis. However, the number of grid points necessary to resolve realistic flow fields numerically can easily exceed the memory capacity of available computers. In addition, geometric shapes of flow fields, such as those in the Space Shuttle Main Engine (SSME) power head, may be impossible to fill with continuous grids upon which to obtain numerical solutions to the equations of fluid motion. The solution to this dilemma is simply to decompose the computational domain into subblocks of manageable size. Computer codes that are single-block by construction can be modified to handle multiple blocks, but ad-hoc changes in the FORTRAN have to be made for each geometry treated. For engineering design and analysis, what is needed is generalization so that the blocking arrangement can be specified by the user. INS3D is a computer program for the solution of steady, incompressible flow problems. It is used frequently to solve engineering problems in the CFD Branch at Marshall Space Flight Center. INS3D uses an implicit solution algorithm and the concept of artificial compressibility to provide the necessary coupling between the pressure field and the velocity field. The development of generalized multi-block capability in INS3D is described.

Patients' and procedural characteristics of AV-block during slow pathway modulation for AVNRT-single center 10year experience.

PubMed

Wasmer, Kristina; Dechering, Dirk G; Köbe, Julia; Leitz, Patrick; Frommeyer, Gerrit; Lange, Phillip S; Kochhäuser, Simon; Reinke, Florian; Pott, Christian; Mönnig, Gerold; Breithardt, Günter; Eckardt, Lars

2017-10-01

Permanent AV-block is a recognized and feared complication of slow pathway modulation for AVNRT. We aimed to assess incidence of transient and permanent AV-block as well as consequences of transient AV-block in a large contemporary AVNRT ablation cohort. We searched our single center prospective ablation database for occurrence of transient and permanent AV-block during slow pathway modulation between January 2004 and October 2015. We analyzed patients' and procedural characteristics as well as outcome of patients in whom transient or permanent AV-block occurred. Of 9170 patients who underwent a catheter ablation at our institution between January 2004 and October 2015, 2101 patients (64% women, mean age 50±18years) underwent slow pathway modulation. In three patients, permanent AV-block occurred during RF application. Additional two patients had transient AV-block that recovered (after a few minutes and 25min), but recurred within two days of the procedure. All five patients underwent dual chamber pacemaker implantation (0.2%). Transient AV-block related to RF delivery occurred in 44 patients (2%). Transient mechanical AV-block occurred in additional 17 patients (0.8%). In 12 patients, ablation was continued despite transient AV-block. One of these patients developed permanent AV-block. Permanent AV-block following slow pathway modulation is a rare event, occurring in 0.2% of patients in a large contemporary single center cohort. Transient AV-block is more frequent (2%). Copyright © 2017 Elsevier B.V. All rights reserved.

Continuous intra-articular local anesthetic drug instillation versus discontinuous sciatic nerve block after total knee arthroplasty.

PubMed

Cip, Johannes; Erb-Linzmeier, Hedwig; Stadlbauer, Peter; Bach, Christian; Martin, Arno; Germann, Reinhard

2016-12-01

Sciatic nerve block (SNB) is commonly used as adjunct to femoralis nerve block (FNB) to achieve high-quality pain relief after total knee arthroplasty (TKA). However, this combination is associated with considerable muscle weakness, foot drop and surgically related nerve injuries may be masked. The purpose of this study was to assess whether low risk continuous intra-articular anesthetic drug instillation is an adequate alternative to SNB when adding to FNB after TKA. Retrospective investigational follow-up study. University teaching hospital. Interdisciplinary postoperative anesthetic and orthopedic survey. For this investigational analysis, 34 of 50 consecutive patients were available. All patients underwent primary unilateral TKA. Group A (18 patients) received a continuous intra-articular 0.33% ropivacaine (5 mL/h) instillation for the first 48 h postoperatively. In Group B (16 patients) a discontinuous SNB was used. Both groups were treated with a continuous FNB. Main endpoints were mean and maximum postoperative pain intensity levels for both anterior and posterior knee side, amount of postoperative administered opioid drugs, differences in functional outcome or hospital stay and rate of postoperative complications. Group A showed higher pain intensity levels for the posterior knee side (P≤.042). Merely on the second postoperative day there were no differences within either study group. No differences were found regarding anterior knee pain. Group A showed a significant higher postoperative piritramid consumption (P≤.007). Length of hospital stay or postoperative functional outcome was not significant different. Postoperative complications were not related to anesthesia techniques. SNB technique resulted in superior pain relief in comparison to continuous intra-articular local anesthetic drug instillation as adjunct to continuous FNB after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

Methodology Investigation of AI(Artificial Intelligence) Test Officer Support Tool. Volume 1

DTIC Science & Technology

1989-03-01

American Association for Artificial inteligence A! ............. Artificial inteliigence AMC ............ Unt:ed States Army Maeriel Comand ASL...block number) FIELD GROUP SUB-GROUP Artificial Intelligence, Expert Systems Automated Aids to Testing 9. ABSTRACT (Continue on reverse if necessary and...identify by block number) This report covers the application of Artificial Intelligence-Techniques to the problem of creating automated tools to

Method for quantifying percentage wood failure in block-shear specimens by a laser scanning profilometer

Treesearch

C. T. Scott; R. Hernandez; C. Frihart; R. Gleisner; T. Tice

2005-01-01

A new method for quantifying percentage wood failure of an adhesively bonded block-shear specimen has been developed. This method incorporates a laser displacement gage with an automated two-axis positioning system that functions as a highly sensitive profilometer. The failed specimen is continuously scanned across its width to obtain a surface failure profile. The...

Oligomers and Polymers Based on Pentacene Building Blocks

PubMed Central

Lehnherr, Dan; Tykwinski, Rik R.

2010-01-01

Functionalized pentacene derivatives continue to provide unique materials for organic semiconductor applications. Although oligomers and polymers based on pentacene building blocks remain quite rare, recent synthetic achievements have provided a number of examples with varied structural motifs. This review highlights recent work in this area and, when possible, contrasts the properties of defined-length pentacene oligomers to those of mono- and polymeric systems.

40 CFR Table 5 to Subpart Jjjjj of... - Continuous Compliance With Emission Limits and Operating Limits

Code of Federal Regulations, 2011 CFR

2011-07-01

... kilns equipped with WS i. Collecting the scrubber pressure drop data according to § 63.8450(a); reducing the scrubber pressure drop data to 3-hour block averages according to § 63.8450(a); maintaining the average scrubber pressure drop for each 3-hour block period at or above the average pressure drop...

Reduction of artifacts caused by orthopedic hardware in the spine in spectral detector CT examinations using virtual monoenergetic image reconstructions and metal-artifact-reduction algorithms.

PubMed

Große Hokamp, Nils; Neuhaus, V; Abdullayev, N; Laukamp, K; Lennartz, S; Mpotsaris, A; Borggrefe, J

2018-02-01

Aim of this study was to assess the artifact reduction in patients with orthopedic hardware in the spine as provided by (1) metal-artifact-reduction algorithms (O-MAR) and (2) virtual monoenergetic images (MonoE) as provided by spectral detector CT (SDCT) compared to conventional iterative reconstruction (CI). In all, 28 consecutive patients with orthopedic hardware in the spine who underwent SDCT-examinations were included. CI, O-MAR and MonoE (40-200 keV) images were reconstructed. Attenuation (HU) and noise (SD) were measured in order to calculate signal-to-noise ratio (SNR) of paravertebral muscle and spinal canal. Subjective image quality was assessed by two radiologists in terms of image quality and extent of artifact reduction. O-MAR and high-keV MonoE showed significant decrease of hypodense artifacts in terms of higher attenuation as compared to CI (CI vs O-MAR, 200 keV MonoE: -396.5HU vs. -115.2HU, -48.1HU; both p ≤ 0.001). Further, artifacts as depicted by noise were reduced in O-MAR and high-keV MonoE as compared to CI in (1) paravertebral muscle and (2) spinal canal-CI vs. O-MAR/200 keV: (1) 34.7 ± 19.0 HU vs. 26.4 ± 14.4 HU, p ≤ 0.05/27.4 ± 16.1, n.s.; (2) 103.4 ± 61.3 HU vs. 72.6 ± 62.6 HU/60.9 ± 40.1 HU, both p ≤ 0.001. Subjectively both O-MAR and high-keV images yielded an artifact reduction in up to 24/28 patients. Both, O-MAR and high-keV MonoE reconstructions as provided by SDCT lead to objective and subjective artifact reduction, thus the combination of O-MAR and MonoE seems promising for further reduction.

Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient.

PubMed

Murray, Michael J; DeBlock, Heidi; Erstad, Brian; Gray, Anthony; Jacobi, Judi; Jordan, Che; McGee, William; McManus, Claire; Meade, Maureen; Nix, Sean; Patterson, Andrew; Sands, M Karen; Pino, Richard; Tescher, Ann; Arbour, Richard; Rochwerg, Bram; Murray, Catherine Friederich; Mehta, Sangeeta

2016-11-01

To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified. This activity was funded by the Society for Critical Care Medicine, and no industry support was provided. Using the Grading of Recommendations Assessment, Development, and Evaluation system, the Grading of Recommendations Assessment, Development, and Evaluation expert on the Task Force created profiles for the evidence related to six of the 21 questions and assigned quality-of-evidence scores to these and the additional 15 questions for which insufficient evidence was available to create a profile. Task Force members reviewed this material and all available evidence and provided recommendations, suggestions, or good practice statements for these 21 questions. The Task Force developed a single strong recommendation: we recommend scheduled eye care that includes lubricating drops or gel and eyelid closure for patients receiving continuous infusions of neuromuscular-blocking agents. The Task Force developed 10 weak recommendations. 1) We suggest that a neuromuscular-blocking agent be administered by continuous intravenous infusion early in the course of acute respiratory distress syndrome for patients with a PaO2/FIO2 less than 150. 2) We suggest against the routine administration of an neuromuscular-blocking agents to mechanically ventilated patients with status asthmaticus. 3) We suggest a trial of a neuromuscular-blocking agents in life-threatening situations associated with profound hypoxemia, respiratory acidosis, or hemodynamic compromise. 4) We suggest that neuromuscular-blocking agents may be used to manage overt shivering in therapeutic hypothermia. 5) We suggest that peripheral nerve stimulation with train-of-four monitoring may be a useful tool for monitoring the depth of neuromuscular blockade but only if it is incorporated into a more inclusive assessment of the patient that includes clinical assessment. 6) We suggest against the use of peripheral nerve stimulation with train of four alone for monitoring the depth of neuromuscular blockade in patients receiving continuous infusion of neuromuscular-blocking agents. 7) We suggest that patients receiving a continuous infusion of neuromuscular-blocking agent receive a structured physiotherapy regimen. 8) We suggest that clinicians target a blood glucose level of less than 180 mg/dL in patients receiving neuromuscular-blocking agents. 9) We suggest that clinicians not use actual body weight and instead use a consistent weight (ideal body weight or adjusted body weight) when calculating neuromuscular-blocking agents doses for obese patients. 10) We suggest that neuromuscular-blocking agents be discontinued at the end of life or when life support is withdrawn. In situations in which evidence was lacking or insufficient and the study results were equivocal or optimal clinical practice varies, the Task Force made no recommendations for nine of the topics. 1) We make no recommendation as to whether neuromuscular blockade is beneficial or harmful when used in patients with acute brain injury and raised intracranial pressure. 2) We make no recommendation on the routine use of neuromuscular-blocking agents for patients undergoing therapeutic hypothermia following cardiac arrest. 3) We make no recommendation on the use of peripheral nerve stimulation to monitor degree of block in patients undergoing therapeutic hypothermia. 4) We make no recommendation on the use of neuromuscular blockade to improve the accuracy of intravascular-volume assessment in mechanically ventilated patients. 5) We make no recommendation concerning the use of electroencephalogram-derived parameters as a measure of sedation during continuous administration of neuromuscular-blocking agents. 6) We make no recommendation regarding nutritional requirements specific to patients receiving infusions of neuromuscular-blocking agents. 7) We make no recommendation concerning the use of one measure of consistent weight over another when calculating neuromuscular-blocking agent doses in obese patients. 8) We make no recommendation on the use of neuromuscular-blocking agents in pregnant patients. 9) We make no recommendation on which muscle group should be monitored in patients with myasthenia gravis receiving neuromuscular-blocking agents. Finally, in situations in which evidence was lacking or insufficient but expert consensus was unanimous, the Task Force developed six good practice statements. 1) If peripheral nerve stimulation is used, optimal clinical practice suggests that it should be done in conjunction with assessment of other clinical findings (e.g., triggering of the ventilator and degree of shivering) to assess the degree of neuromuscular blockade in patients undergoing therapeutic hypothermia. 2) Optimal clinical practice suggests that a protocol should include guidance on neuromuscular-blocking agent administration in patients undergoing therapeutic hypothermia. 3) Optimal clinical practice suggests that analgesic and sedative drugs should be used prior to and during neuromuscular blockade, with the goal of achieving deep sedation. 4) Optimal clinical practice suggests that clinicians at the bedside implement measure to attenuate the risk of unintended extubation in patients receiving neuromuscular-blocking agents. 5) Optimal clinical practice suggests that a reduced dose of an neuromuscular-blocking agent be used for patients with myasthenia gravis and that the dose should be based on peripheral nerve stimulation with train-of-four monitoring. 6) Optimal clinical practice suggests that neuromuscular-blocking agents be discontinued prior to the clinical determination of brain death.

Access block in NSW hospitals, 1999-2001: does the definition matter?

PubMed

Forero, Roberto; Mohsin, Mohammed; Bauman, Adrian E; Ieraci, Sue; Young, Lis; Phung, Hai N; Hillman, Kenneth M; McCarthy, Sally M; Hugelmeyer, C David

2004-01-19

To estimate the magnitude of access block and its trend over time in New South Wales hospitals, using different definitions of access block, and to explore its association with clinical and non-clinical factors. An epidemiological study using the Emergency Department Information System datasets (1 January 1999 to 31 December 2001) from a sample of 55 NSW hospitals. Prevalence of access block measured by four different definitions; strength of association between access block, type of hospital, year of presentation, mode and time of arrival, triage category (an indicator of urgency), age and sex. Rates of access block (for all four definitions) increased between 1999 and 2001 by 1%-2% per year. There were increases across all regions of NSW, but urban regions in particular. Patients presenting to Principal Referral hospitals and those who arrived at night were more likely to experience access block. After adjusting for triage category and year of presentation, the mode of arrival, time of arrival, type of hospital, age and sex were significantly associated with access block. Access block continues to increase across NSW, whatever the definition used. We recommend that hospitals in NSW and Australia move to the use of one standard definition of access block, as our study suggests there is no significant additional information emerging from the use of multiple definitions.

29 CFR 1918.84 - Bulling cargo.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Handling Cargo § 1918.84 Bulling cargo. (a) Bulling cargo... from padeyes, straps, or beam clamps. Snatch blocks or straps shall not be made fast to batten cleats...

The 10 Building Blocks of High-Performing Primary Care

PubMed Central

Bodenheimer, Thomas; Ghorob, Amireh; Willard-Grace, Rachel; Grumbach, Kevin

2014-01-01

Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements—engaged leadership, data-driven improvement, empanelment, and team-based care—that assist the implementation of the other 6 building blocks—patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement. PMID:24615313

Design and Synthesis of Network-Forming Triblock Copolymers Using Tapered Block Interfaces

PubMed Central

Kuan, Wei-Fan; Roy, Raghunath; Rong, Lixia; Hsiao, Benjamin S.; Epps, Thomas H.

2012-01-01

We report a strategy for generating novel dual-tapered poly(isoprene-b-isoprene/styrene-b-styrene-b-styrene/methyl methacrylate-b-methyl methacrylate) [P(I-IS-S-SM-M)] triblock copolymers that combines anionic polymerization, atom transfer radical polymerization (ATRP), and Huisgen 1,3-dipolar cycloaddition click chemistry. The tapered interfaces between blocks were synthesized via a semi-batch feed using programmable syringe pumps. This strategy allows us to manipulate the transition region between copolymer blocks in triblock copolymers providing control over the interfacial interactions in our nanoscale phase-separated materials independent of molecular weight and block constituents. Additionally, we show the ability to retain a desirous and complex multiply-continuous network structure (alternating gyroid) in our dual-tapered triblock material. PMID:23066522

Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: A randomised, open-label feasibility study.

PubMed

Ganapathy, Sugantha; Sondekoppam, Rakesh V; Terlecki, Magdalena; Brookes, Jonathan; Das Adhikary, Sanjib; Subramanian, Lakshmimathy

2015-11-01

We recently described a lateral-to-medial approach for transversus abdominis plane (LM-TAP) block, which may permit preoperative initiation of the block. Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia (TEA). A randomised, open-label study. University Hospital, London Health Sciences Centre, London, Ontario, Canada from July 2008 to August 2012. Fifty adult patients undergoing open abdominal surgery via laparotomy were allocated randomly to receive preoperative catheter-congruent TEA or ultrasound-guided continuous bilateral LM-TAP block for 72 h postoperatively. Reasons for noninclusion were American Society of Anesthesiologists' physical status more than 4, known allergy to study drugs, chronic pain/opioid dependence, spinal abnormalities or psychiatric illness. In the TEA group (n = 24), patient-controlled epidural analgesia was maintained using bupivacaine 0.1% with hydromorphone 10 μg ml⁻¹ after establishment of the initial block. In the LM-TAP group (n = 26), ultrasound-guided LM-TAP catheters were inserted on each side preoperatively after a bolus of 30 ml of ropivacaine 0.5% (20 ml subcostal and 10 ml subumbilical injections on both sides). Analgesia was maintained with an infusion of ropivacaine 0.35% at a rate of 2 to 2.5 ml h⁻¹ through each catheter, along with rescue intravenous patient-controlled analgesia. The primary outcome was pain score on coughing 24 h after the end of surgery. Secondary outcomes were pain scores from 24 to 72 h, intraoperative and postoperative opioid consumption, time to onset of bowel movement and side effect profiles. Mean [95% confidence interval (95% CI)] pain scores at rest ranged from 1. 7 (0.9 to 2.5) to 2.3 (1.1 to 3.4) in TEA vs. 1.5 (0.7 to 2.2) to 2.2 (1.3 to 3.0) in LM-TAP (P = 0.829). The dynamic pain scores ranged from 2.9 (1.5 to 4.4) to 3.8 (2.8 to 4.8) in TEA vs. 3.3 (2.4 to 4.3) to 3.8 (2.7 to 4.9) in LM-TAP (P = 0.551). The variability in pain scores was lower in the LM-TAP group than in the TEA group in the first 24 h postoperatively. Patient satisfaction and other secondary outcomes were similar. Continuous bilateral LM-TAP block can be initiated preoperatively and may provide comparable analgesia to TEA in patients undergoing laparotomy. not registered because registration was not mandatory at the time of starting the trial.

SYSTEM FOR UNLOADING REACTORS

DOEpatents

Rand, A.C. Jr.

1961-05-01

An unloading device for individual vertical fuel channels in a nuclear reactor is shown. The channels are arranged in parallel rows and underneath each is a separate supporting block on which the fuel in the channel rests. The blocks are raounted in contiguous rows on an array of parallel pairs of tracks over the bottom of the reactor. Oblong hollows in the blocks form a continuous passageway through the middle of the row of blocks on each pair of tracks. At the end of each passageway is a horizontal grappling rod with a T- or L extension at the end next to the reactor of a length to permit it to pass through the oblong passageway in one position, but when rotated ninety degrees the head will strike one of the longer sides of the oblong hollow of one of the blocks. The grappling rod is actuated by a controllable reciprocating and rotating device which extends it beyond any individual block desired, rotates it and retracts it far enough to permit the fuel in the vertical channel above the block to fall into a handling tank below the reactor.

Spatial separation of target and competitor cues enhances blocking of human causality judgements.

PubMed

Glautier, Steven

2002-04-01

Three experiments were carried out. Each required subjects to make judgements about the causal status of cues following a two-stage blocking procedure. In Stage 1 a competitor cue was consistently paired with an outcome, and in Stage 2 the competitor continued to be paired with the outcome but was accompanied by a target cue. It was predicted that causal judgements for the target would be reduced by the presence of the competitor. In Experiments 1 and 2 the blocking procedure was implemented as a computer simulation of a card game during which subjects had to learn which cards produced the best payouts. The cues that subjects used to make their judgement were colours and symbols that appeared on the backs of the cards. When the target and competitor cues appeared on the same card blocking effects did not emerge, but when they appeared as part of different cards blocking effects were found. Thus, spatial separation of target and competitor cues appeared to facilitate blocking. Experiment 3 replicated the blocking result using spatially separated target and competitor cues.

Optoelectronic Properties of Conjugated Block Copolymer with Flexible Linking Group

NASA Astrophysics Data System (ADS)

Hu, Zhiqi; Verduzco, Rafael

State-of-the-art organic photovoltaics (OPVs) are prepared by depositing a disordered, co-continuous donor and acceptor blend. While optimization of material processing has produced significant improvements in performance, a fundamental understanding of charge separation and recombination at the donor/acceptor interface is lacking. Block copolymers with donor and acceptor polymer blocks provide an opportunity for controlling the donor-accepter interfacial structure and understanding its relationship to charge separation and photovoltaic performance. Here, we report the synthesis and characterization of donor-linker-acceptor block copolymers for use in OPVs. A series of poly(3-hexylthiophene)-block- poly((9,9-dioctylfluorene)-2,7-diyl-alt-[4,7-bis(thiophen-5-yl)-2,1,3-benzothiadiazole]-2',2''-diyl) (P3HT-linkerPFTBT) are synthesized with flexible oligo-ethylene glycol (PEG) linkers. Photoluminescence measurements demonstrate that the insertion of a non-conjugated linker has a significant impact on energy transfer between the two blocks, and the block copolymers are used as additives for bulk heterojunction OPVs. This work provides insight into the charge separation process and demonstrates a technique for tailoring the donor-accepter interface in OPVs.

HRV analysis in local anesthesia using Continuous Wavelet Transform (CWT).

PubMed

Shafqat, K; Pal, S K; Kumari, S; Kyriacou, P A

2011-01-01

Spectral analysis of Heart Rate Variability (HRV) is used for the assessment of cardiovascular autonomic control. In this study Continuous Wavelet Transform (CWT) has been used to evaluate the effect of local anesthesia on HRV parameters in a group of fourteen patients undergoing axillary brachial plexus block. A new method which takes signal characteristics into account has been presented for the estimation of the variable boundaries associated with the low and the high frequency band of the HRV signal. The variable boundary method might be useful in cases when the power related to respiration component extends beyond the traditionally excepted range of the high frequency band (0.15-0.4 Hz). The statistical analysis (non-parametric Wilcoxon signed rank test) showed that the LF/HF ratio decreased within an hour of the application of the brachial plexus block compared to the values fifteen minutes prior to the application of the block. These changes were observed in thirteen of the fourteen patients included in this study.

Studying Scientific Discovery by Computer Simulation.

DTIC Science & Technology

1983-03-30

Mendel’s laws of inheritance, the law of Gay- Lussac for gaseous reactions, tile law of Dulong and Petit, the derivation of atomic weights by Avogadro...neceseary mid identify by block number) scientific discovery -ittri sic properties physical laws extensive terms data-driven heuristics intensive...terms theory-driven heuristics conservation laws 20. ABSTRACT (Continue on revere. side It necessary and identify by block number) Scientific discovery

Doing New Things in Old Ways

DTIC Science & Technology

1983-05-01

is missing from the educational and organizational literatures are I equally detailed depictions of socialization designed (whether consciously or not...block number) Socialization Role taking CL--’ Cut Iure Managerial education CD,’ Culture of orientation C.. Skill acquisition SL.i 20 ABSTRACT (Continue...on reveree side if necseesry mid Identify by block number) --- "esearch in organizational socialization is typically more concerned with settir s Lj

Effects of continuous infusion of tumor necrosis factor-alpha (TNF) into adipose tissue on glucose and fatty acid metabolism in lactating dairy cattle

USDA-ARS?s Scientific Manuscript database

Late-lactation Holstein cows (n=9/treatment) were used to evaluate effects of TNF-alpha administration on glucose and fatty acid (FA) metabolism. Cows were blocked by feed intake and milk yield and randomly assigned within block to 1 of 3 treatments: control, TNF-alpha, and pair-fed control. Treatme...

Laser-Induced Thermal Damage of Skin

DTIC Science & Technology

1977-12-01

identify by block number) Skin Burns Skin Model Laser Effects \\Thermal Predictions 20 ABSTRACT (Continue on reverse side it necessary and identify by...block number) A computerized model was developed for predicting thermal damage of skin by laser exposures. Thermal, optical, and physiological data are...presented for the model. Model predictions of extent of irreversible damage were compared with histologic determinations of the extent of damage

Continuous spinal anaesthesia versus ultrasound-guided combined psoas compartment-sciatic nerve block for hip replacement surgery in elderly high-risk patients: a prospective randomised study.

PubMed

Aksoy, Mehmet; Dostbil, Aysenur; Ince, Ilker; Ahiskalioglu, Ali; Alici, Hacı Ahmet; Aydin, Ali; Kilinc, Osman Ozgur

2014-01-01

Our aim is to compare the hemodynamic effects of combined psoas compartment-sciatic nerve block (PCSNB) with continuous spinal anaesthesia (CSA) in elderly high-risk patients undergoing hip replacement surgery. Seventy patients over the age of 60 with ASA III or IV physical status were randomly allocated to two groups: In the PCSNB group, ultrasound-guided psoas compartment block was performed with modified Winnie technique using 30 mL of 0.25% bupivacaine with 1:200.000 epinephrine (5 μgr/mL) and iliac crest block was performed using the same local anaesthetic solution (5 mL). All patients in the PCSNB group needed continuing infusion of propofol (2 mg/kg/h) during operation. In the CSA group, CSA was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 2.5 mg of isobaric bupivacaine 0.5%. When sensory block was not reached to the level of T12 within 10 minutes in the CSA group, additional 2.5 mg of isobaric bupivacaine 0.5% was administered through the catheter at 5-min intervals by limiting the total dose of 15 mg until a T12 level of the sensory block was achieved. The PCSNB group had significantly higher mean arterial blood pressure values at the beginning of surgery and at 5(th), 10(th) and 20(th) minutes of surgery compared to the CSA group (P = 0.038, P = 0.029, P = 0.012, P = 0.009 respectively). There were no significant differences between groups in terms of heart rate and peripheral oxygen saturation values during surgery and the postoperative period (P >0.05). Arterial hypotension required ephedrine was observed in 13 patients in the CSA and 4 patients in the PCSNB group (P =0.012). CSA and PCSNB produce satisfactory quality of anaesthesia in elderly high-risk patients with fewer hemodynamic changes in PCSNB cases compared with CSA cases. Australian New Zealand Clinical Trials Registry: ACTRN12614000658617, Registered 24 June 2014.

Gyroid structure via highly asymmetric ABC and AB blends

NASA Astrophysics Data System (ADS)

Ahn, Seonghyeon; Kwak, Jongheon; Choi, Chungryong; Kim, Jin Kon

Gyroid structures are very important because of their co-continuous and network structures. However, a block copolymer shows gyroid structures only at 35 % volume fraction of one block. In this study, we designed ABC/AB blend system. B (polystyrene (PS)) is the matrix, while A (polyisoprene (PI)) and C (poly(2-vinyl pridine (P2VP)) are the core part. This blend shows gyroid structures at 20 % volume fraction, that is smaller than that observed at diblock copolymer. Morphologies of neat block copolymers and blends were characterized by TEM and small angle X-ray scattering.

Unexpected visitor on FDG PET/CT--brown adipose tissue (BAT) in mesentery in a case of retroperitoneal extra-adrenal pheochromocytoma: is the BAT activation secondary to catecholamine-secreting pheochromocytoma?

PubMed

Joshi, Prathamesh Vijay; Lele, Vikram Ramchandra

2012-05-01

Fused positron emission tomography-computed tomography (PET/CT) technology has enabled the determination that nonmalignant fluorodeoxyglucose (FDG) uptake is observed in brown adipose tissue (BAT). FDG uptake in BAT is a known potential source of false-positive interpretations for PET. The typical locations of BAT include neck, supraclavicular area, mediastinum, and paravertebral intercostal spaces. Examples of atypical locations for BAT include posterior neck, left paratracheal area, axillae, perirenal area, and retrocrural area. We report PET/CT findings in a young male patient with malignant retroperitoneal extra-adrenal pheochromocytoma, who demonstrated FDG uptake in BAT at multiple locations including mesenteric BAT. We also propose catecholamine-secreting pheochromocytoma as a possible cause of BAT activation in our case.

PubMed Central

Córdoba-Mosqueda, M. E.; Guerra-Mora, J. R.; Sánchez-Silva, M. C.; Vicuña-González, R. M.; Torre, A. Ibarra-de la

2017-01-01

Background Primary spinal epidural lymphoma (PSEL) is one of the rarest categories of tumors. Spinal cord compression is an uncommon primary manifestation and requires to be treated with surgery for the purpose of diagnosis and decompression. Case Presentation A 45-year-old man presented with a new onset thoracic pain and progress to an anterior spinal syndrome with hypoesthesia and loss of thermalgesia. Magnetic resonance image showed a paravertebral mass that produces medullary compression at T3. The patient was taken up to surgery, where the pathology examination showed a diffuse large B-cell lymphoma. Conclusions PSEL is a pathological entity, which must be considered on a middle-aged man who began with radicular compression, and the treatment of choice is decompression and biopsy. The specific management has not been established yet, but the literature suggests chemotherapy and radiotherapy; however, the outcome is unclear. PMID:28180052

In vitro and in vivo biocompatibility study on laser 3D microstructurable polymers

NASA Astrophysics Data System (ADS)

Malinauskas, Mangirdas; Baltriukiene, Daiva; Kraniauskas, Antanas; Danilevicius, Paulius; Jarasiene, Rasa; Sirmenis, Raimondas; Zukauskas, Albertas; Balciunas, Evaldas; Purlys, Vytautas; Gadonas, Roaldas; Bukelskiene, Virginija; Sirvydis, Vytautas; Piskarskas, Algis

2012-09-01

Films and microstructured scaffolds have been fabricated using direct laser writing out of different polymers: hybrid organic-inorganic ORMOCORE b59, acrylate-based AKRE23, novel organic-inorganic Zr containing hybrid SZ2080, and biodegradable PEG-DA-258. Adult myogenic stem cells were grown on these surfaces in vitro. Their adhesion, growth, and viability test results suggest good potential applicability of the materials in biomedical practice. Pieces of these polymers were implanted in rat's paravertebral back tissue. Histological examination of the implants and surrounding tissue ex vivo after 3 weeks of implantation was conducted and results show the materials to be at least as biocompatible as surgical clips or sutures. The applied direct laser writing technique seems to offer good future prospects in a polymeric 3D scaffold design for artificial tissue engineering with autologous stem cells.

A new species of Rock Gecko genus Cnemaspis (Squamata: Gekkonidae) from Western Sarawak, Malaysia.

PubMed

Kurita, Takaki; Nishikawa, Kanto; Matsui, Masafumi; Hikida, Tsutomu

2017-05-03

A new species of Asian rock gecko, genus Cnemaspis, is described from Padawan, western Sarawak, Malaysian Borneo. The new species forms a clade with C. paripari and C. nigridia of the C. nigridia group in a mitochondrial DNA phylogeny and is similar to them morphologically in some characters such as caudal scalation. It differs from the other Asian Cnemaspis species in its unique combination of snout-vent length (up to 62.7 mm), 4-9 precloacal pores in males, keeled subcaudals with an enlarged, smooth, median row, presence of ventrolateral caudal tubercles, and coloration (head and upper flanks dark-yellow; anterior portion of tail black; posterior portion of tail white with black, paravertebral blob). Phylogenetic relationships within the C. nigridia group and the distributional ranges of species within the group suggest allopatric speciation by geographic isolation.

Hypersomnolence with beta-adrenergic blockers.

PubMed

Thachil, J; Zeller, J R; Kochar, M S

1987-11-01

An elderly, mildly demented, hypertensive male patient developed hypersomnolence on administration of propranolol for treatment of hypertension; no other cause for hypersomnolence was detected. Upon replacement of propranolol with atenolol, he felt better but continued to be quite somnolent. When atenolol was discontinued, he reported to have lack of sleep. On readministration of subtherapeutic doses of the same beta-adrenergic blocking agents, he once again experienced excessive sleepiness. By discontinuing beta-blocking agents and introducing captopril, he felt much better, became pleasant and talkative, and blood pressure was well controlled. Beta antagonists are important drugs in the management of many cardiovascular problems. Propranolol, a lipophilic beta-blocking agent, and atenolol, a hydrophilic beta-blocking agent, are two of the major agents currently used clinically in the United States. Numerous neuropsychiatric side-effects of the beta-adrenergic blocking drugs have been reported, but hypersomnolence is not readily recognized as one of them.

Traveling Rocky Roads: The Consequences of Transcription-Blocking DNA Lesions on RNA Polymerase II.

PubMed

Steurer, Barbara; Marteijn, Jurgen A

2017-10-27

The faithful transcription of eukaryotic genes by RNA polymerase II (RNAP2) is crucial for proper cell function and tissue homeostasis. However, transcription-blocking DNA lesions of both endogenous and environmental origin continuously challenge the progression of elongating RNAP2. The stalling of RNAP2 on a transcription-blocking lesion triggers a series of highly regulated events, including RNAP2 processing to make the lesion accessible for DNA repair, R-loop-mediated DNA damage signaling, and the initiation of transcription-coupled DNA repair. The correct execution and coordination of these processes is vital for resuming transcription following the successful repair of transcription-blocking lesions. Here, we outline recent insights into the molecular consequences of RNAP2 stalling on transcription-blocking DNA lesions and how these lesions are resolved to restore mRNA synthesis. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Composite sandwich structure and method for making same

NASA Technical Reports Server (NTRS)

Magurany, Charles J. (Inventor)

1995-01-01

A core for a sandwich structure which has multi-ply laminate ribs separated by voids is made as an integral unit in one single curing step. Tooling blocks corresponding to the voids are first wrapped by strips of prepreg layup equal to one half of each rib laminate so a continuous wall of prepreg material is formed around the tooling blocks. The wrapped tooling blocks are next pressed together laterally, like tiles, so adjoining walls from two tooling blocks are joined. The assembly is then cured by conventional methods, and afterwards the tooling blocks are removed so voids are formed. The ribs can be provided with integral tabs forming bonding areas for face sheets, and face sheets may be co-cured with the core ribs. The new core design is suitable for discrete ribcores used in space telescopes and reflector panels, where quasiisotropic properties and zero coefficient of thermal expansion are required.

Continuous femoral versus epidural block for attainment of 120° knee flexion after total knee arthroplasty: a randomized controlled trial.

PubMed

Sakai, Norihiro; Inoue, Takaya; Kunugiza, Yasuo; Tomita, Tetsuya; Mashimo, Takashi

2013-05-01

We conducted the prospective randomized controlled trial to test that continuous femoral nerve block (CFNB) improves attainment of 120° knee flexion compared to continuous epidural analgesia (CEA). Sixty-six patients scheduled for unilateral total knee arthroplasty were randomized into two groups; infusion of ropivacaine 0.15% into CEA or CFNB to third postoperative days. We studied the time required to attain 120° knee flexion, variations in thigh and calf circumferences around the treated knee, pain scores, rehabilitation milestones, the need for adjuvant analgesics, and side effects. CFNB patients attained earlier knee flexion to 120°, lower variations in thigh and calf circumferences, less pain during rehabilitation, and less need for adjuvant analgesics. CFNB is a better pain management strategy that accelerates knee flexion rehabilitation. Copyright © 2013 Elsevier Inc. All rights reserved.

Cellient™ automated cell block versus traditional cell block preparation: a comparison of morphologic features and immunohistochemical staining.

PubMed

Wagner, David G; Russell, Donna K; Benson, Jenna M; Schneider, Ashley E; Hoda, Rana S; Bonfiglio, Thomas A

2011-10-01

Traditional cell block (TCB) sections serve as an important diagnostic adjunct to cytologic smears but are also used today as a reliable preparation for immunohistochemical (IHC) studies. There are many ways to prepare a cell block and the methods continue to be revised. In this study, we compare the TCB with the Cellient™ automated cell block system. Thirty-five cell blocks were obtained from 16 benign and 19 malignant nongynecologic cytology specimens at a large university teaching hospital and prepared according to TCB and Cellient protocols. Cell block sections from both methods were compared for possible differences in various morphologic features and immunohistochemical staining patterns. In the 16 benign cases, no significant morphologic differences were found between the TCB and Cellient cell block sections. For the 19 malignant cases, some noticeable differences in the nuclear chromatin and cellularity were identified, although statistical significance was not attained. Immunohistochemical or special stains were performed on 89% of the malignant cases (17/19). Inadequate cellularity precluded full evaluation in 23% of Cellient cell block IHC preparations (4/17). Of the malignant cases with adequate cellularity (13/17), the immunohistochemical staining patterns from the different methods were identical in 53% of cases. The traditional and Cellient cell block sections showed similar morphologic and immunohistochemical staining patterns. The only significant difference between the two methods concerned the lower overall cell block cellularity identified during immunohistochemical staining in the Cellient cell block sections. Copyright © 2010 Wiley-Liss, Inc.

Reaction of Photochemically Generated Organic Cations with Colloidal Clays.

DTIC Science & Technology

1983-05-01

University of Notre Dame. IS. KEY WORDS (Continue on reverse aide if neceary end identify by block number) Chemistry of colloidal montmorillonite Absorption...Centlws m ftves n N mee.iy mi Identify by block number) Qi Organic radical cations will dimerize when adsorbed to the surface D of montmorillonite in...1 The Nature and Chemistry of Micelles .... 2 The Nature and Chemistry of Clay Minerals 5 Montmorillonite Catalyzed Color

Laser Generated Magnetic Fields

DTIC Science & Technology

1976-06-01

30, II dttlormnt from Rmpori) IS. SUPPLEMENTARY NOTES 19. KEY WORDS (Continue on tororoo aldo II nocoommry and Idontlty by block nuaibar) Crater...dependence of laser generated magnetic fields Laser crater cross-sections X-ray detection from laser plasma 20. ABSTRACT (Contlmio on tovormo aid* II...nacaaaary and Idontlty ay block mmtbor) A sequence of laser pulses focussed onto the same spot on a target produces evaporation of target material and the

Subcaliber Guns

DTIC Science & Technology

1988-06-16

310-6 11. TITLE (Include Security Classification) "SUBCALIBER GUNS " 12. PERSONAL AUTHOR(S) 13a. TYPE OF REPORT 13b. TIME COVERED 14. DATE OF REPORT...necessary and identify by block number) FIELD GROUP SUB-GROUP 4Large caliber weapons, .,Subcaliber guns (" J-) Parent weapons.; Small caliber weapons’y...19, ABSTRACT (Continue on reverse if necessary and identify by block number) Provides procedures for determining the suitability of subcaliber guns

Gas Source Molecular Beam Epitaxial Growth of GaN

DTIC Science & Technology

1992-11-25

identify by block number) FIELW GROUP SUB-GROUP 19. ABSTRACT (Continue on reverse if necessary and Identify by block number) Aluminum gallium nitride (AlGaN...AND TASK OBJECTIVES Aluminum gallium nitride (AIGaN) has long been recognized as a promising radiation hard optoelectronic material. AIGaN has a wide...Efficient, pure, low temperature sources for the gas source molecular beam epitaxial (GSMBE) growth of aluminum gallium nitride will essentially

Ultrasonic Nondestructive Evaluation of Damage in Continuous Fiber Composites

DTIC Science & Technology

1989-01-01

Security Classification) Ultrasonic Nondestructive Evalustion of Damage in Continuous Fiber Composites 12. PERSONAL AUTHOR(S) Vikram K. Kinra 13a...Attenuatiorn Composites , Damage / " UltrasonicNondestructive Evaluation. \\ ’k 19. ABSTRACT (Continue on reverse if necessary and identify by block n,,ber) A...n SIrIE -~ 2 4IiCUi’.ZIEfEi Ultrasonic nondestructive evaluation of fibre-reinforced composite materials - a review VIKRAM K KINRA and VINAY DAYAL

Enzymatic Continuous Flow Synthesis of Thiol-Terminated Poly(δ-Valerolactone) and Block Copolymers.

PubMed

Zhu, Ning; Huang, Weijun; Hu, Xin; Liu, Yihuan; Fang, Zheng; Guo, Kai

2018-04-01

Thiol-terminated poly(δ-valerolactone) is directly synthesized via enzymatic 6-mercapto-1-hexanol initiated ring-opening polymerization in both batch and microreactor. By using Candida antartica Lipase B immobilized tubular reactor, narrowly dispersed poly(δ-valerolactone) with higher thiol fidelity is more efficiently prepared in contrast to the batch reactor. Moreover, the integrated enzyme packed tubular reactor system is established to perform the chain extension experiments. Thiol-terminated poly(δ-valerolactone)-block-poly(ε-caprolactone) and poly(ε-caprolactone)-block-poly(δ-valerolactone) are easily prepared by modulating the monomer introduction sequence. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Navy Aegis Ballistic Missile Defense (BMD) Program: Background and Issues for Congress

DTIC Science & Technology

2011-04-19

for SM-3 Block IIA co-development with Japan, for chemical vapor composite silicon carbide and silicon carbide corrugated mirror processes for the SM...to say, this concern is all the more urgent in light of Iran’s continued uranium enrichment program. Iran continues to defy international obligations

Genuine multipartite entanglement of symmetric Gaussian states: Strong monogamy, unitary localization, scaling behavior, and molecular sharing structure

NASA Astrophysics Data System (ADS)

Adesso, Gerardo; Illuminati, Fabrizio

2008-10-01

We investigate the structural aspects of genuine multipartite entanglement in Gaussian states of continuous variable systems. Generalizing the results of Adesso and Illuminati [Phys. Rev. Lett. 99, 150501 (2007)], we analyze whether the entanglement shared by blocks of modes distributes according to a strong monogamy law. This property, once established, allows us to quantify the genuine N -partite entanglement not encoded into 2,…,K,…,(N-1) -partite quantum correlations. Strong monogamy is numerically verified, and the explicit expression of the measure of residual genuine multipartite entanglement is analytically derived, by a recursive formula, for a subclass of Gaussian states. These are fully symmetric (permutation-invariant) states that are multipartitioned into blocks, each consisting of an arbitrarily assigned number of modes. We compute the genuine multipartite entanglement shared by the blocks of modes and investigate its scaling properties with the number and size of the blocks, the total number of modes, the global mixedness of the state, and the squeezed resources needed for state engineering. To achieve the exact computation of the block entanglement, we introduce and prove a general result of symplectic analysis: Correlations among K blocks in N -mode multisymmetric and multipartite Gaussian states, which are locally invariant under permutation of modes within each block, can be transformed by a local (with respect to the partition) unitary operation into correlations shared by K single modes, one per block, in effective nonsymmetric states where N-K modes are completely uncorrelated. Due to this theorem, the above results, such as the derivation of the explicit expression for the residual multipartite entanglement, its nonnegativity, and its scaling properties, extend to the subclass of non-symmetric Gaussian states that are obtained by the unitary localization of the multipartite entanglement of symmetric states. These findings provide strong numerical evidence that the distributed Gaussian entanglement is strongly monogamous under and possibly beyond specific symmetry constraints, and that the residual continuous-variable tangle is a proper measure of genuine multipartite entanglement for permutation-invariant Gaussian states under any multipartition of the modes.

Comparison of continuous femoral nerve block (CFNB/SA) and continuous femoral nerve block with mini-dose spinal morphine (CFNB/SAMO) for postoperative analgesia after total knee arthroplasty (TKA): a randomized controlled study.

PubMed

Sundarathiti, Petchara; Thammasakulsiri, Jadesadha; Supboon, Supawadee; Sakdanuwatwong, Supalak; Piangjai, Molruedee

2016-07-16

Unsatisfactory analgesia for major knee surgery with femoral nerve block (FNB) alone was reported and the additional benefit of sciatic block to continuous femoral nerve block (CFNB) was not conclusive. The aim of the present study was to find the benefit of the additional mini-dose spinal morphine (0.035 mg) to CFNB for postoperative pain control and to compare their associated side effects after total knee arthroplasty (TKA). After written informed consent and with Institutional Ethics Committee approval, 68 American Society of Anesthesiologists (ASA) Physical Status I-III patients scheduled for elective unilateral TKA under spinal anesthesia (SA) were included in the present prospective, randomized controlled study. The patients were allocated into two groups. CFNB was placed in all patients by the inguinal paravascular approach with 20 ml of 0.25 % levobupivacaine. Group I (named CFNB/SA group), SA was administered with 2.8 ml levobupivacaine and Group II (named CFNB/SAMO group), SA with 2.8 ml levobupivacaine plus morphine 0.035 mg. At Post Anesthesia Care Unit (PACU), pain and other adverse effects were recorded. Pain was assessed by visual analog scale (VAS) 0-10. Tramadol 50 mg intravenous (IV) was given if the VAS > 4. In the ward, all patients were maintained by continuous femoral infusion of 0.125 % levobupivacaine rate 7 ml/hr and then reduced to 5 ml/hr if VAS ≤3. Patient's demographics data in each group were not different. At post-operative (PO) 12-24 h, the VAS scores were significantly lesser in the CFNB/SAMO group. Cumulative tramadol IV requirement for PO48h were also significantly lesser in the CFNB/SAMO group. Nausea, vomiting and numbness were significantly greater in the CFNB/SAMO group during early postoperative period (PO1-6 h). Though in some patients CFNB was inadequate, a mini-dose of intrathecal morphine (0.035 mg) in addition to CFNB was found to be effective with minimal side effects. Thai Clinical Trial Registry (identifier: TCTR20150609003 , date of registration: 6 June 2015).

A 2d Block Model For Landslide Simulation: An Application To The 1963 Vajont Case

NASA Astrophysics Data System (ADS)

Tinti, S.; Zaniboni, F.; Manucci, A.; Bortolucci, E.

A 2D block model to study the motion of a sliding mass is presented. The slide is par- titioned into a matrix of blocks the basis of which are quadrilaterals. The blocks move on a specified sliding surface and follow a trajectory that is computed by the model. The forces acting on the blocks are gravity, basal friction, buoyancy in case of under- water motion, and interaction with neighbouring blocks. At any time step, the position of the blocks on the sliding surface is determined in curvilinear (local) co-ordinates by computing the position of the vertices of the quadrilaterals and the position of the block centre of mass. Mathematically, the topology of the system is invariant during the motion, which means that the number of blocks is constant and that each block has always the same neighbours. Physically, this means that blocks are allowed to change form, but not to penetrate into each other, not to coalesce, not to split. The change of form is compensated by the change of height, under the computational assumption that the block volume is constant during motion: consequently lateral expansion or contraction yield respectively height reduction or increment of the blocks. This model is superior to the analogous 1D model where the mass is partitioned into a chain of interacting blocks. 1D models require the a-priori specification of the sliding path, that is of the trajectory of the blocks, which the 2D block model supplies as one of its output. In continuation of previous studies on the catastrophic slide of Vajont that occurred in 1963 in northern Italy and caused more than 2000 victims, the 2D block model has been applied to the Vajont case. The results are compared to the outcome of the 1D model, and more importantly to the observational data concerning the deposit position and morphology. The agreement between simulation and data is found to be quite good.

The StreamCat Dataset: Accumulated Attributes for NHDPlusV2 (Version 2.1) Catchments Riparian Buffer for the Conterminous United States: 2010 US Census Housing Unit and Population Density

EPA Pesticide Factsheets

This dataset represents the population and housing unit density within individual, local NHDPlusV2 catchments and upstream, contributing watersheds riparian buffers based on 2010 US Census data. Densities are calculated for every block group and watershed averages are calculated for every local NHDPlusV2 catchment(see Data Sources for links to NHDPlusV2 data and Census Data). This data set is derived from The TIGER/Line Files and related database (.dbf) files for the conterminous USA. It was downloaded as Block Group-Level Census 2010 SF1 Data in File Geodatabase Format (ArcGIS version 10.0). The landscape raster (LR) was produced based on the data compiled from the questions asked of all people and about every housing unit. The (block-group population / block group area) and (block-group housing units / block group area) were summarized by local catchment and by watershed to produce local catchment-level and watershed-level metrics as a continuous data type (see Data Structure and Attribute Information for a description).

Identification and Reconfigurable Control of Impaired Multi-Rotor Drones

NASA Technical Reports Server (NTRS)

Stepanyan, Vahram; Krishnakumar, Kalmanje; Bencomo, Alfredo

2016-01-01

The paper presents an algorithm for control and safe landing of impaired multi-rotor drones when one or more motors fail simultaneously or in any sequence. It includes three main components: an identification block, a reconfigurable control block, and a decisions making block. The identification block monitors each motor load characteristics and the current drawn, based on which the failures are detected. The control block generates the required total thrust and three axis torques for the altitude, horizontal position and/or orientation control of the drone based on the time scale separation and nonlinear dynamic inversion. The horizontal displacement is controlled by modulating the roll and pitch angles. The decision making algorithm maps the total thrust and three torques into the individual motor thrusts based on the information provided by the identification block. The drone continues the mission execution as long as the number of functioning motors provide controllability of it. Otherwise, the controller is switched to the safe mode, which gives up the yaw control, commands a safe landing spot and descent rate while maintaining the horizontal attitude.

Effects of Pentobarbital on Respiratory Functional Dynamics in Chronically Instrumented Guinea Pigs

DTIC Science & Technology

1991-01-01

inferior cerebellar peduncle; 10, inferior olive; LRN. lateral reticular nu- cleus; NSTTN. nucleus spinal tract of the trigeminal nerve ; STTN, spinal tract...reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP 06 15 sodium pentobarbital; respiration; chronic single unit 06 04 recording...diaphragmatic EMG; guinea pigs 19. ABSTRACT (Continue on reverse if necessary and identify by block number) CHANG. F.-C. T. Effects of pentobarhital

Future United States Role in European Security

DTIC Science & Technology

1992-08-26

MONITORING ORGANIZATION REPORT NUMBER(S) 6a. NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION US Army War College (if...necessary and identify by block number) FIELD GROUP SUB- GROUP 19, ABSTRACT (Continue on reverse if necessary and identify by block number) See reverse...concerning these forces: Of course, they used NATO rules of engagement and worked to NATO standards. They had trained together as NATO forces and

Highlights from the Worldwide Survey of Nonmedical Drug Use and Alcohol Use Among Military Personnel: 1980.

DTIC Science & Technology

1980-11-14

Prepared with assistance of: Yukiko Gamnes and Edward Farley W9 KEY WORDS (Continue on revere.r side it necessary and identify by block number) Drug use... side if neresestry aund idennty by block ntimber) his survey report provides a comprehensive, detailed and accurate estimallte or the preval ence of drug...34 Other Uppers ............. Preludin, Ritalin , Sandrex Tranquilizers ............ Valium, Librium, Miltown Barbiturates ............. Seconal (reds

The Antimicrobial Effects of Various Nutrient Electrolyte Beverages

DTIC Science & Technology

1986-05-01

SUPPLEMENTARY NOTATION 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if n ecessary and identify by block number) FIELD GROUP SUB-GROUP...reverse if necessary and identify by block number) The purpose of this study was to determine if Staphylococcus aureus, Saccharomy ces cerevisiae...sodium benzoate, and malta- dextrin ); inoculated with A. flavus was incubat ed for various time periods at 30°C~ b Cell volumes {mL) were obtained as

Circadian Variation in Host Defense.

DTIC Science & Technology

1987-05-21

block fevers by Inhibiting the production of prostaglandins of the E series (PGE) In the hypothalamus , our data suggest to us that there is a circadian...Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP Key words: Interleukin-l, fever , circadian, rhythm, 08 body...to a rhythm in the thermoregulatory "set-point". The overall goal of our research was to determine whether this represents a circadian " fever ". If

Geometric Theory of Moving Grid Wavefront Sensor

DTIC Science & Technology

1977-06-30

Identify by block numbot) Adaptive Optics WaVefront Sensor Geometric Optics Analysis Moving Ronchi Grid "ABSTRACT (Continue an revere sdde If nooessaY...ad Identify by block nucber)A geometric optics analysis is made for a wavefront sensor that uses a moving Ronchi grid. It is shown that by simple data... optical systems being considered or being developed -3 for imaging an object through a turbulent atmosphere. Some of these use a wavefront sensor to

Series Fault Limiting Resistors for Atlas Marx Modules

DTIC Science & Technology

1995-07-01

use Reticulated Vitreous Carbon (RVC)2 foam blocks for the series resistor element. The blocks will serve as a resistive transmission line on the...3,4. 2. Joseph Wang, (Department of Chemistry, New Mexico State University, Las Cruces NM 88003, USA), " Reticulated Vitreous Carbon -A New Versatile...0.08 Ohm-em fitting our requirements well. The process of producing RVC results in a reproducibly refined form of continuous-fiber, vitreous Carbon

Computational Difficulties in the Identification and Optimization of Control Systems.

DTIC Science & Technology

1980-01-01

necessary and Identify by block number) - -. 3. iABSTRACT (Continue on revers, side It necessary and Identify by block number) As more realistic models ...Island 02912 ABSTRACT As more realistic models for resource management are developed, the need for efficient computational techniques for parameter...optimization (optimal control) in "state" models which This research was supported in part by ttfe National Science Foundation under grant NSF-MCS 79-05774

Synthesis of poly(N-isopropylacrylamide)-co-poly(phenylboronate ester) acrylate and study on their glucose-responsive behavior.

PubMed

Yao, Yuan; Shen, Heyun; Zhang, Guanghui; Yang, Jing; Jin, Xu

2014-10-01

We introduced thermo-sensitive poly(N-isopropylacrylamide) (PNIPAM) into the polymer structure of poly(ethylene glycol)-block-poly(phenylboronate ester) acrylate (MPEG-block-PPBDEMA) by block and random polymerization pathways in order to investigate the effect of polymer architecture on the glucose-responsiveness and enhance their insulin release controllability. By following the structure, the continuous PNIPAM shell of the triblock polymer MPEG-block-PNIPAM-block-PPBDEMA collapsing on the glucose-responsive PPBDEMA core formed the polymeric micelles with a core-shell-corona structure, and MPEG-block-(PNIPAM-rand-PPBDEMA) exhibited core-corona micelles in which the hydrophobic core consisted of PNIPAM and PPBDEMA segments when the environmental temperature was increased above low critical solution temperature (LCST) of PNIPAM. The micellar morphologies can be precisely controlled by temperature change between 15 and 37°C. As a result, the introduction of PNIPAM greatly enhanced the overall stability of insulin encapsulated in the polymeric micelles in the absence of glucose over incubation 80 h at 37°C. Comparing to MPEG-block-PNIPAM-block-PPBDEMA, the nanocarriers from MPEG-block-(PNIPAM-rand-PPBDEMA) showed great insulin release behavior which is zero insulin release without glucose, low release at normal blood glucose concentration (1.0 mg/mL). Therefore, these nanocarriers may be served as promising self-regulated insulin delivery system for diabetes treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

Single-injection or continuous femoral nerve block for total knee arthroplasty?

PubMed

Albrecht, Eric; Morfey, Dorothea; Chan, Vincent; Gandhi, Rajiv; Koshkin, Arkadiy; Chin, Ki Jinn; Robinson, Sylvie; Frascarolo, Philippe; Brull, Richard

2014-05-01

The ideal local anesthetic regime for femoral nerve block that balances analgesia with mobility after total knee arthroplasty (TKA) remains undefined. We compared two volumes and concentrations of a fixed dose of ropivacaine for continuous femoral nerve block after TKA to a single injection femoral nerve block with ropivacaine to determine (1) time to discharge readiness; (2) early pain scores and analgesic consumption; and (3) functional outcomes, including range of motion and WOMAC scores at the time of recovery. Ninety-nine patients were allocated to one of three continuous femoral nerve block groups for this randomized, placebo-controlled, double-blind trial: a high concentration group (ropivacaine 0.2% infusion), a low concentration group (ropivacaine 0.1% infusion), or a placebo infusion group (saline 0.9% infusion). Infusions were discontinued on postoperative Day (POD) 2. The primary outcome was time to discharge readiness. Secondary outcomes included opioid consumption, pain, and functional outcomes. Ninety-three patients completed the study protocol; the study was halted early because of unanticipated changes to pain protocols at the host institution, by which time only 61% of the required number of patients had been enrolled. With the numbers available, the mean time to discharge readiness was not different between groups (high concentration group, 62 hours [95% confidence interval [CI], 51-72 hours]; low concentration group, 73 hours [95% CI, 63-83 hours]; placebo infusion group 65 hours [95% CI, 56-75 hours]; p = 0.27). Patients in the low concentration group consumed significantly less morphine during the period of infusion (POD 1, high concentration group, 56 mg [95% CI, 42-70 mg]; low concentration group, 35 mg [95% CI, 27-43 mg]; placebo infusion group, 48 mg [95% CI, 38-59 mg], p = 0.02; POD 2, high concentration group, 50 mg [95% CI, 41-60 mg]; low concentration group, 33 mg [95% CI, 24-42 mg]; placebo infusion group, 39 mg [95% CI, 30-48 mg], p = 0.04); however, there were no important differences in pain scores or opioid-related side effects with the numbers available. Likewise, there were no important differences in functional outcomes between groups. Based on this study, which was terminated prematurely before the desired sample size could be achieved, we were unable to demonstrate that varying the concentration and volume of a fixed-dose ropivacaine infusion for continuous femoral nerve block influences time to discharge readiness when compared with a conventional single-injection femoral nerve block after TKA. A low concentration of ropivacaine infusion can reduce postoperative opioid consumption but without any important differences in pain scores, side effects, or functional outcomes. These pilot data may be used to inform the statistical power of future randomized trials. Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Multiple blocks of intermittent and continuous theta-burst stimulation applied via transcranial magnetic stimulation differently affect sensory responses in rat barrel cortex.

PubMed

Thimm, Andreas; Funke, Klaus

2015-02-15

Theta-burst stimulation (TBS) applied via transcranial magnetic stimulation is able to modulate human cortical excitability. Here we investigated in a rat model how two different forms of TBS, intermittent (iTBS) and continuous (cTBS), affect sensory responses in rat barrel cortex. We found that iTBS but less cTBS promoted late (>18 ms) sensory response components while not affecting the earliest response (8-18 ms). The effect increased with each of the five iTBS blocks applied. cTBS somewhat reduced the early response component after the first block but had a similar effect as iTBS after four to five blocks. We conclude that iTBS primarly modulates the activity of (inhibitory) cortical interneurons while cTBS may first reduce general neuronal excitability with a single block but reverse to iTBS-like effects with application of several blocks. Cortical sensory processing varies with cortical state and the balance of inhibition to excitation. Repetitive transcranial magnetic stimulation (rTMS) has been shown to modulate human cortical excitability. In a rat model, we recently showed that intermittent theta-burst stimulation (iTBS) applied to the corpus callosum, to activate primarily supragranular cortical pyramidal cells but fewer subcortical neurons, strongly reduced the cortical expression of parvalbumin (PV), indicating reduced activity of fast-spiking interneurons. Here, we used the well-studied rodent barrel cortex system to test how iTBS and continuous TBS (cTBS) modulate sensory responses evoked by either single or double stimuli applied to the principal (PW) and/or adjacent whisker (AW) in urethane-anaesthetized rats. Compared to sham stimulation, iTBS but not cTBS particularly enhanced late (>18 ms) response components of multi-unit spiking and local field potential responses in layer 4 but not the very early response (<18 ms). Similarly, only iTBS diminished the suppression of the second response evoked by paired PW or AW-PW stimulation at 20 ms intervals. The effects increased with each of the five iTBS blocks applied. With cTBS a mild effect similar to that of iTBS was first evident after 4-5 stimulation blocks. Enhanced cortical c-Fos and zif268 expression but reduced PV and GAD67 expression was found only after iTBS, indicating increased cortical activity due to lowered inhibition. We conclude that iTBS but less cTBS may primarily weaken a late recurrent-type cortical inhibition mediated via a subset of PV+ interneurons, enabling stronger late response components believed to contribute to the perception of sensory events. © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society.

The barrier to misfit dislocation glide in continuous, strained, epitaxial layers on patterned substrates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Watson, G.P.; Ast, D.G.; Anderson, T.J.

1993-09-01

In a previous report [G. P. Watson, D. G. Ast, T. J. Anderson, and Y. Hayakawa, Appl. Phys. Lett. [bold 58], 2517 (1991)] we demonstrated that the motion of misfit dislocations in InGaAs, grown by organometallic vapor phase epitaxy on patterned GaAs substrates, can be impeded even if the strained epitaxial layer is continuous. Trenches etched into GaAs before growth are known to act as a barrier to misfit dislocation propagation [E. A. Fitzgerald, G. P. Watson, R. E. Proano, D. G. Ast, P. D. Kirchner, G. D. Pettit, and J. M. Woodall, J. Appl. Phys. [bold 65], 2220 (1989)]more » when those trenches create discontinuities in the epitaxial layers; but even shallow trenches, with continuous strained layers following the surface features, can act as barriers. By considering the strain energy required to change the length of the dislocation glide segments that stretch from the interface to the free surface, a simple model is developed that explains the major features of the unique blocking action observed at the trench edges. The trench wall angle is found to be an important parameter in determining whether or not a trench will block dislocation glide. The predicted blocking angles are consistent with observations made on continuous 300 and 600 nm thick In[sub 0.04]Ga[sub 0.96]As films on patterned GaAs. Based on the model, a structure is proposed that may be used as a filter to yield misfit dislocations with identical Burgers vectors or dislocations which slip in only one glide plane.« less

A Lack of Continuity in Education, Training, and Practice Violates the "Do No Harm" Principle.

PubMed

Englander, Robert; Carraccio, Carol

2018-03-01

The paradigm shift to competency-based medical education (CBME) is under way, but incomplete implementation is blunting the potential impact on learning and patient outcomes. The fundamental principles of CBME call for standardizing outcomes addressing population health needs, then allowing time-variable progression to achieving them. Operationalizing CBME principles requires continuity within and across phases of the education, training, and practice continuum. However, the piecemeal origin of the phases of the "continuum" has resulted in a sequence of undergraduate to graduate medical education to practice that may be continuous temporally but bears none of the integration of a true continuum.With these timed interruptions during phase transitions, learning is not reinforced because of a failure to integrate experiences. Brief block rotations for learners and ever-shorter supervisory assignments for faculty preclude the development of relationships. Without these relationships, feedback falls on deaf ears. Block rotations also disrupt learners' relationships with patients. The harms resulting from such a system include decreases in patient satisfaction with their care and learner satisfaction with their work. Learners in this block system also demonstrate an erosion of empathy compared with those in innovative longitudinal training models. In addition, higher patient mortality during intern transitions has been demonstrated.The current medical education system is violating the first principle of medicine: "Do no harm." Full implementation of competency-based, time-variable education and training, with fixed outcomes aligned with population health needs, continuity in learning and relationships, and support from a developmental program of assessment, holds great potential to stop this harm.

[Clinical studies in health workers employed in the manual lifting of patients: methods for the examination of spinal lesions].

PubMed

Ricci, M G; Menoni, O; Colombini, D; Occhipinti, E

1999-01-01

To enable different research groups to make a standardized collection of clinical data on alterations of the lumbar region of the spine, protocols were used for the collection and classification of data that were proposed and thoroughly validated by the authors. The protocols include a clinical/functional examination of the spine, checking for positive anamnestic threshold, for pain on pressure/palpation of the spiny apophyses and paravertebral muscles, for painful movements, in order to classify 1st, 2nd and 3rd grade functional spondylarthropathy (for different regions of the spine). An ad hoc questionnaire was also prepared for the quantitative and qualitative study of true acute low back pain and the ingravescent low back pain controlled at the onset pharmacologically. The results of this questionnaire make it possible to calculate the incidence of acute low back pain (true and pharmacologically controlled).

Primary Spinal Epidural Lymphoma As a Cause of Spontaneous Spinal Anterior Syndrome: A Case Report and Literature Review.

PubMed

Córdoba-Mosqueda, M E; Guerra-Mora, J R; Sánchez-Silva, M C; Vicuña-González, R M; Torre, A Ibarra-de la

2017-01-01

Background  Primary spinal epidural lymphoma (PSEL) is one of the rarest categories of tumors. Spinal cord compression is an uncommon primary manifestation and requires to be treated with surgery for the purpose of diagnosis and decompression. Case Presentation  A 45-year-old man presented with a new onset thoracic pain and progress to an anterior spinal syndrome with hypoesthesia and loss of thermalgesia. Magnetic resonance image showed a paravertebral mass that produces medullary compression at T3. The patient was taken up to surgery, where the pathology examination showed a diffuse large B-cell lymphoma. Conclusions  PSEL is a pathological entity, which must be considered on a middle-aged man who began with radicular compression, and the treatment of choice is decompression and biopsy. The specific management has not been established yet, but the literature suggests chemotherapy and radiotherapy; however, the outcome is unclear.

Complicated brucellar spondylodiscitis: experience from an endemic area.

PubMed

Ulu-Kilic, Aysegul; Sayar, Merve Sefa; Tütüncü, Ediz; Sezen, Figen; Sencan, Irfan

2013-11-01

The demographical, clinical, and therapeutical features of patients with brucellar spondylodiscitis (BS) were evaluated in this study. Of the 96 patients with brucellosis, 20 (20.8%) were diagnosed with spondylodiscitis. Patients who had BS were more likely to be older (p = 0.001), have higher erythrocyte sedimentation rates (p = 0.01), and more likely to be anemic (p = 0.017). Lumbar segment (18/20) was frequently involved region. BS was complicated with paravertebral or epidural abscess in seven, radiculitis in six, and psoas abscess in five of cases. Antibiotic regimens including two or three antibiotics with combination of doxycycline, rifampin, and streptomycin were used. In this series, the mean duration of antimicrobial therapy was 18 weeks (range 12-56 weeks). Attention is drawn to this disease given the need for prolonged duration of treatment especially in complicated cases in order to avoid possible sequelae.

Infiltrative cervical lesions causing symptomatic occipital neuralgia.

PubMed

Sierra-Hidalgo, F; Ruíz, J; Morales-Cartagena, A; Martínez-Salio, A; Serna, J de la; Hernández-Gallego, J

2011-10-01

Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves, lacking a recognizable local structural aetiology in most cases. Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain, although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord, cervical roots, or occipital nerves have been increasingly reported. We describe two cases (one with typical and another one with atypical clinical features) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion. We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.

Distribution of lymphatic stomata on the pleural surface of the thoracic cavity and the surface topography of the pleural mesothelium in the golden hamster.

PubMed

Shinohara, H

1997-09-01

The distribution of lymphatic stomata that open to the pleural cavity is unclear. The distribution and the surface topography of the pleural and visceral pleurae are key factors in the turnover of pleural fluid and respiration physiology. Nine golden hamsters (Mesocricetus auratus) from 26 to 33 weeks of age were used for the study. The gross anatomy of the thorax and the arterial supply to the lung were studied in four hamsters. Five thoracic hemispheres, three diaphragms, and tissue blocks of the heart and lung were prepared from the remaining five hamsters. The thoracic hemispheres were fixed in 2.5% glutaraldehyde and the muscular bands at each intercostal space were carefully cut along the costae. The intercostal bands were processed for scanning electron microscopy (SEM) and the localization and the number of lymphatic stomata were recorded. The diaphragms and blocks of the lung and heart were also processed for SEM and the surface topography was observed. The right and left superior lobes of the lung were supplied by the bronchial artery that originated from the right costocervical trunk and left internal thoracic artery, respectively. Lymphatic stomata and mesothelial discontinuities (pores and gaps) were predominantly located in areas lined with cuboidal cells. The areas of cuboidal cells occupied approximately 4.6 mm2, namely, 1% of the total area of the thoracic hemisphere. There were about 1,000 lymphatic stomata per thoracic hemisphere. About 15% of lymphatic stomata were distributed in the ventro-cranial regions of the thoracic wall, with about 85% in the dorsocaudal region. In the former region, lymphatic stomata were found along the costal margins. In the latter, they were predominantly located in the pre- and paravertebral fatty tissue. There were also areas of cuboidal cells on the pleural surface of the diaphragm. Some mesothelial pores and gaps were found, but no lymphatic stomata opened on the pleural surface of the diaphragm. The pleural surface of the lung and that of the heart were lined with flattened polygonal cells. The topography of the surface varied, but there were no mesothelial discontinuities of the type commonly found in the parietal pleura. 1) The parietal pleura has a surface structure that is more permeable and absorptive for fluid and particulate matter than the visceral pleura. 2) The distribution of lymphatic stomata does not correspond directly to the pleural liquid pressures that have been reported. 3) The functions of lymphatic stomata should be considered not only in terms of fluid turnover but also in terms of self-defense mechanisms. 4) The presence or absence of lymphatic stomata on the diaphragmatic pleura should be re-examined and determined in a variety of animal species.

Effects of Cocos Ridge Collision on the Western Caribbean: Is there a Panama Block?

NASA Astrophysics Data System (ADS)

Kobayashi, D.; La Femina, P. C.; Geirsson, H.; Chichaco, E.; Abrego M, A. A.; Fisher, D. M.; Camacho, E. I.

2011-12-01

It has been recognized that the subduction and collision of the Cocos Ridge, a 2 km high aseismic ridge standing on >20 km thick oceanic crust of the Cocos plate, drives upper plate deformation in southern Central America. Recent studies of Global Positioning System (GPS) derived horizontal velocities relative to the Caribbean Plate showed a radial pattern centered on the Cocos Ridge axis where Cocos-Caribbean convergence is orthogonal, and margin-parallel velocities to the northwest. Models of the full three-dimensional GPS velocity field and earthquake slip vectors demonstrate low mechanical coupling along the Middle America subduction zone in Nicaragua and El Salvador, and a broad zone of high coupling beneath the Osa Peninsula, where the Cocos Ridge intersects the margin. These results suggest that Cocos Ridge collision may be the main driver for trench-parallel motion of the fore arc to the northwest and for uplift and shortening of the outer fore arc in southern Central America, whereby thickened and hence buoyant Cocos Ridge crust acts as an indenter causing the tectonic escape of the fore arc. These studies, however, were not able to constrain well the pattern of surface deformation east-southeast of the ridge axis due to a lack of GPS stations, and Cocos Ridge collision may be responsible for the kinematics and deformation of the proposed Panama block. Recent reinforcement of the GPS network in southeastern Costa Rica and Panama has increased the spatial and temporal resolution of the network and made it possible to further investigate surface deformation of southern Central America and the Panama block. We present a new regional surface velocity field for Central America from geodetic GPS data collected at 11 recently-installed and 178 existing episodic, semi-continuous, and continuous GPS sites in Nicaragua, Costa Rica, and Panama. We investigate the effects of Cocos Ridge collision on the Panama block through kinematic block modeling. Published earthquake relocation and geologic data are used to define block boundaries and fault geometries. We invert the three-dimensional GPS velocity vectors and earthquake slip vectors to estimate the magnitude and spatial distribution of interplate mechanical coupling on active plate and block boundaries around the Panama block; the Middle America Trench - South Panama Deformed Belt, the Central Costa Rican Deformed Belt, and the North Panama Deformed Belt in particular, and the rates of relative plate motion between the Panama block and the adjacent Cocos, Nazca, and Caribbean plates. This study tests whether the Panama block responds to the ridge collision as a rigid tectonic block or as a deforming zone consisting of multiple blocks.

A global reference database from very high resolution commercial satellite data and methodology for application to Landsat derived 30 m continuous field tree cover data

USGS Publications Warehouse

Pengra, Bruce; Long, Jordan; Dahal, Devendra; Stehman, Stephen V.; Loveland, Thomas R.

2015-01-01

The methodology for selection, creation, and application of a global remote sensing validation dataset using high resolution commercial satellite data is presented. High resolution data are obtained for a stratified random sample of 500 primary sampling units (5 km  ×  5 km sample blocks), where the stratification based on Köppen climate classes is used to distribute the sample globally among biomes. The high resolution data are classified to categorical land cover maps using an analyst mediated classification workflow. Our initial application of these data is to evaluate a global 30 m Landsat-derived, continuous field tree cover product. For this application, the categorical reference classification produced at 2 m resolution is converted to percent tree cover per 30 m pixel (secondary sampling unit)for comparison to Landsat-derived estimates of tree cover. We provide example results (based on a subsample of 25 sample blocks in South America) illustrating basic analyses of agreement that can be produced from these reference data. Commercial high resolution data availability and data quality are shown to provide a viable means of validating continuous field tree cover. When completed, the reference classifications for the full sample of 500 blocks will be released for public use.

Does the valve regulated release of urine from the bladder decrease encrustation and blockage of indwelling catheters by crystalline proteus mirabilis biofilms?

PubMed

Sabbuba, N A; Stickler, D J; Long, M J; Dong, Z; Short, T D; Feneley, R J C

2005-01-01

We tested whether valve regulated, intermittent flow of urine from catheterized bladders decreases catheter encrustation. Laboratory models of the catheterized bladder were infected with Proteus mirabilis. Urine was allowed to drain continuously through the catheters or regulated by valves to drain intermittently at predetermined intervals. The time that catheters required to become blocked was recorded and encrustation was visualized by scanning electron microscopy. When a manual valve was used to drain urine from the bladder at 2-hour intervals 4 times during the day, catheters required significantly longer to become blocked than those on continuous drainage (mean 62.6 vs 35.9 hours, p = 0.039). A similar 1.7-fold increase occurred when urine was drained at 4-hour intervals 3 times daily. Experiments with an automatic valve in which urine was released at 2 or 4-hour intervals through the day and night also showed a significant increase in mean time to blockage compared with continuous drainage (p = 0.001). Scanning electron microscopy confirmed that crystalline biofilm was less extensive on valve regulated catheters. Valve regulated, intermittent flow of urine through catheters increases the time that catheters require to become blocked with crystalline biofilm. The most beneficial effect was recorded when urine was released from the bladder at 4-hour intervals throughout the day and night by an automatic valve.

Intermolecular Slip Mechanism in Tropocollagen Nanofibrils

DTIC Science & Technology

2009-01-01

Imperfecta or Ehlers - Danlos Syndrome . REPORT DOCUMENTATION PAGE (SF298) (Continuation Sheet) Continuation for Block 13 ARO Report Number Intermolecular slip...our studies could advance our knowledge of mechan- isms underlying important collagen-related diseases like Osteogenesis Imperfecta or Ehlers - Danlos ... Syndrome . Keywords: Collagen; Shear; Nanomechanics; Steered mo- lecular dynamics; Adhesion strength; Materiomics 1. Introduction Collagen is the

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty.

PubMed

Seo, Seung Suk; Kim, Ok Gul; Seo, Jin Hyeok; Kim, Do Hoon; Kim, Youn Gu; Park, Beyoung Yun

2017-09-01

This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

A Retrospective Study Evaluating the Effect of Low Doses of Perineural Dexamethasone on Ropivacaine Brachial Plexus Peripheral Nerve Block Analgesic Duration.

PubMed

Schnepper, Gregory D; Kightlinger, Benjamin I; Jiang, Yunyun; Wolf, Bethany J; Bolin, Eric D; Wilson, Sylvia H

2017-09-23

Examination of the effectiveness of perineural dexamethasone administered in very low and low doses on ropivacaine brachial plexus block duration. Retrospective evaluation of brachial plexus block duration in a large cohort of patients receiving peripheral nerve blocks with and without perineural dexamethasone in a prospectively collected quality assurance database. A single academic medical center. A total of 1,942 brachial plexus blocks placed over a 16-month period were reviewed. Demographics, nerve block location, and perineural dexamethasone utilization and dose were examined in relation to block duration. Perineural dexamethasone was examined as none (0 mg), very low dose (2 mg or less), and low dose (greater than 2 mg to 4 mg). Continuous catheter techniques, local anesthetics other than ropivacaine, and block locations with fewer than 15 subjects were excluded. Associations between block duration and predictors of interest were examined using multivariable regression models. A subgroup analysis of the impact of receiving dexamethasone on block duration within each block type was also conducted using a univariate linear regression approach. A total of 1,027 subjects were evaluated. More than 90% of brachial plexus blocks contained perineural dexamethasone (≤4 mg), with a median dose of 2 mg. Increased block duration was associated with receiving any dose of perineural dexamethasone (P < 0.0001), female gender (P = 0.022), increased age (P = 0.048), and increased local anesthetic dose (P = 0.01). In a multivariable model, block duration did not differ with very low- or low-dose perineural dexamethasone after controlling for other factors (P = 0.420). Perineural dexamethasone prolonged block duration compared with ropivacaine alone; however, duration was not greater with low-dose compared with very low-dose perineural dexamethasone. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

M-X Environmental Technical Report. Alternative Potential Operating Base Locations, Coyote Spring Valley.

DTIC Science & Technology

1980-12-22

necessary and identify by block number) MX Coyote Spring, Nevada Siting Analysis Nevada Environnental Report 20. ABSTRACT (Continue on reverse side If...necessary and Identify by block number) The area of analysis (AO) for the Coyote Spring Valley operating base option includes both Clark and Lincoln...counties, and is located in the southern portion of the designated region of influence. Las Vegas and the surrounding suburbs are the major settlements and

Perceptual Integration and Differentiation of Directions in Moving Patterns

DTIC Science & Technology

1981-08-01

ceBssay and identify by block numnbe,) o ~ b 20 ABSTRACT (Continue oil rel’erse side II necosary aid idonlty, by block number) F . A- 1981. (-7 ATTACHED...process, are discussed. REFERENCES Mather, G. and Moulden, B . A simultaneous shift in apparent direction: Further evidence for a "distribution- shift" model...summing process, are discussed. REFERENCES Mather, G. and Moulden, B . A simultaneous shift in apparent direction: Further evidence for a "distribution

Book Analysis: Challenger: A Major Malfunction.

DTIC Science & Technology

1988-04-01

REPORT NUMBER 88-113S TITLE BOOK ANALYSIS: CHALLENGER : A MAJOR MALFUNCTION AUTHOR(S) MAJOR THOMAS M. HALL, USAF FACULTY ADVISOR LT COL JOhN R. GRELLMAN... CHALLENGER : A MAJOR MALFUNCTION 12. PERSONAL AUTHOR(S) Hall, Thomas M., Major, USAF 13a. TYPE OF REPORT 13b. TIME COVERED 14. DATE OF REPORT (Year, Month...identify by block number) FIELD GROUP SUB-GROUP 19. ABSTRACT Continue on reverse if necessary and identify by block number) This report analyzes Challenger

A Study of Secular and Tidal Tilt in Wyoming and Utah.

DTIC Science & Technology

1982-09-15

addition to storing the data from the tiltmeters at each site* . some of the dataloggers will be eq?,ioped with sensors to monitor atmospheric pressure and...WORDS (Continue en reverse side it neceeeary end identify by block number) Earth tides Tiltmeter Hydrofracture Tidal admittance .Ut 20. ABSTRACT...Contput-onreverse side if necessary and identify by block number) Q~ring the period .rvered by this report, we have used our 4porehole tiltmeter arrays to

Synthesis and Examination of New Catalytic Polymers.

DTIC Science & Technology

1985-12-01

Army position, policy, or decision, unless so r-c gg Pd hv othpr ictrnnt.t , *9. KEY WORDS (Continu, on re.erse side If necessary and Identify by block...Enzymatiz reactivity; Reactivity, theory of; Multi-armed systems. 120. ABSTRACT ce at n ,ue Z v-,erse sli f rear’ dz Identify by block number...proximity is achieved in the cyclo- dextrin system by means of a more sophisticated and costly synthesis. This is an important consideration for use

Parallel bulk heterojunction photovoltaics based on all-conjugated block copolymer additives

DOE PAGES

Mok, Jorge W.; Kipp, Dylan; Hasbun, Luis R.; ...

2016-08-23

We demonstrated that the addition of block copolymers to binary donor–acceptor blends represents an effective approach to target equilibrium, co-continuous morphologies of interpenetrating donors and acceptors in our recent study. We report a study of the impact of all-conjugated poly(thieno[3,4-b]-thiophene-co-benzodithiophene)-b-polynaphthalene diimide (PTB7-b-PNDI) block copolymer additives on the electronic properties and photovoltaic performance of bulk heterojunction organic photovoltaic active layers comprised of a PTB7 donor and a phenyl-C61-butyric acid methyl ester (PCBM61) acceptor. We find that small amounts of BCP additives lead to improved performance due to a large increase in the device open-circuit voltage (VOC), and the VOC is pinnedmore » to this higher value for higher BCP additive loadings. Such results contrast prior studies of ternary blend OPVs where either a continuous change in VOC or a value of VOC pinned to the lowest value is observed. We hypothesize and provide evidence in the form of device and morphology analyses that the impact of VOC is likely due to the formation of a parallel bulk heterojunction made up of isolated PCBM and PNDI acceptor domains separated by intermediate PTB7 donor domains. Our work demonstrates that all-conjugated block copolymers can be utilized as additives to both dictate morphology and modulate the electronic properties of the active layer.« less

Emergence and robustness of target waves in a neuronal network

NASA Astrophysics Data System (ADS)

Xu, Ying; Jin, Wuyin; Ma, Jun

2015-08-01

Target waves in excitable media such as neuronal network can regulate the spatial distribution and orderliness as a continuous pacemaker. Three different schemes are used to develop stable target wave in the network, and the potential mechanism for emergence of target waves in the excitable media is investigated. For example, a local pacing driven by external periodical forcing can generate stable target wave in the excitable media, furthermore, heterogeneity and local feedback under self-feedback coupling are also effective to generate continuous target wave as well. To discern the difference of these target waves, a statistical synchronization factor is defined by using mean field theory and artificial defects are introduced into the network to block the target wave, thus the robustness of these target waves could be detected. However, these target waves developed from the above mentioned schemes show different robustness to the blocking from artificial defects. A regular network of Hindmarsh-Rose neurons is designed in a two-dimensional square array, target waves are induced by using three different ways, and then some artificial defects, which are associated with anatomical defects, are set in the network to detect the effect of defects blocking on the travelling waves. It confirms that the robustness of target waves to defects blocking depends on the intrinsic properties (ways to generate target wave) of target waves.

Parallel bulk heterojunction photovoltaics based on all-conjugated block copolymer additives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mok, Jorge W.; Kipp, Dylan; Hasbun, Luis R.

We demonstrated that the addition of block copolymers to binary donor–acceptor blends represents an effective approach to target equilibrium, co-continuous morphologies of interpenetrating donors and acceptors in our recent study. We report a study of the impact of all-conjugated poly(thieno[3,4-b]-thiophene-co-benzodithiophene)-b-polynaphthalene diimide (PTB7-b-PNDI) block copolymer additives on the electronic properties and photovoltaic performance of bulk heterojunction organic photovoltaic active layers comprised of a PTB7 donor and a phenyl-C61-butyric acid methyl ester (PCBM61) acceptor. We find that small amounts of BCP additives lead to improved performance due to a large increase in the device open-circuit voltage (VOC), and the VOC is pinnedmore » to this higher value for higher BCP additive loadings. Such results contrast prior studies of ternary blend OPVs where either a continuous change in VOC or a value of VOC pinned to the lowest value is observed. We hypothesize and provide evidence in the form of device and morphology analyses that the impact of VOC is likely due to the formation of a parallel bulk heterojunction made up of isolated PCBM and PNDI acceptor domains separated by intermediate PTB7 donor domains. Our work demonstrates that all-conjugated block copolymers can be utilized as additives to both dictate morphology and modulate the electronic properties of the active layer.« less

A new species of karst forest Bent-toed Gecko (genus Cyrtodactylus Gray) not yet threatened by foreign cement companies and a summary of Peninsular Malaysia's endemic karst forest herpetofauna and the need for its conservation.

PubMed

Grismer, L Lee; Wood, P L Jr; Anuar, Shahrul; Davis, H R; Cobos, A J; Murdoch, M L

2016-01-04

A new species of Bent-toed Gecko, Cyrtodactylus gunungsenyumensis sp. nov. of the sworderi complex, is described from Hutan Lipur Gunung Senyum, Pahang, Peninsular Malaysia and is differentiated from all other species in the sworderi complex by having a unique combination of characters including a maximum SVL of 74.7 mm; low, rounded, weakly keeled, body tubercles; 34-40 paravertebral tubercles; weak ventrolateral body fold lacking tubercles; 38-41 ventral scales; an abrupt transition between the posterior and ventral femoral scales; 20-23 subdigital lamellae on the fourth toe; enlarged femoral scales; no femoral or precloacal pores; no precloacal groove; wide caudal bands; and an evenly banded dorsal pattern. Cyrtodactylus gunungsenyumensis sp. nov. is a scansorial, karst forest-adapted specialist endemic to the karst ecosystem surrounding Gunung Senyum and occurs on the vertical walls of the limestone towers as well as the branches, trunks, and leaves of the vegetation in the associated karst forest. Cyrtodactylus gunungsenyumensis sp. nov. is the seventh species of karst forest-adapted Cyrtodactylus and the sixteenth endemic species of karst ecosystem reptile discovered in Peninsular Malaysia in the last seven years from only 12 different karst forests. This is a clear indication that many species remain to be discovered in the approximately 558 isolated karst ecosystems in Peninsular Malaysia not yet surveyed. These data continue to underscore the importance of karst ecosystems as reservoirs of biodiversity and microendemism and that they constitute an important component of Peninsular Malaysia's natural heritage and should be protected from the quarrying interests of foreign industrial companies.

Are Cure Rates for Breast Cancer Improved by Local and Regional Anesthesia?

PubMed

Tsigonis, Abraham M; Al-Hamadani, Mohammed; Linebarger, Jared H; Vang, Choua A; Krause, Forrest J; Johnson, Jeanne M; Marchese, Edward; Marcou, Kristen A; Hudak, Jane M; Landercasper, Jeffrey

2016-01-01

Recent preclinical basic science studies suggest that patient tumor immunity is altered by general anesthesia (GA), potentially worsening cancer outcomes. A single retrospective review concluded that breast cancer patients receiving paravertebral block and GA had better cancer outcomes compared with patients receiving GA alone. This study has not been validated. We hypothesized that local or regional anesthesia (LRA) would be associated with better cancer outcomes compared with GA. We retrospectively reviewed a prospectively collected database to identify all stage 0-III breast cancer patients undergoing surgery in a single center during a 9-year period ending January 1, 2010. Patients were divided into 2 groups: those who received only LRA and those who received GA. Overall survival (OS), disease-free survival (DFS), and local regional recurrence (LRR) were calculated using the Kaplan-Meier method with log-rank comparison before and after propensity score matching. Median age of the 1107 patients who met study criteria was 64 years (range, 24-97 years). Median and longest follow-up were 5.5 and 12.5 years, respectively. General anesthesia was used for 461 patients (42%), and 646 (58%) received LRA. The point estimates of cumulative OS, DFS, and LRR "free" rates at 5 years for the GA and LRA groups were 85.5% and 87.1%, 94.2% and 96.1%, and 96.3% and 95.8%, respectively. Cox regression showed no significant differences between the 2 groups (GA and LRA) for the 3 outcomes: OS (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.59-1.10; P = 0.17), DFS (HR, 0.91; 95% CI, 0.55-1.76; P = 0.87), and LRR (HR, 1.73; 95% CI, 0.83-3.63; P = 0.15). Breast cancer OS, DFS, and LRR were not affected by type of anesthesia in our institution. This result differs from that of the only prior published clinical report on this topic and does not provide clinical corroboration of the basic science studies that suggest oncologic benefits to LRA.

Wrinkle surface instability of an inhomogeneous elastic block with graded stiffness

NASA Astrophysics Data System (ADS)

Yang, Shengyou; Chen, Yi-chao

2017-04-01

Surface instabilities have been studied extensively for both homogeneous materials and film/substrate structures but relatively less for materials with continuously varying properties. This paper studies wrinkle surface instability of a graded neo-Hookean block with exponentially varying modulus under plane strain by using the linear bifurcation analysis. We derive the first variation condition for minimizing the potential energy functional and solve the linearized equations of equilibrium to find the necessary conditions for surface instability. It is found that for a homogeneous block or an inhomogeneous block with increasing modulus from the surface, the critical stretch for surface instability is 0.544 (0.456 strain), which is independent of the geometry and the elastic modulus on the surface of the block. This critical stretch coincides with that reported by Biot (1963 Appl. Sci. Res. 12, 168-182. (doi:10.1007/BF03184638)) 53 years ago for the onset of wrinkle instabilities in a half-space of homogeneous neo-Hookean materials. On the other hand, for an inhomogeneous block with decreasing modulus from the surface, the critical stretch for surface instability ranges from 0.544 to 1 (0-0.456 strain), depending on the modulus gradient, and the length and height of the block. This sheds light on the effects of the material inhomogeneity and structural geometry on surface instability.

Modulating Reward Induces Differential Neurocognitive Approaches to Sustained Attention.

PubMed

Esterman, Michael; Poole, Victoria; Liu, Guanyu; DeGutis, Joseph

2017-08-01

Reward and motivation have powerful effects on cognition and brain activity, yet it remains unclear how they affect sustained cognitive performance. We have recently shown that a variety of motivators improve accuracy and reduce variability during sustained attention. In the current study, we investigate how neural activity in task-positive networks supports these sustained attention improvements. Participants performed the gradual-onset continuous performance task with alternating motivated (rewarded) and unmotivated (unrewarded) blocks. During motivated blocks, we observed increased sustained neural recruitment of task-positive regions, which interacted with fluctuations in task performance. Specifically, during motivated blocks, participants recruited these regions in preparation for upcoming targets, and this activation predicted accuracy. In contrast, during unmotivated blocks, no such advanced preparation was observed. Furthermore, during motivated blocks, participants had similar activation levels during both optimal (in-the-zone) and suboptimal (out-of-the-zone) epochs of performance. In contrast, during unmotivated blocks, task-positive regions were only engaged to a similar degree as motivated blocks during suboptimal (out-of-the-zone) periods. These data support a framework in which motivated individuals act as "cognitive investors," engaging task-positive resources proactively and consistently during sustaining attention. When unmotivated, however, the same individuals act as "cognitive misers," engaging maximal task-positive resources only during periods of struggle. Published by Oxford University Press 2016.

Ultrasound-guided greater occipital nerve blocks and pulsed radiofrequency ablation for diagnosis and treatment of occipital neuralgia.

PubMed

Vanderhoek, Matthew David; Hoang, Hieu T; Goff, Brandon

2013-09-01

Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or PRFA of the GON. We report two cases in which ultrasound was used to guide diagnostic greater occipital nerve blocks and greater occipital nerve pulsed radiofrequency ablation for treatment of occipital neuralgia. Two patients with occipital headaches are presented. In Case 1, ultrasound was used to guide diagnostic blocks of the greater occipital nerves. In Case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater occipital nerves. Both patients reported immediate, significant pain relief, with continued pain relief for several months. Further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater occipital nerves.

Ultrasound-Guided Greater Occipital Nerve Blocks and Pulsed Radiofrequency Ablation for Diagnosis and Treatment of Occipital Neuralgia

PubMed Central

VanderHoek, Matthew David; Hoang, Hieu T; Goff, Brandon

2013-01-01

Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or PRFA of the GON. We report two cases in which ultrasound was used to guide diagnostic greater occipital nerve blocks and greater occipital nerve pulsed radiofrequency ablation for treatment of occipital neuralgia. Two patients with occipital headaches are presented. In Case 1, ultrasound was used to guide diagnostic blocks of the greater occipital nerves. In Case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater occipital nerves. Both patients reported immediate, significant pain relief, with continued pain relief for several months. Further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater occipital nerves. PMID:24282778

Development of experimental approach to examine U occurrence continuity over the extended area reconnoitory boreholes: Lostoin Block, West Khasi Hills district, Meghalaya (India).

PubMed

Kukreti, B M; Kumar, Pramod; Sharma, G K

2015-10-01

Exploratory drilling was undertaken in the Lostoin block, West Khasi Hills district of Meghalaya based on the geological extension to the major uranium deposit in the basin. Gamma ray logging of drilled boreholes shows considerable subsurface mineralization in the block. However, environmental and exploration related challenges such as climatic, logistic, limited core drilling and poor core recovery etc. in the block severely restricted the study of uranium exploration related index parameters for the block with a high degree confidence. The present study examines these exploration related challenges and develops an integrated approach using representative sampling of reconnoitory boreholes in the block. Experimental findings validate a similar geochemically coherent nature of radio elements (K, Ra and Th) in the Lostoin block uranium hosting environment with respect to the known block of Mahadek basin and uranium enrichment is confirmed by the lower U to Th correlation index (0.268) of hosting environment. A mineralized zone investigation in the block shows parent (refers to the actual parent uranium concentration at a location and not a secondary concentration such as the daughter elements which produce the signal from a total gamma ray measurement) favoring uranium mineralization. The confidence parameters generated under the present study have implications for the assessment of the inferred category of uranium ore in the block and setting up a road map for the systematic exploration of large uranium potential occurring over extended areas in the basin amid prevailing environmental and exploratory impediments. Copyright © 2015 Elsevier Ltd. All rights reserved.

Integrated geometry and grid generation system for complex configurations

NASA Technical Reports Server (NTRS)

Akdag, Vedat; Wulf, Armin

1992-01-01

A grid generation system was developed that enables grid generation for complex configurations. The system called ICEM/CFD is described and its role in computational fluid dynamics (CFD) applications is presented. The capabilities of the system include full computer aided design (CAD), grid generation on the actual CAD geometry definition using robust surface projection algorithms, interfacing easily with known CAD packages through common file formats for geometry transfer, grid quality evaluation of the volume grid, coupling boundary condition set-up for block faces with grid topology generation, multi-block grid generation with or without point continuity and block to block interface requirement, and generating grid files directly compatible with known flow solvers. The interactive and integrated approach to the problem of computational grid generation not only substantially reduces manpower time but also increases the flexibility of later grid modifications and enhancements which is required in an environment where CFD is integrated into a product design cycle.

Kasei Valles Fractures

NASA Image and Video Library

2010-10-27

The fracture system shown in this image from NASA Mars Odyssey is on the northern margin of the Kasei Valles lowland. Fractures like this can become chaos with continued downdropping of blocks and widening fractures.

U.S. Air Force Research Technology Area Plan, FY 1989

DTIC Science & Technology

1988-09-01

Continue on reverse if necessaty and identify by block number) FIELD GROUP SUB-GROUP 19. ABSTRACT (Continue on reverse if necessary and identify by...Armstrong Aerospace Medical Research Laboratory (AAMRL) USAF School of Aerospace Medical Research Laboratory (USAFSAM) Rome Air Development Center...development of advanced weapon concepts and advance the state of the art in systems development, electromagnetic countermeasures, nuclear weapons

Segmenting the Stream of Consciousness: The Psychological Correlates of Temporal Structures in the Time Series Data of a Continuous Performance Task

ERIC Educational Resources Information Center

Smallwood, Jonathan; McSpadden, Merrill; Luus, Bryan; Schooler, Joanthan

2008-01-01

Using principal component analysis, we examined whether structural properties in the time series of response time would identify different mental states during a continuous performance task. We examined whether it was possible to identify regular patterns which were present in blocks classified as lacking controlled processing, either…

Pyomyositis of the iliacus muscle and pyogenic sacroiliitis after sacroiliac joint block -A case report-.

PubMed

Lee, Mi Hyeon; Byon, Hyo-Jin; Jung, Hyun Jun; Cha, Young-Deog; Lee, Doo Ik

2013-05-01

Sacroiliac joint block can be performed for the diagnosis and treatment of sacroiliac joint dysfunction. Although sacroiliac joint block is a common procedure, complications have not been reported in detail. We report a case of iliacus pyomyositis and sacroiliac joint infection following a sacroiliac joint block. A 70-year-old female patient received sacroiliac joint blocks to relieve pelvic pain. The patient was admitted to the emergency room two days after the final sacroiliac joint block (SIJB) with the chief complaints of left pelvic pain corresponding to a visual analogue scale (VAS) score of 9 and fever. A pelvic MRI indicated a diagnosis of myositis. After 1 month of continuous antibiotic therapy, the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level remained elevated. A (67)Ga SPECT/CT was done. Abnormal uptake was seen at the left sacroiliac joint (SIJ), and septic sacroiliitis was suspected. The CRP normalized to 0.29 mg/dl and the ESR decreased to 60 mm/hr, and the patient had no fever after 57 days of antibiotic therapy. She was directed for follow up at an outpatient clinic.

Continuous tonic spike activity in spider warm cells in the absence of sensory input.

PubMed

Gingl, E; Tichy, H

2006-09-01

The warm cells of the spider tarsal organ respond very sensitively to low-amplitude changes in temperature and discharge continuously as the rate of change in temperature reaches zero. To test whether the continuous tonic discharge remains without sensory input, we blocked the warm cell's receptive region by Epoxy glue. The activity continued in this situation, but its dependence on temperature changes was strongly reduced. We interpret this to mean that the warm cells exhibit specific intrinsic properties that underlie the generation of the tonic discharge. Experiments with electrical stimulation confirmed the observation that the warm cells persist in activity without an external drive. In warm cells with blocked receptive region, the response curves describing the relationship between the tonic discharge and the level of depolarization is the same for different temperatures. In warm cells with intact receptive region, the curves are shifted upward with rising temperature, as if the injected current is simply added to the receptor current. This indicates a modulating effect of the receptor current on the tonic discharge. Stimulation causes a change in the tonic discharge rate and thereby enables individual warm cells to signal the direction in addition to the magnitude of temperature changes.

Kinematics at the intersection of the Garlock and Death Valley fault zones, California: Integration of TM data and field studies

NASA Technical Reports Server (NTRS)

Abrams, Michael; Verosub, Ken; Finnerty, Tony; Brady, Roland

1987-01-01

The Garlock and Death Valley fault zones in SE California are two active strike-slip faults coming together on the east side of the Avawatz Mtns. The kinematics of this intersection, and the possible continuation of either fault zone, are being investigated using a combination of field mapping, and processing and interpretation of remotely sensed image data. Regional and local relationships are derivable from Thematic Mapper data (30 m resolution), including discrimination and relative age dating of alluvial fans, bedrock mapping, and fault mapping. Aircraft data provide higher spatial resolution over more limited areas. Hypotheses being considered are: (1) the Garlock fault extends east of the intersection; (2) the Garlock fault terminates at the intersection and the Death Valley fault continues southeastward; and (3) the Garlock fault has been offset right laterally by the Death Valley fault which continues to the southeast. Preliminary work indicates that the first hypothesis is invalid. From kinematic considerations, image analysis, and field work the third hypothesis is favored. The projected continuation of the Death Valley zone defines the boundary between the Mojave crustal block and the Basin and Range block.

Residents' perceptions of an integrated longitudinal curriculum: a qualitative study.

PubMed

Lubitz, Rebecca; Lee, Joseph; Hillier, Loretta M

2015-01-01

The purpose of this study was to explore family medicine residents' perceptions of a newly restructured integrated longitudinal curriculum. A purposeful sample of 16 family medicine residents participated in focus group interviews conducted from a grounded theory perspective to identify the characteristics of this training model that contribute to and that challenge learning. Eight key themes were identified: continuity of care, relevance to family medicine, autonomy, program-focused preparation, professional development as facilitated by role modeling, patient volume, clarity of expectations for learners, and logistics. Positive learning experiences were marked by high levels of autonomy, continuity, and relevance to family medicine. Less favorable learning experiences were characterized by limited opportunities for continuity of care, limited relevance to family medicine practice and unclear expectations for the resident's role. Family physician-led learning experiences contributed to residents' understanding of the full scope of family medicine practice, more so than specialist-led experiences. The logistics of implementing the integrated block were challenging and negatively impacted continuity and learning. This study suggests that an integrated longitudinalized family medicine block training model has the potential to support the principles of a longitudinal integrated competency-based curriculum to effectively prepare residents for family medicine practice.

AMCCOM (Army Armament, Munitions and Chemical Command) Management Study of Procurement Work Directive (PWD) Processing Costs

DTIC Science & Technology

1988-05-23

Unclass) 12. PERSONAL AUTHOR(S) % Priest, Jolene J., McIllece, Raymond P. I 13a. TYPE OF REPORT 13b. TIME COVERED 14. DATE OF REPORT (Year, Month...and identify by block number) FIELD GROUP SUB-GROUP Procurement (u), Procurement Work Directive (PWD) (u), Administrative Lead Time (ALT) (u...Procurement Administra-( A A o e e e time Lead Time (PALf) (u) "p 19. ABSTRACT (Continue on reverse if necessary and identify by block number) The practice of

On Directional Selectivity in Vertebrate Retina: An Experimental and Computational Study

DTIC Science & Technology

1992-01-01

Borg-Graham MIT Artificial Intelligence Laboratory Approved for public re•l•:sl i istzibu4 93-01232 98 1. 2 114- REPORT DOCUMENTATION PAGE OM[ B o J1...PAGE OF ABSTRACT UNCLASSIFIED UNCLASSIFIED UNCLASSIFIED UNCLASSIFIED %S .4 _ ýB-. u5%Q (*j Block 13 continued: preparation and b ) a whole-cell patch...currents and b ) by re- moving ATP from the electrodes which, in turn, blocks the inhibitory input over time. This finding implies that the necessary and

Continued Development of the AF/SGR Tricorder Program - Laser Eye Protection, Biomarkers of Laser Injury and Sensor Development

DTIC Science & Technology

2012-05-15

After washing, 200ul of 5% Non- Fat Dried Milk in PBST was added to block the wells for 1 hour. This was followed by washing in PBST and then addition...Methanol. The membrane was blocked with 5% Non- Fat Dried Milk in PBST for 1 hour. One PBST and PBS wash was done for 5 minutes each. The anti-GBB5-H9...102 E. PORTABLE BIOSENSOR FOR PROTEIN TARGETS ............................................. 103 1. Summary

Visual System Neural Responses to Laser Exposure from Local Q-Switched Pulses and Extended Source CW Speckle Patterns.

DTIC Science & Technology

1985-09-30

layers of the retina as seen in retinitis pigmentosa (Wolbarsht & Landers, 1980; Stefansson et al, 1981 a). Those are all long-term effects with a delay...block numoer) FIELD GROUP SUB-GROUP retinal damage center-surround 20 05 laser injury cat retina 20 06 visual perception N02 anesthesia 19. ABSTRACT...Continue on reverse if necessary and identify by block number) The reports of retinal damage from exposure to short pulse laser energy without any

Should the United States Army Have a Professional General Staff?

DTIC Science & Technology

1987-03-23

SUPPLEMENTARY NOTES IS. KEY WORDS (Continue on reverse side if necessary and ldentlfy by block number) 20L ABSTRACT (Ceatu m orevere N nc wmy acd...Identify by block nember) 2ontinued on reverse side. 1’,..,* OR A 7 17 ED#-no,* OF INOV 6S IS OBSOLETE OF PG , ,.,. 3 .o o. ., N s. O. ETE SECURITY...Genius for 5 War: The German Army and General Staff 1807 - 1945. I do not intend to address org~ n ~zation. Most governments and * defense

Interactive Implementation of the Optimal Systems Control Design Program (OPTSYSX) on the IBM 3033.

DTIC Science & Technology

1984-03-01

DAS A44 159 INTERACTIVE IMPLEMENTATION OF THE OPTIMAL SYSTEMS I CONTROL DESIGN PROGRAM (OPTSYSX) ON THE 1DM 3033(U NAVAL POSTGRADUATE SCHOOL MONTEREY...noesear end idswtif’r b block number) Optimal Systems Control Systems Control Control Systems 10.; ABSTRACT (Continu an reveree side ff Roe684v ad Id yI...34 by block number) .- This thesis discusses the modification of an existing Optimal Systems Control FORTRAN program (OPTSYS) originally obtained from

Photoionization of Atoms and Ions: Application of Time-Dependent Response Method within the Density Functional Theory.

DTIC Science & Technology

1987-10-13

AD-A±95 686 PHOTOIONIZATION OF ATOMS AND IONS: APPLICATION OF III TIME-DEPENDENT RESPONSE..(U) NAVAL RESEARCH LAB WASHINGTON DC U GUPTA ET AL. 13 OCT...on revere if ncemy and idmntify by block number) FIELD GROUP SUBGROUP Photoionization Density functional Atoms Time dependent 1 S. (Continue on...reverse if necenary and identify by block numnbw) The photoionization cross-section of several atoms (AT, Xe, Rn, Cs) and ions (Ne-like Ar, H-like and Li

Compressibility of Colloids. 2. Compressibility Studies of Tri-Block Non-Ionic Polymers in Toluene and Water Solutions.

DTIC Science & Technology

1984-01-20

different tra Contollin Office) IS. SECURITY CLASS. (.1 ths ,or ) Unclassified IS.. DECLASSIFICATION/DOWNGRADING SCHEDU LE IS. DISTRIBUTION STATEMENT (of...scattering measurements. Those polymers DD , jAN 73 1473 EDITION OF I NOV SS IS OBSOLETE Unclassified .oS/N 0102- I-014-60! SECURITY CL ASSItICATION OF...THIS PAGE (When Dote FsA OE / , . . . SECURITY CLASSIFICATION of THIS PAGE (len Dat& Lntre󈧬 Continued (Block #20) .. that dissolved in toluene

Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance.

PubMed

Carter, Christine E; Grahn, Jessica A

2016-01-01

Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the "contextual interference effect." While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule, although results varied across raters. Participant questionnaires also revealed that the interleaved practice schedule had positive effects on factors such as goal setting, focus, and mistake identification. Taken together, these results suggest that an interleaved practice schedule may be a more effective practice strategy than continuous repetition in a music-learning context.

Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance

PubMed Central

Carter, Christine E.; Grahn, Jessica A.

2016-01-01

Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the “contextual interference effect.” While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule, although results varied across raters. Participant questionnaires also revealed that the interleaved practice schedule had positive effects on factors such as goal setting, focus, and mistake identification. Taken together, these results suggest that an interleaved practice schedule may be a more effective practice strategy than continuous repetition in a music-learning context. PMID:27588014

Seismic responses and controlling factors of Miocene deepwater gravity-flow deposits in Block A, Lower Congo Basin

NASA Astrophysics Data System (ADS)

Wang, Linlin; Wang, Zhenqi; Yu, Shui; Ngia, Ngong Roger

2016-08-01

The Miocene deepwater gravity-flow sedimentary system in Block A of the southwestern part of the Lower Congo Basin was identified and interpreted using high-resolution 3-D seismic, drilling and logging data to reveal development characteristics and main controlling factors. Five types of deepwater gravity-flow sedimentary units have been identified in the Miocene section of Block A, including mass transport, deepwater channel, levee, abandoned channel and sedimentary lobe deposits. Each type of sedimentary unit has distinct external features, internal structures and lateral characteristics in seismic profiles. Mass transport deposits (MTDs) in particular correspond to chaotic low-amplitude reflections in contact with mutants on both sides. The cross section of deepwater channel deposits in the seismic profile is in U- or V-shape. The channel deposits change in ascending order from low-amplitude, poor-continuity, chaotic filling reflections at the bottom, to high-amplitude, moderate to poor continuity, chaotic or sub-parallel reflections in the middle section and to moderate-weak amplitude, good continuity, parallel or sub-parallel reflections in the upper section. The sedimentary lobes are laterally lobate, which corresponds to high-amplitude, good-continuity, moundy reflection signatures in the seismic profile. Due to sediment flux, faults, and inherited terrain, few mass transport deposits occur in the northeastern part of the study area. The front of MTDs is mainly composed of channel-levee complex deposits, while abandoned-channel and lobe-deposits are usually developed in high-curvature channel sections and the channel terminals, respectively. The distribution of deepwater channel, levee, abandoned channel and sedimentary lobe deposits is predominantly controlled by relative sea level fluctuations and to a lesser extent by tectonism and inherited terrain.

Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial.

PubMed

Niraj, G; Kelkar, A; Hart, E; Horst, C; Malik, D; Yeow, C; Singh, B; Chaudhri, S

2014-04-01

Posterior transversus abdominis plane blocks have been reported to be an effective method of providing analgesia after lower abdominal surgery. We compared the efficacy of a novel technique of providing continuous transversus abdominis plane analgesia with epidural analgesia in patients on an enhanced recovery programme following laparoscopic colorectal surgery. A non-inferiority comparison was used. Adult patients undergoing elective laparoscopic colorectal surgery were randomly assigned to receive continuous transversus abdominis plane analgesia (n = 35) vs epidural analgesia (n = 35), in addition to a postoperative analgesic regimen comprising regular paracetamol, regular diclofenac and tramadol as required. Sixty-one patients completed the study. The transversus group received four-quadrant transversus abdominis plane blocks and bilateral posterior transversus abdominis plane catheters that were infused with levobupivacaine 0.25% for 48 h. The epidural group received an infusion of bupivacaine and fentanyl. The primary outcome measure was visual analogue scale pain score on coughing at 24 h after surgery. We found no significant difference in median (IQR [range]) visual analogue scores during coughing at 24 h between the transversus group 2.5 (1.0-3.0 [0-5.5]) and the epidural group 2.5 (1.0-5.0 [0-6.0]). The one-sided 97.5% CI was a 0.0 (∞-1.0) difference in means, establishing non-inferiority. There were no significant differences between the groups for tramadol consumption. Success rate was 28/30 (93%) in the transversus group vs 27/31 (87%) in the epidural group. Continuous transversus abdominis plane infusion was non-inferior to epidural infusion in providing analgesia after laparoscopic colorectal surgery. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

CHOBS: Color Histogram of Block Statistics for Automatic Bleeding Detection in Wireless Capsule Endoscopy Video.

PubMed

Ghosh, Tonmoy; Fattah, Shaikh Anowarul; Wahid, Khan A

2018-01-01

Wireless capsule endoscopy (WCE) is the most advanced technology to visualize whole gastrointestinal (GI) tract in a non-invasive way. But the major disadvantage here, it takes long reviewing time, which is very laborious as continuous manual intervention is necessary. In order to reduce the burden of the clinician, in this paper, an automatic bleeding detection method for WCE video is proposed based on the color histogram of block statistics, namely CHOBS. A single pixel in WCE image may be distorted due to the capsule motion in the GI tract. Instead of considering individual pixel values, a block surrounding to that individual pixel is chosen for extracting local statistical features. By combining local block features of three different color planes of RGB color space, an index value is defined. A color histogram, which is extracted from those index values, provides distinguishable color texture feature. A feature reduction technique utilizing color histogram pattern and principal component analysis is proposed, which can drastically reduce the feature dimension. For bleeding zone detection, blocks are classified using extracted local features that do not incorporate any computational burden for feature extraction. From extensive experimentation on several WCE videos and 2300 images, which are collected from a publicly available database, a very satisfactory bleeding frame and zone detection performance is achieved in comparison to that obtained by some of the existing methods. In the case of bleeding frame detection, the accuracy, sensitivity, and specificity obtained from proposed method are 97.85%, 99.47%, and 99.15%, respectively, and in the case of bleeding zone detection, 95.75% of precision is achieved. The proposed method offers not only low feature dimension but also highly satisfactory bleeding detection performance, which even can effectively detect bleeding frame and zone in a continuous WCE video data.

Scale problems in assessment of hydrogeological parameters of groundwater flow models

NASA Astrophysics Data System (ADS)

Nawalany, Marek; Sinicyn, Grzegorz

2015-09-01

An overview is presented of scale problems in groundwater flow, with emphasis on upscaling of hydraulic conductivity, being a brief summary of the conventional upscaling approach with some attention paid to recently emerged approaches. The focus is on essential aspects which may be an advantage in comparison to the occasionally extremely extensive summaries presented in the literature. In the present paper the concept of scale is introduced as an indispensable part of system analysis applied to hydrogeology. The concept is illustrated with a simple hydrogeological system for which definitions of four major ingredients of scale are presented: (i) spatial extent and geometry of hydrogeological system, (ii) spatial continuity and granularity of both natural and man-made objects within the system, (iii) duration of the system and (iv) continuity/granularity of natural and man-related variables of groundwater flow system. Scales used in hydrogeology are categorised into five classes: micro-scale - scale of pores, meso-scale - scale of laboratory sample, macro-scale - scale of typical blocks in numerical models of groundwater flow, local-scale - scale of an aquifer/aquitard and regional-scale - scale of series of aquifers and aquitards. Variables, parameters and groundwater flow equations for the three lowest scales, i.e., pore-scale, sample-scale and (numerical) block-scale, are discussed in detail, with the aim to justify physically deterministic procedures of upscaling from finer to coarser scales (stochastic issues of upscaling are not discussed here). Since the procedure of transition from sample-scale to block-scale is physically well based, it is a good candidate for upscaling block-scale models to local-scale models and likewise for upscaling local-scale models to regional-scale models. Also the latest results in downscaling from block-scale to sample scale are briefly referred to.

Effectiveness of continuous versus single injection femoral nerve block for total knee arthroplasty: A double blinded, randomized trial.

PubMed

Dixit, Varun; Fathima, Samreen; Walsh, Stephen M; Seviciu, Alexandru; Schwendt, Ivan; Spittler, Karl-Heinz; Briggs, Dana

2018-04-26

Effective analgesia following total knee arthroplasty (TKA) is important for maximizing patient satisfaction, early participation in physical therapy and reducing the hospital stay. This trial compared continuous catheter femoral nerve block (cFNB) to single injection femoral nerve block (sFNB) in terms of analgesia, opioid consumption, and participation in physical therapy and associated side effects. This randomized, double blinded trial was conducted in a non-university hospital setting, without major changes to anesthesia or surgical clinical pathways. A total of 85 patients scheduled for primary TKA were randomized to receive either cFNB (n=44) or sFNB (n=41). All patients had FNB with 0.5% ropivacaine bolus followed by subarachnoid block for surgery. Postoperatively, 0.2% ropivacaine infusion was commenced in cFNB group and a sham catheter was taped to the skin in sFNB group. All patients received a structured multimodal analgesia regimen throughout hospital stay. The primary outcomes were peak resting visual analogue scale (VAS) scores and morphine consumption at 48h postoperatively. VAS scores (Mean difference 0.25, 95% Confidence Interval (CI) -0.56 to 1.06; [P=0.196]) and morphine consumption (Mean difference 0.95mg, 95% CI -9.99 to 11.89; [P=0.863]) were not significantly different among patients who received cFNB versus sFNB at 48h. There was no difference in hospital stay (P=0.517) or long-term functional recovery between the two groups (P=0.385). sFNB block provides equal pain relief compared with cFNB, after TKA with no significant difference in opioid consumption, hospital stay, physical therapy outcomes or associated side effects. Copyright © 2018 Elsevier B.V. All rights reserved.

Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain: discogenic visceral pain.

PubMed

Tang, Yuan-Zhang; Shannon, Moore-Langston; Lai, Guang-Hui; Li, Xuan-Ying; Li, Na; Ni, Jia-Xiang

2013-01-01

Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment. Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed. All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P < 0.05). Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks. It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.

The origin and development of plains-type folds during the cretaceous in Central and western Kansas

USGS Publications Warehouse

Merriam, D.F.; Forster, A.

2000-01-01

Kansas is part of the Central Stable Region of North America. Structural movement on this part of the craton has been mainly the result of tectonism in nearby areas. Response to the outside tectonic forces, transmitted through the rigid Precambrian basement, has been vertical adjustment. Differential movement along an indigenous fault/fracture pattern in the basement created displaced blocks over which the later sediments were draped by differential compaction. After initial formation of this structural regimen in late Mississippian-early Pennsylvanian time, continued movement of the basement blocks gave rise to the plains-type folds so prevalent in the U.S. Midcontinent. The incremental movement continues through the late Paleozoic, Mesozoic, and Tertiary until today. This paper demonstrates the Cretaceous development of some of these structures in central and western Kansas.

DEVELOPING AN INTEGRATED MANAGEMENT SYSTEM FOR URBAN AND ENERGY PLANNING TOWARDS A LOW-CARBON CITY

NASA Astrophysics Data System (ADS)

Maeda, Hideto; Nakakubo, Toyohiko; Tokai, Akihiro

In this study, we developed an integrated management model that supports local government to make a promising energy saving measure on a block-scale combined with urban planning. We applied the model to Osaka city and estimated CO2 emissions from the residential and commercial buildings to 2050. The urban renewal cases selected in this study included advanced multipole accumulation case, normal multipole accumulation case, and actual trend continuation case. The energy saving options introduced in each case included all-electric HP system, micro grid system, and we also set the option where the greater CO2 reduction one is selected in each block. The results showed that CO2 emission in 2050 would be reduced by 54.8-57.6% relative to the actual condition by introducing the new energy system in all cases. In addition, the amount of CO2 reduction in actual trend continuation case was highest. The major factor was that the effect of CO2 emission reductions by installing the solar power generation panel was higher than the effect by utilizing heated water mutually on the high-density blocks in terms of total urban buildings' energy consumption.

Intermittent bradyarrhythmia in a Hispaniolan Amazon parrot (Amazona ventralis).

PubMed

Rembert, Melanie S; Smith, Julie A; Strickland, Keith N; Tully, Thomas N

2008-03-01

A clinically normal 2-year-old Hispaniolan Amazon parrot (Amazona ventralis) was found to have periodic second-degree atrioventricular (AV) block with variable nodal conductions while anesthetized with isoflurane during a thermal-support research project. Arrhythmias were observed on 5 successive weekly electrocardiograms. A complete cardiac evaluation, including a diagnostic electrocardiogram, revealed intermittent bradyarrhythmias ranging from a 2:1 to a 7:1 second-degree AV block, with concurrent hypotensive episodes during the nodal blocks. Results of a complete blood cell count, plasma biochemical profile, blood gas analysis, and atropine-response test, as well as radiography and auscultation, revealed no obvious cause for the arrhythmias. Echocardiography demonstrated cardiac wall thickness, chamber size, and systolic function similar to other psittacine birds. On return to the colony, the parrot continued to be outwardly asymptomatic despite the dramatic conduction disturbances. Although cardiac arrhythmias, including second-degree AV block, have been widely reported in birds, the wide variation of nodal conductions, the intermittent nature, and an arrhythmia with a 7:1 second-degree AV block that spontaneously reverts to normal as seen in this case have not been well documented in parrots.

[Preparation of frozen blocks of fish flesh and its evaluation during storage].

PubMed

Rodríguez, L; Bello, R A

1987-06-01

Minced fish flesh from shrimp by-catch was used as raw material to prepare four frozen blocks under different conditions, as follows: a) Minced fish flesh washed in cool water for 10 minutes with continuous stirring (water-fish proportion, 3:1). b) Minced fish flesh mixed with sodium tripolyphosphate (TPP) (0.5%), and sodium chloride (1%), respectively. c) Minced fish flesh mixed with 0.5% sodium tripolyphosphate, 1% sodium chloride and 7.5% corn starch, and c) Minced fish flesh without any treatment, which was used as control. Fish blocks were frozen at -40 degrees C and stored at -10 degrees C and -30 degrees C freezing points during a six-month period. Physical, chemical and microbiological tests were performed during the storage period. The results obtained indicate that frozen fish blocks stored at -10 degrees C deteriorate faster than those stored at -30 degrees C. The TPP, sodium chloride and corn starch treatments were not effective in reducing protein denaturation, but they do increase the water retention capacity of the blocks.

Novel technique of abdominal wall nerve block for laparoscopic colostomy: Rectus sheath block with transperitoneal approach.

PubMed

Nagata, Jun; Watanabe, Jun; Sawatsubashi, Yusuke; Akiyama, Masaki; Arase, Koichi; Minagawa, Noritaka; Torigoe, Takayuki; Hamada, Kotaro; Nakayama, Yoshifumi; Hirata, Keiji

2017-08-27

A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twenty-four hours postoperatively, the patient's pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.

The effect of UV-blocking contact lenses as a therapy for canine chronic superficial keratitis.

PubMed

Denk, Nora; Fritsche, Jens; Reese, Sven

2011-05-01

To evaluate the effect of UV-blocking soft contact lenses in treatment for chronic superficial keratitus (CSK). Twenty six dogs with CSK were treated continuously with UV-blocking contact lenses for 6 months. A contact lens was placed on one eye of each dog; the other eye remained without a lens as a control eye. After this primary study, five of the dogs were further treated and they wore then contact lenses in both eyes. Continuously, all patients were concurrently treated topically with cyclosporine. The contact lenses were changed every 4 weeks and an ophthalmic examination performed. Evaluation criteria included corneal alterations as pigmentation, edema, pannus and vascularization. To determine the transmittance characteristics of the contact lenses before and after use, 32 contact lenses were measured with a UV-vis-NIR spectrophotometer. Pigmentation increased in eyes wearing lenses and in control eyes over the evaluation period of 6 months. Corneal edema increased in the eyes wearing lenses, but remained unaffected in the control eyes. A significant difference in the incidence of pannus and the extent of corneal vascularisation could not be evaluated. Adverse effects were noted in six cases (corneal edema and vascularisation, conjunctivitis, blepharospasm). All new lenses studied reduced UV-radiation to a safe level, whereas used lenses did not maintain their transmittance characteristics. No positive effect of UV-blocking contact lenses could be proven with the study design used. © 2011 American College of Veterinary Ophthalmologists.

What can Written-Words Tell us About Lexical Retrieval in Speech Production?

PubMed Central

Navarrete, Eduardo; Mahon, Bradford Z.; Lorenzoni, Anna; Peressotti, Francesca

2016-01-01

In recent decades, researchers have exploited semantic context effects in picture naming tasks in order to investigate the mechanisms involved in the retrieval of words from the mental lexicon. In the blocked naming paradigm, participants name target pictures that are either blocked or not blocked by semantic category. In the continuous naming task, participants name a sequence of target pictures that are drawn from multiple semantic categories. Semantic context effects in both tasks are a highly reliable phenomenon. The empirical evidence is, however, sparse and inconsistent when the target stimuli are printed-words instead of pictures. In the first part of the present study we review the empirical evidence regarding semantic context effects with written-word stimuli in the blocked and continuous naming tasks. In the second part, we empirically test whether semantic context effects are transferred from picture naming trials to word reading trials, and from word reading trials to picture naming trials. The results indicate a transfer of semantic context effects from picture naming to subsequently read within-category words. There is no transfer of semantic effects from target words that were read to subsequently named within-category pictures. These results replicate previous findings (Navarrete et al., 2010) and are contrary to predictions from a recent theoretical analysis by Belke (2013). The empirical evidence reported in the literature together with the present results, are discussed in relation to current accounts of semantic context effects in speech production. PMID:26779090

The Building Blocks for JWST I and T (Integrations and Test) to Operations - From Simulator to Flight Units

NASA Technical Reports Server (NTRS)

Fatig, Curtis; Ochs, William; Johns, Alan; Seaton, Bonita; Adams, Cynthia; Wasiak, Francis; Jones, Ronald; Jackson, Wallace

2012-01-01

The James Webb Space Telescope (JWST) Project has an extended integration and test (I&T) phase due to long procurement and development times of various components as well as recent launch delays. The JWST Ground Segment and Operations group has developed a roadmap of the various ground and flight elements and their use in the various JWST I&T test programs. The JWST Project s building block approach to the eventual operational systems, while not new, is complex and challenging; a large-scale mission like JWST involves international partners, many vendors across the United States, and competing needs for the same systems. One of the challenges is resource balancing so simulators and flight products for various elements congeal into integrated systems used for I&T and flight operations activities. This building block approach to an incremental buildup provides for early problem identification with simulators and exercises the flight operations systems, products, and interfaces during the JWST I&T test programs. The JWST Project has completed some early I&T with the simulators, engineering models and some components of the operational ground system. The JWST Project is testing the various flight units as they are delivered and will continue to do so for the entire flight and operational system. The JWST Project has already and will continue to reap the value of the building block approach on the road to launch and flight operations.

Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial.

PubMed

Bjørnholdt, Karen T; Jensen, Jan M; Bendtsen, Thomas F; Søballe, Kjeld; Nikolajsen, Lone

2015-12-01

Shoulder replacement involves significant post-operative pain, which is often managed by continuous interscalene brachial plexus block. Catheter displacement and complications limit the beneficial effect of the block. Local infiltration analgesia (LIA) has provided good results in knee replacement. We aimed to assess the effectiveness of LIA for pain after shoulder replacement. Patients scheduled for primary shoulder replacement under general anaesthesia were randomized to receive either local infiltration analgesia (LIA) (150 ml ropivacaine 0.2 % with epinephrine intra-operatively) or interscalene brachial plexus catheter (ISC) (ropivacaine 0.75 %, 7 ml bolus followed by 48-h 5 ml/h infusion). The primary outcome was opioid consumption during the first 24 post-operative hours. Secondary outcomes were pain ratings, supplementary analgesics, and side effects for 3 days, and complications until 3 months after surgery. Data were analysed for 61 patients (LIA 30, ISC 31). Twenty-four-hour opioid consumption was higher in the LIA group compared with the ISC group: median (IQR) 95 mg (70-150 mg) versus 40 mg (8-76 mg) (P = 0.0001). No significant difference in opioid consumption was found between groups during the following 3 days. The LIA group had higher pain scores at 0, 2, 4, and 8 h. Two patients in the ISC group had long-lasting complications. The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.

A METHOD FOR USING BLOCKED AND EVENT-RELATED FMRI DATA TO STUDY “RESTING STATE” FUNCTIONAL CONNECTIVITY

PubMed Central

Fair, Damien A.; Schlaggar, Bradley L.; Cohen B.A., Alexander L.; Miezin, Francis M.; Dosenbach, Nico U.F.; Wenger, Kristin K.; Fox, Michael D.; Snyder, Abraham Z.; Raichle, Marcus E.; Petersen, Steven E.

2007-01-01

Resting state functional connectivity MRI (fcMRI) has become a particularly useful tool for studying regional relationships in typical and atypical populations. Because many investigators have already obtained large datasets of task related fMRI, the ability to use this existing task data for resting state fcMRI is of considerable interest. Two classes of datasets could potentially be modified to emulate resting state data. These datasets include: 1) “interleaved” resting blocks from blocked or mixed blocked/event-related sets, and 2) residual timecourses from event-related sets that lack rest blocks. Using correlation analysis, we compared the functional connectivity of resting epochs taken from a mixed blocked/event-related design fMRI data set and the residuals derived from event-related data with standard continuous resting state data to determine which class of data can best emulate resting state data. We show that despite some differences, the functional connectivity for the interleaved resting periods taken from blocked designs is both qualitatively and quantitatively very similar to that of “continuous” resting state data. In contrast, despite being qualitatively similar to “continuous” resting state data, residuals derived from event-related design data had several distinct quantitative differences. These results suggest that the interleaved resting state data such as those taken from blocked or mixed blocked/event-related fMRI designs are well-suited for resting state functional connectivity analyses. Although using event-related data residuals for resting state functional connectivity may still be useful, results should be interpreted with care. PMID:17239622

Comments on the Yule Marble Haines block: potential replacement, Tomb of the Unknown Soldier, Arlington National Cemetery

USGS Publications Warehouse

Mossotti, Victor G.

2014-01-01

Marble for the Tomb of the Unknown Soldier at Arlington National Cemetery was cut from the Colorado Yule Marble Quarry in 1931. Although anecdotal reports suggest that cracks were noticed in the main section of the monument shortly after its installation at the Arlington National Cemetery in Arlington, Virginia, detailed documentation of the extent of cracking did not appear until 1963. Although debate continues as to whether the main section of the Tomb of the Unknowns monument should be repaired or replaced, Mr. John S. Haines of Glenwood Springs, Colorado, in anticipation of the permanent closing of the Yule Quarry, donated a 58-ton block of Yule Marble, the so-called Haines block, as a potential backup. The brief study reported here was conducted during mid-summer 2009 at the behest of the superintendent of Arlington National Cemetery. The field team entered the subterranean Yule Marble Quarry with the Chief Extraction Engineer in order to contrast the method used for extraction of the Haines block with the method that was probably used to extract the marble block that is now cracked. Based on surficial inspection and shallow coring of the Haines block, and on the nature of crack propagation in Yule Marble as judged by close inspection of a large collection of surrogate Yule Marble blocks, the team found the block to be structurally sound and cosmetically equivalent to the marble used for the current monument. If the Haines block were needed, it would be an appropriate replacement for the existing cracked section of the Tomb of the Unknown Soldier Monument.

Effect of Transversus Abdominis Plane Block on Cost of Laparoscopic Cholecystectomy Anesthesia

PubMed Central

Kokulu, Serdar; Bakı, Elif Doğan; Kaçar, Emre; Bal, Ahmet; Şenay, Hasan; Üstün, Kübra Demir; Yılmaz, Sezgin; Ela, Yüksel; Sıvacı, Remziye Gül

2014-01-01

Background Use of transversus abdominis plane (TAP) block for postoperative analgesia is continuously increasing. However, few studies have investigated intraoperative effects of TAP block. We aimed to study the effects of TAP block in terms of cost-effectiveness and consumption of inhalation agents. Material/Methods Forty patients undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomly divided into 2 groups: Group 1 (n=20) patients received TAP block and Group 2 (n=20) patients did not receive TAP block. Standard anesthesia induction was used in all patients. For the maintenance of anesthesia, fractional inspired oxygen (FIO2) of 50% in air with desflurane was used with a fresh gas flow of 4 L/min. All patients were monitored with electrocardiography and for peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ET), heart rate (HR), noninvasive mean blood pressure (MBP), and bispectral index (BIS). Bilateral TAP blocks were performed under ultrasound guidance to Group 1 patients. The BIS value was maintained at between 40 and 50 during the surgery. The Dion formula was used to calculate consumption of desflurane for each patient. Results There was no difference between the groups with respect to demographic characteristics of the patients. Duration of anesthesia, surgery time, and dosage of fentanyl were similar in the 2 groups. However, the cost and consumption of desflurane was significantly lower in Group 1. Conclusions Total anesthesia consumption was lower and the cost-effectiveness of anesthesia was better in TAP block patients with general anesthesia than in non-TAP block patients undergoing laparoscopic cholecystectomy. PMID:25534331

Effect of transversus abdominis plane block on cost of laparoscopic cholecystectomy anesthesia.

PubMed

Kokulu, Serdar; Bakı, Elif Doğan; Kaçar, Emre; Bal, Ahmet; Şenay, Hasan; Üstün, Kübra Demir; Yılmaz, Sezgin; Ela, Yüksel; Sıvacı, Remziye Gül

2014-12-23

Use of transversus abdominis plane (TAP) block for postoperative analgesia is continuously increasing. However, few studies have investigated intraoperative effects of TAP block. We aimed to study the effects of TAP block in terms of cost-effectiveness and consumption of inhalation agents. Forty patients undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomly divided into 2 groups: Group 1 (n=20) patients received TAP block and Group 2 (n=20) patients did not receive TAP block. Standard anesthesia induction was used in all patients. For the maintenance of anesthesia, fractional inspired oxygen (FIO2) of 50% in air with desflurane was used with a fresh gas flow of 4 L/min. All patients were monitored with electrocardiography and for peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ET), heart rate (HR), noninvasive mean blood pressure (MBP), and bispectral index (BIS). Bilateral TAP blocks were performed under ultrasound guidance to Group 1 patients. The BIS value was maintained at between 40 and 50 during the surgery. The Dion formula was used to calculate consumption of desflurane for each patient. There was no difference between the groups with respect to demographic characteristics of the patients. Duration of anesthesia, surgery time, and dosage of fentanyl were similar in the 2 groups. However, the cost and consumption of desflurane was significantly lower in Group 1. Total anesthesia consumption was lower and the cost-effectiveness of anesthesia was better in TAP block patients with general anesthesia than in non-TAP block patients undergoing laparoscopic cholecystectomy.

An Application of Computerized Axial Tomography (CAT) Technology to Mass Raid Tracking

DTIC Science & Technology

1989-08-01

ESD-TR-89-305 MTR-10542 An Application of Computerized Axial Tomography ( CAT ) Technology to Mass Raid Tracking By John K. Barr August 1989...NO 11. TITLE (Include Security Classification) An Application of Computerized Axial Tomography ( CAT ) Technology to Mass Raid Tracking 12...by block number) Computerized Axial Tomography ( CAT ) Scanner Electronic Support Measures (ESM) Fusion (continued) 19. ABSTRACT (Continue on

76 FR 5053 - Continuation of the National Emergency With Respect to the Situation in or in Relation to C[ocirc...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-28

... January 26, 2011 Continuation of the National Emergency With Respect to the Situation in or in Relation to... emergency, pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701-1706), to deal with... constituted by the situation in or in relation to C[ocirc]te d'Ivoire and ordered related measures blocking...

75 FR 5675 - Continuation of the National Emergency With Respect to the Situation in or in Relation to C[ocirc...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... February 2, 2010 Continuation of the National Emergency With Respect to the Situation in or in Relation to... emergency, pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701-1706), to deal with... constituted by the situation in or in relation to C[ocirc]te d'Ivoire and ordered related measures blocking...

Application of DIVWAG at Rodman Laboratory

DTIC Science & Technology

1976-03-01

Continue on reveree eide It neceaemry mnd identify by block number) DIVWAG War Game Simulation Mathematical Model 20. ABSTRACT (Continue on...parameters. Rodman Laboratory is using DIVWAG in a simulation mode. In this model of operation, once a game has been completed, a representative...a period of play by a blue (red) artillery battery as a function of range and game time). t Ü UNCLASSIFIED SECURITY CLASSIFICATION OF THIS

Human Histologic Repair and Regeneration After Biologic Preparation of Diseased Root Surfaces,

DTIC Science & Technology

1983-12-01

Continue on reverse side if neceesar and Identify by block number) Periodontal disease Tooth roots Connective tissue regeneration 20 ABSTRACT (Continue on... regeneration of periodontal attachment loss, due to inflammatory periodontal disease (1). Most procedures for new attachment achieve a new dentogingival...good appearance for a lifetime. Oral hygiene is the most important factor in the prevention and treatment of inflammatory periodontal diseases

Computational Methods for Control and Estimation of Distributed System

DTIC Science & Technology

1988-08-01

prey example. [1987, August] Estimation of Nonlinearities in Parabolic Models for Growth, Predation and Dispersal of Populations. S a ON A VARIATIONAL ...NOTATION 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP 19. ABSTRACT (Continue...techniques for infinite dimensional systems. (v) Control and stabilization of visco-elastic structures. (vi) Approximation in delay and Volterra type

Seismic anisotropy beneath the southern Ordos block and the Qinling-Dabie orogen, China: Eastward Tibetan asthenospheric flow around the southern Ordos

NASA Astrophysics Data System (ADS)

Yu, Yong; Chen, Yongshun John

2016-12-01

SKS wave splitting analysis is performed to estimate the seismic anisotropy in the upper mantle using teleseismic data recorded by a temporary seismic array of 180 stations called SOSArray deployed in the southern Ordos block and the Qinling-Dabie orogen. The most important finding is that large delay times with NW-SE fast polarization directions in the northeastern Tibet are continuous across the boundary into the southwestern part of the Ordos block, where the SKS wave splitting results are significantly different from those in the rest of the Ordos block. Based on our SKS wave splitting results in addition to the results from previous studies, we propose an asthenospheric flow model for the eastward extrusion of the Tibetan upper mantle. The model consists of two corner flows around the southwestern corner and the southeastern corner of the Ordos block and the eastward flow along the Weihe graben and the Qinling-Dabie orogen for the escaping Tibetan upper mantle. Finally, the clockwise turning flow of the asthenosphere around the southwestern corner of Ordos block has currently extended laterally into the interior of the Ordos block, suggesting that the thick cold lithospheric root of the southwestern Ordos block there is currently being replaced with hot Tibetan asthenosphere at depths, that is, we observed an on-going process of thermal erosion of a cratonic lithosphere by lateral hot asthenospheric flow.

The Effect of Adductor Canal Block on Knee Extensor Muscle Strength 6 Weeks After Total Knee Arthroplasty: A Randomized, Controlled Trial.

PubMed

Rousseau-Saine, Nicolas; Williams, Stephan R; Girard, François; Hébert, Luc J; Robin, Florian; Duchesne, Luc; Lavoie, Frédéric; Ruel, Monique

2018-03-01

Total knee arthroplasty (TKA) reduces knee extensor muscle strength (KES) in the operated limb for several months after the surgery. Immediately after TKA, compared to either inguinal femoral nerve block or placebo, adductor canal block (ACB) better preserves KES. Whether this short-term increase in KES is maintained several weeks after surgery remains unknown. We hypothesized that 48 hours of continuous ACB immediately after TKA would improve KES 6 weeks after TKA, compared to placebo. Patients scheduled for primary unilateral TKA were randomized to receive either a continuous ACB (group ACB) or a sham block (group SHAM) for 48 hours after surgery. Primary outcome was the difference in maximal KES 6 weeks postoperatively, measured with a dynamometer during maximum voluntary isometric contraction. Secondary outcomes included postoperative day 1 (POD1) and day 2 (POD2) KES, pain scores at rest and peak effort, and opioid consumption; variation at 6 weeks of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of hospital stay. Sixty-three subjects were randomized and 58 completed the study. Patients in group ACB had less pain at rest during POD1 and during peak effort on POD1 and POD2, consumed less opioids on POD1 and POD2, and had higher median KES on POD1. There was no significant difference between groups for median KES on POD2, variation of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of stay. There was no difference between groups in median KES 6 weeks after surgery (52 Nm [31-89 Nm] for group ACB vs 47 Nm [30-78 Nm] for group SHAM, P= .147). Continuous ACB provides better analgesia and KES for 24-48 hours after surgery, but does not affect KES 6 weeks after TKA. Further research could evaluate whether standardized and optimized rehabilitation over the long term would allow early KES improvements with ACB to be maintained over a period of weeks or months.

Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation

PubMed Central

Park, Hee-Sun; Kim, Ha-Jung; Ro, Young-Jin; Yang, Hong-Seuk; Koh, Won-Uk

2017-01-01

Abstract Rationale: Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck. Patient concerns: A 59 year old woman was planned for open acromioplasty and rotator cuff repair under general anesthesia. General anesthesia was induced following an ISB using 0.2% ropivacaine and catheter insertion for postoperative pain control. Diagnoses: While recovering in the postanesthesia care unit (PACU), however, the patient complained of a sore throat and hoarseness without respiratory insufficiency. On the morning of the first postoperative day, she still complained of mild dyspnea, dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral vocal cord paresis following an endoscopic laryngoscopy examination. Interventions: The continuous ISB catheter was immediately removed and the dyspnea and hoarseness symptoms improved, although mild aspiration during drinking water was still present. Outcomes: On the 4th postoperative day, a laryngoscopy examination revealed that the right vocal cord movement had returned to normal but that the left vocal cord paresis still remained. Lessons: When ISB is planned, a detailed history-taking and examination of the airway are essential for patient safety and we recommend that any local anesthetics be carefully injected under ultrasound guidance. We also recommend the use of low concentration of local anesthetics to avoid possible paralysis of the vocal cord. PMID:28403100

Rock cities, periglacial mass-wasting, and honeycomb weathering in Warren County, northwestern Pennsylvania

DOE Office of Scientific and Technical Information (OSTI.GOV)

Inners, J.D.; Sevon, W.D.; Moore, M.E.

1993-03-01

Imposing hilltop rock-cities developed from widely jointed outcrops of Olean conglomerate (Lower Pennsylvanian) create picturesque scenery on the Allegheny High Plateau in Warren Co., Pa. At least six such rock cities 2 to 5 acres in extent are associated with the Late Wisconsinan glacial border in the northern half of the county. Farther to the south, jumbled Olean and Knapp (Lower Mississippian) joint blocks occur on steep slopes below valley-wall cliffs. The rock cities and accumulations of displaced joint blocks are largely relics of Late Wisconsinan periglacial mass-wasting. Frost splitting initiated opening of bedrock joints to form buildings. Gravity, soilmore » wedging, and possibly gelifluction then widened the fissures into streets. Gelifluction moved blocks downslope and oriented their long axes parallel with slope (Warren Rocks). Forward toppling of high, unstable blocks contributed to mass-movement on some steep slopes (Rimrock). Today, rock cities and downslope blocks are stable in areas of gentle (less than 10 percent) slopes, but toppling, solifluction, creep, and debris flows cause continued slow movement of large blocks on moderately steep to steep (greater than 30 percent) slopes. Blocks of Olean and Knapp conglomerate have both stratabound pitting and intricate honeycomb weathering. Deep pitting is controlled largely by variations in silica cementation. Honeycomb weathering is most evident in sandy layers and results from patterns of iron-oxide impregnation. Both are Holocene surface-weathering processes.« less

Identifying a Small Molecule Blocking Antigen Presentation in Autoimmune Thyroiditis.

PubMed

Li, Cheuk Wun; Menconi, Francesca; Osman, Roman; Mezei, Mihaly; Jacobson, Eric M; Concepcion, Erlinda; David, Chella S; Kastrinsky, David B; Ohlmeyer, Michael; Tomer, Yaron

2016-02-19

We previously showed that an HLA-DR variant containing arginine at position 74 of the DRβ1 chain (DRβ1-Arg74) is the specific HLA class II variant conferring risk for autoimmune thyroid diseases (AITD). We also identified 5 thyroglobulin (Tg) peptides that bound to DRβ1-Arg74. We hypothesized that blocking the binding of these peptides to DRβ1-Arg74 could block the continuous T-cell activation in thyroiditis needed to maintain the autoimmune response to the thyroid. The aim of the current study was to identify small molecules that can block T-cell activation by Tg peptides presented within DRβ1-Arg74 pockets. We screened a large and diverse library of compounds and identified one compound, cepharanthine that was able to block peptide binding to DRβ1-Arg74. We then showed that Tg.2098 is the dominant peptide when inducing experimental autoimmune thyroiditis (EAT) in NOD mice expressing human DRβ1-Arg74. Furthermore, cepharanthine blocked T-cell activation by thyroglobulin peptides, in particular Tg.2098 in mice that were induced with EAT. For the first time we identified a small molecule that can block Tg peptide binding and presentation to T-cells in autoimmune thyroiditis. If confirmed cepharanthine could potentially have a role in treating human AITD. © 2016 by The American Society for Biochemistry and Molecular Biology, Inc.

Assessment of apical transportation caused by nickel-titanium rotary systems with full rotation and reciprocating movements using extracted teeth and resin blocks with simulated root canals: A comparative study.

PubMed

Alrahabi, M; Zafar, M S

2018-06-01

: We compared apical transportation in the WaveOne and ProTaper Next systems, which are rotary nickel-titanium systems with reciprocating and continuous rotation movements, respectively, using manual measurements obtained from resin blocks with simulated root canals and double digital radiographs of extracted teeth. : We used 30 resin blocks with simulated root canals and 30 extracted teeth for this study. The same endodontist performed root canal shaping using the WaveOne or ProTaper Next system. We assessed apical transportation by measuring the amounts (in mm) of material lost 1 mm from the apical foramen in the resin blocks and by using double digital radiography for the extracted teeth. Significant differences between groups were assessed using t-tests. P < 0.05 was considered statistically significant. : The amount of apical transportation differed significantly between the two systems when resin blocks were used for assessment (P < 0.05), but there were no significant differences when extracted teeth were used (P < 0.05). In the current study, there was no significant difference in apical transportation between natural teeth prepared using WaveOne and those prepared using ProTaper Next. However, significant differences were observed between the two systems with resin blocks. These findings indicate that the use of resin blocks is not an accurate method for apical transportation evaluation.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Quanlin; Oldenburg, Curtis M.; Spangler, Lee H.

Analytical solutions with infinite exponential series are available to calculate the rate of diffusive transfer between low-permeability blocks and high-permeability zones in the subsurface. Truncation of these series is often employed by neglecting the early-time regime. Here in this paper, we present unified-form approximate solutions in which the early-time and the late-time solutions are continuous at a switchover time. The early-time solutions are based on three-term polynomial functions in terms of square root of dimensionless time, with the first coefficient dependent only on the dimensionless area-to-volume ratio. The last two coefficients are either determined analytically for isotropic blocks (e.g., spheresmore » and slabs) or obtained by fitting the exact solutions, and they solely depend on the aspect ratios for rectangular columns and parallelepipeds. For the late-time solutions, only the leading exponential term is needed for isotropic blocks, while a few additional exponential terms are needed for highly anisotropic rectangular blocks. The optimal switchover time is between 0.157 and 0.229, with highest relative approximation error less than 0.2%. The solutions are used to demonstrate the storage of dissolved CO 2 in fractured reservoirs with low-permeability matrix blocks of single and multiple shapes and sizes. These approximate solutions are building blocks for development of analytical and numerical tools for hydraulic, solute, and thermal diffusion processes in low-permeability matrix blocks.« less

Block versus longitudinal integrated clerkships: students' views of rural clinical supervision.

PubMed

Witney, Martin; Isaac, Vivian; Playford, Denese; Walker, Leesa; Garne, David; Walters, Lucie

2018-07-01

Medical students undertaking longitudinal integrated clerkships (LICs) train in multiple disciplines concurrently, compared with students in block rotations who typically address one medical discipline at a time. Current research suggests that LICs afford students increased access to patients and continuity of clinical supervision. However, these factors are less of an issue in rural placements where there are fewer learners. The aim of this study was to compare rural LIC and rural block rotation students' reported experiences of clinical supervision. De-identified data from the 2015 version of the Australian national rural clinical schools (RCSs) exit survey was used to compare students in LICs with those in block rotations in relation to how they evaluate their clinical supervisors and how they rate their own clinical competence. Multivariate general linear modelling showed no association between placement type (LIC versus Block) and reported clinical supervision. The single independent predictor of positive perception of clinical supervisors was choosing an RCS as a first preference. There was also no association between placement type (LIC versus Block) and self-rated clinical competence. Instead, the clinical supervision score and male gender predicted more positive self-ratings of clinical competence. The quality of clinical supervision in block placements and LIC programmes in rural Australian settings was reported by students as equivalent. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Fundamental Flux Equations for Fracture-Matrix Interactions with Linear Diffusion

NASA Astrophysics Data System (ADS)

Oldenburg, C. M.; Zhou, Q.; Rutqvist, J.; Birkholzer, J. T.

2017-12-01

The conventional dual-continuum models are only applicable for late-time behavior of pressure propagation in fractured rock, while discrete-fracture-network models may explicitly deal with matrix blocks at high computational expense. To address these issues, we developed a unified-form diffusive flux equation for 1D isotropic (spheres, cylinders, slabs) and 2D/3D rectangular matrix blocks (squares, cubes, rectangles, and rectangular parallelepipeds) by partitioning the entire dimensionless-time domain (Zhou et al., 2017a, b). For each matrix block, this flux equation consists of the early-time solution up until a switch-over time after which the late-time solution is applied to create continuity from early to late time. The early-time solutions are based on three-term polynomial functions in terms of square root of dimensionless time, with the coefficients dependent on dimensionless area-to-volume ratio and aspect ratios for rectangular blocks. For the late-time solutions, one exponential term is needed for isotropic blocks, while a few additional exponential terms are needed for highly anisotropic blocks. The time-partitioning method was also used for calculating pressure/concentration/temperature distribution within a matrix block. The approximate solution contains an error-function solution for early times and an exponential solution for late times, with relative errors less than 0.003. These solutions form the kernel of multirate and multidimensional hydraulic, solute and thermal diffusion in fractured reservoirs.

Increased prevalence of third-degree atrioventricular block in patients with type II diabetes mellitus.

PubMed

Movahed, Mohammad-Reza; Hashemzadeh, Mehrtash; Jamal, M Mazen

2005-10-01

Diabetes mellitus (DM) is a major risk for cardiovascular disease and mortality. There is some evidence that third-degree atrioventricular (AV) block occurs more commonly in patients with DM. In this study, we evaluated any possible association between DM and third-degree AV block using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in a very large inpatient database. We used patient treatment files containing discharge diagnoses using ICD-9 codes of inpatient treatment from all Veterans Health Administration hospitals. The cohort was stratified using the ICD-9-CM code for DM (n = 293,124), a control group with hypertension but no DM (n = 552,623), and the ICD-9 code for third-degree AV block (426.0) and smoking (305.1, V15.82). We performed multivariate analysis adjusting for coronary artery disease, congestive heart failure, smoking, and hyperlipidemia. Continuous and binary variables were analyzed using chi2 and Fisher exact tests. Third-degree AV block diagnosis was present in 3,240 of DM patients (1.1%) vs 3,367 patients (0.6%) in the control group. Using multivariate analysis, DM remained strongly associated with third-degree AV block (odds ratio, 3.1; 95% confidential interval, 3.0 to 3.3; p < 0.0001). Third-degree AV block occurs significantly more in patients with DM. This finding may, in part, explain the high cardiovascular mortality in DM patients.

Building blocks for career advancement.

PubMed

Broomall, Thomas; Snyder, Bruce

2007-01-01

After attaining IAHSS certification, protective services officers at CCHMC continue on a Career Ladder Program designed to improve knowledge and performance and improve the chances of officer retention. That program is described in detail in this article.

Towards an implantable bio-sensor platform for continuous real-time monitoring of anti-epileptic drugs.

PubMed

Hammoud, Abbas; Chamseddine, Ahmad; Nguyen, Dang K; Sawan, Mohamad

2016-08-01

The need of continuous real-time monitoring device for in-vivo drug level detection has been widely articulated lately. Such monitoring could guide drug posology and timing of intake, detect low or high drug levels, in order to take adequate measures, and give clinicians a valuable window into patients' health and their response to therapeutics. This paper presents a novel implantable bio-sensor based on impedance measurement capable of continuously monitoring various antiepileptic drug levels. This portable point-of-care microsystem replaces large and stationary conventional macrosystems, and is a one of a kind system designed with an array of electrodes to monitor various anti-epileptic drugs rather than one drug. The micro-system consists of (i) the front-end circuit including an inductive coil to receive energy from an external base station, and to exchange data with the latter; (ii) the power management block; (iii) the readout and control block; and (iv) the biosensor array. The electrical circuitry was designed using the 0.18-um CMOS process technology intended to be miniature and consume ultra-low power.

There's more than one way to scan a cat: imaging cat auditory cortex with high-field fMRI using continuous or sparse sampling.

PubMed

Hall, Amee J; Brown, Trecia A; Grahn, Jessica A; Gati, Joseph S; Nixon, Pam L; Hughes, Sarah M; Menon, Ravi S; Lomber, Stephen G

2014-03-15

When conducting auditory investigations using functional magnetic resonance imaging (fMRI), there are inherent potential confounds that need to be considered. Traditional continuous fMRI acquisition methods produce sounds >90 dB which compete with stimuli or produce neural activation masking evoked activity. Sparse scanning methods insert a period of reduced MRI-related noise, between image acquisitions, in which a stimulus can be presented without competition. In this study, we compared sparse and continuous scanning methods to identify the optimal approach to investigate acoustically evoked cortical, thalamic and midbrain activity in the cat. Using a 7 T magnet, we presented broadband noise, 10 kHz tones, or 0.5 kHz tones in a block design, interleaved with blocks in which no stimulus was presented. Continuous scanning resulted in larger clusters of activation and more peak voxels within the auditory cortex. However, no significant activation was observed within the thalamus. Also, there was no significant difference found, between continuous or sparse scanning, in activations of midbrain structures. Higher magnitude activations were identified in auditory cortex compared to the midbrain using both continuous and sparse scanning. These results indicate that continuous scanning is the preferred method for investigations of auditory cortex in the cat using fMRI. Also, choice of method for future investigations of midbrain activity should be driven by other experimental factors, such as stimulus intensity and task performance during scanning. Copyright © 2014 Elsevier B.V. All rights reserved.

The StreamCat Dataset: Accumulated Attributes for NHDPlusV2 Catchments (Version 2.1) for the Conterminous United States: 2010 US Census Housing Unit and Population Density

EPA Pesticide Factsheets

This dataset represents the population and housing unit density within individual, local NHDPlusV2 catchments and upstream, contributing watersheds based on 2010 US Census data. Densities are calculated for every block group and watershed averages are calculated for every local NHDPlusV2 catchment(see Data Sources for links to NHDPlusV2 data and Census Data). This data set is derived from The TIGER/Line Files and related database (.dbf) files for the conterminous USA. It was downloaded as Block Group-Level Census 2010 SF1 Data in File Geodatabase Format (ArcGIS version 10.0). The landscape raster (LR) was produced based on the data compiled from the questions asked of all people and about every housing unit. The (block-group population / block group area) and (block-group housing units / block group area) were summarized by local catchment and by watershed to produce local catchment-level and watershed-level metrics as a continuous data type (see Data Structure and Attribute Information for a description). Using a riparian buffer(see Process Steps), statistics were generated for areas within each catchment that are within 100 meters of the stream reach in an attempt to evaluate for the riparian zone.

High-voltage pulsed generator for dynamic fragmentation of rocks

NASA Astrophysics Data System (ADS)

Kovalchuk, B. M.; Kharlov, A. V.; Vizir, V. A.; Kumpyak, V. V.; Zorin, V. B.; Kiselev, V. N.

2010-10-01

A portable high-voltage (HV) pulsed generator has been designed for rock fragmentation experiments. The generator can be used also for other technological applications. The installation consists of low voltage block, HV block, coaxial transmission line, fragmentation chamber, and control system block. Low voltage block of the generator, consisting of a primary capacitor bank (300 μF) and a thyristor switch, stores pulse energy and transfers it to the HV block. The primary capacitor bank stores energy of 600 J at the maximum charging voltage of 2 kV. HV block includes HV pulsed step up transformer, HV capacitive storage, and two electrode gas switch. The following technical parameters of the generator were achieved: output voltage up to 300 kV, voltage rise time of ˜50 ns, current amplitude of ˜6 kA with the 40 Ω active load, and ˜20 kA in a rock fragmentation regime (with discharge in a rock-water mixture). Typical operation regime is a burst of 1000 pulses with a frequency of 10 Hz. The operation process can be controlled within a wide range of parameters. The entire installation (generator, transmission line, treatment chamber, and measuring probes) is designed like a continuous Faraday's cage (complete shielding) to exclude external electromagnetic perturbations.

High-voltage pulsed generator for dynamic fragmentation of rocks.

PubMed

Kovalchuk, B M; Kharlov, A V; Vizir, V A; Kumpyak, V V; Zorin, V B; Kiselev, V N

2010-10-01

A portable high-voltage (HV) pulsed generator has been designed for rock fragmentation experiments. The generator can be used also for other technological applications. The installation consists of low voltage block, HV block, coaxial transmission line, fragmentation chamber, and control system block. Low voltage block of the generator, consisting of a primary capacitor bank (300 μF) and a thyristor switch, stores pulse energy and transfers it to the HV block. The primary capacitor bank stores energy of 600 J at the maximum charging voltage of 2 kV. HV block includes HV pulsed step up transformer, HV capacitive storage, and two electrode gas switch. The following technical parameters of the generator were achieved: output voltage up to 300 kV, voltage rise time of ∼50 ns, current amplitude of ∼6 kA with the 40 Ω active load, and ∼20 kA in a rock fragmentation regime (with discharge in a rock-water mixture). Typical operation regime is a burst of 1000 pulses with a frequency of 10 Hz. The operation process can be controlled within a wide range of parameters. The entire installation (generator, transmission line, treatment chamber, and measuring probes) is designed like a continuous Faraday's cage (complete shielding) to exclude external electromagnetic perturbations.

MX Siting Investigation. Water Resources Program, Technical Summary Report. Volume IIA.

DTIC Science & Technology

1981-11-30

Block 20. it dilfe.ent from Report) L (.TN IS. SUPPLEMENTARY NOTES 19. KEY WORDS (Continue on reserse side It necessary amd Identify by block number...Sv .,zt 2*O:LI-y lo’.L1 _ XI e A.I p .*.",//. / /V_ , 20. ABSTRACT (Conitnuo on reverese side It necessary end idenLiy by b)ock number...51-II A-I WELL AND SPRING NUMBERING SYSTEM-NEVADA The numbering system for wells and springs in this report is based on the rectangular subdivision of

Randolph AFB, San Antonio, Texas. Revised Uniform Summary of Surface Weather Observations (RUSSWO). Parts A-F.

DTIC Science & Technology

1982-02-08

is printed in any year-month block when the extreme value Is based on an in- complete month (at least one day missing for the month). When a month has...means, standard deviations, and total number of valid observations for each month and annual (all months). An asterisk (*) is printed n each data block...becomes the extreme or monthly total in any of these tables it is printed as "TRACE." Continued on Reverse Side Values ’or means and standard

Intelligence/Electronic Warfare (IEW) Direction-Finding and Fix Estimation Analysis Report. Volume 2. Trailblazer

DTIC Science & Technology

1985-12-20

Report) Approved for Public Disemination I 17. DISTRIBUTION STATEMENT (of the abstract entered In Block 20, It different from Report) I1. SUPPLEMENTARY...Continue an riverl. aid. It neceseary ind Idoni..•y by block number) Fix Estimation Statistical Assumptions, Error Budget, Unnodclcd Errors, Coding...llgedl i t Eh’ fI) t r !". 1 I ’ " r, tl 1: a Icr it h m hc ro ,, ] y zcd arc Csedil other Current TIV! Sysem ’ he report examines the underlying

Water-induced nanochannel networks in self-assembled block ionomers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mineart, Kenneth P.; Al-Mohsin, Heba A.; Lee, Byeongdu

2016-03-07

Block ionomers cast from solution exhibit solvent-templated morphologies that can be altered by solvent-vapor annealing. When cast from a mixed solvent, a midblock-sulfonated pentablock ion- omer self-assembles into spherical ionic microdomains that are loosely connected. Upon exposure to liquid water, nanoscale channels irreversibly develop between the microdomains due to swelling and form a continuous mesoscale network. We use electron tomography and real-time X-ray scat- tering to follow this transformation and show that the resultant morphology provides a highly effec- tive diffusive pathway.

31 CFR 543.508 - Authorization of emergency medical services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY CôTE D'IVOIRE SANCTIONS REGULATIONS... property and interests in property are blocked pursuant to § 543.201(a) is authorized, provided that all...

31 CFR 543.508 - Authorization of emergency medical services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY CôTE D'IVOIRE SANCTIONS REGULATIONS... property and interests in property are blocked pursuant to § 543.201(a) is authorized, provided that all...

24 CFR 570.703 - Eligible activities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES COMMUNITY DEVELOPMENT BLOCK GRANTS Loan Guarantees § 570.703... relocation assistance for individuals, families, businesses, nonprofit organizations, and farm operations who...

Rotary adsorbers for continuous bulk separations

DOEpatents

Baker, Frederick S [Oak Ridge, TN

2011-11-08

A rotary adsorber for continuous bulk separations is disclosed. The rotary adsorber includes an adsorption zone in fluid communication with an influent adsorption fluid stream, and a desorption zone in fluid communication with a desorption fluid stream. The fluid streams may be gas streams or liquid streams. The rotary adsorber includes one or more adsorption blocks including adsorbent structure(s). The adsorbent structure adsorbs the target species that is to be separated from the influent fluid stream. The apparatus includes a rotary wheel for moving each adsorption block through the adsorption zone and the desorption zone. A desorption circuit passes an electrical current through the adsorbent structure in the desorption zone to desorb the species from the adsorbent structure. The adsorbent structure may include porous activated carbon fibers aligned with their longitudinal axis essentially parallel to the flow direction of the desorption fluid stream. The adsorbent structure may be an inherently electrically-conductive honeycomb structure.

Polydispersity-Driven Block Copolymer Amphiphile Self-Assembly into Prolate-Spheroid Micelles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schmitt, Andrew L.; Repollet-Pedrosa, Milton H.; Mahanthappa, Mahesh K.

The aqueous self-assembly behavior of polydisperse poly(ethylene oxide-b-1,4-butadiene-b-ethylene oxide) (OBO) macromolecular triblock amphiphiles is examined to discern the implications of continuous polydispersity in the hydrophobic block on the resulting aqueous micellar morphologies of otherwise monodisperse polymer surfactants. The chain length polydispersity and implicit composition polydispersity of these samples furnishes a distribution of preferred interfacial curvatures, resulting in dilute aqueous block copolymer dispersions exhibiting coexisting spherical and rod-like micelles with vesicles in a single sample with a O weight fraction, w{sub O}, of 0.18. At higher w{sub O} = 0.51-0.68, the peak in the interfacial curvature distribution shifts and we observemore » the formation of only American football-shaped micelles. We rationalize the formation of these anisotropically shaped aggregates based on the intrinsic distribution of preferred curvatures adopted by the polydisperse copolymer amphiphiles and on the relief of core block chain stretching by chain-length-dependent intramicellar segregation.« less

ETARA PC version 3.3 user's guide: Reliability, availability, maintainability simulation model

NASA Technical Reports Server (NTRS)

Hoffman, David J.; Viterna, Larry A.

1991-01-01

A user's manual describing an interactive, menu-driven, personal computer based Monte Carlo reliability, availability, and maintainability simulation program called event time availability reliability (ETARA) is discussed. Given a reliability block diagram representation of a system, ETARA simulates the behavior of the system over a specified period of time using Monte Carlo methods to generate block failure and repair intervals as a function of exponential and/or Weibull distributions. Availability parameters such as equivalent availability, state availability (percentage of time as a particular output state capability), continuous state duration and number of state occurrences can be calculated. Initial spares allotment and spares replenishment on a resupply cycle can be simulated. The number of block failures are tabulated both individually and by block type, as well as total downtime, repair time, and time waiting for spares. Also, maintenance man-hours per year and system reliability, with or without repair, at or above a particular output capability can be calculated over a cumulative period of time or at specific points in time.

Race, Wealth, and Solid Waste Facilities in North Carolina

PubMed Central

Norton, Jennifer M.; Wing, Steve; Lipscomb, Hester J.; Kaufman, Jay S.; Marshall, Stephen W.; Cravey, Altha J.

2007-01-01

Background Concern has been expressed in North Carolina that solid waste facilities may be disproportionately located in poor communities and in communities of color, that this represents an environmental injustice, and that solid waste facilities negatively impact the health of host communities. Objective Our goal in this study was to conduct a statewide analysis of the location of solid waste facilities in relation to community race and wealth. Methods We used census block groups to obtain racial and economic characteristics, and information on solid waste facilities was abstracted from solid waste facility permit records. We used logistic regression to compute prevalence odds ratios for 2003, and Cox regression to compute hazard ratios of facilities issued permits between 1990 and 2003. Results The adjusted prevalence odds of a solid waste facility was 2.8 times greater in block groups with ≥50% people of color compared with block groups with < 10% people of color, and 1.5 times greater in block groups with median house values < $60,000 compared with block groups with median house values ≥$100,000. Among block groups that did not have a previously permitted solid waste facility, the adjusted hazard of a new permitted facility was 2.7 times higher in block groups with ≥50% people of color compared with block groups with < 10% people of color. Conclusion Solid waste facilities present numerous public health concerns. In North Carolina solid waste facilities are disproportionately located in communities of color and low wealth. In the absence of action to promote environmental justice, the continued need for new facilities could exacerbate this environmental injustice. PMID:17805426

Transversus abdominis plane block in renal allotransplant recipients: A retrospective chart review.

PubMed

Gopwani, S R; Rosenblatt, M A

2016-01-01

The efficacy of the transversus abdominis plane (TAP) block appears to vary considerably, depending on the surgical procedure and block technique. This study aims to add to the existing literature and provide a more clear understanding of the TAP blocks role as a postoperative analgesic technique, specifically in renal allotransplant recipients. A retrospective chart review was conducted by querying the intraoperative electronic medical record system of a 1200-bed tertiary academic hospital over a 5 months period, and reviewing anesthetic techniques, as well as postoperative morphine equivalent consumption. Fifty renal allotransplant recipients were identified, 13 of whom received TAP blocks while 37 received no regional analgesic technique. All blocks were performed under ultrasound guidance, with 20 mL of 0.25% bupivacaine injected in the transversus abdominis fascial plane under direct visualization. The primary outcome was postoperative morphine equivalent consumption. Morphine consumption was compared with the two-tailed Mann-Whitney U -test. Continuous variables of patient baseline characteristics were analyzed with unpaired t -test and categorical variables with Fischer Exact Test. A P < 0.05 was considered statistically significant. A statistically significant decrease in cumulative morphine consumption was found in the group that received the TAP block at 6 h (2.46 mg vs. 7.27 mg, P = 0.0010), 12 h (3.88 mg vs. 10.20 mg, P = 0.0005), 24 h (6.96 mg vs. 14.75 mg, P = 0.0013), and 48 h (11 mg vs. 20.13 mg, P = 0.0092). The TAP block is a beneficial postoperative analgesic, opiate-sparing technique in renal allotransplant recipients.

Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block.

PubMed

Yun, M J; Kim, Y H; Han, M K; Kim, J H; Hwang, J W; Do, S H

2009-11-01

In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture. The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 microg/kg, followed by a continuous infusion of alfentanil 0.25 microg/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual analogue pain scale (VAS) scores, time to achieve spinal anaesthesia, quality of patient positioning, and patient acceptance were compared. VAS scores during positioning (mean and range) were lower in the FIC group than in the IVA group [2.0 (1-4) vs. 3.5 (2-6), P=0.001], and the mean (+/- SD) time to achieve spinal anaesthesia was shorter in the FIC group (6.9 +/- 2.7 min vs. 10.8 +/- 5.6 min; P=0.009). Patient acceptance (yes/no) was also better in the FIC group (19/1) than in the IVA group (12/8)(P=0.008). An FIC block is more efficacious than i.v. alfentanil in terms of facilitating the lateral position for spinal anaesthesia in elderly patients undergoing surgery for femoral neck fractures.

Aortic rupture complicating a fracture of an ankylosed thoracic spine. A case report.

PubMed

Savolaine, E R; Ebraheim, N A; Stitgen, S; Jackson, W T

1991-11-01

A 34-year-old man was injured in a motorcycle accident and suffered both aortic rupture and thoracic spinal fracture, complicated by an underlying undetected ankylosing spondylitis. The latter disease can affect the integrity of vascular and spinal structure. Aortography is recommended as a high priority for the patient in an unstable cardiovascular condition requiring a definitive diagnosis. Aortic rupture and thoracic spine fracture may occur from high energy deceleration trauma. Motor vehicle passenger and pedestrian injuries are most commonly involved, although airline accidents and high falls also generate some cases. Mediastinal widening, displacement of esophagus and trachea, apical dissection of blood, and, especially, paravertebral pleural space widening are common to both injuries. Whereas most mediastinal hematomas are nonaortic in origin, a combined injury must be considered because clinical features may also overlap. These include hypotension (hypovolemic or spinal shock), paraplegia, and severe back pain. In light of the high mortality and time constraints associated with aortic rupture, immediate diagnostic resolution is necessary for appropriate management and priority of investigation.

Atypical Distant Metastasis of Breast Malignant Phyllodes Tumors: A Case Report and Literature Review.

PubMed

de Foucher, Tiphaine; Roussel, Hélène; Hivelin, Mikael; Rossi, Léa; Cornou, Caroline; Bats, Anne-Sophie; Deloménie, Myriam; Lécuru, Fabrice; Ngô, Charlotte

2017-01-01

Malignant phyllodes tumors (MPT) are rare breast neoplasms. Preoperative diagnosis is often challenging due to the unspecific clinical, radiological, and histological characteristics of the tumor. Dissemination pathways are local with chest wall invasion, regional with lymph nodes metastasis, and distant, hematogenous, mostly to the lungs, bones, and brain. Distant metastasis (DM) can be synchronous or appear months to years after the diagnosis and initial management. The current report describes the case of a 57-year-old woman presenting with a giant/neglected MPT of the breast, with no DM at initial staging, treated by radical modified mastectomy. Motor disorders due to medullar compression by a paravertebral mass appeared at short follow-up, also treated surgically. The patient died from several DM of rapid evolution. To our knowledge, this is the only case described of MPT with metastases to soft tissue causing medullar compression. We present a literature review on unusual metastatic localizations of MPT.