Sample records for idiopathic dilated congestive

  1. Idiopathic annular dilation: a rare cause of isolated severe tricuspid regurgitation.

    PubMed

    Girard, S E; Nishimura, R A; Warnes, C A; Dearani, J A; Puga, F J

    2000-03-01

    The management of patients with severe tricuspid regurgitation (TR) requires the clinician to clarify the mechanism of regurgitation. Primary disorders of the tricuspid valve, either congenital or acquired, may be readily identified by echocardiography. Severe TR most often results from left-sided heart disease and secondary pulmonary hypertension. Cardiomyopathic processes may also cause right ventricular failure and functional TR. We report three patients with severe TR due to idiopathic annular dilation. The tricuspid valves were otherwise normal on surgical inspection, and the pulmonary pressures were not significantly elevated. Each patient was aged over 65 years and had chronic atrial fibrillation with preserved left ventricular systolic function. Surgical treatment was associated with marked clinical improvement. Clinicians should recognize this unusual but treatable cause of right-sided congestive heart failure.

  2. Treatment of oropharyngeal dysphagia secondary to idiopathic cricopharyngeal bar: Surgical cricopharyngeal muscle myotomy versus dilation.

    PubMed

    Marston, Alexander P; Maldonado, Francisco J; Ravi, Karthik; Kasperbauer, Jan L; Ekbom, Dale C

    To compare swallowing outcomes following cricopharyngeal (CP) dilation versus surgical myotomy in patients with dysphagia secondary to idiopathic CP bar. All patients had an idiopathic CP bar without a history of Zenker's diverticulum, head and neck cancer, or systemic neurologic disease treated between 2000 and 2013. The Functional Outcome Swallowing Scale (FOSS) was utilized to assess dysphagia symptoms. Twenty-three patients underwent 46 dilations and 20 patients had a myotomy. Nineteen of 23 (83%) patients in the dilation group and all patients in the myotomy group reported improved swallow function. The median difference in pre- versus post-intervention FOSS scores was not statistically significant (p=0.07) between the dilation and myotomy groups with mean reductions of 1.3 and 1.8, respectively. Seventeen of 23 (74%) dilation patients had persistent or recurrent dysphagia with 13 (57%) requiring repeat dilation and 4 (17%) undergoing CP myotomy. The median time to first reintervention in the dilation group was 13.6months. Nineteen of 20 (95%) surgical myotomy patients did not experience recurrent dysphagia. Both endoscopic CP dilation and myotomy led to similar initial improvement in swallow function for patients with primary idiopathic CP bar; however, dilation is more likely to provide temporary benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Idiopathic dilated cardiomyopathy: computerized anatomic study of relashionship between septal and free left ventricle wall.

    PubMed

    Juliani, Paulo Sérgio; Costa, Eder França da; Correia, Aristides Tadeu; Monteiro, Rosangela; Jatene, Fabio Biscegli

    2014-01-01

    A feature of dilated cardiomyopathy is the deformation of ventricular cavity, which contributes to systolic dysfunction. Few studies have evaluated this deformation bearing in mind ventricular regions and segments of the ventricle, which could reveal important details of the remodeling process, supporting a better understanding of its role in functional impairment and the development of new therapeutic strategies. To evaluate if, in basal, equatorial and apical regions, increased internal transverse perimeter of left ventricle in idiopathic dilated cardiomyopathy occurs proportionally between the septal and non-septal segment. We performed an anatomical study with 28 adult hearts from human cadavers. One group consisted of 18 hearts with idiopathic dilated cardiomyopathy and another group with 10 normal hearts. After lamination and left ventricle digital image capture, in three different regions (base, equator and apex), the transversal internal perimeter of left ventricle was divided into two segments: septal and not septal. These segments were measured by proper software. It was established an index of proportionality between these segments, called septal and non-septal segment index. Then we determined whether this index was the same in both groups. Among patients with normal hearts and idiopathic dilated cardiomyopathy, the index of proportionality between the two segments (septal and non-septal) showed no significant difference in the three regions analyzed. The comparison results of the indices NSS/SS among normal and enlarged hearts were respectively: in base 1.99 versus 1.86 (P=0.46), in equator 2.22 versus 2.18 (P=0.79) and in apex 2.96 versus 3.56 (P=0.11). In the idiopathic dilated cardiomyopathy, the transversal dilatation of left ventricular internal perimeter occurs proportionally between the segments corresponding to the septum and free wall at the basal, equatorial and apical regions of this chamber.

  4. Idiopathic dilated cardiomyopathy: computerized anatomic study of relashionship between septal and free left ventricle wall

    PubMed Central

    Juliani, Paulo Sérgio; da Costa, Éder França; Correia, Aristides Tadeu; Monteiro, Rosangela; Jatene, Fabio Biscegli

    2014-01-01

    Introduction A feature of dilated cardiomyopathy is the deformation of ventricular cavity, which contributes to systolic dysfunction. Few studies have evaluated this deformation bearing in mind ventricular regions and segments of the ventricle, which could reveal important details of the remodeling process, supporting a better understanding of its role in functional impairment and the development of new therapeutic strategies. Objective To evaluate if, in basal, equatorial and apical regions, increased internal transverse perimeter of left ventricle in idiopathic dilated cardiomyopathy occurs proportionally between the septal and non-septal segment. Methods We performed an anatomical study with 28 adult hearts from human cadavers. One group consisted of 18 hearts with idiopathic dilated cardiomyopathy and another group with 10 normal hearts. After lamination and left ventricle digital image capture, in three different regions (base, equator and apex), the transversal internal perimeter of left ventricle was divided into two segments: septal and not septal. These segments were measured by proper software. It was established an index of proportionality between these segments, called septal and non-septal segment index. Then we determined whether this index was the same in both groups. Results Among patients with normal hearts and idiopathic dilated cardiomyopathy, the index of proportionality between the two segments (septal and non-septal) showed no significant difference in the three regions analyzed. The comparison results of the indices NSS/SS among normal and enlarged hearts were respectively: in base 1.99 versus 1.86 (P=0.46), in equator 2.22 versus 2.18 (P=0.79) and in apex 2.96 versus 3.56 (P=0.11). Conclusion In the idiopathic dilated cardiomyopathy, the transversal dilatation of left ventricular internal perimeter occurs proportionally between the segments corresponding to the septum and free wall at the basal, equatorial and apical regions of this chamber

  5. High prevalence of myocardial monoclonal antimyosin antibody uptake in patients with chronic idiopathic dilated cardiomyopathy

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

    Obrador, D.; Ballester, M.; Carrio, I.

    1989-05-01

    Monoclonal antimyosin antibody studies were undertaken to assess the presence of myocardial uptake in patients with chronic idiopathic dilated cardiomyopathy. Three groups were studied: 17 patients with chronic (greater than 12 months) idiopathic dilated cardiomyopathy, 12 patients with a large, poorly contracting left ventricle not due to dilated cardiomyopathy (control patients) and 8 normal individuals. The patients in the cardiomyopathy and control groups showed a similar degree of clinical and functional impairment. Imaging was undertaken 48 h after antimyosin injection. The heart/lung ratio of antimyosin uptake was used to assess the results. The mean ratio in the cardiomyopathy group wasmore » 1.83 +/- 0.36 (range 1.40 to 2.80), a value significantly higher than that obtained in the control patients without cardiomyopathy (mean 1.46 +/- 0.04, range 1.38 to 1.50) or normal subjects (mean 1.46 +/- 0.13, range 1.31 to 1.6) (p less than 0.01). No difference in the ratio was noted between the normal subjects and control patients. Abnormal antimyosin uptake was seen in 12 (70%) of the 17 patients with cardiomyopathy and in only 1 (8%) of the 12 control patients. Positive monoclonal antimyosin antibody studies are highly prevalent in chronic idiopathic dilated cardiomyopathy.« less

  6. Iodine-123 metaiodobenzylguanidine imaging of the heart in idiopathic congestive cardiomyopathy and cardiac transplants

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

    Glowniak, J.V.; Turner, F.E.; Gray, L.L.

    1989-07-01

    Iodine-123 metaiodobenzylguanidine ((/sup 123/I)MIBG) is a norepinephrine analog which can be used to image the sympathetic innervation of the heart. In this study, cardiac imaging with (/sup 123/I)MIBG was performed in patients with idiopathic congestive cardiomyopathy and compared to normal controls. Initial uptake, half-time of tracer within the heart, and heart to lung ratios were all significantly reduced in patients compared to normals. Uptake in lungs, liver, salivary glands, and spleen was similar in controls and patients with cardiomyopathy indicating that decreased MIBG uptake was not a generalized abnormality in these patients. Iodine-123 MIBG imaging was also performed in cardiacmore » transplant patients to determine cardiac nonneuronal uptake. Uptake in transplants was less than 10% of normals in the first 2 hr and nearly undetectable after 16 hr. The decreased uptake of MIBG suggests cardiac sympathetic nerve dysfunction while the rapid washout of MIBG from the heart suggests increased cardiac sympathetic nerve activity in idiopathic congestive cardiomyopathy.« less

  7. Multi-Detector Row Computed Tomography Findings of Pelvic Congestion Syndrome Caused by Dilated Ovarian Veins

    PubMed Central

    Eren, Suat

    2010-01-01

    Objective: To evaluate the efficacy of multi-detector row CT (MDCT) on pelvic congestion syndrome (PCS), which is often overlooked or poorly visualized with routine imaging examination. Materials and Methods: We evaluated the MDCT features of 40 patients with PCS (mean age, 45 years; range, 29–60 years) using axial, coronal, sagittal, 3D volume-rendered, and Maximum Intensity Projection MIP images. Results: MDCT revealed pelvic varices and ovarian vein dilatations in all patients. Bilateral ovarian vein dilatation was present in 25 patients, and 15 patients had unilateral dilatation. While 12 cases of secondary pelvic varices occurred simultaneously with a retroaortic left renal vein, 10 cases were due solely to a mass obstruction or stenosis of venous structures. Conclusion: MDCT is an effective tool in the evaluation of PCS, and it has more advantages than other imaging modalities. PMID:25610142

  8. BENIGN IDIOPATHIC ESOPHAGEAL STRICTURE IN A LION ( PANTHERA LEO): DILATION BY AN ACHALASIA BALLOON.

    PubMed

    Ayala, Ignacio; Laredo, Francisco; Escobar; Alberca, Fernando

    2018-03-01

    A 1-yr old female lion ( Panthera leo) was referred with a 10-mo history of dysphagia for solid food (meat), episodic regurgitation, and poor weight gain. Esophagoscopy confirmed an esophagitis (midesophagus) and a stricture estimated to be of 13 mm diameter. This was subsequently dilated using a 20-mm-diameter balloon for 2 min followed by a 35-mm achalasia balloon for 3 min. The etiology remains undetermined in spite of a thorough history. The animal progressed satisfactorily, reaching 124 kg after 1 yr and has had no further signs. To the authors' knowledge, neither idiopathic esophageal stricture nor dilation using an achalasia balloon has been reported in Panthera spp.

  9. Risk of Idiopathic Dilated Cardiomyopathy in 29 000 Patients With Celiac Disease

    PubMed Central

    Emilsson, Louise; Andersson, Bert; Elfström, Peter; Green, Peter H.R.; Ludvigsson, Jonas F.

    2012-01-01

    Background Dilated cardiomyopathy (DCM) is a rare disease of largely unknown origin. Previous studies have suggested an increased prevalence of celiac disease (CD) in patients with DCM. These studies, however, were based on a maximum of 5 patients with both CD and DCM. In the present large Swedish population-based cohort study, we examined the risk of idiopathic DCM in patients with CD determined by small-intestinal histopathology. Methods and Results From 2006 to 2008, we collected duodenal/jejunal biopsy data on CD (equal to villous atrophy, Marsh stage 3, n=29 071 unique individuals) from (all) 28 pathology departments in Sweden. These individuals were compared with 144 429 reference individuals matched for age, sex, calendar year, and county. Data on DCM were obtained through the National Patient Register and confirmed by patient charts and echocardiography data. During follow-up, 17 patients with CD and 52 reference individuals developed idiopathic DCM. Thus, patients with CD were at an increased risk of idiopathic DCM (hazard ratio, 1.73; 95% confidence interval, 1.00 to 3.00), although the risk estimate failed to attain statistical significance (P=0.052). Conclusion This nationwide study found a moderately but not statistically significantly increased risk of idiopathic DCM in patients with biopsy-verified CD. (J Am Heart Assoc. 2012;1:e001594 doi: 10.1161/JAHA.112.001594.) PMID:23130142

  10. Characterization and Long-Term Prognosis of Postmyocarditic Dilated Cardiomyopathy Compared With Idiopathic Dilated Cardiomyopathy.

    PubMed

    Merlo, Marco; Anzini, Marco; Bussani, Rossana; Artico, Jessica; Barbati, Giulia; Stolfo, Davide; Gigli, Marta; Muça, Matilda; Naso, Paola; Ramani, Federica; Di Lenarda, Andrea; Pinamonti, Bruno; Sinagra, Gianfranco

    2016-09-15

    Dilated cardiomyopathy (DC) is the final common pathway of different pathogenetic processes and presents a significant prognostic heterogeneity, possibly related to its etiologic variety. The characterization and long-term prognosis of postmyocarditic dilated cardiomyopathy (PM-DC) remain unknown. This study assesses the clinical-instrumental evolution and long-term prognosis of a large cohort of patients with PM-DC. We analyzed 175 patients affected with DC consecutively enrolled from 1993 to 2008 with endomyocardial biopsy (EMB) data available. PM-DC was defined in the presence of borderline myocarditis at EMB or persistent left ventricular dysfunction 1 year after diagnosis of active myocarditis at EMB. Other patients were defined as affected by idiopathic dilated cardiomyopathy (IDC). Analysis of follow-up evaluations was performed at 24, 60, and 120 months. We found 72 PM-DC of 175 enrolled patients (41%). Compared with IDC, patients with PM-DC were more frequently females and less frequently presented a familial history of DC. No other baseline significant differences were found. During the long-term follow-up (median 154, first to third interquartile range 78 to 220 months), patients with PM-DC showed a trend toward slower disease progression. Globally, 18 patients with PM-DC (25%) versus 49 with IDC (48%) experienced death/heart transplantation (p = 0.045). The prognostic advantage for patients with PM-DC became significant beyond 40 months of follow-up. At multivariable time-dependent Cox analysis, PM-DC was confirmed to have a global independent protective role (hazard ratio 0.53, 95% confidence interval 0.28 to 0.97, p = 0.04). In conclusion, PM-DC is characterized by better long-term prognosis compared with IDC. An exhaustive etiologic characterization appears relevant in the prognostic assessment of DC. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Serum proteome profiling in canine idiopathic dilated cardiomyopathy using TMT-based quantitative proteomics approach.

    PubMed

    Bilić, Petra; Guillemin, Nicolas; Kovačević, Alan; Beer Ljubić, Blanka; Jović, Ines; Galan, Asier; Eckersall, Peter David; Burchmore, Richard; Mrljak, Vladimir

    2018-05-15

    Idiopathic dilated cardiomyopathy (iDCM) is a primary myocardial disorder with an unknown aetiology, characterized by reduced contractility and ventricular dilation of the left or both ventricles. Naturally occurring canine iDCM was used herein to identify serum proteomic signature of the disease compared to the healthy state, providing an insight into underlying mechanisms and revealing proteins with biomarker potential. To achieve this, we used high-throughput label-based quantitative LC-MS/MS proteomics approach and bioinformatics analysis of the in silico inferred interactome protein network created from the initial list of differential proteins. To complement the proteomic analysis, serum biochemical parameters and levels of know biomarkers of cardiac function were measured. Several proteins with biomarker potential were identified, such as inter-alpha-trypsin inhibitor heavy chain H4, microfibril-associated glycoprotein 4 and apolipoprotein A-IV, which were validated using an independent method (Western blotting) and showed high specificity and sensitivity according to the receiver operating characteristic curve analysis. Bioinformatics analysis revealed involvement of different pathways in iDCM, such as complement cascade activation, lipoprotein particles dynamics, elastic fibre formation, GPCR signalling and respiratory electron transport chain. Idiopathic dilated cardiomyopathy is a severe primary myocardial disease of unknown cause, affecting both humans and dogs. This study is a contribution to the canine heart disease research by means of proteomic and bioinformatic state of the art analyses, following similar approach in human iDCM research. Importantly, we used serum as non-invasive and easily accessible biological source of information and contributed to the scarce data on biofluid proteome research on this topic. Bioinformatics analysis revealed biological pathways modulated in canine iDCM with potential of further targeted research. Also, several

  12. Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

    PubMed

    Ponikowski, P; Anker, S D; Chua, T P; Szelemej, R; Piepoli, M; Adamopoulos, S; Webb-Peploe, K; Harrington, D; Banasiak, W; Wrabec, K; Coats, A J

    1997-06-15

    After acute myocardial infarction, depressed heart rate variability (HRV) has been proven to be a powerful independent predictor of a poor outcome. Although patients with chronic congestive heart failure (CHF) have also markedly impaired HRV, the prognostic value of HRV analysis in these patients remains unknown. The aim of this study was to investigate whether HRV parameters could predict survival in 102 consecutive patients with moderate to severe CHF (90 men, mean age 58 years, New York Heart Association [NYHA] class II to IV, CHF due to idiopathic dilated cardiomyopathy in 24 patients and ischemic heart disease in 78 patients, ejection fraction [EF], 26%; peak oxygen consumption, 16.9 ml/kg/min) after exclusion of patients in atrial fibrilation with diabetes or with chronic renal failure. In the prognostic analysis (Cox proportional-hazards model, Kaplan-Meier survival analysis), the following factors were investigated: age, CHF etiology, NYHA class, EF, peak oxygen consumption, presence of ventricular tachycardia on Holter monitoring, and HRV measures derived from 24-hour electrocardiography monitoring, calculated in the time (standard deviation of all normal RR intervals [SDNN], standard deviation of 5-minute RR intervals [SDANN], mean of all 5-minute standard deviations of RR intervals [SD], root-mean-square of difference of successive RR intervals [rMSSD], and percentage of adjacent RR intervals >50 ms different [pNN50]) and frequency domain (total power [TP], power within low-frequency band [LF], and power within high-frequency band [HF]). During follow-up of 584 +/- 405 days (365 days in all who survived), 19 patients (19%) died (mean time to death: 307 +/- 315 days, range 3 to 989). Cox's univariate analysis identified the following factors to be predictors of death: NYHA (p = 0.003), peak oxygen consumption (p = 0.01), EF (p = 0.02), ventricular tachycardia on Holter monitoring (p = 0.05), and among HRV measures: SDNN (p = 0.004), SDANN (p = 0.003), SD

  13. Forearm vasodilatation following release of venous congestion

    PubMed Central

    Caro, C. G.; Foley, T. H.; Sudlow, M. F.

    1970-01-01

    1. The volume rate of forearm blood flow was measured with a mercury-in-rubber strain gauge, or with a water-filled plethysmograph, from 1 sec after termination of a 2-3 min period of venous congestion. 2. When congesting pressure had been less than 18 mm Hg, average post-congestion flow (five subjects) was constant during approx. 10 sec and not significantly different from resting flow. 3. When congesting pressure had been 30 mm Hg, average post-congestion flow (eight subjects) was 26% higher than resting, during 3-4 sec after release of congestion, but rose to 273% of resting during 4-6 sec after release of congestion. 4. In other studies forearm vascular resistance had been found normal or increased during such venous congestion, and theoretical studies here indicated that passive mechanical factors could not account for the delayed occurrence of high post-congestion flow. 5. It appears, therefore, that the forearm vascular bed dilates actively shortly after release of substantial venous congestion. It would seem more likely that a myogenic mechanism, rather than a metabolic one, is responsible. PMID:5532541

  14. Protein Aggregates and Novel Presenilin Gene Variants in Idiopathic Dilated Cardiomyopathy

    PubMed Central

    Gianni, Davide; Li, Airong; Tesco, Giuseppina; McKay, Kenneth M.; Moore, John; Raygor, Kunal; Rota, Marcello; Gwathmey, Judith K; Dec, G William; Aretz, Thomas; Leri, Annarosa; Semigran, Marc J; Anversa, Piero; Macgillivray, Thomas E; Tanzi, Rudolph E.; Monte, Federica del

    2010-01-01

    Background Heart failure (HF) is a debilitating condition resulting in severe disability and death. In a subset of cases, clustered as Idiopathic Dilated Cardiomyopathy (iDCM), the origin of HF is unknown. In the brain of patients with dementia, proteinaceous aggregates and abnormal oligomeric assemblies of β-amyloid impair cell function and lead to cell death. Methods and Results We have similarly characterized fibrillar and oligomeric assemblies in the hearts of iDCM patients pointing to abnormal protein aggregation as a determinant of iDCM. We also showed that oligomers alter myocyte Ca2+ homeostasis. Additionally, we have identified two new sequence variants in the presenilin-1 (PSEN1) gene promoter leading to reduced gene and protein expression. We also show that presenilin-1 co-immunoprecipitates with SERCA2a. Conclusions Based on these findings we propose that two mechanisms may link protein aggregation and cardiac function: oligomer-induced changes on Ca2+ handling and a direct effect of PSEN1 sequence variants on EC-coupling protein function. PMID:20194882

  15. Cardiomyocyte hypertrophy, oncosis, and autophagic vacuolization predict mortality in idiopathic dilated cardiomyopathy with advanced heart failure.

    PubMed

    Vigliano, Carlos A; Cabeza Meckert, Patricia M; Diez, Mirta; Favaloro, Liliana E; Cortés, Claudia; Fazzi, Lucía; Favaloro, Roberto R; Laguens, Rubén P

    2011-04-05

    The aim of this study was to identify the remodeling parameters cardiomyocyte (CM) damage or death, hypertrophy, and fibrosis that may be linked to outcomes in patients with advanced heart failure (HF) in an effort to understand the pathogenic mechanisms of HF that may support newer therapeutic modalities. There are controversial results on the influence of fibrosis, CM hypertrophy, and apoptosis on outcomes in patients with HF; other modalities of cell damage have been poorly investigated. In endomyocardial biopsy specimens from 100 patients with idiopathic dilated cardiomyopathy and advanced HF, CM diameter and the extent of fibrosis were determined by morphometry. The proportion of CMs with evidence of apoptosis, autophagic vacuolization (AuV), and oncosis was investigated by immunohistochemical methods and by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling. Those parameters were correlated with mortality in 3 years of follow-up by univariate analysis and with multivariate models incorporating the clinical variables more relevant to the prediction of outcomes. CM AuV occurred in 28 patients (0.013 ± 0.012%) and oncosis in 41 (0.109 ± 0.139%). Nineteen patients showed both markers. Apoptotic CM nuclei were observed in 3 patients. In univariate analysis, CM diameter and AuV, either alone or associated with oncosis, were predictors of mortality. In multivariate analysis, CM diameter (hazard ratio: 1.37; 95% confidence interval: 1.12 to 1.68; p = 0.002) and simultaneous presence in the same endomyocardial biopsy specimen of AuV and oncosis (hazard ratio: 2.82; 95% confidence interval: 1.12 to 7.13; p = 0.028) were independent predictors of mortality. CM hypertrophy and AuV, especially in association with oncosis, are predictors of outcome in patients with idiopathic dilated cardiomyopathy and severe HF. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Ivabradine, a novel heart rate slower: is it a sword of double blades in patients with idiopathic dilated cardiomyopathy?

    PubMed

    Rayan, Mona; Tawfik, Mazen; Alabd, Ali; Gamal, Amr

    2011-08-01

    To prospectively assess the safety and efficacy of ivabradine in patients with idiopathic dilated cardiomyopathy. We included 35 patients with idiopathic dilated cardiomyopathy with an ejection fraction (EF) <40% and heart rate >70 beats/min despite optimal medical therapy, according to the international guidelines in this prospective, non-randomized, single-arm, open-label safety study. Ivabradine was used as an add-on therapy to the maximally tolerated b-blocker in an increasing titrated dose till a target dose of 15 mg/day or resting heart rate of 60 beats/min for 3 months. During follow-up period the safety, patient tolerance and efficacy of this drug were assessed. All patients underwent 12-lead resting electrocardiography and Holter monitoring at inclusion and after 3 months. Statistical analysis was accomplished using paired t-test and Pearson correlation analysis. We found a significant reduction in the resting heart rate by a mean of 25.9 ± 9.4%, without a significant change of blood pressure. There was no prolongation of PR, QTc or QRS durations. Ventricular ectopic activity showed significant reduction (p<0.001). There was a significant correlation between the resting heart rate, NYHA and left ventricular ejection fraction (p<0.001 for both). One patient developed photopsia and decompensation was observed in another patient. Ivabradine is a safe and effective drug in reducing resting heart rate, improving NYHA functional class without undesirable effects on conduction parameters or ectopic activity.

  17. Functional Class in Children with Idiopathic Dilated Cardiomyopathy. A pilot Study

    PubMed Central

    Tavares, Aline Cristina; Bocchi, Edimar Alcides; Guimarães, Guilherme Veiga

    2016-01-01

    Background Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. Objective The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. Method Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. Results Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). Conclusion Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification. PMID:27168472

  18. Dilated cardiomyopathy secondary to rickets-related hypocalcaemia: eight case reports and a review of the literature.

    PubMed

    Yilmaz, Osman; Olgun, Hasim; Ciftel, Murat; Kilic, Omer; Kartal, Ibrahim; Iskenderoglu, Nebahat Y; Laloglu, Fuat; Ceviz, Naci

    2015-02-01

    Dilated cardiomyopathy is usually idiopathic and may arise secondary to infections or metabolic or genetic causes. Another rare cause is hypocalcaemia. Owing to the fact that calcium plays an essential role in excitation and contraction of myocardial muscle, myocardial contractility may decline in patients with hypocalcaemia. Patients with symptoms of congestive heart failure and rickets-related hypocalcaemia were assessed clinically and by echocardiography in a paediatric cardiology clinic. Echocardiography was performed for all patients. Rickets was diagnosed according to the clinical, laboratory, and radiologic findings. Maternal lifestyle and living conditions were investigated, and the maternal 25-OH vitamin D3 blood level was measured. We evaluated eight patients who developed heart failure as a result of severe hypocalcaemia associated with rickets between August, 1999 and June, 2012. The age distribution of the patients was 3-12 months. Laboratory results were consistent with advanced-stage rickets. Severe hypocalcaemia was detected in all patients. The maternal 25-OH vitamin D3 levels were low. Echocardiography revealed increased pre-treatment left ventricle end-systolic and end-diastolic diameters for age and reduced ejection fraction and fractional shortening. After clinical improvement, the patients were discharged. Severe hypocalcaemia associated with rickets must always be kept in mind among the causes of dilated cardiomyopathy and impaired cardiac function in infants. If diagnosed and treated in time, dilated cardiomyopathy and severe heart failure related to rickets respond well.

  19. I(f) current inhibitor ivabradine in patients with idiopathic dilated cardiomyopathy: Impact on the exercise tolerance and quality of life.

    PubMed

    Abdel-Salam, Zainab; Rayan, Mona; Saleh, Ayman; Abdel-Barr, Mohamed G; Hussain, Mohamed; Nammas, Wail

    2015-01-01

    Evidence supported a beneficial effect of ivabradine on clinical outcome of patients with systolic heart failure, and a sinus heart rate (HR) ≥ 70 bpm. We explored the effect of ivabradine, vs. placebo, added to evidence-based treatment on exercise tolerance and quality of life in patients with idiopathic dilated cardiomyopathy. We enrolled 43 consecutive patients with dilated cardiomyopathy of no apparent cause, a left ventricular ejection fraction (LVEF) < 40%, New York Heart Association class ≥ II, sinus HR ≥ 70 bpm, and background evidence-based anti-failure medications. Ischemic heart disease was ruled out. Patients were randomized (1:1) to receive ivabradine or placebo. Ivabradine was titrated up gradually till 7.5 mg twice daily, or a HR < 60 bpm, and continued for 3 months. Symptom-limited exercise tolerance test was performed, and quality of life was assessed by the Minnesota Living With Heart Failure Questionnaire at 0, and 3 months. Forty-three patients were randomized to ivabradine (n = 20), or placebo (n = 23). Mean age was 50.8 ± 14.5 years (53.5% males). Mean HR was 85 ± 12 bpm, and mean LVEF was 32 ± 6%. Mean dose of carvedilol was 31.2% of the target dose. Baseline HR, blood pressure, exercise tolerance, Minnesota questionnaire score, and left ventricular systolic function were comparable between the two groups (p > 0.05 for all). At 3 months, mean dose of ivabradine was 6.8 mg bid. Ivabradine-treated patients had a lower HR, and improved left ventricular dimensions and systolic function, versus placebo-treated ones (p < 0.05 for all). HR dropped by a mean of 14 bpm in the ivabradine group, corrected for placebo. Both exercise tolerance, and Minnesota questionnaire score were better in the ivabradine group (p < 0.05 both). Ivabradine was well-tolerated. In symptomatic patients with idiopathic dilated cardiomyopathy, the addition of ivabradine, vs. placebo, to evidence-based treatment, reduced HR, and improved functional capacity, at short

  20. Usefulness of running wheel for detection of congestive heart failure in dilated cardiomyopathy mouse model.

    PubMed

    Sugihara, Masami; Odagiri, Fuminori; Suzuki, Takeshi; Murayama, Takashi; Nakazato, Yuji; Unuma, Kana; Yoshida, Ken-ichi; Daida, Hiroyuki; Sakurai, Takashi; Morimoto, Sachio; Kurebayashi, Nagomi

    2013-01-01

    Inherited dilated cardiomyopathy (DCM) is a progressive disease that often results in death from congestive heart failure (CHF) or sudden cardiac death (SCD). Mouse models with human DCM mutation are useful to investigate the developmental mechanisms of CHF and SCD, but knowledge of the severity of CHF in live mice is necessary. We aimed to diagnose CHF in live DCM model mice by measuring voluntary exercise using a running wheel and to determine causes of death in these mice. A knock-in mouse with a mutation in cardiac troponin T (ΔK210) (DCM mouse), which results in frequent death with a t(1/2) of 70 to 90 days, was used as a DCM model. Until 2 months of age, average wheel-running activity was similar between wild-type and DCM mice (approximately 7 km/day). At approximately 3 months, some DCM mice demonstrated low running activity (LO: <1 km/day) while others maintained high running activity (HI: >5 km/day). In the LO group, the lung weight/body weight ratio was much higher than that in the other groups, and the lungs were infiltrated with hemosiderin-loaded alveolar macrophages. Furthermore, echocardiography showed more severe ventricular dilation and a lower ejection fraction, whereas Electrocardiography (ECG) revealed QRS widening. There were two patterns in the time courses of running activity before death in DCM mice: deaths with maintained activity and deaths with decreased activity. Our results indicate that DCM mice with low running activity developed severe CHF and that running wheels are useful for detection of CHF in mouse models. We found that approximately half of ΔK210 DCM mice die suddenly before onset of CHF, whereas others develop CHF, deteriorate within 10 to 20 days, and die.

  1. Reduction of myocardial blood flow reserve in idiopathic dilated cardiomyopathy without overt heart failure and its relation with functional indices: an echo-Doppler and positron emission tomography study.

    PubMed

    Morales, Maria-Aurora; Neglia, Danilo; L'Abbate, Antonio

    2008-08-01

    Myocardial blood flow during pharmacological vasodilatation is depressed in patients with idiopathic dilated cardiomyopathy even the in absence of overt heart failure; the extent of myocardial blood flow abnormalities is not predictable by left ventricular ejection fraction (LVEF) and diastolic dimensions. To assess whether myocardial blood flow impairment in idiopathic dilated cardiomyopathy without overt heart failure can be related to Doppler-derived dP/dt and to echocardiographically determined left ventricular end systolic stress - which is linked to myocardial blood flow reserve in advanced disease. Twenty-six patients, New York Heart Association Class I-II, (LVEF 37.4 +/- 1.4%, left ventricular diastolic dimensions 62.6 +/- 0.9 mm) underwent resting/dipyridamole [13N]NH3 flow positron emission tomography and an ultrasonic study. Regional myocardial blood flow values (ml/min per g) were computed from positron emission tomography data in 13 left ventricular (LV) myocardial regions and averaged to provide mean myocardial blood flow and myocardial blood flow reserve, defined as dipyridamole/resting mean myocardial blood flow ratio. Resting myocardial blood flow was 0.686 +/- 0.045, dipyridamole myocardial blood flow 1.39 +/- 0.15 and myocardial blood flow reserve 2.12 +/- 0.2, lower than in controls (P < 0.01). The ratio dP/dt was directly related to dipyridamole myocardial blood flow and myocardial blood flow reserve (r = 0.552 and 0.703, P < 0.005 and P < 0.0001); no relation was found between myocardial blood flow and LVEF left ventricular diastolic dimensions, and left ventricular end systolic stress. In idiopathic dilated cardiomyopathy patients without overt heart failure, the extent of myocardial blood flow reserve impairment is related to dP/dt but not to more classical indices of left ventricular function.

  2. Persistent recovery of normal left ventricular function and dimension in idiopathic dilated cardiomyopathy during long‐term follow‐up: does real healing exist?

    PubMed

    Merlo, Marco; Stolfo, Davide; Anzini, Marco; Negri, Francesco; Pinamonti, Bruno; Barbati, Giulia; Ramani, Federica; Lenarda, Andrea Di; Sinagra, Gianfranco

    2015-01-13

    An important number of patients with idiopathic dilated cardiomyopathy have dramatically improved left ventricular function with optimal treatment; however, little is known about the evolution and long-term outcome of this subgroup, which shows apparent healing. This study assesses whether real healing actually exists in dilated cardiomyopathy. Persistent apparent healing was evaluated among 408 patients with dilated cardiomyopathy receiving tailored medical treatment and followed over the very long-term. Persistent apparent healing was defined as left ventricular ejection fraction ≥50% and indexed left ventricular end-diastolic diameter ≤33 mm/m(2) at both mid-term (19±4 months) and long-term (103±9 months) follow-up. At mid-term, 63 of 408 patients (15%) were apparently healed; 38 (60%; 9%of the whole population) showed persistent apparent healing at long-term evaluation. No predictors of persistent apparent healing were found. Patients with persistent apparent healing showed better heart transplant–free survival at very long-term follow-up (95% versus 71%; P=0.014) compared with nonpersistently normalized patients. Nevertheless, in the very longterm, 37% of this subgroup experienced deterioration of left ventricular systolic function, and 5% died or had heart transplantation. Persistent long-term apparent healing was evident in a remarkable proportion of dilated cardiomyopathy patients receiving optimal medical treatment and was associated with stable normalization of main clinical and laboratory features. This condition can be characterized by a decline of left ventricular function over the very long term, highlighting the relevance of serial nd individualized follow-up in all patients with dilated cardiomyopathy, especially considering the absence of predictors for longterm apparent healing.

  3. The role of sarcomere gene mutations in patients with idiopathic dilated cardiomyopathy

    PubMed Central

    Møller, Daniel Vega; Andersen, Paal Skytt; Hedley, Paula; Ersbøll, Mads Kristian; Bundgaard, Henning; Moolman-Smook, Johanna; Christiansen, Michael; Køber, Lars

    2009-01-01

    We investigated a Danish cohort of 31 unrelated patients with idiopathic dilated cardiomyopathy (IDC), to assess the role that mutations in sarcomere protein genes play in IDC. Patients were genetically screened by capillary electrophoresis single strand conformation polymorphism and subsequently by bidirectional DNA sequencing of conformers in the coding regions of MYH7, MYBPC3, TPM1, ACTC, MYL2, MYL3, TNNT2, CSRP3 and TNNI3. Eight probands carried disease-associated genetic variants (26%). In MYH7, three novel mutations were found; in MYBPC3, one novel variant and two known mutations were found; and in TNNT2, a known mutation was found. One proband was double heterozygous. We find evidence of phenotypic plasticity: three mutations described earlier as HCM causing were found in four cases of IDC, with no history of a hypertrophic phase. Furthermore, one pedigree presented with several cases of classic DCM as well as one case with left ventricular non-compaction. Disease-causing sarcomere gene mutations were found in about one-quarter of IDC patients, and seem to play an important role in the causation of the disease. The genetics is as complex as seen in HCM. Thus, our data suggest that a genetic work-up should include screening of the most prominent sarcomere genes even in the absence of a family history of the disease. PMID:19293840

  4. Intramyocardial VEGF-B167 gene delivery delays the progression towards congestive failure in dogs with pacing-induced dilated cardiomyopathy.

    PubMed

    Pepe, Martino; Mamdani, Mohammed; Zentilin, Lorena; Csiszar, Anna; Qanud, Khaled; Zacchigna, Serena; Ungvari, Zoltan; Puligadda, Uday; Moimas, Silvia; Xu, Xiaobin; Edwards, John G; Hintze, Thomas H; Giacca, Mauro; Recchia, Fabio A

    2010-06-25

    Vascular endothelial growth factor (VEGF)-B selectively binds VEGF receptor (VEGFR)-1, a receptor that does not mediate angiogenesis, and is emerging as a major cytoprotective factor. To test the hypothesis that VEGF-B exerts non-angiogenesis-related cardioprotective effects in nonischemic dilated cardiomyopathy. AAV-9-carried VEGF-B(167) cDNA (10(12) genome copies) was injected into the myocardium of chronically instrumented dogs developing tachypacing-induced dilated cardiomyopathy. After 4 weeks of pacing, green fluorescent protein-transduced dogs (AAV-control, n=8) were in overt congestive heart failure, whereas the VEGF-B-transduced (AAV-VEGF-B, n=8) were still in a well-compensated state, with physiological arterial Po(2). Left ventricular (LV) end-diastolic pressure in AAV-VEGF-B and AAV-control was, respectively, 15.0+/-1.5 versus 26.7+/-1.8 mm Hg and LV regional fractional shortening was 9.4+/-1.6% versus 3.0+/-0.6% (all P<0.05). VEGF-B prevented LV wall thinning but did not induce cardiac hypertrophy and did not affect the density of alpha-smooth muscle actin-positive microvessels, whereas it normalized TUNEL-positive cardiomyocytes and caspase-9 and -3 activation. Consistently, activated Akt, a major negative regulator of apoptosis, was superphysiological in AAV-VEGF-B, whereas the proapoptotic intracellular mediators glycogen synthase kinase (GSK)-3beta and FoxO3a (Akt targets) were activated in AAV-control, but not in AAV-VEGF-B. Cardiac VEGFR-1 expression was reduced 4-fold in all paced dogs, suggesting that exogenous VEGF-B(167) exerted a compensatory receptor stimulation. The cytoprotective effects of VEGF-B(167) were further elucidated in cultured rat neonatal cardiomyocytes exposed to 10(-8) mol/L angiotensin II: VEGF-B(167) prevented oxidative stress, loss of mitochondrial membrane potential, and, consequently, apoptosis. We determined a novel, angiogenesis-unrelated cardioprotective effect of VEGF-B(167) in nonischemic dilated cardiomyopathy

  5. Psoriasis and dilated cardiomyopathy: coincidence or associated diseases?

    PubMed

    Eliakim-Raz, Noa; Shuvy, Mony; Lotan, Chaim; Planer, David

    2008-01-01

    Psoriasis is a common immune-mediated disease which affects 1-3% of the population. The etiology of psoriasis is unknown. Idiopathic dilated cardiomyopathy is probably the end result of a variety of toxic, metabolic or infectious agents. During a computerized search for cardiomyopathy among all patients hospitalized with psoriasis in the Hadassah University Hospital since 1980 we found an increased prevalence of cardiomyopathy, and specifically dilated cardiomyopathy. We present 4 patients who suffer from both conditions. In accordance with previous data, an association between preexisting psoriasis and dilated cardiomyopathy is suggested. We suggest that the genetic risk factors of dilated cardiomyopathy are shared by psoriasis, and more specifically psoriatic arthritis. Alternatively, the immune reaction that is triggered in dilated cardiomyopathy leading to the progression of the disease might be enhanced in patients with psoriasis or psoriatic arthritis. Chronic inflammation and persistent secretion of proinflammatory cytokines may be considered a potential pathway, triggering the initiation and progression of dilated cardiomyopathy in psoriatic patients. Further investigation of the genetic and immune risk factors involved in dilated cardiomyopathy and in psoriasis may lead to a better understanding of the pathogenesis and treatment of dilated cardiomyopathy. Copyright 2008 S. Karger AG, Basel.

  6. Nebivolol improves coronary flow reserve in patients with idiopathic dilated cardiomyopathy

    PubMed Central

    Erdogan, Dogan; Gullu, Hakan; Caliskan, Mustafa; Ciftci, Ozgur; Baycan, Semra; Yildirir, Aylin; Muderrisoglu, Haldun

    2007-01-01

    Background Impaired coronary flow reserve (CFR) is a significant predictor of poor prognosis in patients with idiopathic dilated cardiomyopathy (IDC). Nebivolol reduces mortality and morbidity in patients with heart failure and left ventricular dysfunction, including cases caused by IDC. Objective To assess the effects of nebivolol on CFR in patients with IDC. Methods CFR was measured in 21 clinically stable patients with IDC (mean (SD) ejection fraction 35.7 (6.2)) at baseline and after 1 month of treatment with nebivolol once daily. A control group of apparently healthy subjects who were matched for age and sex was used for comparison. Resting and hyperaemic coronary flows were measured using transthoracic second‐harmonic Doppler echocardiography. None of the subjects had any systemic disease. Results After 1 month of treatment, heart rate was reduced significantly (p<0.001). The blood pressure was decreased significantly (p<0.001). The left ventricular end‐diastolic diameter and stroke volume were not changed significantly, but end‐systolic diameter was decreased significantly (p<0.05). Resting rate–pressure product was lower after treatment with nebivolol, but dipyridamole‐induced change was not influenced by the treatment. Nebivolol treatment reduced significantly coronary velocities at rest (p<0.02) and also caused a significant increase in coronary velocities after dipyridamole (p<0.02), leading to a greater CFR (2.02 (0.35) vs 2.61 (0.43), p<0.001). Nebivolol induced an absolute increase of 6% in the CFR in 17 of 21 patients (80.9%). Conclusions In patients with IDC, 1 month of treatment with nebivolol induces a marked increase in CFR. PMID:17065184

  7. The prognostic impact of dynamic ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy and narrow QRS.

    PubMed

    D'Andrea, Antonello; Mele, Donato; Nistri, Stefano; Riegler, Lucia; Galderisi, Maurizio; Agricola, Eustachio; Losi, Maria Angela; Ballo, Piercarlo; Mondillo, Sergio; Badano, Luigi P

    2013-02-01

    Asynchronous myocardial contraction adversely influences left ventricular (LV) function and is therefore associated with a poor prognosis in heart failure. Exercise-induced change in ventricular dyssynchrony may be an important determinant of dynamic changes in cardiac output and mitral regurgitation. A prospective, longitudinal study was designed with pre-defined dyssynchrony index and outcome variables to test the hypothesis that dynamic dyssynchrony is associated with worse long-term event-free survival in patients with dilated cardiomyopathy (DCM) and 'narrow' QRS complex. One-hundred eighty patients (62 ± 8 years; 110 males) with NYHA class II-III, idiopathic DCM, ejection fraction ≤35%, and QRS duration <120 ms were selected. All the patients underwent standard Doppler echo, colour tissue velocity imaging (DTI), and supine bicycle exercise stress echocardiography. Cardiac synchronicity was defined, at rest and at peak exercise, as DTI velocity opposing-wall delay (significant if ≥65 ms). Outcome was defined as freedom from death, heart transplantation, or LV-assist device implantation, over a median follow-up of 48 months, and a Cox proportional hazards model was used for survival analysis. At baseline examination, DCM patients showed a reduced LV ejection fraction (31 + 4%). A significant electromechanical delay in 58 patients (32%). At the peak of physical exercise, a significant electromechanical delay was detected in 103 patients (57%). There were 41 events during the follow-up (23%): 28 cardiac deaths, 8 heart transplantations, and 5 LV-assist device implantations over 4 years. When adjusted for confounding baseline variables, LV end-diastolic volume, restrictive mitral flow pattern, severity of mitral regurgitation, and the presence of exercise-induced intraventricular dyssynchrony were the only independent determinants of an adverse outcome. In patients with idiopathic DCM and narrow QRS, the increase in echocardiographic dyssynchrony during

  8. Heart rate variability in idiopathic dilated cardiomyopathy: relation to disease severity and prognosis.

    PubMed Central

    Yi, G.; Goldman, J. H.; Keeling, P. J.; Reardon, M.; McKenna, W. J.; Malik, M.

    1997-01-01

    OBJECTIVE: To assess the clinical importance of heart rate variability (HRV) in patients with idiopathic dilated cardiomyopathy (DCM). PATIENTS AND METHODS: Time domain analysis of 24 hour HRV was performed in 64 patients with DCM, 19 of their relatives with left ventricular enlargement (possible early DCM), and 33 healthy control subjects. RESULTS: Measures of HRV were reduced in patients with DCM compared with controls (P < 0.05). HRV parameters were similar in relatives and controls. Measures of HRV were lower in DCM patients in whom progressive heart failure developed (n = 28) than in those who remained clinically stable (n = 36) during a follow up of 24 (20) months (P = 0.0001). Reduced HRV was associated with NYHA functional class, left ventricular end diastolic dimension, reduced left ventricular ejection fraction, and peak exercise oxygen consumption (P < 0.05) in all patients. DCM patients with standard deviation of normal to normal RR intervals calculated over the 24 hour period (SDNN) < 50 ms had a significantly lower survival rate free of progressive heart failure than those with SDNN > 50 ms (P = 0.0002, at 12 months; P = 0.0001, during overall follow up). Stepwise multiple regression analysis showed that SDNN < 50 ms identified, independently of other clinical variables, patients who were at increased risk of developing progressive heart failure (P = 0.0004). CONCLUSIONS: HRV is reduced in patients with DCM and related to disease severity. HRV is clinically useful as an early non-invasive marker of DCM deterioration. PMID:9068391

  9. Recurrent urethral obstruction secondary to idiopathic renal hematuria in a puppy.

    PubMed

    Hawthorne, J C; deHaan, J J; Goring, R L; Randall, S R; Kennedy, F S; Stone, E; Zimmerman, K M; McAbee, S W

    1998-01-01

    A seven-month-old, neutered male Catahoula leopard dog cross was presented for recurrent urethral obstruction and intermittent hematuria. After exploratory laparotomy and ventral cystotomy, unilateral idiopathic renal hematuria was diagnosed based on gross observation of hematuria from the left ureteral catheter. The hematuria resolved after nephrectomy of the left kidney. The histopathological diagnosis was multifocal, acute congestion and intratubular hemorrhage. Although idiopathic renal hematuria has been described previously, this puppy was unique because the hematuria caused recurrent, complete urethral obstruction.

  10. [A reversible cause of dilated cardiomyopathy: hypocalcemia].

    PubMed

    Benzarouel, D; Hasni, K; Ashab, H; El Hattaoui, M

    2014-04-01

    Hypocalcemia is very rare reversible cause of dilated cardiomyopathy (DCMP) witch can concern one or both ventricules. We here presented two cases of DCMP that caused by hypocalcemia and recovered totally after oral calcium and vitamin D supplementation. CASE PRESENTATION 1: A 29-year-old Caucasian female was admitted in our hospital due to congestive heart failure with dyspnea (NYHA class IV) and generalized edema for 2days. She had a history of total thyroidectomy one year a go. She had taken synthyroid as a daily medication associated to calcium supplementation and vitamin D because of hypoparathyroidism. Patient was not compliant to treatment. Trans thoracic echocardiography (TTE) showed a dilated left ventricule (LV) with global hypokinesia with 28% of left ventricule ejection and moderate mitral regurgitation. Laboratory test showed a severe hypocalcemia. After correction of hypocalcemia, there was a clear clinical improvement and four months later a total recovery was found. CASE PRESENTATION 2: A 44-year-old Caucasian male was referred to the hospital for rebel congestive heart failure with dyspnea and edema of lower limbs despite optimal treatment. Patient had no medical past history. TEE showed dilated cardiomyopathy with severe alteration of left ventricule systolic function (25%). Biological tests showed a hypocalcemia and primary hypoparathyroidism. An improvement of symptoms after correction of metabolic disorder was found. LV gradually recovered its performance. Patients outcome in end stage heart failure is different from the classical outcomes in patients with hypocalcemia induced heart disease. DCMP induced by hypocalcemia should be considered in patients with heart failure associated with medical conditions leading to hypocalcemia. It requires a specific treatment. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  11. Status of therapeutic gene transfer to treat canine dilated cardiomyopathy in dogs.

    PubMed

    Sleeper, Meg M; Bish, Lawrence T; Sweeney, H Lee

    2010-07-01

    Therapeutic gene transfer holds promise as a way to treat dilated cardiomyopathy from any underlying cause because the approach attempts to address metabolic disturbances that occur at the molecular level of the failing heart. Calcium-handling abnormalities and increased rates of apoptosis are abnormalities that occur in many types of heart disease, and gene therapies that target these metabolic defects have proven to be beneficial in numerous rodent models of heart disease. The authors are currently evaluating this approach to treat canine idiopathic dilated cardiomyopathy.

  12. Endoscopic Cold Incision, Balloon Dilation, Mitomycin C Application, and Steroid Injection for Adult Laryngotracheal Stenosis

    PubMed Central

    Parker, Noah P.; Bandyopadhyay, Dipankar; Misono, Stephanie; Goding, George S.

    2017-01-01

    Objectives/Hypothesis To describe the presentation, stenosis characteristics, etiological differences, and outcomes of adult laryngotracheal stenosis treated with endoscopic cold incision, balloon dilation, topical mitomycin C application, and steroid injection. Study Design Retrospective chart review. Methods Demographic and clinical data were extracted for patients treated between March 2000 and December 2010. Prolonged intubation and idiopathic patient data were utilized for comparative analysis. Results Eighty patients (65 females; 15 males; 220 procedures; 2.9 years mean follow-up) presented with dyspnea (81%) and/or exercise intolerance (40%). Most commonly, etiologies were idiopathic (53 of 80; 66%) or prolonged intubation (14 of 80; 18%). Mean procedures per patient and interval between procedures were 2.8 procedures and 405 days, respectively. Mean stenosis length and distance from the caudal phonating edge of the true vocal folds were 9 mm and 19 mm. Complication, tracheotomy, and open-procedure rates were 1.8%, 1.4%, and 10.0%, respectively. Patients with more than two procedures demonstrated a mean 4-mm reduction in stenosis length and a 2-mm cephalad progression of stenosis over time. More caudal stenoses required more frequent procedures. Procedures were less frequent as more procedures were performed. Stenosis characteristics, interval between procedures, and total procedures were similar between idiopathic patients with or without intubation histories, but different between idiopathic and prolonged intubation patients. Conclusions This procedure was shown to be a viable option in adult laryngotracheal stenosis. Repeat dilation was likely, but was performed without adversely affecting stenosis characteristics. Stenoses farther from the vocal folds required procedures more frequently. Idiopathic patients with a history of brief, elective intubation had stenosis characteristics and responses to therapy similar to idiopathic patients without an

  13. Intestinal Volvulus in Idiopathic Steatorrhea

    PubMed Central

    Warner, H. A.; Kinnear, D. G.; Cameron, D. G.

    1963-01-01

    Volvulus of the intestine has recently been observed in three patients with idiopathic steatorrhea in relapse. Two patients gave a history of intermittent abdominal pain, distension and obstipation. Radiographic studies during these attacks revealed obstruction at the level of the sigmoid colon. Reduction under proctoscopic control was achieved in one instance, spontaneous resolution occurring in the other. The third patient presented as a surgical emergency and underwent operative reduction of a small intestinal volvulus. Persistence of diarrhea and weight loss postoperatively led to further investigation and a diagnosis of idiopathic steatorrhea. In all cases, treatment resulted in clinical remission with a coincident disappearance of obstructive intestinal symptoms. The pathogenesis of volvulus in sprue is poorly understood. Atonicity and dilatation of the bowel and stretching of the mesentery likely represent important factors. The symptoms of recurrent abdominal pain and distension in idiopathic steatorrhea necessitate an increased awareness of intestinal volvulus as a complication of this disease. ImagesFig. 1Fig. 2Fig. 3Figs. 4 and 5Fig. 6 PMID:13998948

  14. Exome Sequencing Establishes Diagnosis of Alström Syndrome in an Infant Presenting with Non-Syndromic Dilated Cardiomyopathy

    PubMed Central

    Long, Pamela A.; Evans, Jared M.; Olson, Timothy M.

    2015-01-01

    Idiopathic dilated cardiomyopathy is a heritable, genetically heterogeneous disorder characterized by progressive heart failure. Dilated cardiomyopathy typically exhibits autosomal dominant inheritance, yet frequently remains clinically silent until adulthood. We sought to discover the molecular basis of idiopathic, non-syndromic dilated cardiomyopathy in a one-month-old male presenting with severe heart failure. Previous comprehensive testing of blood, urine, and skin biopsy specimen was negative for metabolic, mitochondrial, storage, and infectious etiologies. Ophthalmologic examination was normal. Chromosomal microarray and commercial dilated cardiomyopathy gene panel testing failed to identify a causative mutation. Parental screening echocardiograms revealed no evidence of clinically silent dilated cardiomyopathy. Whole exome sequencing was carried out on the family trio on a research basis, filtering for rare, deleterious, recessive and de novo genetic variants. Pathogenic compound heterozygous truncating mutations were identified in ALMS1, diagnostic of Alström syndrome and prompting disclosure of genetic findings. Alström syndrome is a known cause for dilated cardiomyopathy in children yet delayed and mis-diagnosis are common owing to its rarity and age-dependent emergence of multisystem clinical manifestations. At six months of age the patient ultimately developed bilateral nystagmus and hyperopia, features characteristic of the syndrome. Early diagnosis is guiding clinical monitoring of other organ systems and allowing for presymptomatic intervention. Furthermore, recognition of recessive inheritance as the mechanism for sporadic disease has informed family planning. This case highlights a limitation of standard gene testing panels for pediatric dilated cardiomyopathy and exemplifies the potential for whole exome sequencing to solve a diagnostic dilemma and enable personalized care. PMID:25706677

  15. An Upgrade on the Rabbit Model of Anthracycline-Induced Cardiomyopathy: Shorter Protocol, Reduced Mortality, and Higher Incidence of Overt Dilated Cardiomyopathy

    PubMed Central

    Talavera, Jesús; Fernández-Del-Palacio, María Josefa; García-Nicolás, Obdulio; Seva, Juan; Brooks, Gavin; Moraleda, Jose M.

    2015-01-01

    Current protocols of anthracycline-induced cardiomyopathy in rabbits present with high premature mortality and nephrotoxicity, thus rendering them unsuitable for studies requiring long-term functional evaluation of myocardial function (e.g., stem cell therapy). We compared two previously described protocols to an in-house developed protocol in three groups: Group DOX2 received doxorubicin 2 mg/kg/week (8 weeks); Group DAU3 received daunorubicin 3 mg/kg/week (10 weeks); and Group DAU4 received daunorubicin 4 mg/kg/week (6 weeks). A cohort of rabbits received saline (control). Results of blood tests, cardiac troponin I, echocardiography, and histopathology were analysed. Whilst DOX2 and DAU3 rabbits showed high premature mortality (50% and 33%, resp.), DAU4 rabbits showed 7.6% premature mortality. None of DOX2 rabbits developed overt dilated cardiomyopathy; 66% of DAU3 rabbits developed overt dilated cardiomyopathy and quickly progressed to severe congestive heart failure. Interestingly, 92% of DAU4 rabbits showed overt dilated cardiomyopathy and 67% developed congestive heart failure exhibiting stable disease. DOX2 and DAU3 rabbits showed alterations of renal function, with DAU3 also exhibiting hepatic function compromise. Thus, a shortened protocol of anthracycline-induced cardiomyopathy as in DAU4 group results in high incidence of overt dilated cardiomyopathy, which insidiously progressed to congestive heart failure, associated to reduced systemic compromise and very low premature mortality. PMID:26788502

  16. A splice site mutation in a gene encoding for PDK4, a mitochondrial protein, is associated with the development of dilated cardiomyopathy in the Doberman pinscher

    USDA-ARS?s Scientific Manuscript database

    Familial dilated cardiomyopathy is a primary myocardial disease that can result in the development of congestive heart failure and sudden cardiac death. Spontaneous animal models of familial dilated cardiomyopathy exist and the Doberman pinscher dog is one of the most commonly reported canine breeds...

  17. Endoscopic Management of Idiopathic Subglottic Stenosis.

    PubMed

    Shabani, Sepehr; Hoffman, Matthew R; Brand, William T; Dailey, Seth H

    2017-02-01

    To describe a homogeneous idiopathic subglottic stenosis (ISS) population undergoing endoscopic balloon dilation and evaluate factors affecting inter-dilation interval (IDI). Retrospective review of 37 patients. Co-morbidity prevalence versus normal population was evaluated using chi-square tests. Correlations were evaluated using Pearson product moment tests. Independent samples t tests/rank sum tests assessed differences between groups of interest. All patients were female aged 45.9 ± 15.4 years at diagnosis. Four required a tracheotomy during management. Most prevalent co-morbidity was gastroesophageal reflux disease (GERD) (64.9%; P = .036). Body mass indices (BMI) at first and most recent dilation were 29.8 and 30.8 ( P = .564). Degree of stenosis before first dilation was 53 ± 14%. Patients underwent 3.8 ± 1.8 dilations (range, 1-11). Average IDI was 635 ± 615 days (range, 49-3130 days), including 556 ± 397 days for patients receiving concomitant steroid injection and 283 ± 36 for those who did not ( P = .079). Inter-dilation interval was not correlated with BMI ( r = 0.0486; P = .802) or number of co-morbidities ( r = -0.225, P = .223). Most patients with ISS can be managed endoscopically, and IDI may be increased with steroid injection. Gastroesophageal reflux disease is a common co-morbidity. Body mass index did not change over time despite potential effects on exercise tolerance; BMI did not affect IDI. Methods to determine optimal timing for next intervention are warranted.

  18. A New Procedure for Wrapped-Negative Pressure Wound Therapy for Congestion After Arterialized Venous Flap Surgery

    PubMed Central

    Niimi, Yosuke; Mori, Satoko; Takeuchi, Masaki

    2017-01-01

    Negative pressure wound therapy (NPWT) is a method for treating wound. However, there are no case reports using NPWT for treating congestion after arterialized venous flap. Therefore, this study reported favorable outcomes after using a single-use NPWT system for managing congestion. A 39-year-old man had his index finger caught by a press machine. The finger had a soft tissue defect at the ventral part. An arterialized venous flap taken from the right forearm was transplanted. Perfusion of the flap was favorable, but on postoperative day 5, congestion and the edema of the flap were found. Then, NPWT was initiated. The congestion and edema in the flap were improved without complications such as flap necrosis and wound infection. At 4 months postoperatively, the morphology of the finger was favorable. In this study, NPWT was speculated to force the deeper blood vessels within the flap to dilate with inducing drainage and the simultaneous reduction in excess blood flow to the cortical layer, resulting in the improvement of congestion. Negative pressure wound therapy was used for treating congestion after the transplantation of arterialized venous flap, and the wound was favorably managed. PMID:29270041

  19. A predictive model for canine dilated cardiomyopathy-a meta-analysis of Doberman Pinscher data.

    PubMed

    Simpson, Siobhan; Edwards, Jennifer; Emes, Richard D; Cobb, Malcolm A; Mongan, Nigel P; Rutland, Catrin S

    2015-01-01

    Dilated cardiomyopathy is a prevalent and often fatal disease in humans and dogs. Indeed dilated cardiomyopathy is the third most common form of cardiac disease in humans, reported to affect approximately 36 individuals per 100,000 individuals. In dogs, dilated cardiomyopathy is the second most common cardiac disease and is most prevalent in the Irish Wolfhound, Doberman Pinscher and Newfoundland breeds. Dilated cardiomyopathy is characterised by ventricular chamber enlargement and systolic dysfunction which often leads to congestive heart failure. Although multiple human loci have been implicated in the pathogenesis of dilated cardiomyopathy, the identified variants are typically associated with rare monogenic forms of dilated cardiomyopathy. The potential for multigenic interactions contributing to human dilated cardiomyopathy remains poorly understood. Consistent with this, several known human dilated cardiomyopathy loci have been excluded as common causes of canine dilated cardiomyopathy, although canine dilated cardiomyopathy resembles the human disease functionally. This suggests additional genetic factors contribute to the dilated cardiomyopathy phenotype.This study represents a meta-analysis of available canine dilated cardiomyopathy genetic datasets with the goal of determining potential multigenic interactions relating the sex chromosome genotype (XX vs. XY) with known dilated cardiomyopathy associated loci on chromosome 5 and the PDK4 gene in the incidence and progression of dilated cardiomyopathy. The results show an interaction between known canine dilated cardiomyopathy loci and an unknown X-linked locus. Our study is the first to test a multigenic contribution to dilated cardiomyopathy and suggest a genetic basis for the known sex-disparity in dilated cardiomyopathy outcomes.

  20. D117N in Cypher/ZASP may not be a causative mutation for dilated cardiomyopathy and ventricular arrhythmias.

    PubMed

    Levitas, Aviva; Konstantino, Yuval; Muhammad, Emad; Afawi, Zaid; Marc Weinstein, Jean; Amit, Guy; Etzion, Yoram; Parvari, Ruti

    2016-05-01

    Dilated cardiomyopathy (DCM) and malignant ventricular arrhythmias are important causes of congestive heart failure, heart transplantation, and sudden cardiac death in young patients. Cypher/ZASP is a cytoskeletal protein localized in the sarcomeric Z-line that has a pivotal role in maintaining adult cardiac structure and function. The putative mutation p.(D117N) in Cypher/ZASP has been suggested to cause systolic dysfunction, dilated left ventricle with hypertrabeculated myocardium, and intraventricular conduction disturbance, based on two reported sporadic cases. In two unrelated Bedouin families, one with pediatric DCM and the other with DCM and ventricular arrhythmias at young adulthood searching for the causative mutation by exome sequencing we identified the p.(D117N) variant in Cypher/ZASP. However, p.(D117N) did not segregate as the causative mutation in these families, i.e. it was not present in some patients and was found in several individuals who had no clinical manifestations. Furthermore, the carrier frequency in the Bedouin population of origin is estimated to be 5.2%, which is much higher than the incidence of idiopathic DCM in this population. Thus, our data support the notion that the p.(D117N) variant in Cypher/ZASP is not a causative mutation in the families tested by us. The results also indicates that at least in some cases, the p.(D117N) in Cypher/ZASP is not a causative mutation and the role of D117N in Cypher/ZASP in cardiac pathologies should be further clarified and re-evaluated.

  1. D117N in Cypher/ZASP may not be a causative mutation for dilated cardiomyopathy and ventricular arrhythmias

    PubMed Central

    Levitas, Aviva; Konstantino, Yuval; Muhammad, Emad; Afawi, Zaid; Marc Weinstein, Jean; Amit, Guy; Etzion, Yoram; Parvari, Ruti

    2016-01-01

    Dilated cardiomyopathy (DCM) and malignant ventricular arrhythmias are important causes of congestive heart failure, heart transplantation, and sudden cardiac death in young patients. Cypher/ZASP is a cytoskeletal protein localized in the sarcomeric Z-line that has a pivotal role in maintaining adult cardiac structure and function. The putative mutation p.(D117N) in Cypher/ZASP has been suggested to cause systolic dysfunction, dilated left ventricle with hypertrabeculated myocardium, and intraventricular conduction disturbance, based on two reported sporadic cases. In two unrelated Bedouin families, one with pediatric DCM and the other with DCM and ventricular arrhythmias at young adulthood searching for the causative mutation by exome sequencing we identified the p.(D117N) variant in Cypher/ZASP. However, p.(D117N) did not segregate as the causative mutation in these families, i.e. it was not present in some patients and was found in several individuals who had no clinical manifestations. Furthermore, the carrier frequency in the Bedouin population of origin is estimated to be 5.2%, which is much higher than the incidence of idiopathic DCM in this population. Thus, our data support the notion that the p.(D117N) variant in Cypher/ZASP is not a causative mutation in the families tested by us. The results also indicates that at least in some cases, the p.(D117N) in Cypher/ZASP is not a causative mutation and the role of D117N in Cypher/ZASP in cardiac pathologies should be further clarified and re-evaluated. PMID:26419279

  2. Echocardiography-based spectrum of severe tricuspid regurgitation: the frequency of apparently idiopathic tricuspid regurgitation.

    PubMed

    Mutlak, Diab; Lessick, Jonathan; Reisner, Shimon A; Aronson, Doron; Dabbah, Salim; Agmon, Yoram

    2007-04-01

    The cause of tricuspid valve (TV) regurgitation (TR) occasionally remains unclear. The objectives of our study were to define the causal spectrum of severe TR diagnosed by echocardiography at a tertiary medical center and to assess the relative frequency and determine the clinical and echocardiographic characteristics of TR without an apparent cause (idiopathic TR). Consecutive patients with severe TR were identified by the echocardiography laboratory computerized database. The echocardiographic reports of all patients were reviewed and the causes of TR were determined. The echocardiographic studies and medical charts were reviewed in patients without an obvious cause of TR. Of 242 consecutive patients diagnosed with severe TR, organic TV disease was evident in 23 patients (9.5%) and significant pulmonary hypertension (estimated pulmonary artery systolic pressure > 50 mm Hg) in an additional 157 patients (64.9%). After further excluding patients with various confounding factors, possibly associated with occult organic TV disease or significant pulmonary hypertension, 23 patients (9.5%) had severe TR without an apparent cause. Of these, TV coaptation appeared relatively intact, allowing adequate estimation of pulmonary artery pressure, in 15 patients (6.2% of all patients with severe TR; idiopathic TR group). Patients with idiopathic TR were older (76 +/- 10 years), with a high frequency of atrial fibrillation (93%), and prominent TV annular dilatation. After excluding multiple potential causes of TR, severe TR is occasionally idiopathic. Annular dilatation (secondary to aging, atrial fibrillation, or other causes) is the likely mechanism of TR in these patients.

  3. Neutrophil to lymphocyte ratio predicts appropriate therapy in idiopathic dilated cardiomyopathy patients with primary prevention implantable cardioverter defibrillator

    PubMed Central

    Uçar, Fatih M.; Açar, Burak

    2017-01-01

    Objectives: To investigate whether an inflammatory marker of neutrophil to lymphocyte ratio (NLR) predicts appropriate implantable cardioverter defibrillator (ICD) therapy (shock or anti tachycardia pacing) in idiopathic dilated cardiomyopathy (IDC) patients. Methods: We retrospectively examined IDC patients (mean age: 58.3 ± 11.8 years, 81.5% male) with ICD who admitted to outpatient clinic for pacemaker control at 2 tertiary care hospitals in Ankara and Edirne, Turkey from January 2013-2015. All ICDs were implanted for primary prevention. Hematological and biochemical parameters were measured prior procedure. Results: Over a median follow-up period of 43 months (Range 7-125), 68 (33.1%) patients experienced appropriate ICD therapy. The NLR was increased in patients that received appropriate therapy (4.39 ± 2.94 versus 2.96 ± 1.97, p<0.001). To identify independent risk factors for appropriate therapy, a multivariate linear regression model was conducted and age (β=0.163, p=0.013), fasting glucose (β=0.158, p=0.017), C-reactive protein (CRP) (β=0.289, p<0.001) and NLR (β=0.212, p<0.008) were found to be independent risk factors for appropriate ICD therapy. Conclusions: Before ICD implantation by using NLR and CRP, arrhythmic episodes may be predictable and better antiarrhythmic medical therapy optimization may protect these IDC patients from unwanted events. PMID:28133686

  4. Traffic congestion and reliability : trends and advanced strategies for congestion mitigation.

    DOT National Transportation Integrated Search

    2005-09-01

    The report Traffic Congestion and Reliability: Trends and Advanced Strategies for : Congestion Mitigation provides a snapshot of congestion in the United States by : summarizing recent trends in congestion, highlighting the role of travel time : reli...

  5. Micromethods for determining activities of energy-producing and non-energy-producing pathways in myocardial tissue.

    PubMed Central

    King, J. W.; Kennedy, F. S.; Hanley, H. G.; Lierl, J. J.; Fowler, M. R.; White, M. C.

    1986-01-01

    The increasingly frequent use of endomyocardial biopsies for diagnosis has provided the opportunity to study myocardial metabolism in patients with cardiac diseases. The authors have tested microassays of the hexose monophosphate shunt, glycolytic pathway, and Krebs cycle and demonstrated that they are easily and reproducibly performed on small pieces of cardiac tissue. They have also used these assays to study myocardial metabolism in 2 patients with endocarditis uncomplicated by congestive heart failure and in 2 patients with congestive heart failure due to idiopathic dilated cardiomyopathy. The ability to quantitate myocardial metabolism in biopsies from patients with a variety of cardiac diseases may enhance our understanding of cardiac pathophysiology. PMID:3706492

  6. High-resolution manometry findings in patients with achalasia and massive dilated megaesophagus.

    PubMed

    Menezes, M A; Andolfi, C; Herbella, F A M; Patti, M G

    2017-05-01

    Achalasia may present in a non-advanced or an advanced (end stage) stage based on the degree of esophageal dilatation. Manometric parameters and esophageal caliber may be prognostic for the outcome of treatment. The correlation between manometry and disease stage has not been yet fully studied. This study aims to describe high-resolution manometry findings in patients with achalasia and massive dilated megaesophagus. Eighteen patients (mean age 61 years, 55% females) with achalasia and massive dilated megaesophagus, as defined by a maximum esophageal dilatation >10 cm at the barium esophagram, were studied. Achalasia was considered secondary to Chagas' disease in 14 (78%) of the patients and idiopathic in the remaining. All patients underwent high-resolution manometry. Upper esophageal sphincter was hypotonic and had impaired relaxation in the majority of patients. Aperistalsis was seen in all patients with an equal distribution of Chicago type I and type II. No type III was noticed. Lower esophageal sphincter did not have a characteristic manometric pattern. In 50% of the cases, the manometry catheter was not able to reach the stomach. Our results did not show a manometric pattern in patients with achalasia and massive dilated esophagus. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Predictors of electrical storm in patients with idiopathic dilated cardiomyopathy--how to stratify the risk of electrical storm.

    PubMed

    Takigawa, Masateru; Noda, Takashi; Kurita, Takashi; Aihara, Naohiko; Yamada, Yuko; Okamura, Hideo; Satomi, Kazuhiro; Suyama, Kazuhiro; Shimizu, Wataru; Kamakura, Shiro

    2010-09-01

    Electrical storm (ES) is a serious problem in patients with an implantable cardioverter defibrillator (ICD). However, insufficient reports have indicated the predictors of ES in ICD patients with idiopathic dilated cardiomyopathy (DCM). The purpose of this study was to clarify the predictors of ES for risk stratification in DCM patients with an ICD. Of 446 ICD patients, 53 DCM patients were included in this study. During a mean follow-up of 55+/-36 months, ES (> or =3 times appropriate ICD therapy within 24 h) occurred in 18/53 (34%) patients. According to multivariate Cox proportional hazard regression analysis, a duration of the terminal low amplitude signals of <40 microV (LAS40) (HR 1.4/10 ms increase, 95% confidence interval (CI) 1.1-2.1; P=0.0049) or root mean square voltage of the last 40 ms of the QRS complex (RMS40) (HR 0.88/1 microV, 95%CI 0.77-0.96; P=0.001) on the signal averaged electrocardiogram, and a history of atrial fibrillation (AF) before ICD implantation (HR 2.3, 95%CI 1.2-5.0; P=0.013) were independently associated with an increased risk of ES. Our data indicated that a longer LAS40, lower RMS40 and history of AF before ICD implantation could strongly predict ES, and the combination of those parameters could effectively stratify the risk of ES in DCM patients.

  8. RESTRICTIVE CARDIOMYOPATHY AND SECONDARY CONGESTIVE HEART FAILURE IN A MCDOWELL'S CARPET PYTHON (MORELIA SPILOTA MCDOWELLI).

    PubMed

    Schilliger, Lionel; Chetboul, Valérie; Damoiseaux, Cécile; Nicolier, Alexandra

    2016-12-01

    Echocardiography is an established and noninvasive diagnostic tool used in herpetologic cardiology. Various cardiac lesions have been previously described in reptiles with the exception of restrictive cardiomyopathy. In this case report, restrictive cardiomyopathy and congestive heart failure associated with left atrial and sinus venosus dilation were diagnosed in a 2-yr-old captive lethargic McDowell's carpet python ( Morelia spilota mcdowelli), based on echocardiographic, Doppler, and histopathologic examinations. This cardiomyopathy was also associated with thrombosis within the sinus venosus.

  9. Non-marfan idiopathic medionecrosis (cystic medial necrosis) presenting with multiple visceral artery aneurysms and diffuse connective tissue fragility: Two brothers

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

    Kubota, Jun; Tsunemura, Mami; Amano, Shigeko

    1997-05-15

    Two brothers with multiple visceral artery aneurysms or dilatations and diffuse connective tissue fragility who did not have clinical features of Marfan syndrome are reported. One presented with retroperitoneal hemorrhage during angiography, and idiopathic medionecrosis was proved by resection of the aneurysms. These cases belong to the heterogeneous group of Marfan syndrome. The angiographical features (multiple dilation of visceral arteries) suggests fragility of connective tissue and is predictive of hazards during and after a catheterization and operation.

  10. Dynamic, stochastic models for congestion pricing and congestion securities.

    DOT National Transportation Integrated Search

    2010-12-01

    This research considers congestion pricing under demand uncertainty. In particular, a robust optimization (RO) approach is applied to optimal congestion pricing problems under user equilibrium. A mathematical model is developed and an analysis perfor...

  11. Reducing congestion : congestion pricing has promise for improving use of transportation infrastructure

    DOT National Transportation Integrated Search

    2003-05-06

    Congestion pricing can potentially reduce congestion by providing incentives for drivers to shift trips to off-peak periods, use less congested routes, or use alternative modes, thereby spreading out demand for available transportation infrastructure...

  12. Cutting balloon and high-pressure balloon dilation for palliative treatment of congenital double-chambered right ventricle and primary infundibular stenosis in a Golden retriever dog.

    PubMed

    Schober, Karsten E; Rhinehart, Jaylyn; Kohnken, Rebecca; Bonagura, John D

    2017-12-01

    Combined cutting balloon and high-pressure balloon dilation was performed in a dog with a double-chambered right ventricle and severe infundibular stenosis of the right ventricular outflow tract. The peak systolic pressure gradient across the stenosis decreased by 65% after dilation (from 187 mmHg before to 66 mmHg after) affirming the intervention as successful. However, early re-stenosis occurred within 3 months leading to exercise intolerance, exercise-induced syncope, and right-sided congestive heart failure. Cutting balloon followed by high-pressure balloon dilation provided temporary but not long-term relief of right ventricular obstruction in this dog. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance.

    PubMed

    Meyer, F J; Borst, M M; Zugck, C; Kirschke, A; Schellberg, D; Kübler, W; Haass, M

    2001-05-01

    In congestive heart failure (CHF), the prognostic significance of impaired respiratory muscle strength has not been established. Maximal inspiratory pressure (Pi(max)) was prospectively determined in 244 consecutive patients (207 men) with CHF (ischemic, n=75; idiopathic dilated cardiomyopathy, n=169; age, 54+/-11 years; left ventricular ejection fraction [LVEF], 22+/-10%). Pi(max) was lower in the 244 patients with CHF than in 25 control subjects (7.6+/-3.3 versus 10.5+/-3.7 kPa; P=0.001). The 57 patients (23%) who died during follow-up (23+/-16 months; range, 1 to 48 months) had an even more reduced Pi(max) (6.3+/-3.2 versus 8.1+/-3.2 kPa in survivors; P=0.001). Kaplan-Meier survival curves differentiated between patients subdivided according to quartiles for Pi(max) (P=0.014). Pi(max) was a strong risk predictor in both univariate (P=0.001) and multivariate Cox proportional hazard analyses (P=0.03); multivariate analyses also included NYHA functional class, LVEF, peak oxygen consumption (peak VO(2)), and norepinephrine plasma concentration. The areas under the receiver-operating characteristic curves for prediction of 1-year survival were comparable for Pi(max) and peak VO(2) (area under the curve [AUC], 0.68 versus 0.73; P=0.28), and they improved with the triple combination of Pi(max), peak VO(2), and LVEF (AUC, 0.82; P=0.004 compared with AUC of Pi(max)). In patients with CHF, inspiratory muscle strength is reduced and emerges as a novel, independent predictor of prognosis. Because testing for Pi(max) is simple in clinical practice, it might serve as an additional factor to improve risk stratification and patient selection for cardiac transplantation.

  14. The relationship between potency of oxidative stress and severity of dilated cardiomyopathy.

    PubMed

    Demirbag, Recep; Yilmaz, Remzi; Erel, Ozcan; Gultekin, Unal; Asci, Durmus; Elbasan, Zafer

    2005-08-01

    It has been suggested that oxidative stress may have a role in the etiopathogenesis of congestive heart failure. To investigate and compare the oxidative-antioxidative status and oxidative stress index (OSI) of patients with idiopathic dilated cardiomyopathy (IDC) with those of healthy volunteers, and to determine the relationship between total antioxidant capacity (TAC) and ejection fraction (EF). Twenty-eight patients with IDC and 24 control subjects were enrolled in the study. Antioxidative status was evaluated by measuring the TAC and the vitamin C and thiol levels in the plasma. Oxidative status was evaluated by measuring the total peroxide level. The per cent ratio of TAC to total peroxide level was accepted as the OSI. EF was measured using Simpson's method. TAC and vitamin C and thiol levels of plasma were found to be significantly lower in patients with IDC than in control subjects (P < 0.001). In contrast, total peroxide levels and OSIs were significantly higher in patients with IDC than in control subjects (P = 0.002 and P = 0.002, respectively). An important positive correlation was found between TAC and EF (r = 0.772; P < 0.001). On the other hand, significant negative correlations were found between EF and OSI and between EF and total peroxide levels in patients. Oxidants are increased and antioxidants are decreased in patients with IDC; as a result, the oxidative-antioxidative balance is shifted to the oxidative side. There is a significant correlation between the potency of oxidative stress and the severity of IDC. It is believed that supplementation of antioxidants in the treatment of IDC may be helpful to these patients.

  15. Stem-cell therapy for dilated cardiomyopathy: a pilot study evaluating retrograde coronary venous delivery.

    PubMed

    Pogue, B; Estrada, A H; Sosa-Samper, I; Maisenbacher, H W; Lamb, K E; Mincey, B D; Erger, K E; Conlon, T J

    2013-07-01

    To evaluate retrograde coronary venous stem-cell delivery for Dobermanns with dilated cardiomyopathy. Retrograde coronary venous delivery of adipose-derived mesenchymal stem cells transduced with tyrosine mutant adeno-associated virus 2 to express stromal-derived factor-1 was performed in Dobermanns with dilated cardiomyopathy. Cases were followed for 2 years and electrocardiograms (ECG), echocardiograms and Holter monitoring were performed. Delivery of cells was feasible in 15 of 15 dogs. One dog died following the development of ventricular fibrillation 24 hours after cell delivery. The remaining 14 dogs were discharged the following day without complications. Echocardiographic measurements of left ventricular size and function showed continued progression of disease. On the basis of Kaplan-Meier product limit estimates, median survival for dogs following stem-cell delivery was 620 days (range of 1-799 days). When including only the occult-dilated cardiomyopathy population and excluding those dogs already in congestive heart failure, median survival was 652 days (range of 46-799 days). Retrograde venous delivery of tyrosine mutant adeno-associated virus 2-stromal-derived factor-1 adipose-derived mesenchymal stem cells appears safe. Stem-cell therapy in dogs with occult-dilated cardiomyopathy does not appear to offer advantage compared to recently published survival data in similarly affected Dobermanns. © 2013 British Small Animal Veterinary Association.

  16. High-resolution manometry classifications for idiopathic achalasia in patients with Chagas' disease esophagopathy.

    PubMed

    Vicentine, Fernando P P; Herbella, Fernando A M; Allaix, Marco E; Silva, Luciana C; Patti, Marco G

    2014-02-01

    Idiopathic achalasia (IA) and Chagas' disease esophagopathy (CDE) share several similarities. The comparison between IA and CDE is important to evaluate whether treatment options and their results can be accepted universally. High-resolution manometry (HRM) has proved a better diagnostic tool compared to conventional manometry. This study aims to evaluate HRM classifications for idiopathic achalasia in patients with CDE. We studied 98 patients: 52 patients with CDE (52 % females, mean age, 57 ± 14 years) and 46 patients with IA (54 % females; mean age 48 ± 19 years). All patients underwent a HRM and barium esophagogram. The Chicago classification was distributed in IA as Chicago I, 35 %; Chicago II, 63 %; and Chicago III, 2 %, and in CDE as Chicago I, 52 %; Chicago II, 48 %; and Chicago III, 0 % (p = 0.1, 0.1, and 0.5, respectively). All patients had the classic Rochester type. CDE patients had more pronounced degrees of esophageal dilatation (p < 0.002). The degree of esophageal dilatation did not correlate with Chicago classification (p = 0.08). In nine (9 %) patients, the HRM pattern changed during the test from Chicago I to II. Our results show that (a) HRM classifications for IA can be applied in patients with CDE and (b) HRM classifications did not correlate with the degree of esophageal dilatation. HRM classifications may reflect esophageal repletion and pressurization instead of muscular contraction. The correlation between manometric findings and treatment outcomes for CDE needs to be answered in the near future.

  17. Concurrent gall bladder, liver lobe torsion, and bile peritonitis in a German shepherd dog 2 months after gastric dilatation/volvulus gastropexy and splenectomy.

    PubMed

    Tubby, Kurtis G

    2013-08-01

    Postmortem examination of a 7-year-old German shepherd dog which had gastric dilatation/volvulus and splenectomy 2 months earlier revealed that the right middle and quadrate liver lobes were diffusely congested and torsed. The gall bladder was grossly distended and torsed along its long axis and there was evidence of bile peritonitis.

  18. Esophageal dilatation using the Eder Puestow dilators.

    PubMed

    Royston, C M; Dowling, B L; Gear, M W

    1976-06-01

    We have performed fifty-one dilatations in twenty-six patients using an end-viewing fiberoptic endoscope and Eder Puestow dilators. All (except two) were performed using intravenous diazepam, the majority on an outpatient basis. The only complication has been a single case of aspiration pneumonia. We have found this method of esophageal dilatation particularly useful in the preoperative dilatation of benign strictures, and in those elderly frail patients who are unsuitable for surgery. Transthoracic resection of the stricture is avoided and thus transabdominal repair of the hiatus hernia may be undertaken.

  19. Making the Traffic Operations Case for Congestion Pricing: Operational Impacts of Congestion Pricing

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

    Chin, Shih-Miao; Hu, Patricia S; Davidson, Diane

    2011-02-01

    Congestion begins when an excess of vehicles on a segment of roadway at a given time, resulting in speeds that are significantly slower than normal or 'free flow' speeds. Congestion often means stop-and-go traffic. The transition occurs when vehicle density (the number of vehicles per mile in a lane) exceeds a critical level. Once traffic enters a state of congestion, recovery or time to return to a free-flow state is lengthy; and during the recovery process, delay continues to accumulate. The breakdown in speed and flow greatly impedes the efficient operation of the freeway system, resulting in economic, mobility, environmentalmore » and safety problems. Freeways are designed to function as access-controlled highways characterized by uninterrupted traffic flow so references to freeway performance relate primarily to the quality of traffic flow or traffic conditions as experienced by users of the freeway. The maximum flow or capacity of a freeway segment is reached while traffic is moving freely. As a result, freeways are most productive when they carry capacity flows at 60 mph, whereas lower speeds impose freeway delay, resulting in bottlenecks. Bottlenecks may be caused by physical disruptions, such as a reduced number of lanes, a change in grade, or an on-ramp with a short merge lane. This type of bottleneck occurs on a predictable or 'recurrent' basis at the same time of day and same day of week. Recurrent congestion totals 45% of congestion and is primarily from bottlenecks (40%) as well as inadequate signal timing (5%). Nonrecurring bottlenecks result from crashes, work zone disruptions, adverse weather conditions, and special events that create surges in demand and that account for over 55% of experienced congestion. Figure 1.1 shows that nonrecurring congestion is composed of traffic incidents (25%), severe weather (15%), work zones, (10%), and special events (5%). Between 1995 and 2005, the average percentage change in increased peak traveler delay

  20. Infectious agents and inflammation in donated hearts and dilated cardiomyopathies related to cardiovascular diseases, Chagas' heart disease, primary and secondary dilated cardiomyopathies.

    PubMed

    Mangini, Sandrigo; Higuchi, Maria de Lourdes; Kawakami, Joyce Tiyeko; Reis, Marcia Martins; Ikegami, Renata Nishiyama; Palomino, Suely Aparecida Pinheiro; Pomerantzeff, Pablo Maria Alberto; Fiorelli, Alfredo Inácio; Marcondes-Braga, Fabiana Goulart; Bacal, Fernando; Ferreira, Sílvia Moreira Ayub; Issa, Victor Sarli; Souza, Germano Emílio Conceição; Chizzola, Paulo Roberto; Bocchi, Edimar Alcides

    2015-01-15

    Clinical and experimental conflicting data have questioned the relationship between infectious agents, inflammation and dilated cardiomyopathy (DCM). The aim of this study was to determine the frequency of infectious agents and inflammation in endomyocardial biopsy (EMB) specimens from patients with idiopathic DCM, explanted hearts from different etiologies, including Chagas' disease, compared to donated hearts. From 2008 to 2011, myocardial samples from 29 heart donors and 55 patients with DCMs from different etiologies were studied (32 idiopathic, 9 chagasic, 6 ischemic and 8 other specific etiologies). Inflammation was investigated by immunohistochemistry and infectious agents by immunohistochemistry, molecular biology, in situ hybridization and electron microscopy. There were no differences regarding the presence of macrophages, expression of HLA class II and ICAM-I in donors and DCM. Inflammation in Chagas' disease was predominant. By immunohistochemistry, in donors, there was a higher expression of antigens of enterovirus and Borrelia, hepatitis B and C in DCMs. By molecular biology, in all groups, the positivity was elevated to microorganisms, including co-infections, with a higher positivity to adenovirus and HHV6 in donors towards DCMs. This study was the first to demonstrate the presence of virus in the heart tissue of chagasic DCM. The presence of inflammation and infectious agents is frequent in donated hearts, in the myocardium of patients with idiopathic DCM, myocardial dysfunction related to cardiovascular diseases, and primary and secondary cardiomyopathies, including Chagas' disease. The role of co-infection in Chagas' heart disease physiopathology deserves to be investigated in future studies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Concurrent gall bladder, liver lobe torsion, and bile peritonitis in a German shepherd dog 2 months after gastric dilatation/volvulus gastropexy and splenectomy

    PubMed Central

    Tubby, Kurtis G.

    2013-01-01

    Postmortem examination of a 7-year-old German shepherd dog which had gastric dilatation/volvulus and splenectomy 2 months earlier revealed that the right middle and quadrate liver lobes were diffusely congested and torsed. The gall bladder was grossly distended and torsed along its long axis and there was evidence of bile peritonitis. PMID:24155480

  2. Adult idiopathic hypertrophic pyloric stenosis - a common presentation with an uncommon diagnosis

    PubMed Central

    Mubarik, Ateeq; Muddassir, Salman; Haq, Furqan

    2018-01-01

    ABSTRACT Background and Objectives: Adult Idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare but well-defined entity in adults with only 200-300 cases reported so far in the literature.We describe a case of AIHPS and the relevant literature review. Methods and Results: The patient presented with acute onset upper abdominal pain associated with nausea, vomiting, foul-smelling black tarry stools, and anorexia. On the Esophagogastroduodenoscopy (EGD), pylorus demonstrated a unique “cervix sign.” The patient had multiple endoscopic dilations with minimal relief. She then underwent a distal partial gastrectomy with a Billroth 1 gastroduodenostomy with considerable  improvement in her symptoms on follow up. Conclusion: Adult Idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare disease which is also underreported due to a difficulty in diagnosis. The most common symptoms of AIHPS are postprandial nausea, vomiting, early satiety, and epigastric pain as seen in our patient. Endoscopy usually shows ?Cervix sign? a unique sign showing a fixed, markedly narrowed pylorus with a smooth border. Multiple treatments have been proposed for AIHPS, including endoscopic dilation, pyloromyotomy with or without pyloroplasty, gastrectomy with a Billroth 1 gastroduodenostomy. Currently, there is no evidence of one surgical technique being superior to another. Further research needs to be done on AIHPS before one technique can be standardized as the standard of care. PMID:29686790

  3. Focal nodular hyperplasia with major sinusoidal dilatation: a misleading entity

    PubMed Central

    Laumonier, Hervé; Frulio, Nora; Laurent, Christophe; Balabaud, Charles; Zucman-Rossi, Jessica; Bioulac-Sage, Paulette

    2010-01-01

    Focal nodular hyperplasia (FNH) is a benign liver lesion thought to be a non-specific response to locally increased blood flow. Although the diagnosis of FNH and hepatocellular adenoma (HCA) has made great progress over the last few years using modern imaging techniques, there are still in daily practice some difficulties concerning some atypical nodules. Here, the authors report the case of a 47-year-old woman with a single liver lesion thought to be, by imaging, an inflammatory HCA with major sinusoidal congestion. This nodule was revealed to be, at the microscopical level and after specific immunostaining and molecular analysis, an FNH with sinusoidal dilatation (so-called telangiectatic focal nodular hyperplasia). PMID:22798311

  4. Comparing Perceptions and Measures of Congestion

    DOT National Transportation Integrated Search

    2012-10-01

    Peoples perception of congestion and the actual measured congestion do not always agree. Measured : congestion relates to the delay resulting from field measurements of traffic volume, speed, and travel : time. Peoples perception of congestion ...

  5. Idiopathic restrictive cardiomyopathy is part of the clinical expression of cardiac troponin I mutations

    PubMed Central

    Mogensen, Jens; Kubo, Toru; Duque, Mauricio; Uribe, William; Shaw, Anthony; Murphy, Ross; Gimeno, Juan R.; Elliott, Perry; McKenna, William J.

    2003-01-01

    Restrictive cardiomyopathy (RCM) is an uncommon heart muscle disorder characterized by impaired filling of the ventricles with reduced volume in the presence of normal or near normal wall thickness and systolic function. The disease may be associated with systemic disease but is most often idiopathic. We recognized a large family in which individuals were affected by either idiopathic RCM or hypertrophic cardiomyopathy (HCM). Linkage analysis to selected sarcomeric contractile protein genes identified cardiac troponin I (TNNI3) as the likely disease gene. Subsequent mutation analysis revealed a novel missense mutation, which cosegregated with the disease in the family (lod score: 4.8). To determine if idiopathic RCM is part of the clinical expression of TNNI3 mutations, genetic investigations of the gene were performed in an additional nine unrelated RCM patients with restrictive filling patterns, bi-atrial dilatation, normal systolic function, and normal wall thickness. TNNI3 mutations were identified in six of these nine RCM patients. Two of the mutations identified in young individuals were de novo mutations. All mutations appeared in conserved and functionally important domains of the gene. PMID:12531876

  6. A case of reversible dilated cardiomyopathy after alpha-interferon therapy in a patient with renal cell carcinoma.

    PubMed

    Kuwata, Akiko; Ohashi, Masuo; Sugiyama, Masaya; Ueda, Ryuzo; Dohi, Yasuaki

    2002-12-01

    A 47-year-old man with renal cell carcinoma underwent nephrectomy, and postoperative chemotherapy was performed with recombinant alpha-interferon. Five years later, he experienced dyspnea during physical exertion. An echocardiogram revealed dilatation and systolic dysfunction of the left ventricle, and thallium-201 myocardial scintigraphy showed diffuse heterogeneous perfusion. We diagnosed congestive heart failure because of cardiomyopathy induced by alpha-interferon therapy. Withdrawal of interferon therapy and the combination of an angiotensin-converting enzyme inhibitor, diuretics, and digitalis improved left ventricular systolic function. Furthermore, myocardial scintigraphy using [123I] beta-methyl-p-iodophenylpentadecanoic acid (123I-BMIPP) or [123 I]metaiodobenzylguanidine (123I-MIBG) revealed normal perfusion after the improvement of congestive heart failure. This is a rare case of interferon-induced cardiomyopathy that resulted in normal myocardial images in 123I-BMIPP and 123I-MIBG scintigrams after withdrawal of interferon therapy.

  7. Balloon dilatation of benign and malignant esophageal strictures. Blind retrograde balloon dilatation.

    PubMed

    Graham, D Y; Smith, J L

    1985-06-01

    Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the Eder-Puestow system. The authors used balloon dilators in 22 patients with dysphagia secondary to benign or malignant strictures. Dilatation was performed with fluoroscopic guidance, blindly, or by a combination of these techniques. For "blind" stricture dilatation, an Eder-Puestow spring-tipped guide wire is placed into the stomach using a fiberoptic endoscope. The distance from the incisor teeth to the stricture is measured, and the balloon shaft is marked to indicate when the middle of the balloon is within the stricture. Dilatation is then performed using the antegrade or, the preferred, retrograde technique. Finally, the dilated stricture is calibrated by pulling an inflated balloon through the previously strictured area without difficulty. An attempt was made to achieve an esophageal diameter of 15 mm at the initial dilatation episode, and patient discomfort was used as a guide as to the final diameter. The balloon dilatation technique was highly successful, and a stricture diameter of 15 mm (45-47 French) was achieved at the initial dilatation in most instances. Malignant strictures were easily dilated. Balloon dilatation is convenient, effective, quick, and potentially safer than the previous Eder-Puestow or mercury-filled bougie techniques.

  8. Histology and Glutamine Synthetase Immunoreactivity in Liver Biopsies From Patients With Congestive Heart Failure

    PubMed Central

    Horvath, Bela; Zhu, Lei; Allende, Daniela; Xie, Hao; Guirguis, John; Cruise, Michael; Patil, Deepa T.; O’Shea, Robert; Rivas, John; Yordanka, Reyna; Lan, Nan; Liu, Xiuli

    2017-01-01

    Background Long-standing congestive heart failure can induce a constellation of histopathology changes in the liver that can range from mild sinusoidal dilation to advanced fibrosis and loss of normal perivenular expression of glutamine synthetase (GS). Liver biopsies might be performed to assess the perioperative risk of these patients or to determine the need of synchronous liver transplant. We aimed to assess interobserver agreement in recognizing these liver histologic features in patients undergoing evaluation for heart transplantation and to examine whether immunohistochemistry of GS will aid the diagnosis of cardiac hepatopathy (CH). Methods Hematoxylin-eosin and trichrome-stained slides from 36 liver biopsies from patients undergoing evaluation for heart transplantation were reviewed by four liver pathologists. Histologic features of CH were reviewed and an overall fibrosis (stage) was assessed according to a recently proposed congestive hepatic fibrosis score (CHFS). In addition, 24 liver biopsies with a consensus diagnosis of CH and eight liver biopsies with no significant pathological changes were subjected to immunohistochemistry for GS. The Fleiss’ kappa coefficient (K) analysis was performed to determine the interobserver agreement. Further, histologic features of CH were correlated with the staining pattern of GS. Results Sinusoidal dilation, centrilobular hepatocyte atrophy, centrilobular fibrosis and hemorrhage were the most common findings in this cohort with a substantial-to-fair level of interobserver agreement among four reviewers. The overall agreement on the diagnosis of CH and CHFS was moderate (K = 0.55, 95% confidence interval (CI): 0.32 - 0.73) and fair (K = 0.35, 95% CI: 0.24 - 0.49), respectively. Twelve (of 24, 50%) cases of CH showed loss of the normal perivenular GS staining, while the remaining 12 cases of CH and all eight controls showed retained GS expression. Histologic features of CH (presence of sinusoidal dilation

  9. Determinants of 6-minute walk distance in patients with idiopathic pulmonary fibrosis undergoing lung transplant evaluation.

    PubMed

    Porteous, Mary K; Rivera-Lebron, Belinda N; Kreider, Maryl; Lee, James; Kawut, Steven M

    2016-03-01

    Little is known about the physiologic determinants of 6-minute walk distance in idiopathic pulmonary fibrosis. We investigated the demographic, pulmonary function, echocardiographic, and hemodynamic determinants of 6-minute walk distance in patients with idiopathic pulmonary fibrosis evaluated for lung transplantation. We performed a cross-sectional analysis of 130 patients with idiopathic pulmonary fibrosis who completed a lung transplantation evaluation at the Hospital of the University of Pennsylvania between 2005 and 2010. Multivariable linear regression analysis was used to generate an explanatory model for 6-minute walk distance. After adjustment for age, sex, race, height, and weight, the presence of right ventricular dilation was associated with a decrease of 50.9 m (95% confidence interval [CI], 8.4-93.3) in 6-minute walk distance ([Formula: see text]). For each 200-mL reduction in forced vital capacity, the walk distance decreased by 15.0 m (95% CI, 9.0-21.1; [Formula: see text]). For every increase of 1 Wood unit in pulmonary vascular resistance, the walk distance decreased by 17.3 m (95% CI, 5.1-29.5; [Formula: see text]). Six-minute walk distance in idiopathic pulmonary fibrosis depends in part on circulatory impairment and the degree of restrictive lung disease. Future trials that target right ventricular morphology, pulmonary vascular resistance, and forced vital capacity may potentially improve exercise capacity in patients with idiopathic pulmonary fibrosis.

  10. Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia.

    PubMed

    Vanuytsel, Tim; Lerut, Toni; Coosemans, Willy; Vanbeckevoort, Dirk; Blondeau, Kathleen; Boeckxstaens, Guy; Tack, Jan

    2012-02-01

    Esophageal perforation is the most serious adverse event of pneumatic dilation (PD) for achalasia; it is usually managed by surgical repair. We investigated risk factors for esophageal perforation after PD and evaluated safety and long-term outcome of nonsurgical management strategies. We analyzed medical records of patients with achalasia who were treated with PD from 1992-2010 at the University Hospital Gasthuisberg in Leuven, Belgium; all patients with esophageal perforation were contacted to determine long-term outcomes. Achalasia outcomes were assessed by using the Vantrappen criteria. Of 830 PD procedures performed on 372 patients with manometry-confirmed achalasia (57 ± 1 years, 51% male), 16 were complicated by transmural esophageal perforation (4.3% of patients, 1.9% of dilations). Age >65 years was the only significant risk factor for complications (odds ratio, 3.5; 95% confidence interval, 1.2-10.2). All patients were treated conservatively with broad-spectrum antibiotics and nothing by mouth. In 6 patients (38%) the clinical course was further complicated by a pleural effusion, which required a drain in 4 patients. One patient (6%) died of mediastinal hemorrhage within 12 hours after PD. Patients with complications were discharged after 19 ± 2.3 days, compared with 4 ± 0.2 days for those without complications (P < .0001). Long-term outcomes (mean follow-up, 84 ± 14 months) were determined for 12 patients (75%); 11 had excellent or good outcomes (69%), and 1 had a moderate outcome (6%). Age >65 years is a significant risk factor for esophageal perforation after PD. Nonsurgical management of transmural esophageal tears is feasible, with favorable short-term and long-term outcomes, but is not devoid of complications. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

  11. Computed tomographic features of idiopathic fibrosing interstitial pneumonia: comparison with pulmonary fibrosis related to collagen vascular disease.

    PubMed

    Hwang, Jeong-Hwa; Misumi, Shigeki; Sahin, Hakan; Brown, Kevin K; Newell, John D; Lynch, David A

    2009-01-01

    To compare the computed tomographic (CT) features of idiopathic fibrosing interstitial pneumonia with those of pulmonary fibrosis related to collagen vascular disease (CVD). We reviewed the CT scans of 177 patients with diffuse interstitial pulmonary fibrosis, of which 97 had idiopathic fibrosing interstitial pneumonia and 80 had CVD. The CT images were systematically scored for the presence and extent of pulmonary and extrapulmonary abnormalities. Computed tomographic diagnosis of usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP) was assigned. A CT pattern of UIP was identified in 59 (60.8%) of patients with idiopathic fibrosing interstitial pneumonia compared with 15 (18.7%) of those patients with CVD; conversely, the CT diagnosis of NSIP was made in 51 (64%) of patients with CVD compared with 36 (37%) of patients with idiopathic disease (P < 0.01). In 113 patients who had lung biopsy, the CT diagnoses of UIP and NSIP were concordant with the histologic diagnoses in 36 of 50 patients and 34 of 41 patients, respectively. Pleural effusions, esophageal dilation, and pericardial abnormalities were more frequent in patients with CVD than in patients with idiopathic fibrosing interstitial pneumonia. Compared with patients with CVD, those patients with an idiopathic fibrosing interstitial pneumonia showed a higher prevalence of a UIP pattern and lower prevalence of an NSIP pattern as determined by CT. Identification of coexisting extrapulmonary abnormalities on CT can support a diagnosis of CVD.

  12. Coronary artery abnormalities in children with systemic-onset juvenile idiopathic arthritis.

    PubMed

    Lefèvre-Utile, Alain; Galeotti, Caroline; Koné-Paut, Isabelle

    2014-05-01

    Still's disease (Systemic-onset Juvenile Idiopathic Arthritis: SoJIA) is characterised by high-spiking daily fevers, arthritis and evanescent rashes. Diagnosis of Still's disease is often challenging. Infectious diseases and other inflammatory conditions, especially in young children, Kawasaki disease may look similar. Clinicians often rely on echocardiographic evidence of coronary artery abnormalities to differentiate between Kawasaki disease and Still's disease. Coronary artery dilation would typically favour the diagnosis of Kawasaki disease. We present four children with Still's disease and coronary artery abnormalities who were initially misdiagnosed as Kawasaki disease. The first patient had pericarditis and an irregular wall of the left coronary artery, without dilation on echocardiography. The second patient had a left coronary artery dilatation and a pericarditis. The third patient had thickened left coronary artery walls, and the fourth patient had a hyperechogenicity of the left and right coronary arteries. They received IVIG without success. The diagnosis of Still's disease was made secondary with evidence of persistent arthritis. All but one patient finally needed biologic treatments. Coronary abnormalities may be observed during various febrile conditions and do not exclude the diagnosis of Still's disease. Copyright © 2013 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  13. Idiopathic ophthalmodynia and idiopathic rhinalgia: two topographic facial pain syndromes.

    PubMed

    Pareja, Juan A; Cuadrado, María L; Porta-Etessam, Jesús; Fernández-de-las-Peñas, César; Gili, Pablo; Caminero, Ana B; Cebrián, José L

    2010-09-01

    To describe 2 topographic facial pain conditions with the pain clearly localized in the eye (idiopathic ophthalmodynia) or in the nose (idiopathic rhinalgia), and to propose their distinction from persistent idiopathic facial pain. Persistent idiopathic facial pain, burning mouth syndrome, atypical odontalgia, and facial arthromyalgia are idiopathic facial pain syndromes that have been separated according to topographical criteria. Still, some other facial pain syndromes might have been veiled under the broad term of persistent idiopathic facial pain. Through a 10-year period we have studied all patients referred to our neurological clinic because of facial pain of unknown etiology that might deviate from all well-characterized facial pain syndromes. In a group of patients we have identified 2 consistent clinical pictures with pain precisely located either in the eye (n=11) or in the nose (n=7). Clinical features resembled those of other localized idiopathic facial syndromes, the key differences relying on the topographic distribution of the pain. Both idiopathic ophthalmodynia and idiopathic rhinalgia seem specific pain syndromes with a distinctive location, and may deserve a nosologic status just as other focal pain syndromes of the face. Whether all such focal syndromes are topographic variants of persistent idiopathic facial pain or independent disorders remains a controversial issue.

  14. Signalling and obfuscation for congestion control

    NASA Astrophysics Data System (ADS)

    Mareček, Jakub; Shorten, Robert; Yu, Jia Yuan

    2015-10-01

    We aim to reduce the social cost of congestion in many smart city applications. In our model of congestion, agents interact over limited resources after receiving signals from a central agent that observes the state of congestion in real time. Under natural models of agent populations, we develop new signalling schemes and show that by introducing a non-trivial amount of uncertainty in the signals, we reduce the social cost of congestion, i.e., improve social welfare. The signalling schemes are efficient in terms of both communication and computation, and are consistent with past observations of the congestion. Moreover, the resulting population dynamics converge under reasonable assumptions.

  15. Analysis of Random Drop for Gateway Congestion Control

    DTIC Science & Technology

    1989-11-01

    effective congest)on control policies. Currently No Gateway Policy is used to relieve and signal congestion, which leads to unfair service to the...early application of the policy removes the pressure of congestion relief and allows more accurate signaling of congestion. ’ To be used effectively ...prompted the need for more effective congestion control policies. Currently No Gateway Policy is used to relieve and signal congestion, which leads to

  16. External nasal dilators: definition, background, and current uses

    PubMed Central

    Dinardi, Ricardo Reis; de Andrade, Cláudia Ribeiro; Ibiapina, Cássio da Cunha

    2014-01-01

    Our goal was to revise the literature about external nasal dilators (ENDs) as to their definition, history, and current uses. We reviewed journals in the PubMed and MEDLINE databases. The current uses hereby presented and discussed are physical exercise, nasal congestion and sleep, snoring, pregnancy, cancer, and healthy individuals. Numerous studies have shown that ENDs increase the cross-sectional area of the nasal valve, reducing nasal resistance and transnasal inspiratory pressure and stabilizing the lateral nasal vestibule, avoiding its collapse during final inspiration. These effects also facilitate breathing and are beneficial to patients with nasal obstruction. Furthermore, END use is simple, noninvasive, painless, affordable, and bears minimum risk to the user. Most studies have limited sample size and are mainly focused on physical exercise. In conclusion, ENDs seem useful, so further studies involving potential effects on the performance of physical tests and improvements in sleep quality are necessary, especially in children and teenagers. PMID:25419156

  17. Congestion pricing : a primer : overview

    DOT National Transportation Integrated Search

    2008-10-01

    This Overview primer was produced to explain the concept of congestion pricing and its benefits, to present examples of congestion-pricing approaches implemented in the United States and abroad, and to briefly discuss federal-aid policy and programs ...

  18. Sokolow-Lyon voltage is suitable for monitoring improvement in cardiac function and prognosis of patients with idiopathic dilated cardiomyopathy.

    PubMed

    Fukaya, Kenji; Takeshita, Kyosuke; Okumura, Takahiro; Hiraiwa, Hiroaki; Aoki, Soichiro; Ichii, Takeo; Sugiura, Yuki; Kitagawa, Katsuhide; Kondo, Toru; Watanabe, Naoki; Kano, Naoaki; Furusawa, Kenji; Sawamura, Akinori; Morimoto, Ryota; Bando, Yasuko; Murohara, Toyoaki

    2017-09-01

    The clinical significance of electrocardiogram in the assessment of patients with idiopathic dilated cardiomyopathy (IDCM) is currently unknown. The aim of this study was to determine the feasibility of recording serial changes in Sokolow-Lyon voltage (∆%QRS-voltage) in one year to estimate left ventricular reverse remodeling (LVRR) and predict a prognosis of IDCM patients under tailored medical therapy. Sixty-eight consecutive patients with mild symptoms (52.1 ± 13 years old; 69% men; NYHA I/II/III/IV; 33/29/6/0) underwent electrocardiography and echocardiography at baseline and 12 month follow-up (follow-up period: 3.9 years). LVRR was observed in 30 patients (44.1%). The ∆%QRS-voltage was significantly lower in the LVRR group (LVRR; -26.9%, non-LVRR: -9.2%, p < .001). Univariate analysis showed that ∆%QRS-voltage correlated with ∆%LV end-diastolic diameter (r = .634, p < .001), and with ∆%LV ejection fraction and ∆%LV mass index (r = -.412, p < .001; r = .429, p < .001 respectively). Using receiver operating characteristic curve analysis for the estimation of LVRR, ∆%QRS of -14.7% showed optimal sensitivity (63.2%) and specificity (83.3%) (AUC = 0.775, p < .001). The composite endpoints of cardiac death (n = 0), hospitalization for advanced heart failure (n = 11) and fatal arrhythmia (n = 2) were observed in 13 patients during the follow-up period. Kaplan-Meier analysis showed significantly higher event-free rate in patients of the low ∆%QRS-voltage group (<-14.7%) (83%) than those of the high group (66%, p = .022). The present study showed that decrease in Sokolow-Lyon voltage is associated with improvement in cardiac function and favorable prognosis in IDCM patients on medical therapy, suggesting that this index is a feasible marker for response to treatment of IDCM. © 2017 Wiley Periodicals, Inc.

  19. Etiology and Pathogenesis of Idiopathic Achalasia.

    PubMed

    Pressman, Amanda; Behar, Jose

    2017-03-01

    This review examines the etiology and pathogenesis of idiopathic achalasia. This disease is clinically characterized by dysphagia of solids and liquids due to the presence of simultaneous or absent esophageal contractions and impaired or absent relaxation of the lower esophageal sphincter. It includes a review of (a) etiology and pathogenesis of this inflammatory process that damage the ganglion cells of the Auerbach plexus that is limited to the esophagus; (b) genetic abnormalities and polymorphisms associated with this disease that may help explain its heterogeneity expressed by the different motility abnormalities of its phenotypes as well as differences in its clinical progression. These different genetic abnormalities may be responsible for the slow progression of types I or II phenotypes; (c) indirect evidence of viruses present in these patients that may initiate its development; (d) the abnormalities of the muscle layer that may be responsible for the dilation of the body of the esophagus that ultimately causes the sigmoid-like esophagus in the very last phase of this disease. This progression to the end-stage phase tends to occur in about 5% of patients. And, (e) the chronic inflammatory abnormalities in the squamous mucosa that may be the cause of the dysplastic and neoplastic changes that may lead to squamous cell carcinoma whose incidence in this disease is increased. These mucosal abnormalities are usually present in patients with markedly dilated body of the esophagus and severe food stasis.

  20. Idiopathic anaphylaxis.

    PubMed

    Fenny, Nana; Grammer, Leslie C

    2015-05-01

    Idiopathic anaphylaxis is a diagnosis of exclusion after other causes have been thoroughly evaluated and excluded. The pathogenesis of idiopathic anaphylaxis remains uncertain, although increased numbers of activated lymphocytes and circulating histamine-releasing factors have been implicated. Signs and symptoms of patients diagnosed with idiopathic anaphylaxis are indistinguishable from the manifestations of other forms of anaphylaxis. Treatment regimens are implemented based on the frequency and severity of patient symptoms and generally include the use of epinephrine autoinjectors, antihistamines, and steroids. The prognosis of idiopathic anaphylaxis is generally favorable with well-established treatment regimens and effective patient education. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Urban roadway congestion : annual report

    DOT National Transportation Integrated Search

    1998-01-01

    The annual traffic congestion study is an effort to monitor roadway congestion in major urban areas in the United States. The comparisons to other areas and to previous experiences in each area are facilitated by a database that begins in 1982 and in...

  2. Delivering Faster Congestion Feedback with the Mark-Front Strategy

    NASA Technical Reports Server (NTRS)

    Liu, Chunlei; Jain, Raj

    2001-01-01

    Computer networks use congestion feedback from the routers and destinations to control the transmission load. Delivering timely congestion feedback is essential to the performance of networks. Reaction to the congestion can be more effective if faster feedback is provided. Current TCP/IP networks use timeout, duplicate Acknowledgement Packets (ACKs) and explicit congestion notification (ECN) to deliver the congestion feedback, each provides a faster feedback than the previous method. In this paper, we propose a markfront strategy that delivers an even faster congestion feedback. With analytical and simulation results, we show that mark-front strategy reduces buffer size requirement, improves link efficiency and provides better fairness among users. Keywords: Explicit Congestion Notification, mark-front, congestion control, buffer size requirement, fairness.

  3. Dilation and Curettage (D&C)

    MedlinePlus

    ... For Patients About ACOG Dilation and Curettage (D&C) Home For Patients Search FAQs Dilation and Curettage ( ... February 2016 PDF Format Dilation and Curettage (D&C) Special Procedures What is dilation and curettage (D& ...

  4. Autonomous Congestion Control in Delay-Tolerant Networks

    NASA Technical Reports Server (NTRS)

    Burleigh, Scott; Jennings, Esther; Schoolcraft, Joshua

    2006-01-01

    Congestion control is an important feature that directly affects network performance. Network congestion may cause loss of data or long delays. Although this problem has been studied extensively in the Internet, the solutions for Internet congestion control do not apply readily to challenged network environments such as Delay Tolerant Networks (DTN) where end-to-end connectivity may not exist continuously and latency can be high. In DTN, end-to-end rate control is not feasible. This calls for congestion control mechanisms where the decisions can be made autonomously with local information only. We use an economic pricing model and propose a rule-based congestion control mechanism where each router can autonomously decide on whether to accept a bundle (data) based on local information such as available storage and the value and risk of accepting the bundle (derived from historical statistics). Preliminary experimental results show that this congestion control mechanism can protect routers from resource depletion without loss of data.

  5. Acute gastric dilatation and volvulus in a free-living polar bear

    USGS Publications Warehouse

    Amstrup, Steven C.; Nielsen, Carol A.

    1989-01-01

    A large, adult male polar bear (Ursus maritimus) was found dead on a barrier island north of Prudhoe Bay, Alaska (USA), in June 1987. There were no external signs of trauma. A twisted distended stomach, distinctive parenchymal and fascial congestion, and significant difficulty in repositioning the anterior abdominal organs, indicated that gastric dilatation-volvulus (GDV) was the proximate cause of death. Polar bears frequently consume large quantities of food at one time and have large stomachs that are well adapted to periodic gorging. The scarcity of food in winter and early spring, combined with voluntary fasting and protracted vigorous activity during the breeding season in late spring may have predisposed this bear to GDV. The relationship between GDV and postprandial exercise emphasizes the need for a better understanding of how the present human invasion of arctic habitats may influence polar bear activities.

  6. Idiopathic Ophthalmodynia and Idiopathic Rhinalgia: A Prospective Series of 16 New Cases.

    PubMed

    Pareja, Juan A; Montojo, Teresa; Guerrero, Ángel L; Álvarez, Mónica; Porta-Etessam, Jesús; Cuadrado, María L

    2015-01-01

    Idiopathic ophthalmodynia and idiopathic rhinalgia were described a few years ago. These conditions seem specific pain syndromes with a distinctive location in the eye or in the nose. We aimed to present a new prospective series in order to verify the consistency of these syndromes. We performed a descriptive study of all patients referred to our regional neurologic clinics from 2010 to 2014 because of facial pain exclusively felt in the eye or in the nose fulfilling the proposed diagnostic criteria for idiopathic ophthalmodynia and idiopathic rhinalgia. There were 9 patients with idiopathic ophthalmodynia and 7 patients with idiopathic rhinalgia, with a clear female preponderance, and a mean age at onset in the fifth decade. The pain was usually moderate and the temporal pattern was generally chronic. Only one patient reported accompaniments (hypersensitivity to the light and to the flow of air in the symptomatic eye). Preventive treatment with amitriptyline, pregabalin, or gabapentin was partially or totally effective. The clinical features of this new series parallels those of the original description, thus indicating that both idiopathic ophthalmodynia and idiopathic rhinalgia have clear-cut clinical pictures with excellent consistency both inter- and intra-individually. © 2015 American Headache Society.

  7. Better road congestion measures are needed

    DOT National Transportation Integrated Search

    2003-05-01

    Road congestion is growing worse as demand : outstrips new roadway construction and other : efforts to increase traffic flows. : Better ways to measure congestion are needed to : effectively address the problem. : Actual measures of speeds an...

  8. Autonomous Congestion Control in Delay-Tolerant Networks

    NASA Technical Reports Server (NTRS)

    Burleigh, Scott C.; Jennings, Esther H.

    2005-01-01

    Congestion control is an important feature that directly affects network performance. Network congestion may cause loss of data or long delays. Although this problem has been studied extensively in the Internet, the solutions for Internet congestion control do not apply readily to challenged network environments such as Delay Tolerant Networks (DTN) where end-to-end connectivity may not exist continuously and latency can be high. In DTN, end-to-end rate control is not feasible. This calls for congestion control mechanisms where the decisions can be made autonomously with local information only. We use an economic pricing model and propose a rule-based congestion control mechanism where each router can autonomously decide on whether to accept a bundle (data) based on local information such as available storage and the value and risk of accepting the bundle (derived from historical statistics).

  9. Traffic congestion and reliability : linking solutions to problems.

    DOT National Transportation Integrated Search

    2004-07-19

    The Traffic Congestion and Reliability: Linking Solutions to Problems Report provides : a snapshot of congestion in the United States by summarizing recent trends in : congestion, highlighting the role of unreliable travel times in the effects of con...

  10. Delay-based virtual congestion control in multi-tenant datacenters

    NASA Astrophysics Data System (ADS)

    Liu, Yuxin; Zhu, Danhong; Zhang, Dong

    2018-03-01

    With the evolution of cloud computing and virtualization, the congestion control of virtual datacenters has become the basic issue for multi-tenant datacenters transmission. Regarding to the friendly conflict of heterogeneous congestion control among multi-tenant, this paper proposes a delay-based virtual congestion control, which translates the multi-tenant heterogeneous congestion control into delay-based feedback uniformly by setting the hypervisor translation layer, modifying three-way handshake of explicit feedback and packet loss feedback and throttling receive window. The simulation results show that the delay-based virtual congestion control can effectively solve the unfairness of heterogeneous feedback congestion control algorithms.

  11. Cardiac fibrosis detected by magnetic resonance imaging on predicting time course diversity of left ventricular reverse remodeling in patients with idiopathic dilated cardiomyopathy.

    PubMed

    Ikeda, Yuki; Inomata, Takayuki; Fujita, Teppei; Iida, Yuichiro; Nabeta, Takeru; Ishii, Shunsuke; Maekawa, Emi; Yanagisawa, Tomoyoshi; Mizutani, Tomohiro; Naruke, Takashi; Koitabashi, Toshimi; Takeuchi, Ichiro; Ako, Junya

    2016-11-01

    This study aimed to identify the association between the time course of left ventricular reverse remodeling (LVRR) and late gadolinium enhancement in cardiac magnetic resonance imaging (LGE-cMRI) in patients with idiopathic dilated cardiomyopathy (IDCM). We identified 214 IDCM patients treated by optimal pharmacotherapies. LVRR was defined as ≥10 % increment in LV ejection fraction along with ≥10 % reduction in LV end-diastolic dimension. Findings of LGE-cMRI focusing on presence and extent of LGE were evaluated at baseline. Echocardiographic evaluation for detecting LVRR was performed in all patients for 3 years. The primary endpoint was defined as composite events (CEs) including readmission for heart failure, detection of major ventricular arrhythmia, and all-cause mortality. LVRR was found at <1 year in 59 patients (28 %, early responder), ≥1 year in 56 patients (26 %, late responder), and was absent in 99 patients (46 %, non-responder). Multivariate Cox-proportional hazards analysis revealed that both early responders (P = 0.02) and late responders (P < 0.001) had lower incidence of CEs than non-responders. Among 66 subjects (23 %) with complete cMRI evaluation, LGE was detected more often in late and non- than early responders (65, 83 vs. 23 % P < 0.001, respectively), whereas the LGE area was smaller in both early and late than non-responders (2 ± 3, 4 ± 3 vs. 12 ± 10 %, P < 0.001, respectively). In conclusion, evaluating the presence and the extent of LGE is useful for predicting the clinical differences of LVRR time course and subsequent long-term outcomes.

  12. Alternative performance measures for evaluating congestion.

    DOT National Transportation Integrated Search

    2004-04-01

    This report summarizes the results of the work performed under the project Alternative Performance Measures for Evaluating : Congestion. The study first outlines existing approaches to looking at congestion. It then builds on the previous work in the...

  13. Idiopathic normal-pressure hydrocephalus: temporal changes in ADC during cardiac cycle.

    PubMed

    Ohno, Naoki; Miyati, Tosiaki; Mase, Mitsuhito; Osawa, Tomoshi; Kan, Hirohito; Kasai, Harumasa; Hara, Masaki; Shibamoto, Yuta; Hayashi, Norio; Gabata, Toshifumi; Matsui, Osamu

    2011-11-01

    To determine whether temporal changes in apparent diffusion coefficient (ADC) over the cardiac cycle are different in patients with idiopathic normal-pressure hydrocephalus (INPH) as compared with patients with ex vacuo ventricular dilatation and healthy control subjects. This prospective study was approved by the institutional review board and was performed only after informed consent was obtained from each patient. At 1.5 T, electrocardiographically triggered single-shot diffusion echo-planar magnetic resonance imaging (b = 0 and 1000 sec/mm(2)) was performed with sensitivity encoding and half-scan techniques to minimize bulk motion. ΔADC was defined as the difference between maximum and minimum ADC on a pixel-by-pixel basis over 20 phases of the cardiac cycle. Mean ADC during the diastolic phase and ΔADC in the frontal white matter were determined in patients with INPH (n = 13), patients with ex vacuo ventricular dilatation (n = 8), and healthy volunteers (n = 10). Kruskal-Wallis tests were used to determine significance between groups. Mean ΔADC in the INPH group was significantly higher than that in the ex vacuo ventricular dilatation and control groups (P < .01 for both). There was no significant difference in ΔADC between the ex vacuo ventricular dilatation and control groups (P = .86). There was no significant difference in mean ADC during the diastolic phase among groups (P > .05 for all). There was no significant correlation between ΔADC and mean ADC during the diastolic phase in any group. Determination of fluctuation of ADC over the cardiac cycle may render it possible to noninvasively obtain new and more detailed information than that provided by standard ADC measurement in suspected INPH, potentially facilitating the diagnosis of this disease. RSNA, 2011

  14. Understanding congested travel in urban areas

    NASA Astrophysics Data System (ADS)

    Çolak, Serdar; Lima, Antonio; González, Marta C.

    2016-03-01

    Rapid urbanization and increasing demand for transportation burdens urban road infrastructures. The interplay of number of vehicles and available road capacity on their routes determines the level of congestion. Although approaches to modify demand and capacity exist, the possible limits of congestion alleviation by only modifying route choices have not been systematically studied. Here we couple the road networks of five diverse cities with the travel demand profiles in the morning peak hour obtained from billions of mobile phone traces to comprehensively analyse urban traffic. We present that a dimensionless ratio of the road supply to the travel demand explains the percentage of time lost in congestion. Finally, we examine congestion relief under a centralized routing scheme with varying levels of awareness of social good and quantify the benefits to show that moderate levels are enough to achieve significant collective travel time savings.

  15. Modeling the pressure-dilatation correlation

    NASA Technical Reports Server (NTRS)

    Sarkar, S.

    1991-01-01

    It is generally accepted that pressure dilatation, which is an additional compressibility term in turbulence transport equations, may be important for high speed flows. Recent direct simulations of homogeneous shear turbulence have given concrete evidence that the pressure dilatation is important insofar that it contributes to the reduced growth of turbulent kinetic energy due to compressibility effects. The problem of modeling pressure dilatation is addressed. A component of the pressure dilatation is isolated which exhibits temporal oscillations and, using direct numerical simulations of homogeneous shear turbulence and isotropic turbulence, show that it has a negligible contribution to the evolution of turbulent kinetic energy. Then, an analysis for the case of homogeneous turbulence is performed to obtain a model for the nonoscillatory pressure dilatation. This model algebraically relates the pressure dilatation to quantities traditionally obtained in incompressible turbulence closures. The model is validated by direct comparison with the pressure dilatation data obtained from the simulations.

  16. Understanding congested travel in urban areas

    PubMed Central

    Çolak, Serdar; Lima, Antonio; González, Marta C.

    2016-01-01

    Rapid urbanization and increasing demand for transportation burdens urban road infrastructures. The interplay of number of vehicles and available road capacity on their routes determines the level of congestion. Although approaches to modify demand and capacity exist, the possible limits of congestion alleviation by only modifying route choices have not been systematically studied. Here we couple the road networks of five diverse cities with the travel demand profiles in the morning peak hour obtained from billions of mobile phone traces to comprehensively analyse urban traffic. We present that a dimensionless ratio of the road supply to the travel demand explains the percentage of time lost in congestion. Finally, we examine congestion relief under a centralized routing scheme with varying levels of awareness of social good and quantify the benefits to show that moderate levels are enough to achieve significant collective travel time savings. PMID:26978719

  17. A splice site mutation in a gene encoding for PDK4, a mitochondrial protein, is associated with the development of dilated cardiomyopathy in the Doberman pinscher.

    PubMed

    Meurs, Kathryn M; Lahmers, Sunshine; Keene, Bruce W; White, Stephen N; Oyama, Mark A; Mauceli, Evan; Lindblad-Toh, Kerstin

    2012-08-01

    Familial dilated cardiomyopathy is a primary myocardial disease that can result in the development of congestive heart failure and sudden cardiac death. Spontaneous animal models of familial dilated cardiomyopathy exist and the Doberman pinscher dog is one of the most commonly reported canine breeds. The objective of this study was to evaluate familial dilated cardiomyopathy in the Doberman pinscher dog using a genome-wide association study for a genetic alteration(s) associated with the development of this disease in this canine model. Genome-wide association analysis identified an area of statistical significance on canine chromosome 14 (p(raw) = 9.999e-05 corrected for genome-wide significance), fine-mapping of additional SNPs flanking this region localized a signal to 23,774,190-23,781,919 (p = 0.001) and DNA sequencing identified a 16-base pair deletion in the 5' donor splice site of intron 10 of the pyruvate dehydrogenase kinase 4 gene in affected dogs (p < 0.0001). Electron microscopy of myocardium from affected dogs demonstrated disorganization of the Z line, mild to moderate T tubule and sarcoplasmic reticulum dilation, marked pleomorphic mitochondrial alterations with megamitochondria, scattered mitochondria with whorling and vacuolization and mild aggregates of lipofuscin granules. In conclusion, we report the identification of a splice site deletion in the PDK4 gene that is associated with the development of familial dilated cardiomyopathy in the Doberman pinscher dog.

  18. Contemporary approaches to congestion pricing : lessons learned from the national evaluation of congestion pricing strategies at six sites.

    DOT National Transportation Integrated Search

    2015-08-01

    This document represents the final report of the national evaluation of congestion reduction strategies at six sites that received federal funding under the Urban Partnership Agreement (UPA) and Congestion Reduction Demonstration (CRD) programs. The ...

  19. Idiopathic Syringomyelia in a Military Helicopter Pilot.

    PubMed

    Schiemer, Anthony

    2017-10-01

    A syrinx is a fluid-filled cavity within the spinal cord. They can lead to a variety of symptoms, including limb weakness and back pain. Incidental finding of syringomyelia provides a challenge for clinicians due to the wide variety of possible symptoms. In military aviation, neurological findings in pilots can result in extensive investigation that can lead to potentially invasive management. Conversely, the potential for chronic progression of a spinal syrinx and subsequent neurological deterioration makes early identification critical. Ultimately, the discovery of a lesion may have implications for flying status and operational capability. A 25-yr-old man working as a navy Seahawk helicopter pilot presented with episodes of right arm paraesthesia and pain between the scapulae. On at least one occasion, these symptoms woke him at night. Upon magnetic resonance imaging, dilatation of the central canal in a syrinx-like pattern in the lower cervical region was noted. Neurology review suggested the finding was persistent and unlikely to be responsible for his symptoms. No surgical input was recommended. His symptoms were attributed to mild cervical spondylosis, which resolved with ongoing physiotherapy, and he was returned to flying status. This case highlights several issues involved with the incidental finding of a syringomyelia. Surgical intervention has been known to worsen symptoms. Conversely, studies have identified minimal radiological progression in cases of idiopathic syringomyelia, with fewer individuals displaying neurological deterioration. For aircrew, potentially unnecessary neurosurgical intervention poses risks to a flying career and overall operational capability.Schiemer A. Idiopathic syringomyelia in a military helicopter pilot. Aerosp Med Hum Perform. 2017; 88(10):962-965.

  20. Combining Segmented Grey and White Matter Images Improves Voxel-based Morphometry for the Case of Dilated Lateral Ventricles.

    PubMed

    Goto, Masami; Abe, Osamu; Aoki, Shigeki; Kamagata, Koji; Hori, Masaaki; Miyati, Tosiaki; Gomi, Tsutomu; Takeda, Tohoru

    2018-01-18

    To evaluate the error in segmented tissue images and to show the usefulness of the brain image in voxel-based morphometry (VBM) using Statistical Parametric Mapping (SPM) 12 software and 3D T 1 -weighted magnetic resonance images (3D-T 1 WIs) processed to simulate idiopathic normal pressure hydrocephalus (iNPH). VBM analysis was performed on sagittal 3D-T 1 WIs obtained in 22 healthy volunteers using a 1.5T MR scanner. Regions of interest for the lateral ventricles of all subjects were carefully outlined on the original 3D-T 1 WIs, and two types of simulated 3D-T 1 WI were also prepared (non-dilated 3D-T 1 WI as normal control and dilated 3D-T 1 WI to simulate iNPH). All simulated 3D-T 1 WIs were segmented into gray matter, white matter, and cerebrospinal fluid images, and normalized to standard space. A brain image was made by adding the gray and white matter images. After smoothing with a 6-mm isotropic Gaussian kernel, group comparisons (dilated vs non-dilated) were made for gray and white matter, cerebrospinal fluid, and brain images using a paired t-test. In evaluation of tissue volume, estimation error was larger using gray or white matter images than using the brain image, and estimation errors in gray and white matter volume change were found for the brain surface. To our knowledge, this is the first VBM study to show the possibility that VBM of gray and white matter volume on the brain surface may be more affected by individual differences in the level of dilation of the lateral ventricles than by individual differences in gray and white matter volumes. We recommend that VBM evaluation in patients with iNPH should be performed using the brain image rather than the gray and white matter images.

  1. Improving Explicit Congestion Notification with the Mark-Front Strategy

    NASA Technical Reports Server (NTRS)

    Liu, Chunlei; Jain, Raj

    2001-01-01

    Delivering congestion signals is essential to the performance of networks. Current TCP/IP networks use packet losses to signal congestion. Packet losses not only reduces TCP performance, but also adds large delay. Explicit Congestion Notification (ECN) delivers a faster indication of congestion and has better performance. However, current ECN implementations mark the packet from the tail of the queue. In this paper, we propose the mark-front strategy to send an even faster congestion signal. We show that mark-front strategy reduces buffer size requirement, improves link efficiency and provides better fairness among users. Simulation results that verify our analysis are also presented.

  2. Rhode Island congestion management plan : executive summary

    DOT National Transportation Integrated Search

    1997-09-01

    This document provides an overview of the Rhode Island Congestion Management System (CMS) program consisting of the following: Congestion Management System Plan; Incident Management Plan; and Intelligent Transportation System (ITS) Early Deployment P...

  3. Technologies that enable congestion pricing : a primer

    DOT National Transportation Integrated Search

    2008-10-01

    This volume explores transportation technologies that enable congestion pricing. This document considers the following: the functional processes for tolling and congestion pricing; what technologies there are to consider; how the technologies are app...

  4. Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy?

    PubMed

    Zugck, C; Krüger, C; Dürr, S; Gerber, S H; Haunstetter, A; Hornig, K; Kübler, W; Haass, M

    2000-04-01

    The 6-min walk test may serve as a more simple clinical tool to assess functional capacity in congestive heart failure than determination of peak oxygen uptake by cardiopulmonary exercise testing. The purpose of the study was to prospectively examine whether the distance ambulated during a 6-min walk test (i) correlates with peak oxygen uptake, (ii) allows peak oxygen uptake to be predicted, and (iii) provides prognostic information similar to peak oxygen uptake in patients with dilated cardiomyopathy and left ventricular ejection fraction < or = 35%. In 113 patients (age: 54+/-12 years, NYHA: 2.2+/-0.8) with dilated cardiomyopathy (left ventricular ejection fraction 19+/-7%) a 6-min walk test and cardiopulmonary exercise testing were performed. The 6-min walk test and peak oxygen uptake were closely correlated at the initial visit (r=0.68, n=113), as well as after 263+/-114 (r=0.71, n=28) and 381+/-170 days (r=0.74, n=14). During serial exercise testing the 6-min walk test allowed peak oxygen uptake to be reliably predicted (r=0.76 between calculated and real peak oxygen uptake). After 528+/-234 days, 42 patients were hospitalized due to worsening heart failure and/or died from cardiovascular causes. Compared to clinically stable patients, these 42 patients walked a shorter distance (423+/-104 vs 501+/-95 m, P<0.001) and had a lower peak oxygen uptake (12.7+/-4.0 vs 17.4 + 5.6 ml x min(-1) x kg(-1), P<0.001). By univariate analysis the 6-min walk test outperformed other prognostic parameters such as left ventricular ejection fraction, cardiac index and plasma norepinephrine concentration and conferred a prognostic power similar to peak oxygen uptake. This predictive value could be further improved in a multivariate model, by combining the 6-min walk test with independent variables, such as left ventricular ejection fraction or cardiac index. The 6-min walk test correlated with peak oxygen uptake when tested serially over the course of the disease. Although both

  5. Income-based equity impacts of congestion pricing

    DOT National Transportation Integrated Search

    2008-12-01

    This equity primer was produced to examine the impacts of congestion pricing on low-income groups, public opinion as expressed by various income groups, and ways to mitigate the equity impacts of congestion pricing

  6. Income-based equity impacts of congestion pricing.

    DOT National Transportation Integrated Search

    2008-12-01

    This equity primer was produced to examine the impacts of congestion pricing on low-income groups, public opinion as expressed by various income groups, and ways to mitigate the equity impacts of congestion pricing.

  7. Technologies that complement congestion pricing : a primer.

    DOT National Transportation Integrated Search

    2008-10-01

    The purpose of this volume is to consider the technology options that are available to complement congestion-pricing approaches. This primer explores how technology broadens the success for congestion pricing by supporting the traveler's decision to ...

  8. Atlanta congestion reduction demonstration : national evaluation report.

    DOT National Transportation Integrated Search

    2014-03-01

    This document presents the final report on the national evaluation of the Atlanta Congestion Reduction Demonstration (CRD) under the United States Department of Transportation (U.S. DOT) CRD Program. The Atlanta CRD projects focus on reducing congest...

  9. Cardiac compartment-specific overexpression of a modified retinoic acid receptor produces dilated cardiomyopathy and congestive heart failure in transgenic mice.

    PubMed

    Colbert, M C; Hall, D G; Kimball, T R; Witt, S A; Lorenz, J N; Kirby, M L; Hewett, T E; Klevitsky, R; Robbins, J

    1997-10-15

    Retinoids play a critical role in cardiac morphogenesis. To examine the effects of excessive retinoid signaling on myocardial development, transgenic mice that overexpress a constitutively active retinoic acid receptor (RAR) controlled by either the alpha- or beta-myosin heavy chain (MyHC) promoter were generated. Animals carrying the alpha-MyHC-RAR transgene expressed RARs in embryonic atria and in adult atria and ventricles, but developed no signs of either malformations or disease. In contrast, beta-MyHC-RAR animals, where expression was activated in fetal ventricles, developed a dilated cardiomyopathy that varied in severity with transgene copy number. Characteristic postmortem lesions included biventricular chamber dilation and left atrial thrombosis; the incidence and severity of these lesions increased with increasing copy number. Transcript analyses showed that molecular markers of hypertrophy, alpha-skeletal actin, atrial natriuretic factor and beta-MyHC, were upregulated. Cardiac performance of transgenic hearts was evaluated using the isolated perfused working heart model as well as in vivo, by transthoracic M-mode echocardiography. Both analyses showed moderate to severe impairment of left ventricular function and reduced cardiac contractility. Thus, expression of a constitutively active RAR in developing atria and/ or in postnatal ventricles is relatively benign, while ventricular expression during gestation can lead to significant cardiac dysfunction.

  10. Cardiac compartment-specific overexpression of a modified retinoic acid receptor produces dilated cardiomyopathy and congestive heart failure in transgenic mice.

    PubMed Central

    Colbert, M C; Hall, D G; Kimball, T R; Witt, S A; Lorenz, J N; Kirby, M L; Hewett, T E; Klevitsky, R; Robbins, J

    1997-01-01

    Retinoids play a critical role in cardiac morphogenesis. To examine the effects of excessive retinoid signaling on myocardial development, transgenic mice that overexpress a constitutively active retinoic acid receptor (RAR) controlled by either the alpha- or beta-myosin heavy chain (MyHC) promoter were generated. Animals carrying the alpha-MyHC-RAR transgene expressed RARs in embryonic atria and in adult atria and ventricles, but developed no signs of either malformations or disease. In contrast, beta-MyHC-RAR animals, where expression was activated in fetal ventricles, developed a dilated cardiomyopathy that varied in severity with transgene copy number. Characteristic postmortem lesions included biventricular chamber dilation and left atrial thrombosis; the incidence and severity of these lesions increased with increasing copy number. Transcript analyses showed that molecular markers of hypertrophy, alpha-skeletal actin, atrial natriuretic factor and beta-MyHC, were upregulated. Cardiac performance of transgenic hearts was evaluated using the isolated perfused working heart model as well as in vivo, by transthoracic M-mode echocardiography. Both analyses showed moderate to severe impairment of left ventricular function and reduced cardiac contractility. Thus, expression of a constitutively active RAR in developing atria and/ or in postnatal ventricles is relatively benign, while ventricular expression during gestation can lead to significant cardiac dysfunction. PMID:9329959

  11. Activin-A, transforming growth factor-beta, and myostatin signaling pathway in experimental dilated cardiomyopathy.

    PubMed

    Mahmoudabady, Maryam; Mathieu, Myrielle; Dewachter, Laurence; Hadad, Ielham; Ray, Lynn; Jespers, Pascale; Brimioulle, Serge; Naeije, Robert; McEntee, Kathleen

    2008-10-01

    The pathogenic mechanisms of dilated cardiomyopathy are still uncertain. A number of cytokines and growth factors participate in the remodeling process of the disease. We investigated the cardiac myostatin, transforming growth factor (TGF)beta, and activin-A/Smad growth inhibitory signaling pathway in experimental dilated cardiomyopathy. Transvenous endomyocardial biopsies of the interventricular septum were taken weekly in 15 beagle dogs during the development of heart failure (HF) induced by rapid pacing over a period of 7 weeks. Genes involved in the myostatin-TGFbeta-activin-A/Smad signaling pathway and the cardiac hypertrophic process were quantified by real-time quantitative polymerase chain reaction. Left ventricular volume, function, and mass were evaluated by echocardiography. Overpacing was associated with increased left ventricular volumes and decreased ejection fraction, whereas the left ventricular mass remained unchanged. TGFbeta was increased in moderate HF. Activin-A mRNA expression was 4-fold higher in overt congestive HF than at baseline. A 2-fold decrease of activin type II receptors and activin receptor interacting protein 2 gene expressions were observed, as well as a transient decrease of follistatin. Activin type I receptors, activin receptor interacting protein 1, follistatin-related gene, and myostatin remained unchanged. The inhibitory Smad 7, a negative feedback loop regulator of the Smad pathway, was overexpressed in severe HF. Gene expression of the cyclin-dependent kinase inhibitor p21, a direct target gene of the Smad pathway, was 8-fold up-regulated in HF, whereas cyclin D1 was down-regulated. We conclude that tachycardia-induced dilated cardiomyopathy is characterized by gene overexpression of the TGFbeta-activin-A/Smad signaling pathway and their target gene p21 and by the absence of ventricular hypertrophy.

  12. Investigating the effect of freeway congestion thresholds on decision-making inputs.

    DOT National Transportation Integrated Search

    2010-05-01

    Congestion threshold is embedded in the congestion definition. Two basic approaches exist in : current practice for setting the congestion threshold. One common approach uses the free-flow or : unimpeded conditions as the congestion threshold. ...

  13. Network congestion control algorithm based on Actor-Critic reinforcement learning model

    NASA Astrophysics Data System (ADS)

    Xu, Tao; Gong, Lina; Zhang, Wei; Li, Xuhong; Wang, Xia; Pan, Wenwen

    2018-04-01

    Aiming at the network congestion control problem, a congestion control algorithm based on Actor-Critic reinforcement learning model is designed. Through the genetic algorithm in the congestion control strategy, the network congestion problems can be better found and prevented. According to Actor-Critic reinforcement learning, the simulation experiment of network congestion control algorithm is designed. The simulation experiments verify that the AQM controller can predict the dynamic characteristics of the network system. Moreover, the learning strategy is adopted to optimize the network performance, and the dropping probability of packets is adaptively adjusted so as to improve the network performance and avoid congestion. Based on the above finding, it is concluded that the network congestion control algorithm based on Actor-Critic reinforcement learning model can effectively avoid the occurrence of TCP network congestion.

  14. Understanding the topological characteristics and flow complexity of urban traffic congestion

    NASA Astrophysics Data System (ADS)

    Wen, Tzai-Hung; Chin, Wei-Chien-Benny; Lai, Pei-Chun

    2017-05-01

    For a growing number of developing cities, the capacities of streets cannot meet the rapidly growing demand of cars, causing traffic congestion. Understanding the spatial-temporal process of traffic flow and detecting traffic congestion are important issues associated with developing sustainable urban policies to resolve congestion. Therefore, the objective of this study is to propose a flow-based ranking algorithm for investigating traffic demands in terms of the attractiveness of street segments and flow complexity of the street network based on turning probability. Our results show that, by analyzing the topological characteristics of streets and volume data for a small fraction of street segments in Taipei City, the most congested segments of the city were identified successfully. The identified congested segments are significantly close to the potential congestion zones, including the officially announced most congested streets, the segments with slow moving speeds at rush hours, and the areas near significant landmarks. The identified congested segments also captured congestion-prone areas concentrated in the business districts and industrial areas of the city. Identifying the topological characteristics and flow complexity of traffic congestion provides network topological insights for sustainable urban planning, and these characteristics can be used to further understand congestion propagation.

  15. Juvenile Idiopathic Arthritis

    MedlinePlus

    ... Is Juvenile Idiopathic Arthritis the same as Juvenile Rheumatoid Arthritis? Yes, Juvenile Idiopathic Arthritis (JIA) is a new ... of chronic inflammatory diseases that affect children. Juvenile Rheumatoid Arthritis (JRA) is the older term that was used ...

  16. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

    MedlinePlus

    ... Asked Questions Español Condiciones Chinese Conditions Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) En Español Read in Chinese What is idiopathic intracranial hypertension? Idiopathic intracranial hypertension (IIH) is a disorder that ...

  17. Research on Urban Road Traffic Congestion Charging Based on Sustainable Development

    NASA Astrophysics Data System (ADS)

    Ye, Sun

    Traffic congestion is a major problem which bothers our urban traffic sustainable development at present. Congestion charging is an effective measure to alleviate urban traffic congestion. The paper first probes into several key issues such as the goal, the pricing, the scope, the method and the redistribution of congestion charging from theoretical angle. Then it introduces congestion charging practice in Singapore and London and draws conclusion and suggestion that traffic congestion charging should take scientific plan, support of public, public transportation development as the premise.

  18. Antarctic Analog for Dilational Bands on Europa

    NASA Technical Reports Server (NTRS)

    Hurford, T. A.; Brunt, K. M.

    2014-01-01

    Europa's surface shows signs of extension, which is revealed as lithospheric dilation expressed along ridges, dilational bands and ridged bands. Ridges, the most common tectonic feature on Europa, comprise a central crack flanked by two raised banks a few hundred meters high on each side. Together these three classes may represent a continuum of formation. In Tufts' Dilational Model ridge formation is dominated by daily tidal cycling of a crack, which can be superimposed with regional secular dilation. The two sources of dilation can combine to form the various band morphologies observed. New GPS data along a rift on the Ross Ice Shelf, Antarctica is a suitable Earth analog to test the framework of Tufts' Dilational Model. As predicted by Tufts' Dilational Model, tensile failures in the Ross Ice Shelf exhibit secular dilation, upon which a tidal signal can be seen. From this analog we conclude that Tufts' Dilational Model for Europan ridges and bands may be credible and that the secular dilation is most likely from a regional source and not tidally driven.

  19. Juvenile idiopathic arthritis.

    PubMed

    Boros, Christina; Whitehead, Ben

    2010-09-01

    Juvenile idiopathic arthritis is the most common rheumatic disease in childhood, occurring in approximately 1:500 children. Despite a recent expansion in treatment options and improvement of outcomes, significant morbidity still occurs. This article outlines the clinical manifestations, assessment, detection of complications, treatment options and monitoring requirements, with the aid of guidelines recently published by The Royal Australian College of General Practitioners, which provide practical support for general practitioners to ensure best practice care and to prevent lifelong disability in patients with juvenile idiopathic arthritis. General practice plays an important role in the early detection, initial management and ongoing monitoring of children with juvenile idiopathic arthritis. Early detection involves understanding the classification framework for subtypes of juvenile idiopathic arthritis, and being aware of the clinical manifestations and how to look for them, through history, examination and appropriate investigation. The major extra-articular manifestations of juvenile idiopathic arthritis are uveitis and growth disturbance. Treatment options include nonsteroidal anti-inflammatory drugs, methotrexate, biologic agents, and corticosteroids. Management using a multidisciplinary approach can prevent long term sequelae. Unfortunately, approximately 50% of children will have active disease as adults.

  20. Randomized controlled trial comparing esophageal dilation to no dilation among adults with esophageal eosinophilia and dysphagia.

    PubMed

    Kavitt, R T; Ates, F; Slaughter, J C; Higginbotham, T; Shepherd, B D; Sumner, E L; Vaezi, M F

    2016-11-01

    The role of esophageal dilation in patients with esophageal eosinophilia with dysphagia remains unknown. The practice of dilation is currently based on center preferences and expert opinion. The aim of this study is to determine if, and to what extent, dysphagia improves in response to initial esophageal dilation followed by standard medical therapies. We conducted a randomized, blinded, controlled trial evaluating adult patients with dysphagia and newly diagnosed esophageal eosinophilia from 2008 to 2013. Patients were randomized to dilation or no dilation at time of endoscopy and blinded to dilation status. Endoscopic features were graded as major and minor. Subsequent to randomization and endoscopy, all patients received fluticasone and dexlansoprazole for 2 months. The primary study outcome was reduction in overall dysphagia score, assessed at 30 and 60 days post-intervention. Patients with severe strictures (less than 7-mm esophageal diameter) were excluded from the study. Thirty-one patients were randomized and completed the protocol: 17 randomized to dilation and 14 to no dilation. Both groups were similar with regard to gender, age, eosinophil density, endoscopic score, and baseline dysphagia score. The population exhibited moderate to severe dysphagia and moderate esophageal stricturing at baseline. Overall, there was a significant (P < 0.001) but similar reduction in mean dysphagia score at 30 and 60 days post-randomization compared with baseline in both groups. No significant difference in dysphagia scores between treatment groups after 30 (P = 0.93) or 60 (P = 0.21) days post-intervention was observed. Esophageal dilation did not result in additional improvement in dysphagia score compared with treatment with proton pump inhibitor and fluticasone alone. In patients with symptomatic esophageal eosinophilia without severe stricture, dilation does not appear to be a necessary initial treatment strategy. © 2015 International Society for

  1. Vocal cord paralysis: What matters between idiopathic and non-idiopathic cases?

    PubMed

    Özbal Koç, Ayça Eltaf; Türkoğlu, Seda Babakurban; Erol, Ozan; Erbek, Selim

    2016-01-01

    This study aims to evaluate the demographic and clinical characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP). This retrospective cohort was performed on data extracted from medical files of 92 consecutive patients (43 males, 49 females; median age 52.1±23.1 years; min. 1 - max. 87) with VCP diagnosed in the otorhinolaryngology department between April 2012 and December 2015. Diagnoses associated with VCP, side of involvement (right, left or bilateral) and previous medical histories were noted and compared between patients with idiopathic and non-idiopathic VCP. Vocal cord paralysis occurred on the left side (n=56, 60.9%), right side (n=28, 30.4%) or bilaterally (n=8, 8.7%). A clinical entity related with VCP was identified in 63 patients (68.5%), while 29 (31.5%) patients had idiopathic VCP. Most common etiologies for VCP were thyroid surgery (n=32, 34.8%), cardiovascular surgery (n=9, 9.8%), lung cancer (n=6, 6.5%) and cardiac anomalies (n=4, 4.3%), respectively. Patients with idiopathic VCP were significantly older (p<0.001), while gender distribution (p=0.121) and side of involvement (p=0.340) did not differ between two groups. Vocal cord paralysis is a relatively common clinical entity with substantial rate of morbidity. Identification of the underlying etiology and awareness on the clinical characteristics are keystones for foreseeing complications and determining the appropriate therapeutic modality.

  2. Unipedal Diagnostic Lymphangiography Followed by Sequential CT Examinations in Patients With Idiopathic Chyluria: A Retrospective Study.

    PubMed

    Dong, Jian; Xin, Jianfeng; Shen, Wenbin; Chen, Xiaobai; Wen, Tingguo; Zhang, Chunyan; Wang, Rengui

    2018-04-01

    The objective of our study was to investigate the clinical value of diagnostic lymphangiography followed by sequential CT examinations in patients with idiopathic chyluria. Thirty-six patients with idiopathic chyluria underwent unipedal diagnostic lymphangiography and then underwent sequential CT examinations. The examinations were reviewed separately by two radiologists. Abnormal distribution of contrast medium, lymphourinary leakages, and retrograde flow were noted, and the range and distribution of lymphatic vessel lesions were recorded. The stage of idiopathic chyluria based on CT findings and the stage based on clinical findings were compared. Therapeutic management and follow-up were recorded. Statistical analyses were performed. Compared with CT studies performed after lymphangiography, diagnostic lymphangiography showed a unique capability to depict lymphourinary leakages in three patients. Lymphourinary fistulas and abnormal dilated lymphatic vessels were found in and around kidney in all patients. CT depicted retrograde flow of lymph fluid in 47.2% of patients. The consistency in staging chyluria based on CT findings and clinical findings was fair (κ = 0.455). Twenty-nine patients underwent conservative therapy, and seven underwent surgery. Surgical therapy was superior to conservative management (no recurrence, 85.7% of patients who underwent surgery vs 62.1% of patients who underwent conservative therapy; p = 0.025). From assessing the drainage of contrast medium on unipedal diagnostic lymphangiography and the redistribution of contrast medium on sequential CT examinations, it is possible to detect the existence of lymphourinary fistulas, the precise location of lymphatic anomalies, the distribution of collateral lymphatic vessels, and hydrodynamic pressure abnormality in the lymph circulation in patients with idiopathic chyluria. CT staging of chyluria provides additional information that can be used to guide therapeutic management.

  3. Idiopathic hypersomnia.

    PubMed

    Billiard, Michel; Sonka, Karel

    2016-10-01

    Idiopathic hypersomnia continues to evolve from the concept of "sleep drunkenness" introduced by Bedrich Roth in Prague in 1956 and the description of idiopathic hypersomnia with two forms, polysymptomatic and monosymptomatic, by the same Bedrich Roth in 1976. The diagnostic criteria of idiopathic hypersomnia have varied with the successive revisions of the International classifications of sleep disorders, including the recent 3rd edition. No epidemiological studies have been conducted so far. Disease onset occurs most often during adolescence or young adulthood. A familial background is often present but rigorous studies are still lacking. The key manifestation is hypersomnolence. It is often accompanied by sleep of long duration and debilitating sleep inertia. Polysomnography (PSG) followed by a multiple sleep latency test (MSLT) is mandatory, as well as a 24 h PSG or a 2-wk actigraphy in association with a sleep log to ensure a total 24-h sleep time longer than or equal to 66O minutes, when the mean sleep latency on the MSLT is longer than 8 min. Yet, MSLT is neither sensitive nor specific and the polysomnographic diagnostic criteria require continuous readjustment and biologic markers are still lacking. Idiopathic hypersomnia is most often a chronic condition though spontaneous remission may occur. The condition is disabling, sometimes even more so than narcolepsy type 1 or 2. Based on neurochemical, genetic and immunological analyses as well as on exploration of the homeostatic and circadian processes of sleep, various pathophysiological hypotheses have been proposed. Differential diagnosis involves a number of diseases and it is not yet clear whether idiopathic hypersomnia and narcolepsy type 2 are not the same condition. Until now, the treatment of idiopathic hypersomnia has mirrored that of the sleepiness of narcolepsy type 1 or 2. The first randomized, double-blind, placebo-controlled trials of modafinil have just been published, as well as a double

  4. Bmi1 limits dilated cardiomyopathy and heart failure by inhibiting cardiac senescence

    PubMed Central

    Gonzalez-Valdes, I.; Hidalgo, I.; Bujarrabal, A.; Lara-Pezzi, E.; Padron-Barthe, L.; Garcia-Pavia, P.; Gómez-del Arco, Pablo; Redondo, J.M.; Ruiz-Cabello, J.M.; Jimenez-Borreguero, L.J.; Enriquez, J.A.; de la Pompa, J.L.; Hidalgo, A.; Gonzalez, S.

    2015-01-01

    Dilated cardiomyopathy (DCM) is the most frequent cause of heart failure and the leading indication for heart transplantation. Here we show that epigenetic regulator and central transcriptional instructor in adult stem cells, Bmi1, protects against DCM by repressing cardiac senescence. Cardiac-specific Bmi1 deletion induces the development of DCM, which progresses to lung congestion and heart failure. In contrast, Bmi1 overexpression in the heart protects from hypertrophic stimuli. Transcriptome analysis of mouse and human DCM samples indicates that p16INK4a derepression, accompanied by a senescence-associated secretory phenotype (SASP), is linked to severely impaired ventricular dimensions and contractility. Genetic reduction of p16INK4a levels reverses the pathology of Bmi1-deficient hearts. In parabiosis assays, the paracrine senescence response underlying the DCM phenotype does not transmit to healthy mice. As senescence is implicated in tissue repair and the loss of regenerative potential in aging tissues, these findings suggest a source for cardiac rejuvenation. PMID:25751743

  5. 2012 urban congestion trends, operations : the key to reliable travel.

    DOT National Transportation Integrated Search

    2013-04-01

    Congestion levels remained relatively unchanged : from 2011 to 2012 in the 19 urban areas in the United States monitored : in this report. : Congestion levels across all of the congestion measures are still generally : below the levels experienced in...

  6. Idiopathic (primary) achalasia

    PubMed Central

    Farrokhi, Farnoosh; Vaezi, Michael F

    2007-01-01

    Idiopathic achalasia is a primary esophageal motor disorder characterized by esophageal aperistalsis and abnormal lower esophageal sphincter (LES) relaxation in response to deglutition. It is a rare disease with an annual incidence of approximately 1/100,000 and a prevalence rate of 1/10,000. The disease can occur at any age, with a similar rate in men and women, but is usually diagnosed between 25 and 60 years. It is characterized predominantly by dysphagia to solids and liquids, bland regurgitation, and chest pain. Weight loss (usually between 5 to 10 kg) is present in most but not in all patients. Heartburn occurs in 27%–42% of achalasia patients. Etiology is unknown. Some familial cases have been reported, but the rarity of familial occurrence does not support the hypothesis that genetic inheritance is a significant etiologic factor. Association of achalasia with viral infections and auto-antibodies against myenteric plexus has been reported, but the causal relationship remains unclear. The diagnosis is based on history of the disease, radiography (barium esophagogram), and esophageal motility testing (esophageal manometry). Endoscopic examination is important to rule out malignancy as the cause of achalasia. Treatment is strictly palliative. Current medical and surgical therapeutic options (pneumatic dilation, surgical myotomy, and pharmacologic agents) aimed at reducing the LES pressure and facilitating esophageal emptying by gravity and hydrostatic pressure of retained food and liquids. Although it cannot be permanently cured, excellent palliation is available in over 90% of patients. PMID:17894899

  7. Dilatational band formation in bone

    PubMed Central

    Poundarik, Atharva A.; Diab, Tamim; Sroga, Grazyna E.; Ural, Ani; Boskey, Adele L.; Gundberg, Caren M.; Vashishth, Deepak

    2012-01-01

    Toughening in hierarchically structured materials like bone arises from the arrangement of constituent material elements and their interactions. Unlike microcracking, which entails micrometer-level separation, there is no known evidence of fracture at the level of bone’s nanostructure. Here, we show that the initiation of fracture occurs in bone at the nanometer scale by dilatational bands. Through fatigue and indentation tests and laser confocal, scanning electron, and atomic force microscopies on human and bovine bone specimens, we established that dilatational bands of the order of 100 nm form as ellipsoidal voids in between fused mineral aggregates and two adjacent proteins, osteocalcin (OC) and osteopontin (OPN). Laser microdissection and ELISA of bone microdamage support our claim that OC and OPN colocalize with dilatational bands. Fracture tests on bones from OC and/or OPN knockout mice (OC−/−, OPN−/−, OC-OPN−/−;−/−) confirm that these two proteins regulate dilatational band formation and bone matrix toughness. On the basis of these observations, we propose molecular deformation and fracture mechanics models, illustrating the role of OC and OPN in dilatational band formation, and predict that the nanometer scale of tissue organization, associated with dilatational bands, affects fracture at higher scales and determines fracture toughness of bone. PMID:23129653

  8. Diagnostic strategies in nasal congestion

    PubMed Central

    Krouse, John; Lund, Valerie; Fokkens, Wytske; Meltzer, Eli O

    2010-01-01

    Nasal congestion is a major symptom of upper respiratory tract disorders, and its characterization an important part of the diagnosis of these illnesses. Patient history and assessment of nasal symptoms are essential components of diagnosis, providing an initial evaluation that may be adequate to rule out serious conditions. However, current congestion medications are not always fully effective. Thus, if symptoms do not respond adequately to therapy, or symptoms suggestive of more serious conditions are present, specialized assessments may be needed. Various techniques are available for diagnosing patients, including those used chiefly by primary care clinicians and those requiring the expertise of otolaryngologists, allergists, and other specialists. Endoscopy remains a mainstay for evaluating nasal blockage and its causes, while modalities such as peak nasal inspiratory flow and acoustic rhinometry are evolving to provide easy-to-use, noninvasive procedures that are sensitive enough to measure small but clinically important abnormalities and therapeutic changes. Several imaging modalities are available to the specialist for severe or unusual cases, as are specialized diagnostic procedures that measure adjunctive features of congestion, such as impaired mucociliary function. PMID:20463824

  9. Auctionable fixed transmission rights for congestion management

    NASA Astrophysics Data System (ADS)

    Alomoush, Muwaffaq Irsheid

    Electric power deregulation has proposed a major change to the regulated utility monopoly. The change manifests the main part of engineers' efforts to reshape three components of today's regulated monopoly: generation, distribution and transmission. In this open access deregulated power market, transmission network plays a major role, and transmission congestion is a major problem that requires further consideration especially when inter-zonal/intra-zonal scheme is implemented. Declaring that engineering studies and experience are the criteria to define zonal boundaries or defining a zone based on the fact that a zone is a densely interconnected area (lake) and paths connecting these densely interconnected areas are inter-zonal lines will render insufficient and fuzzy definitions. Moreover, a congestion problem formulation should take into consideration interactions between intra-zonal and inter-zonal flows and their effects on power systems. In this thesis, we introduce a procedure for minimizing the number of adjustments of preferred schedules to alleviate congestion and apply control schemes to minimize interactions between zones. In addition, we give the zone definition a certain criterion based on the Locational Marginal Price (LMP). This concept will be used to define congestion zonal boundaries and to decide whether any zone should be merged with another zone or split into new zones. The thesis presents a unified scheme that combines zonal and FTR schemes to manage congestion. This combined scheme is utilized with LMPs to define zonal boundaries more appropriately. The presented scheme gains the best features of the FTR scheme, which are providing financial certainty, maximizing the efficient use of the system and making users pay for the actual use of congested paths. LMPs may give an indication of the impact of wheeling transactions, and calculations of and comparisons of LMPs with and without wheeling transactions should be adequate criteria to approve

  10. 23 CFR 971.214 - Federal lands congestion management system (CMS).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... congestion management strategies; (v) Determine methods to monitor and evaluate the performance of the multi... Federal lands congestion management system (CMS). (a) For purposes of this section, congestion means the... for the transportation systems providing access to and within National Forests, as appropriate, that...

  11. 23 CFR 970.214 - Federal lands congestion management system (CMS).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Federal lands congestion management system (CMS). 970... LANDS HIGHWAYS NATIONAL PARK SERVICE MANAGEMENT SYSTEMS National Park Service Management Systems § 970.214 Federal lands congestion management system (CMS). (a) For purposes of this section, congestion...

  12. Molecular screening by polymerase chain reaction detects panleukopenia virus DNA in formalin-fixed hearts from cats with idiopathic cardiomyopathy and myocarditis.

    PubMed

    Meurs, K M; Fox, P R; Magnon, A L; Liu, S; Towbin, J A

    2000-01-01

    Viral myocarditis has been suggested as an etiology for cardiomyopathy in several mammalian species. Myocarditis and idiopathic cardiomyopathy have been reported in the domestic cat, although a viral etiology has not been demonstrated. Because of the continuing interest in the potential relationship between viral myocarditis and cardiomyopathy, we evaluated hearts from cats with spontaneous, idiopathic cardiomyopathy for viral genomic material within myocytes by polymerase chain reaction, and for the presence of myocarditis by light microscopy. Thirty-one (31) formalin-fixed hearts from domestic cats who died of idiopathic cardiomyopathy were randomly selected from pathology archives. Seventeen (17) formalin-fixed hearts from healthy cats were similarly selected as normal controls. The polymerase chain reaction (PCR) was used to evaluate myocardial tissue for the presence of viral genome from feline panleukopenia virus, herpes virus, calici virus, and corona virus. Hearts were examined using light microscopy for histologic evidence of myocarditis according to the Dallas criteria. Panleukopenia virus was identified by PCR in 10 of 31 cats with cardiomyopathy but in none of the controls. Neither cardiomyopathic or control cats tested positive by PCR for herpes virus, calici virus, and corona virus. Myocarditis was detected by histologic examination in 18 of 31 cardiomyopathic cats and in none of 17 control cats. Myocarditis and or feline panleukopenia virus genome was detected in felines with idiopathic hypertrophic, dilated, and restrictive cardiomyopathy, suggesting a possible role of viral infection and inflammation in the pathogenesis of cardiomyopathy in this species.

  13. Air quality assessment at a congested urban intersection

    DOT National Transportation Integrated Search

    2000-09-01

    The deficient transportation system of Beirut results in significant economic losses for the city and causes severe traffic congestion in the urban areas. Proposals have been made for grade separations at some of the worst congested intersections. Th...

  14. Impact of congestion on bus operations and costs.

    DOT National Transportation Integrated Search

    2003-10-01

    Traffic congestion in Northern New Jersey imposes substantial operational and monetary penalty on bus service. The purpose of this project was to quantify the additional time and costs due to traffic congestion. A regression model was developed that ...

  15. The economic cost of traffic congestion in Florida.

    DOT National Transportation Integrated Search

    2010-08-01

    Traffic congestion in the U.S. is bad and getting worse, and it is expensive. Appropriate solutions to this problem require appropriate information. A comprehensive and accurate analysis of congestion costs is a critical tool for planning and impleme...

  16. Diagnosis and management of nasal congestion: the role of intranasal corticosteroids.

    PubMed

    Benninger, Michael

    2009-01-01

    Nasal congestion is considered the most bothersome of allergic rhinitis (AR) symptoms and can significantly impair ability to function at work, home, and school. Effective management of AR-related nasal congestion depends on accurate diagnosis and appropriate treatment. Many individuals with AR and AR-related congestion remain undiagnosed and do not receive prescription medication. However, new tools intended to improve the diagnosis of nasal congestion have been developed and validated. Intranasal corticosteroids (INSs) are recommended as first-line therapy for patients with moderate-to-severe AR and also when nasal congestion is a prominent symptom. Double blind, randomized clinical trials have demonstrated greater efficacy of INSs versus placebo, antihistamines, or montelukast for relief of all nasal symptoms, especially congestion. Patient adherence to treatment also affects outcomes, and this may be influenced by patient preferences for the sensory attributes of an individual drug. Increased awareness of the effects of AR-related nasal congestion, the efficacy and safety of available pharmacotherapies, and barriers to adherence may improve clinical outcomes.

  17. Development of congestion performance measures using ITS information.

    DOT National Transportation Integrated Search

    2003-01-01

    The objectives of this study were to define a performance measure(s) that could be used to show congestion levels on critical corridors throughout Virginia and to develop a method to select and calculate performance measures to quantify congestion in...

  18. Congestion road tax and physical activity.

    PubMed

    Bergman, Patrick; Grjibovski, Andrej M; Hagströmer, Maria; Patterson, Emma; Sjöström, Michael

    2010-02-01

    Large-scale policy and environmental changes, such as congestion road taxes, may be a way to promote active transportation. This study aimed to examine the potential effect of a congestion road tax on physical activity. Baseline data were collected during October-November 2003, follow-up data in May 2006, and analysis was performed in September 2008. The short self-administered version of the International Physical Activity Questionnaire was used to assess physical activity. Data from those with access to motorized vehicles in the Stockholm region (n=165), where the tax was in place, were compared with those from the Göteborg/Malmö regions (n=138). Within each region before and during the road tax implementation, the data were analyzed for differences in time spent at different intensity levels of physical activity, in addition to sitting, as well as for changes in reported time in overall (weighted) physical activity. There were no significant differences in the magnitude of the changes of the intensity levels of physical activity, weighted overall physical activity, or sitting, between Stockholm and Göteborg/Malmö. Among those exposed to the congestion road tax and with access to motorized vehicles, an increase in moderate physical activity (p=0.036); overall physical activity (p=0.015); and a reduction in time spent sitting (p=0.009) was observed. No differences were observed among those unexposed. The results from this study on the influence of a congestion road tax on levels of physical activity, though inconclusive, suggest that policy changes such as a congestion road tax might promote improvements in physical activity levels in individuals with motorized vehicles. Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Analysis of random drop for gateway congestion control. M.S. Thesis

    NASA Technical Reports Server (NTRS)

    Hashem, Emam Salaheddin

    1989-01-01

    Lately, the growing demand on the Internet has prompted the need for more effective congestion control policies. Currently No Gateway Policy is used to relieve and signal congestion, which leads to unfair service to the individual users and a degradation of overall network performance. Network simulation was used to illustrate the character of Internet congestion and its causes. A newly proposed gateway congestion control policy, called Random Drop, was considered as a promising solution to the pressing problem. Random Drop relieves resource congestion upon buffer overflow by choosing a random packet from the service queue to be dropped. The random choice should result in a drop distribution proportional to the bandwidth distribution among all contending TCP connections, thus applying the necessary fairness. Nonetheless, the simulation experiments demonstrate several shortcomings with this policy. Because Random Drop is a congestion control policy, which is not applied until congestion has already occurred, it usually results in a high drop rate that hurts too many connections including well-behaved ones. Even though the number of packets dropped is different from one connection to another depending on the buffer utilization upon overflow, the TCP recovery overhead is high enough to neutralize these differences, causing unfair congestion penalties. Besides, the drop distribution itself is an inaccurate representation of the average bandwidth distribution, missing much important information about the bandwidth utilization between buffer overflow events. A modification of Random Drop to do congestion avoidance by applying the policy early was also proposed. Early Random Drop has the advantage of avoiding the high drop rate of buffer overflow. The early application of the policy removes the pressure of congestion relief and allows more accurate signaling of congestion. To be used effectively, algorithms for the dynamic adjustment of the parameters of Early Random Drop

  20. Idiopathic Inflammatory Myopathies

    PubMed Central

    Dimachkie, Mazen M.; Barohn, Richard J.

    2012-01-01

    The idiopathic inflammatory myopathies are a group of rare disorders including polymyositis (PM), dermatomyositis (DM), and autoimmune necrotizing myopathies (NMs). The idiopathic inflammatory myopathies share many similarities. They present acutely, subacutely, or chronically with marked proximal and symmetric muscle weakness, except for associated distal and asymmetric weakness in inclusion body myositis. The idiopathic inflammatory myopathies also share a variable degree of creatine kinase (CK) elevation and a nonspecifically abnormal electromyogram demonstrating an irritative myopathy. The muscle pathology demonstrates inflammatory exudates of variable distribution within the muscle fascicle. Despite these similarities, the idiopathic inflammatory myopathies are a heterogeneous group. The overlap syndrome (OS) refers to the association of PM, DM, or NM with connective tissue disease, such as scleroderma or systemic lupus erythematosus. In addition to elevated antinuclear antibodies (ANA), patients with OS may be weaker in the proximal arms than the legs mimicking the pattern seen in some muscular dystrophies. In this review, we focus on DM, PM, and NM and examine current and promising therapies. PMID:23117947

  1. Histopathology of balloon-dilation Eustachian tuboplasty.

    PubMed

    Kivekäs, Ilkka; Chao, Wei-Chieh; Faquin, William; Hollowell, Monica; Silvola, Juha; Rasooly, Tali; Poe, Dennis

    2015-02-01

    Surgical intervention of the Eustachian tube (ET) has become increasingly common in the past decade, and balloon dilation has shown promising results in recent studies. It is unclear how balloon dilation enhances ET function. Our aim was to evaluate histological changes in the ET's mucosal lumen comparing before balloon dilation, immediately after, and postoperatively. Case series. Thirteen patients with bilateral ET dysfunction were enrolled. Biopsies of the ET mucosa were obtained just before balloon dilation; immediately after; and in three cases, 5 to 12 weeks postoperatively. Specimens were retrospectively examined under light microscopy by two pathologists blinded to the clinical information and whether specimens were pre- or postballoon dilation. Preoperative biopsies were characterized by inflammatory changes within the epithelium and submucosal layer. Immediate response to balloon dilation was thinning of the mucosa, shearing of epithelium and crush injury to the submucosa, especially to lymphocytic infiltrates. Postoperative biopsies demonstrated healthy pseudocolumnar epithelium and replacement of lymphocytic infiltrate with a thinner layer of fibrous tissue. Reduction of inflammatory epithelial changes and submucosal inflammatory infiltrate appeared to be the principal result of balloon dilation. The balloon may shear or crush portions of inflamed epithelium but usually spared the basal layer, allowing for rapid healing. Additionally, it appeared to effectively crush lymphocytes and lymphocytic follicles that may become replaced with thinner fibrous scar. Histopathology of the ET undergoing balloon dilation demonstrated effects that could reduce the overall inflammatory burden and may contribute to clinical improvement in ET function. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  2. Botulinum toxin, a new treatment modality for chronic idiopathic constipation in children: long-term follow-up of a double-blind randomized trial.

    PubMed

    Keshtgar, Alireza S; Ward, Harry C; Sanei, Ahmad; Clayden, Graham S

    2007-04-01

    Myectomy of the internal anal sphincter (IAS) has been performed on some children after failure of medical treatment to treat idiopathic constipation. The aim of this study was to compare botulinum toxin injection with myectomy of the IAS in the treatment of chronic idiopathic constipation and soiling in children. This was a double-blind randomized trial. Patients between 4 and 16 years old were included in the study if they had failed to respond to laxative treatment and anal dilatation for chronic idiopathic constipation. All study patients had anorectal manometry and anal endosonography under ketamine anesthesia. Outcome was measured using a validated symptom severity (SS) scoring system, with scores ranging from 0 to 65. Of 42 children, 21 were randomized to the botulinum group and 21 were randomized to the myectomy group. At the 3-month follow-up, the median preoperative SS score improved from 34 (range = 19-47) to 20 (range = 2-43) in the botulinum group (P < .001) and from 31 (range = 18-49) to 19 (range = 3-47) in the myectomy group (P < .002). At the 12-month follow-up, the scores were 19 (range = 0-45) and 14.5 (range = 0-41) for the botulinum group and the myectomy group, respectively (P < .0001). There was no complication in both groups. Botulinum toxin is equally effective as and less invasive than myectomy of the IAS for chronic idiopathic constipation and fecal incontinence in children.

  3. Genetics Home Reference: X-linked dilated cardiomyopathy

    MedlinePlus

    ... Twitter Home Health Conditions X-linked dilated cardiomyopathy X-linked dilated cardiomyopathy Printable PDF Open All Close ... Javascript to view the expand/collapse boxes. Description X-linked dilated cardiomyopathy is a form of heart ...

  4. A Bayesian ridge regression analysis of congestion's impact on urban expressway safety.

    PubMed

    Shi, Qi; Abdel-Aty, Mohamed; Lee, Jaeyoung

    2016-03-01

    With the rapid growth of traffic in urban areas, concerns about congestion and traffic safety have been heightened. This study leveraged both Automatic Vehicle Identification (AVI) system and Microwave Vehicle Detection System (MVDS) installed on an expressway in Central Florida to explore how congestion impacts the crash occurrence in urban areas. Multiple congestion measures from the two systems were developed. To ensure more precise estimates of the congestion's effects, the traffic data were aggregated into peak and non-peak hours. Multicollinearity among traffic parameters was examined. The results showed the presence of multicollinearity especially during peak hours. As a response, ridge regression was introduced to cope with this issue. Poisson models with uncorrelated random effects, correlated random effects, and both correlated random effects and random parameters were constructed within the Bayesian framework. It was proven that correlated random effects could significantly enhance model performance. The random parameters model has similar goodness-of-fit compared with the model with only correlated random effects. However, by accounting for the unobserved heterogeneity, more variables were found to be significantly related to crash frequency. The models indicated that congestion increased crash frequency during peak hours while during non-peak hours it was not a major crash contributing factor. Using the random parameter model, the three congestion measures were compared. It was found that all congestion indicators had similar effects while Congestion Index (CI) derived from MVDS data was a better congestion indicator for safety analysis. Also, analyses showed that the segments with higher congestion intensity could not only increase property damage only (PDO) crashes, but also more severe crashes. In addition, the issues regarding the necessity to incorporate specific congestion indicator for congestion's effects on safety and to take care of the

  5. Congestion information surveillance system

    DOT National Transportation Integrated Search

    1992-10-14

    This document advances a proposal to implement a Congestion Information Surveillance System (CISS)for the Albuquerque metropolitan area. The CISS will offer agencies in the region responsible for transportation and air quality management a new capabi...

  6. Fixed-rate layered multicast congestion control

    NASA Astrophysics Data System (ADS)

    Bing, Zhang; Bing, Yuan; Zengji, Liu

    2006-10-01

    A new fixed-rate layered multicast congestion control algorithm called FLMCC is proposed. The sender of a multicast session transmits data packets at a fixed rate on each layer, while receivers each obtain different throughput by cumulatively subscribing to deferent number of layers based on their expected rates. In order to provide TCP-friendliness and estimate the expected rate accurately, a window-based mechanism implemented at receivers is presented. To achieve this, each receiver maintains a congestion window, adjusts it based on the GAIMD algorithm, and from the congestion window an expected rate is calculated. To measure RTT, a new method is presented which combines an accurate measurement with a rough estimation. A feedback suppression based on a random timer mechanism is given to avoid feedback implosion in the accurate measurement. The protocol is simple in its implementation. Simulations indicate that FLMCC shows good TCP-friendliness, responsiveness as well as intra-protocol fairness, and provides high link utilization.

  7. Phase diagram of congested traffic flow: An empirical study

    PubMed

    Lee; Lee; Kim

    2000-10-01

    We analyze traffic data from a highway section containing one effective on-ramp. Based on two criteria, local velocity variation patterns and expansion (or nonexpansion) of congested regions, three distinct congested traffic states are identified. These states appear at different levels of the upstream flux and the on-ramp flux, thereby generating a phase digram of the congested traffic flow. Observed traffic states are compared with recent theoretical analyses and both agreeing and disagreeing features are found.

  8. Post-earthquake dilatancy recovery

    NASA Technical Reports Server (NTRS)

    Scholz, C. H.

    1974-01-01

    Geodetic measurements of the 1964 Niigata, Japan earthquake and of three other examples are briefly examined. They show exponentially decaying subsidence for a year after the quakes. The observations confirm the dilatancy-fluid diffusion model of earthquake precursors and clarify the extent and properties of the dilatant zone. An analysis using one-dimensional consolidation theory is included which agrees well with this interpretation.

  9. Mobility and the costs of congestion in New Jersey : 2001 update

    DOT National Transportation Integrated Search

    2001-07-01

    The objective of the Mobility and the Costs of Congestion study is to measure quantifiable and qualitative impacts of roadway congestion in New Jersey. The study addresses the impacts of congestion on an average traveler or affected person, as well a...

  10. Coding Sequence Mutations Identified in MYH7, TNNT2, SCN5A, CSRP3, LBD3, and TCAP from 313 Patients with Familial or Idiopathic Dilated Cardiomyopathy

    PubMed Central

    Hershberger, Ray E.; Parks, Sharie B.; Kushner, Jessica D.; Li, Duanxiang; Ludwigsen, Susan; Jakobs, Petra; Nauman, Deirdre; Burgess, Donna; Partain, Julie; Litt, Michael

    2008-01-01

    Abstract Background: More than 20 genes have been reported to cause idiopathic and familial dilated cardiomyopathy (IDC/FDC), but the frequency of genetic causation remains poorly understood. Methods and Results: Blood samples were collected and DNA prepared from 313 patients, 183 with FDC and 130 with IDC. Genomic DNA underwent bidirectional sequencing of six genes, and mutation carriers were followed up by evaluation of additional family members. We identified in 36 probands, 31 unique protein‐altering variants (11.5% overall) that were not identified in 253 control subjects (506 chromosomes). These included 13 probands (4.2%) with 12 β‐myosin heavy chain (MYH7) mutations, nine probands (2.9%) with six different cardiac troponin T (TNNT2) mutations, eight probands (2.6%) carrying seven different cardiac sodium channel (SCN5A) mutations, three probands (1.0%) with three titin‐cap or telethonin (TCAP) mutations, three probands (1.0%) with two LIM domain binding 3 (LDB3) mutations, and one proband (0.3%) with a muscle LIM protein (CSRP3) mutation. Four nucleotide changes did not segregate with phentoype and/or did not alter a conserved amino acid and were therefore considered unlikely to be disease‐causing. Mutations in 11 probands were assessed as likely disease‐causing, and in 21 probands were considered possibly disease‐causing. These 32 probands included 14 of the 130 with IDC (10.8%) and 18 of the 183 with FDC (9.8%) Conclusions: Mutations of these six genes each account for a small fraction of the genetic cause of FDC/IDC. The frequency of possible or likely disease‐causing mutations in these genes is similar for IDC and FDC. PMID:19412328

  11. Snoring and Nasal Congestion

    MedlinePlus

    ... treat the various causes of nasal congestion include: Topical nasal steroid spray Topical nasal antihistamine spray Oral antibiotic (in case of ... include more than just the decrease in oxygen levels at night during the apnea episodes. They also ...

  12. Pneumomediastinum after self-dilation of the esophagus.

    PubMed

    Noppen, M M; Corne, L; Peters, O; Smekens, L; Musch, W; Vincken, W

    1987-10-01

    Pneumomediastinum following esophageal perforation is a known complication of Eder Puestow dilation for esophageal stenosis. This is the first reported case of esophageal perforation and pneumomediastinum occurring after instrumental self-dilation of a stenotic esophageal lesion. The observed 0.02 percent perforation rate in this patient (compared to the reported 0.3 percent in Eder Puestow "hetero"-dilation) makes the Eder Puestow auto-dilation procedure seem justifiable in a well-trained and well-informed patient.

  13. Statewide GIS mapping of recurring congestion corridors : final report.

    DOT National Transportation Integrated Search

    2009-07-01

    Recurring congestion occurs when travel demand reaches or exceeds the available roadway : capacity. This project developed an interactive geographic information system (GIS) map of the : recurring congestion corridors (labeled herein as hotspots) in ...

  14. Interaction between worsening renal function and persistent congestion in acute decompensated heart failure.

    PubMed

    Wattad, Malak; Darawsha, Wisam; Solomonica, Amir; Hijazi, Maher; Kaplan, Marielle; Makhoul, Badira F; Abassi, Zaid A; Azzam, Zaher S; Aronson, Doron

    2015-04-01

    Worsening renal function (WRF) and congestion are inextricably related pathophysiologically, suggesting that WRF occurring in conjunction with persistent congestion would be associated with worse clinical outcome. We studied the interdependence between WRF and persistent congestion in 762 patients with acute decompensated heart failure (HF). WRF was defined as ≥0.3 mg/dl increase in serum creatinine above baseline at any time during hospitalization and persistent congestion as ≥1 sign of congestion at discharge. The primary end point was all-cause mortality with mean follow-up of 15 ± 9 months. Readmission for HF was a secondary end point. Persistent congestion was more common in patients with WRF than in patients with stable renal function (51.0% vs 26.6%, p <0.0001). Both persistent congestion and persistent WRF were significantly associated with mortality (both p <0.0001). There was a strong interaction (p = 0.003) between persistent WRF and congestion, such that the increased risk for mortality occurred predominantly with both WRF and persistent congestion. The adjusted hazard ratio for mortality in patients with persistent congestion as compared with those without was 4.16 (95% confidence interval [CI] 2.20 to 7.86) in patients with WRF and 1.50 (95% CI 1.16 to 1.93) in patients without WRF. In conclusion, persisted congestion is frequently associated with WRF. We have identified a substantial interaction between persistent congestion and WRF such that congestion portends increased mortality particularly when associated with WRF. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Comparison of monocyte gene expression among patients with neurocysticercosis-associated epilepsy, Idiopathic Epilepsy and idiopathic headaches in India.

    PubMed

    Prabhakaran, Vasudevan; Drevets, Douglas A; Ramajayam, Govindan; Manoj, Josephine J; Anderson, Michael P; Hanas, Jay S; Rajshekhar, Vedantam; Oommen, Anna; Carabin, Hélène

    2017-06-01

    Neurocysticercosis (NCC), a neglected tropical disease, inflicts substantial health and economic costs on people living in endemic areas such as India. Nevertheless, accurate diagnosis using brain imaging remains poorly accessible and too costly in endemic countries. The goal of this study was to test if blood monocyte gene expression could distinguish patients with NCC-associated epilepsy, from NCC-negative imaging lesion-free patients presenting with idiopathic epilepsy or idiopathic headaches. Patients aged 18 to 51 were recruited from the Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India, between January 2013 and October 2014. mRNA from CD14+ blood monocytes was isolated from 76 patients with NCC, 10 Recovered NCC (RNCC), 29 idiopathic epilepsy and 17 idiopathic headaches patients. A preliminary microarray analysis was performed on six NCC, six idiopathic epilepsy and four idiopathic headaches patients to identify genes differentially expressed in NCC-associated epilepsy compared with other groups. This analysis identified 1411 upregulated and 733 downregulated genes in patients with NCC compared to Idiopathic Epilepsy. Fifteen genes up-regulated in NCC patients compared with other groups were selected based on possible relevance to NCC, and analyzed by qPCR in all patients' samples. Differential gene expression among patients was assessed using linear regression models. qPCR analysis of 15 selected genes showed generally higher gene expression among NCC patients, followed by RNCC, idiopathic headaches and Idiopathic Epilepsy. Gene expression was also generally higher among NCC patients with single cyst granulomas, followed by mixed lesions and single calcifications. Expression of certain genes in blood monocytes can distinguish patients with NCC-related epilepsy from patients with active Idiopathic Epilepsy and idiopathic headaches. These findings are significant because they may lead to the development of new tools to

  16. Determining queue and congestion in highway work zone bottlenecks.

    DOT National Transportation Integrated Search

    2011-03-11

    Construction zones, though required for infrastructure maintenance, have become congestion choke points on most highway systems in the US. The congestion may create potentially unsafe driving conditions for approaching motorists that do not expect qu...

  17. Determining Queue and Congestion in Highway Work Zone Bottlenecks

    DOT National Transportation Integrated Search

    2011-03-11

    Construction zones, though required for infrastructure maintenance, have become congestion choke points on most highway systems in the US. The congestion may create potentially unsafe driving conditions for approaching motorists that do not expect qu...

  18. 99 mTc-MIBI washout as a complementary factor in the evaluation of idiopathic dilated cardiomyopathy (IDCM) using myocardial perfusion imaging.

    PubMed

    Shiroodi, Mohammad Kazem; Shafiei, Babak; Baharfard, Nastaran; Gheidari, Mohammad Esmail; Nazari, Babak; Pirayesh, Elaheh; Kiasat, Ali; Hoseinzadeh, Samaneh; Hashemi, Abolghassem; Akbarzadeh, Mohammad Ali; Javadi, Hamid; Nabipour, Iraj; Assadi, Majid

    2012-01-01

    Rapid technetium-99 m methoxyisobutylisonitrile (99 mTc-MIBI) washout has been shown to occur in impaired myocardia. This study is based on the hypothesis that scintigraphy can be applied to calculate the myocardial 99 mTc-MIBI washout rate (WR) to diagnose and evaluate heart failure severity and other left ventricular functional parameters specifically in idiopathic dilated cardiomyopathy (IDCM) patients. Patients with IDCMP (n = 17; 52.65 ± 11.47 years) and normal subjects (n = 6; 49.67 ± 10.15 years) were intravenously administered 99 mTc-hexakis-2-methoxyisobutylisonitrile (99 mTc-MIBI). Next, early and delayed planar data were acquired (at 3.5-h intervals), and electrocardiogram (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT) was performed. The 99 mTc-MIBI WR was calculated using early and delayed planar images. Left ventricular functional parameters were also analyzed using quantitative gated SPECT (QGS) data. In target group, myocardial WRs (29.13 ± 6.68%) were significantly higher than those of control subjects (14.17 ± 3.31%; P < 0.001). The 99 mTc-MIBI WR increased with the increasing severity of the NYHA functional class (23.16 ± 1.72% for class I, 30.25 ± 0.95% for class II, 32.60 ± 6.73% for class III, and 37.50 ± 7.77% for class IV; P = 0.02). The WR was positively correlated with the end-diastolic volume (EDV) index (r (2) = 0.216; β = 0.464; P = 0.02 [ml/m(2)], the end-systolic volume (ESV) index (r (2) = 0.234; β = 0.484; P = 0.01 [ml/m(2)]), the summed motion score (SMS) (r (2) = 0.544; β = 0.738; P = 0.00), and the summed thickening score (STS) (r (2) = 0.656; β = 0.810; P = 0.00); it was negatively correlated with the left ventricular ejection fraction (LVEF) (r (2) = 0.679; β = -0.824; P = 0.00). It can be concluded that 99 mTc-MIBI scintigraphy might be a valuable molecular imaging tool for the diagnosis and evaluation of myocardial damage or dysfunction severity.

  19. Local empathy provides global minimization of congestion in communication networks

    NASA Astrophysics Data System (ADS)

    Meloni, Sandro; Gómez-Gardeñes, Jesús

    2010-11-01

    We present a mechanism to avoid congestion in complex networks based on a local knowledge of traffic conditions and the ability of routers to self-coordinate their dynamical behavior. In particular, routers make use of local information about traffic conditions to either reject or accept information packets from their neighbors. We show that when nodes are only aware of their own congestion state they self-organize into a hierarchical configuration that delays remarkably the onset of congestion although leading to a sharp first-order-like congestion transition. We also consider the case when nodes are aware of the congestion state of their neighbors. In this case, we show that empathy between nodes is strongly beneficial to the overall performance of the system and it is possible to achieve larger values for the critical load together with a smooth, second-order-like, transition. Finally, we show how local empathy minimize the impact of congestion as much as global minimization. Therefore, here we present an outstanding example of how local dynamical rules can optimize the system’s functioning up to the levels reached using global knowledge.

  20. A toolbox for alleviating traffic congestion and enhancing mobility

    DOT National Transportation Integrated Search

    2012-06-01

    This report presents the Tolling Data Test Plan for the national evaluation of the Los Angeles (LA) Congestion Reduction Demonstration (Metro ExpressLanes) under the United States Department of Transportation (U.S. DOT) Congestion Reduction Demonstra...

  1. 23 CFR 450.320 - Congestion management process in transportation management areas.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Congestion management process in transportation... Programming § 450.320 Congestion management process in transportation management areas. (a) The transportation planning process in a TMA shall address congestion management through a process that provides for safe and...

  2. 23 CFR 450.320 - Congestion management process in transportation management areas.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Congestion management process in transportation... Programming § 450.320 Congestion management process in transportation management areas. (a) The transportation planning process in a TMA shall address congestion management through a process that provides for safe and...

  3. 23 CFR 450.320 - Congestion management process in transportation management areas.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Congestion management process in transportation... Programming § 450.320 Congestion management process in transportation management areas. (a) The transportation planning process in a TMA shall address congestion management through a process that provides for safe and...

  4. Effect of androgen replacement therapy on atherosclerotic risk markers in young-to-middle-aged men with idiopathic hypogonadotropic hypogonadism.

    PubMed

    Doğan, Berçem Ayçiçek; Karakılıç, Ersen; Tuna, Mazhar Müslüm; Arduç, Ayşe; Berker, Dilek; Güler, Serdar

    2015-03-01

    Idiopathic hypogonadotropic hypogonadism is a rare disorder. This study evaluated the effect of androgen replacement therapy on atherosclerotic risk markers in young-to-middle-aged men with this disorder. Forty-three male patients aged 30 (range: 24-39 years) who were newly diagnosed with idiopathic hypogonadotropic hypogonadism and 20 age-, sex- and weight-matched controls (range: 26-39 years) were included in the study. Androgen replacement therapy was given according to the Algorithm of Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes (2010; Journal of Clinical Endocrinology and Metabolism, 95, 2536). The patients were assessed at a pretreatment visit and 3 and 6 months after the treatment. Inflammatory markers and lipid parameters were evaluated. Endothelial function was assessed with brachial flow-mediated dilation of a brachial artery and high-resolution ultrasonography of the carotid intima-media thickness. The carotid intima-media thickness (P < 0·001) was higher and the brachial flow-mediated diameter (P = 0·002) was lower in patients with idiopathic hypogonadotropic hypogonadism compared to the control subjects at the pretreatment visit. There was a negative correlation between the total testosterone level and carotid intima-media thickness (r = -0·556, P = <0·001). The carotid intima-media thickness and per cent flow-mediated diameter were significantly improved in the patient group 6 months after the androgen replacement therapy (P = 0·002 and 0·026, respectively). This study indicated that low total testosterone levels can be considered a significant marker of atherosclerosis in patients with idiopathic hypogonadotropic hypogonadism and that androgen replacement therapy significantly reduces atherosclerotic risk markers in these patients after 6 months. © 2014 John Wiley & Sons Ltd.

  5. Mobility and the Costs of Congestion in New Jersey

    DOT National Transportation Integrated Search

    2000-02-01

    This study measured quantifiable and qualitative impacts of congestion in New Jersey on mobility, the cost of transportation, and economic productivity. It addressed the impacts of congestion on both an individual level (impacts on an average travele...

  6. Curbing gridlock: Peak-period fees to relieve traffic congestion. Volume 2. Commissioned papers. Special report

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

    Not Available

    1994-01-01

    ;Contents: Volume 2: Commissioned Papers: Congestion Trends in Metropolitan Areas; Alternative Methods for Measuring Congestion Levels; Potential of Congestion Pricing in the Metropolitan Washington Region; Transportation Pricing and Travel Behavior; Peak Pricing Strategies in Transportation, Utilities, and Telecommunications: Lessons for Road Pricing; Cashing Out Employer-Paid Parking: A Precedent for Congestion Pricing; The New York Region: First in Tolls, Last in Road Pricing; Pricing Urban Roadways: Administrative and Institutional Issues; Equity and Fairness Considerations of Congestion Pricing; The Politics of Congestion Pricing; Institutional and Political Challenges in Implementing Congestion Pricing: Case Study of the San Francisco Bay Area; How Congestion Pricingmore » Came to Be Proposed in the San Diego Region: A Case History; Urban Transportation Congestion Pricing: Effects on Urban Form; Congestion Pricing and Motor Vehicle Emissions: An Initial Review; Private Toll Roads: Acceptability of Congestion Pricing in Southern California; Potential of Next-Generation Technology; Electronic Toll Collection Systems; and Impacts of Congestion Pricing on Transit and Carpool Demand and Supply.« less

  7. Dilated cardiomyopathy

    MedlinePlus

    ... other causes of dilated cardiomyopathy, including: Alcohol or cocaine abuse Diabetes, thyroid disease, or hepatitis Medicines that ... how much salt (sodium) you get in your diet. Most people who have heart failure need to ...

  8. An evaluation of congestion-reducing measures used in Virginia.

    DOT National Transportation Integrated Search

    1992-01-01

    Congestion on our nation's highways, especially in urban areas, is a serious problem that is growing steadily worse. In Virginia, it is estimated that 28 percent of the daily vehicle miles of travel (VMT) occurring during peak hour traffic is congest...

  9. Vaginal dilator therapy for women receiving pelvic radiotherapy.

    PubMed

    Miles, Tracie; Johnson, Nick

    2014-09-08

    Vaginal dilation therapy is advocated after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina), but can be uncomfortable and psychologically distressing. To assess the benefits and harms of different types of vaginal dilation methods offered to women treated by pelvic radiotherapy for cancer. Searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 5), MEDLINE (1950 to June week 2, 2013), EMBASE (1980 to 2013 week 24) and CINAHL (1982 to 2013). Comparative data of any type, which evaluated dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer. Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and therefore analysed no data. We identified no studies for inclusion in the original review or for this update. However, we felt that some studies that were excluded warranted discussion. These included one randomised trial (RCT), which showed no improvement in sexual scores associated with encouraging women to practise dilation therapy; a recent small RCT that did not show any advantage to dilation over vibration therapy during radiotherapy; two non-randomised comparative studies; and five correlation studies. One of these showed that objective measurements of vaginal elasticity and length were not linked to dilation during radiotherapy, but the study lacked power. One study showed that women who dilated tolerated a larger dilator, but the risk of objectivity and bias with historical controls was high. Another study showed that the vaginal measurements increased in length by a mean of 3 cm after dilation was introduced 6 to 10 weeks after radiotherapy, but there was no control group; another case series showed the opposite. Three recent studies showed less stenosis associated with prophylactic dilation after radiotherapy. One small case series suggested that dilation years after radiotherapy might restore the

  10. Oxymetazoline plus dexpanthenol in nasal congestion.

    PubMed

    Jagade, Mohan V; Langade, Deepak G; Pophale, Rupesh R; Prabhu, Arun

    2008-12-01

    To compare the efficacy and tolerability of Oxymetazoline 0.05 % plus Dexpanthanol 5% versus Xylometazoline 0.1 % nasal drops in patients with nasal congestion due to allergic rhinitis and following nasal surgery. An investigator-blind, randomized, controlled, phase IV clinical trial conducted in 100 patients with acute allergic rhinitis or patients post-nasal surgery. Patients received either Oxymetazoline 0.05% with Dexpanthanol 5% (OD) or Xylometazoline 0.1% (XO) nasal drops. Relief from nasal congestion was significantly better in the OD group then in the XO group (mean nasal scores 1.24 vs 1.86). Significantly more improvement in sneezing and decrease in nasal discharge was seen in the OD group than the XO group. Nasal irritation in the OD group was significantly less as compared to XO group (0.38 v/s 1.12 on second day and 0.10 vs 0.36 on the fourth day). The recovery time for OD group was 1.08 hours, which was significantly (46 min) lesser than that of the XO group. Rebound congestion was significantly less in OD as compared to XO group (6.25% vs 82.98%). 93.75% of the physicians in the OD group and 51.28% in XO group reported response to therapy as good to excellent. 95.83% patients in the OD group and only 52.91% patients in the XO group rated tolerability to therapy as good to excellent. Oxymetazoline and dexpanthenol combination has a better efficacy, shorter recovery time, causes lesser rebound congestion and has better tolerability than xylometazoline.

  11. Application of Electrocautery Needle Knife Combined with Balloon Dilatation versus Balloon Dilatation in the Treatment of Tracheal Fibrotic Scar Stenosis.

    PubMed

    Bo, Liyan; Li, Congcong; Chen, Min; Mu, Deguang; Jin, Faguang

    Electrocautery needle knives can largely reduce scar and granulation tissue hyperplasia and play an important role in treating patients with benign stricture. The aim of this retrospective study was to evaluate the efficacy and safety of electrocautery needle knife combined with balloon dilatation versus balloon dilatation alone in the treatment of tracheal stenosis caused by tracheal intubation or tracheotomy. We retrospectively analysed the clinical data of 43 patients with tracheal stenosis caused by tracheotomy or tracheal intubation in our department from January 2013 to January 2016. Among these 43 patients, 23 had simple web-like stenosis and 20 had complex steno sis. All patients were treated under general anaesthesia, and the treatment methods were (1) balloon dilatation alone, (2) needle knife excision of fibrotic tissue combined with balloon dilatation, and (3) needle knife radial incision of fibrotic tissue combined with balloon dilatation. After treatment the symptoms, such as shortness of breath, were markedly improved immediately in all cases. The stenosis degree of patients who were treated with the elec-trocautery needle knife combined with balloon dilatation had better improvement compared with that of those treated with balloon dilatation treatment alone after 3 months (0.45 ± 0.04 vs. 0.67 ± 0.05, p < 0.01), and the proportion of restenosis occurrence that required further treatment was decreased at 6 months (46.9 vs. 81.8%), especially for the web-like stenosis patients, as most of their stenoses dilated with no obvious restenosis and achieved clinical cure. Electrocautery needle knife combined with balloon dilatation is an effective and safe treatment for tracheal fibrotic stenosis compared with balloon dilatation alone. © 2017 S. Karger AG, Basel.

  12. On-board congestion control for satellite packet switching networks

    NASA Technical Reports Server (NTRS)

    Chu, Pong P.

    1991-01-01

    It is desirable to incorporate packet switching capability on-board for future communication satellites. Because of the statistical nature of packet communication, incoming traffic fluctuates and may cause congestion. Thus, it is necessary to incorporate a congestion control mechanism as part of the on-board processing to smooth and regulate the bursty traffic. Although there are extensive studies on congestion control for both baseband and broadband terrestrial networks, these schemes are not feasible for space based switching networks because of the unique characteristics of satellite link. Here, we propose a new congestion control method for on-board satellite packet switching. This scheme takes into consideration the long propagation delay in satellite link and takes advantage of the the satellite's broadcasting capability. It divides the control between the ground terminals and satellite, but distributes the primary responsibility to ground terminals and only requires minimal hardware resource on-board satellite.

  13. Fixture congestion modulates post-match recovery kinetics in professional soccer players.

    PubMed

    Lundberg, Tommy R; Weckström, Kristoffer

    2017-01-01

    This study examined the influence of fixture congestion on physical performance and biochemical variables in professional male footballers. After 3 competitive matches within a week (3M cycle), 16 players underwent blood sampling and field testing 72 h after the last match. The same tests were performed after a regular 1 match-week cycle (1M cycle). The 1M vs. 3M change scores were compared between Congested (high match exposure) and non-selected Control players. The change score in muscle soreness was greater (effect size 1.0; CI 0.0-1.9) in the Congested players than Controls, indicating a possible negative effect of fixture congestion. There were no effects on sprint and jump performance. The change in plasma (P)-Urea was greater in Congested players than controls (effect size 1.3; CI 0.3-2.2). The effects on other blood variables were either non-existing/trivial, or unclear. Altogether, physical fitness and immune function were not compromised by match congestion, yet some indices of physiological stress and muscle damage were still evident.

  14. Effects of treatment on respiratory rate, serum natriuretic peptide concentration, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure secondary to degenerative mitral valve disease and dilated cardiomyopathy.

    PubMed

    Schober, Karsten E; Hart, Taye M; Stern, Joshua A; Li, Xiaobai; Samii, Valerie F; Zekas, Lisa J; Scansen, Brian A; Bonagura, John D

    2011-08-15

    To evaluate the effects of treatment on respiratory rate, serum natriuretic peptide concentrations, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure (CHF) secondary to degenerative mitral valve disease (MVD) and dilated cardiomyopathy (DCM). Prospective cohort study. 63 client-owned dogs. Physical examination, thoracic radiography, analysis of natriuretic peptide concentrations, and Doppler echocardiography were performed twice, at baseline (examination 1) and 5 to 14 days later (examination 2). Home monitoring of respiratory rate was performed by the owners between examinations. In dogs with MVD, resolution of CHF was associated with a decrease in respiratory rate, serum N-terminal probrain natriuretic peptide (NT-proBNP) concentration, and diastolic functional class and an increase of the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic lateral mitral annulus motion (E:Ea Lat). In dogs with DCM, resolution of CHF was associated with a decrease in respiratory rate and serum NT-proBNP concentration and significant changes in 7 Doppler echocardiographic variables, including a decrease of E:Ea Lat and the ratio of peak velocity of early diastolic transmitral flow to isovolumic relaxation time. Only respiratory rate predicted the presence of CHF at examination 2 with high accuracy. Resolution of CHF was associated with predictable changes in respiratory rate, serum NT-proBNP concentration, and selected Doppler echocardiographic variables in dogs with DCM and MVD. Home monitoring of respiratory rate was simple and was the most useful in the assessment of successful treatment of CHF.

  15. Statewide planning scenario synthesis : transportation congestion measurement and management.

    DOT National Transportation Integrated Search

    2005-09-01

    This study is a review of current practices in 13 states to: (1) measure traffic congestion and its costs; and (2) manage congestion with programs and techniques that do not involve the building of new highway capacity. In regard to the measures of c...

  16. Fair and efficient network congestion control based on minority game

    NASA Astrophysics Data System (ADS)

    Wang, Zuxi; Wang, Wen; Hu, Hanping; Deng, Zhaozhang

    2011-12-01

    Low link utility, RTT unfairness and unfairness of Multi-Bottleneck network are the existing problems in the present network congestion control algorithms at large. Through the analogy of network congestion control with the "El Farol Bar" problem, we establish a congestion control model based on minority game(MG), and then present a novel network congestion control algorithm based on the model. The result of simulations indicates that the proposed algorithm can make the achievements of link utility closing to 100%, zero packet lose rate, and small of queue size. Besides, the RTT unfairness and the unfairness of Multi-Bottleneck network can be solved, to achieve the max-min fairness in Multi-Bottleneck network, while efficiently weaken the "ping-pong" oscillation caused by the overall synchronization.

  17. Involvement of systemic venous congestion in heart failure.

    PubMed

    Rubio Gracia, J; Sánchez Marteles, M; Pérez Calvo, J I

    2017-04-01

    Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. 76 FR 75875 - Plan for Conduct of 2012 Electric Transmission Congestion Study

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-05

    ... DEPARTMENT OF ENERGY Plan for Conduct of 2012 Electric Transmission Congestion Study AGENCY... preparation of a study of electric transmission congestion pursuant to section 216(a)(1) of the Federal Power...-register at this Web site: http://energy.gov/oe/congestion-study-2012 . [[Page 75876

  19. Mean field games with congestion

    NASA Astrophysics Data System (ADS)

    Achdou, Yves; Porretta, Alessio

    2018-03-01

    We consider a class of systems of time dependent partial differential equations which arise in mean field type models with congestion. The systems couple a backward viscous Hamilton-Jacobi equation and a forward Kolmogorov equation both posed in $(0,T)\\times (\\mathbb{R}^N /\\mathbb{Z}^N)$. Because of congestion and by contrast with simpler cases, the latter system can never be seen as the optimality conditions of an optimal control problem driven by a partial differential equation. The Hamiltonian vanishes as the density tends to $+\\infty$ and may not even be defined in the regions where the density is zero. After giving a suitable definition of weak solutions, we prove the existence and uniqueness results of the latter under rather general assumptions. No restriction is made on the horizon $T$.

  20. Modeling the effect of accessibility and congestion in location choice.

    DOT National Transportation Integrated Search

    2012-12-01

    This study explores the relationship between accessibility and congestion, and their impacts on property values. Three research questions are addressed: (1) What is the relation between accessibility and congestion both regional and neighborhood leve...

  1. Developing a congestion mitigation toolbox.

    DOT National Transportation Integrated Search

    2011-09-30

    Researchers created A Michigan Toolbox for Mitigating Traffic Congestion to be a useful desk reference for practitioners and an educational tool for elected officials acting through public policy boards to better understand the development, planning,...

  2. Evaluation of the phospholamban gene in purebred large-breed dogs with dilated cardiomyopathy.

    PubMed

    Stabej, Polona; Leegwater, Peter A; Stokhof, Arnold A; Domanjko-Petric, Aleksandra; van Oost, Bernard A

    2005-03-01

    To evaluate the role of the phospholamban gene in purebred large-breed dogs with dilated cardiomyopathy (DCM). 6 dogs with DCM, including 2 Doberman Pinschers, 2 Newfoundlands, and 2 Great Danes. All dogs had clinical signs of congestive heart failure, and a diagnosis of DCM was made on the basis of echocardiographic findings. Blood samples were collected from each dog, and genomic DNA was isolated by a salt extraction method. Specific oligonucleotides were designed to amplify the promoter, exon 1, the 5'-part of exon 2 including the complete coding region, and part of intron 1 of the canine phospholamban gene via polymerase chain reaction procedures. These regions were screened for mutations in DNA obtained from the 6 dogs with DCM. No mutations were identified in the promoter, 5' untranslated region, part of intron 1, part of the 3' untranslated region, and the complete coding region of the phospholamban gene in dogs with DCM. Results indicate that mutations in the phospholamban gene are not a frequent cause of DCM in Doberman Pinschers, Newfoundlands, and Great Danes.

  3. Land use and traffic congestion.

    DOT National Transportation Integrated Search

    2012-03-01

    "The study investigated the link between land use, travel behavior, and traffic congestion. Popular wisdom : suggests that higher-density development patterns may be beneficial in reducing private vehicle dependency : and use, which if true, could ho...

  4. Congestion Management System Process Report

    DOT National Transportation Integrated Search

    1996-03-01

    In January 1995, the Indianapolis Metropolitan Planning Organization with the help of an interagency Study Review Committee began the process of developing a Congestion Management System (CMS) Plan resulting in this report. This report documents the ...

  5. Analysis of Aircraft Clusters to Measure Sector-Independent Airspace Congestion

    NASA Technical Reports Server (NTRS)

    Bilimoria, Karl D.; Lee, Hilda Q.

    2005-01-01

    The Distributed Air/Ground Traffic Management (DAG-TM) concept of operations* permits appropriately equipped aircraft to conduct Free Maneuvering operations. These independent aircraft have the freedom to optimize their trajectories in real time according to user preferences; however, they also take on the responsibility to separate themselves from other aircraft while conforming to any local Traffic Flow Management (TFM) constraints imposed by the air traffic service provider (ATSP). Examples of local-TFM constraints include temporal constraints such as a required time of arrival (RTA), as well as spatial constraints such as regions of convective weather, special use airspace, and congested airspace. Under current operations, congested airspace typically refers to a sector(s) that cannot accept additional aircraft due to controller workload limitations; hence Dynamic Density (a metric that is indicative of controller workload) can be used to quantify airspace congestion. However, for Free Maneuvering operations under DAG-TM, an additional metric is needed to quantify the airspace congestion problem from the perspective of independent aircraft. Such a metric would enable the ATSP to prevent independent aircraft from entering any local areas of congestion in which the flight deck based systems and procedures may not be able to ensure separation. This new metric, called Gaggle Density, offers the ATSP a mode of control to regulate normal operations and to ensure safety and stability during rare-normal or off-normal situations (e.g., system failures). It may be difficult to certify Free Maneuvering systems for unrestricted operations, but it may be easier to certify systems and procedures for specified levels of Gaggle Density that could be monitored by the ATSP, and maintained through relatively minor flow-rate (RTA type) restrictions. Since flight deck based separation assurance is airspace independent, the challenge is to measure congestion independent of sector

  6. Natural history of idiopathic diabetes insipidus.

    PubMed

    Richards, Gail E; Thomsett, Michael J; Boston, Bruce A; DiMeglio, Linda A; Shulman, Dorothy I; Draznin, Martin

    2011-10-01

    To determine what percentage of diabetes insipidus (DI) in childhood is idiopathic and to assess the natural history of idiopathic DI. We conducted a retrospective chart review of 105 patients with DI who were born or had DI diagnosed between 1980-1989 at 3 medical centers. A second cohort of 30 patients from 6 medical centers in whom idiopathic DI was diagnosed after 1990 was evaluated retrospectively for subsequent etiologic diagnoses and additional hypothalamic/pituitary deficiencies and prospectively for quality of life. In the first cohort, 11% of patients had idiopathic DI. In the second cohort, additional hypothalamic/pituitary hormone deficiencies developed in 33%, and 37% received an etiologic diagnosis for DI. Health-related quality of life for all the patients with idiopathic DI was comparable with the healthy reference population. Only a small percentage of patients with DI will remain idiopathic after first examination. Other hormone deficiencies will develop later in one-third of those patients, and slightly more than one-third of those patients will have an etiology for the DI diagnosed. Long-term surveillance is important because tumors have been diagnosed as long as 21 years after the onset of DI. Quality of life for these patients is as good as the reference population. Copyright © 2011 Mosby, Inc. All rights reserved.

  7. The pressure-dilatation correlation in compressible flows

    NASA Technical Reports Server (NTRS)

    Sarkar, S.

    1992-01-01

    Simulations of simple compressible flows have been performed to enable the direct estimation of the pressure-dilatation correlation. The generally accepted belief that this correlation may be important in high-speed flows has been verified by the simulations. The pressure-dilatation correlation is theoretically investigated by considering the equation for fluctuating pressure in an arbitrary compressible flow. This leads to the isolation of a component of the pressure-dilatation that exhibits temporal oscillations on a fast time scale. Direct numerical simulations of homogeneous shear turbulence and isotropic turbulence show that this fast component has a negligible contribution to the evolution of turbulent kinetic energy. Then, an analysis for the case of homogeneous turbulence is performed to obtain a formal solution for the nonoscillatory pressure-dilatation. Simplifications lead to a model that algebraically relates the pressure-dilatation to quantities traditionally obtained in incompressible turbulence closures. The model is validated by direct comparison with the simulations.

  8. Surgical treatment analysis of idiopathic esophageal achalasia.

    PubMed

    Aquino, José Luis Braga de; Said, Marcelo Manzano; Pereira, Douglas Rizzanti; Amaral, Paula Casals do; Lima, Juliana Carolina Alves; Leandro-Merhi, Vânia Aparecida

    2015-01-01

    Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia. To demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications. Were studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease. The patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported improvement in life quality, with return to swallowing. The

  9. Congestion-based emergency vehicle preemption.

    DOT National Transportation Integrated Search

    2010-08-01

    This research analyzed and evaluated a new strategy for preemption of emergency vehicles along a corridor, which is : route-based and adaptive to real-time traffic conditions. The method uses dynamic offsets which are adjusted using : congestion-leve...

  10. Vitamin D deficiency in chronic idiopathic urticaria.

    PubMed

    Movahedi, Masoud; Tavakol, Marzieh; Hirbod-Mobarakeh, Armin; Gharagozlou, Mohammad; Aghamohammadi, Asghar; Tavakol, Zahra; Momenzadeh, Kaveh; Nabavi, Mohammad; Dabbaghzade, Abbas; Mosallanejad, Asieh; Rezaei, Nima

    2015-04-01

    Chronic urticaria is the most common skin diseases, characterized by chronic cutaneous lesions which severely debilitates patients in several aspects of their everyday life. Vitamin D is known to exert several actions in the immune system and to influence function and differentiation of mast cells, central role players in the pathogenesis of chronic idiopathic urticaria. This study was performed to evaluate the relationship between vitamin D levels and susceptibility to chronic idiopathic urticaria. One hundred and fourteen patients with chronic idiopathic urticaria were recruited in this study along with one hundred and eighty seven sex-matched and age-matched healthy volunteers as the control group. For each patient, urticaria activity score was calculated and autologous serum skin test was done. Vitamin D metabolic statue was measured in serum as 25 hydroxyvitamin D using enzyme immunoassay method. Patients with chronic idiopathic urticaria significantly showed lower levels of vitamin D. Vitamin D deficiency was significantly associated with increased susceptibility to chronic idiopathic urticaria. There was a significant positive correlation between vitamin D levels and urticaria activity score. This study showed that patients with chronic idiopathic urticaria had reduced levels of vitamin D, while vitamin D deficiency could increase susceptibility to chronic idiopathic urticaria.

  11. Idiopathic ventricular tachycardia and fibrillation.

    PubMed

    Belhassen, B; Viskin, S

    1993-06-01

    Important data have recently been added to our understanding of sustained ventricular tachyarrhythmias occurring in the absence of demonstrable heart disease. Idiopathic ventricular tachycardia (VT) is usually of monomorphic configuration and can be classified according to its site of origin as either right monomorphic (70% of all idiopathic VTs) or left monomorphic VT. Several physiopathological types of monomorphic VT can be presently individualized, according to their mode of presentation, their relationship to adrenergic stress, or their response to various drugs. The long-term prognosis is usually good. Idiopathic polymorphic VT is a much rarer type of arrhythmia with a less favorable prognosis. Idiopathic ventricular fibrillation may represent an underestimated cause of sudden cardiac death in ostensibly healty patients. A high incidence of inducibility of sustained polymorphic VT with programmed ventricular stimulation has been found by our group, but not by others. Long-term prognosis on Class IA antiarrhythmic medications that are highly effective at electrophysiologic study appears excellent.

  12. Spectral dilation of L(B,H)-valued measures and its application to stationary dilation for Banach space valued processes

    NASA Technical Reports Server (NTRS)

    Miamee, A. G.

    1988-01-01

    Let B be a Banach space and H and K two Hilbert spaces. The spectral dilation of L(B,H)-valued measures is studied and it is shown that the recent results of Makagon and Salehi (1986) and Rosenberg (1982) on the dilation of L(K,H)-valued measures can be extended to hold for the general Banach space setting of L(B,H)-valued measures. These L(B,H)-valued measures are closely connected to the Banach space valued processes. This connection is recalled and as application of spectral dilation of L(B,H)-valued measures the well known stationary dilation results for scalar valued processes is extended to the case of Banach space valued processes.

  13. 21 CFR 876.5470 - Ureteral dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ureteral dilator. 876.5470 Section 876.5470 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5470 Ureteral dilator. (a...

  14. 21 CFR 876.5520 - Urethral dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Urethral dilator. 876.5520 Section 876.5520 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5520 Urethral dilator. (a...

  15. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Esophageal dilator. 876.5365 Section 876.5365 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a...

  16. 21 CFR 876.5470 - Ureteral dilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ureteral dilator. 876.5470 Section 876.5470 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5470 Ureteral dilator. (a...

  17. Congestion Pricing for Aircraft Pushback Slot Allocation.

    PubMed

    Liu, Lihua; Zhang, Yaping; Liu, Lan; Xing, Zhiwei

    2017-01-01

    In order to optimize aircraft pushback management during rush hour, aircraft pushback slot allocation based on congestion pricing is explored while considering monetary compensation based on the quality of the surface operations. First, the concept of the "external cost of surface congestion" is proposed, and a quantitative study on the external cost is performed. Then, an aircraft pushback slot allocation model for minimizing the total surface cost is established. An improved discrete differential evolution algorithm is also designed. Finally, a simulation is performed on Xinzheng International Airport using the proposed model. By comparing the pushback slot control strategy based on congestion pricing with other strategies, the advantages of the proposed model and algorithm are highlighted. In addition to reducing delays and optimizing the delay distribution, the model and algorithm are better suited for use for actual aircraft pushback management during rush hour. Further, it is also observed they do not result in significant increases in the surface cost. These results confirm the effectiveness and suitability of the proposed model and algorithm.

  18. Global alteration in gene expression profiles of deciduas from women with idiopathic recurrent pregnancy loss.

    PubMed

    Krieg, S A; Fan, X; Hong, Y; Sang, Q-X; Giaccia, A; Westphal, L M; Lathi, R B; Krieg, A J; Nayak, N R

    2012-09-01

    Recurrent pregnancy loss (RPL) occurs in ∼5% of women. However, the etiology is still poorly understood. Defects in decidualization of the endometrium during early pregnancy contribute to several pregnancy complications, such as pre-eclampsia and intrauterine growth restriction (IUGR), and are believed to be important in the pathogenesis of idiopathic RPL. We performed microarray analysis to identify gene expression alterations in the deciduas of idiopathic RPL patients. Control patients had one antecedent term delivery, but were undergoing dilation and curettage for current aneuploid miscarriage. Gene expression differences were evaluated using both pathway and gene ontology (GO) analysis. Selected genes were validated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). A total of 155 genes were found to be significantly dysregulated in the deciduas of RPL patients (>2-fold change, P < 0.05), with 22 genes up-regulated and 133 genes down-regulated. GO analysis linked a large percentage of genes to discrete biological functions, including immune response (23%), cell signaling (18%) and cell invasion (17.1%), and pathway analysis revealed consistent changes in both the interleukin 1 (IL-1) and IL-8 pathways. All genes in the IL-8 pathway were up-regulated while genes in the IL-1 pathway were down-regulated. Although both pathways can promote inflammation, IL-1 pathway activity is important for normal implantation. Additionally, genes known to be critical for degradation of the extracellular matrix, including matrix metalloproteinase 26 and serine peptidase inhibitor Kazal-type 1, were also highly up-regulated. In this first microarray approach to decidual gene expression in RPL patients, our data suggest that dysregulation of genes associated with cell invasion and immunity may contribute significantly to idiopathic recurrent miscarriage.

  19. Balloon dilatation of nasopharyngeal stenosis in a dog.

    PubMed

    Berent, Allyson C; Kinns, Jennifer; Weisse, Chick

    2006-08-01

    A dog was examined because of a 6-month history of upper airway stridor that began after postoperative regurgitation of gastric contents. Constant stridor was evident during inspiration and expiration, although it was worse during inspiration. The stridor was no longer evident when the dog's mouth was manually held open. Computed tomography, rhinoscopy, and fluoroscopy were used to confirm a diagnosis of nasopharyngeal stenosis. The dog was anesthetized, and balloon dilatation of the stenosis was performed. Prednisone was prescribed for 4 weeks after the procedure to decrease fibrous tissue formation. Although the dog was initially improved, signs recurred 3.5 weeks later, and balloon dilatation was repeated. This time, however, triamcinolone was injected into the area of stenosis at the end of the dilatation procedure. Two months later, although the dog did not have clinical signs of stridor, a third dilatation procedure was performed because mild stenosis was seen on follow-up computed tomographic images; again, triamcinolone was injected into the area of stenosis at the end of the dilatation procedure. Three and 6 months after the third dilatation procedure, the dog reportedly was clinically normal. Findings suggest that balloon dilatation may be an effective treatment for nasopharyngeal stenosis in dogs.

  20. Colonic strictures: dilation and stents.

    PubMed

    Adler, Douglas G

    2015-04-01

    Colonic strictures, both benign and malignant, are commonly encountered in clinical practice. Benign strictures are most commonly treated by balloon dilation and less frequently with stents. Balloon dilation can help forestall or obviate surgery in some patients. Colonic strictures of malignant etiology generally need to be managed by stents and/or surgery. This article reviews endoscopic approaches to the management of colonic strictures. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Relationship Between Carbon Dioxide Levels and Reported Congestion and Headaches on the International Space Station

    NASA Technical Reports Server (NTRS)

    Cole, Robert; Wear, Mary; Young, Millennia; Cobel, Christopher; Mason, Sara

    2017-01-01

    Congestion is commonly reported during spaceflight, and most crewmembers have reported using medications for congestion during International Space Station (ISS) missions. Although congestion has been attributed to fluid shifts during spaceflight, fluid status reaches equilibrium during the first week after launch while congestion continues to be reported throughout long duration missions. Congestion complaints have anecdotally been reported in relation to ISS CO2 levels; this evaluation was undertaken to determine whether or not an association exists. METHODS: Reported headaches, congestion symptoms, and CO2 levels were obtained for ISS expeditions 2-31, and time-weighted means and single-point maxima were determined for 24-hour (24hr) and 7-day (7d) periods prior to each weekly private medical conference. Multiple imputation addressed missing data, and logistic regression modeled the relationship between probability of reported event of congestion or headache and CO2 levels, adjusted for possible confounding covariates. The first seven days of spaceflight were not included to control for fluid shifts. Data were evaluated to determine the concentration of CO2 required to maintain the risk of congestion below 1% to allow for direct comparison with a previously published evaluation of CO2 concentrations and headache. RESULTS: This study confirmed a previously identified significant association between CO2 and headache and also found a significant association between CO2 and congestion. For each 1-mm Hg increase in CO2, the odds of a crew member reporting congestion doubled. The average 7-day CO2 would need to be maintained below 1.5 mmHg to keep the risk of congestion below 1%. The predicted probability curves of ISS headache and congestion curves appear parallel when plotted against ppCO2 levels with congestion occurring at approximately 1mmHg lower than a headache would be reported. DISCUSSION: While the cause of congestion is multifactorial, this study showed

  2. 21 CFR 876.5450 - Rectal dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Rectal dilator. 876.5450 Section 876.5450 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5450 Rectal dilator. (a) Identification. A rectal...

  3. 21 CFR 876.5450 - Rectal dilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Rectal dilator. 876.5450 Section 876.5450 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5450 Rectal dilator. (a) Identification. A rectal...

  4. Relation between adolescent idiopathic scoliosis and morphologic somatotypes.

    PubMed

    LeBlanc, R; Labelle, H; Rivard, C H; Poitras, B

    1997-11-01

    A prospective and controlled comparative study. To verify the difference in morphologic appearance between a group of adolescents with progressive adolescent idiopathic scoliosis and a control group of normal adolescents. In a previous retrospective study, the possibility of a relation between progressive adolescent idiopathic scoliosis and specific morphotypes was demonstrated. Fifty-two adolescent girls with progressive adolescent idiopathic scoliosis were compared with an age-matched control group of 62 unaffected girls using a classification technique based on morphologic somatotypes. Morphotypes were evaluated with standardized pre-established criteria based on Sheldon's technique. Patients with progressive adolescent idiopathic scoliosis showed significantly less mesomorphism (mean value of 0.88 +/- 0.51) than control girls (mean value of 1.72 +/- 0.52). Adolescent girls with progressive adolescent idiopathic scoliosis have a morphologic somatotype that is different from the normal adolescent population. Subjects with progressive adolescent idiopathic scoliosis are significantly less mesomorphic than control girls. This observation may be of value as a predictive factor for early identification of subjects with adolescent idiopathic scoliosis at greater risk of progression.

  5. Perspective: Update on Idiopathic Intracranial Hypertension

    PubMed Central

    Bruce, Beau B.; Biousse, Valérie; Newman, Nancy J.

    2011-01-01

    Purpose Provide an update on various features of idiopathic intracranial hypertension. Design Perspective. Methods Selected articles on the epidemiology, clinical and imaging features, natural history, pathophysiology, and treatment of idiopathic intracranial hypertension were reviewed and interpreted in the context of the authors’ clinical and research experience. Results Idiopathic intracranial hypertension is primarily a disease of obese women of childbearing age, but it can affect patients of any weight, sex, and age. Although a relatively rare disorder, idiopathic intracranial hypertension’s associated costs in the U.S. entail hundreds of millions of dollars. Even following treatment, headaches are frequently persistent and may require the continued involvement of a neurologist. Quality of life reductions and depression are common among idiopathic intracranial hypertension patients. However, visual dysfunction, especially visual field abnormalities, represents the major morbidity of this disorder, and serial automated perimetry remains the primary mode of patient monitoring. Patients who are men, black, very obese, or anemic are at higher risk of visual loss. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding idiopathic intracranial hypertension’s pathophysiology. Treatment studies show that lumbar puncture is a valuable treatment (in addition to its crucial diagnostic role) and that weight management is critical. However, open questions remain regarding the efficacy of acetazolamide, CSF diversion procedures, and cerebral venous stenting. Conclusions Many questions remain unanswered about idiopathic intracranial hypertension. Ongoing studies, especially an ongoing NIH-funded clinical trial of acetazolamide, should provide more insight into this important, yet poorly understood syndrome of isolated intracranial hypertension. PMID:21696699

  6. CONGESTIVE HEART FAILURE ASSOCIATED WITH PREGNANCY IN OKAPI (OKAPIA JOHNSTONI).

    PubMed

    Warren, Joshua D; Aitken-Palmer, Copper; Weldon, Alan D; Flanagan, Joseph P; Howard, Lauren L; Garner, Michael M; Citino, Scott B

    2017-03-01

    Acute signs associated with cardiovascular disease occurred in three pregnant okapi ( Okapia johnstoni ) during early to midgestation and progressed to congestive heart failure. Congestive heart failure was diagnosed antemortem using echocardiography and plasma cardiac troponin levels. Clinical signs included decreased activity, hyporexia, tachypnea, dyspnea, flared nostrils, and productive coughing with copious amounts of foamy nasal discharge. Parenteral and oral treatment with furosemide, enalapril, and spironolactone controlled clinical signs in the three okapi allowing each to carry out one pregnancy to term. Two okapi carried the first pregnancy to term after showing signs, while one okapi aborted the first calf and gave birth to a healthy calf in a subsequent pregnancy. Subsequent pregnancy in one okapi ended with abortion and associated dystocia and endometritis. Following parturition, clinical signs associated with heart failure resolved in all three individuals; serial echocardiography in two individuals showed improvement in fractional shortening and left atrial size and all three okapi showed markedly decreased pleural effusion and resolution of pulmonary edema. However, subsequent pregnancies in all three okapi induced respiratory distress and recurrence of congestive heart failure; one okapi died from congestive heart failure associated with subsequent pregnancy. This case series describes the clinical presentation and pathologic findings of congestive heart failure during pregnancy in adult okapi.

  7. Large-scale transportation network congestion evolution prediction using deep learning theory.

    PubMed

    Ma, Xiaolei; Yu, Haiyang; Wang, Yunpeng; Wang, Yinhai

    2015-01-01

    Understanding how congestion at one location can cause ripples throughout large-scale transportation network is vital for transportation researchers and practitioners to pinpoint traffic bottlenecks for congestion mitigation. Traditional studies rely on either mathematical equations or simulation techniques to model traffic congestion dynamics. However, most of the approaches have limitations, largely due to unrealistic assumptions and cumbersome parameter calibration process. With the development of Intelligent Transportation Systems (ITS) and Internet of Things (IoT), transportation data become more and more ubiquitous. This triggers a series of data-driven research to investigate transportation phenomena. Among them, deep learning theory is considered one of the most promising techniques to tackle tremendous high-dimensional data. This study attempts to extend deep learning theory into large-scale transportation network analysis. A deep Restricted Boltzmann Machine and Recurrent Neural Network architecture is utilized to model and predict traffic congestion evolution based on Global Positioning System (GPS) data from taxi. A numerical study in Ningbo, China is conducted to validate the effectiveness and efficiency of the proposed method. Results show that the prediction accuracy can achieve as high as 88% within less than 6 minutes when the model is implemented in a Graphic Processing Unit (GPU)-based parallel computing environment. The predicted congestion evolution patterns can be visualized temporally and spatially through a map-based platform to identify the vulnerable links for proactive congestion mitigation.

  8. Large-Scale Transportation Network Congestion Evolution Prediction Using Deep Learning Theory

    PubMed Central

    Ma, Xiaolei; Yu, Haiyang; Wang, Yunpeng; Wang, Yinhai

    2015-01-01

    Understanding how congestion at one location can cause ripples throughout large-scale transportation network is vital for transportation researchers and practitioners to pinpoint traffic bottlenecks for congestion mitigation. Traditional studies rely on either mathematical equations or simulation techniques to model traffic congestion dynamics. However, most of the approaches have limitations, largely due to unrealistic assumptions and cumbersome parameter calibration process. With the development of Intelligent Transportation Systems (ITS) and Internet of Things (IoT), transportation data become more and more ubiquitous. This triggers a series of data-driven research to investigate transportation phenomena. Among them, deep learning theory is considered one of the most promising techniques to tackle tremendous high-dimensional data. This study attempts to extend deep learning theory into large-scale transportation network analysis. A deep Restricted Boltzmann Machine and Recurrent Neural Network architecture is utilized to model and predict traffic congestion evolution based on Global Positioning System (GPS) data from taxi. A numerical study in Ningbo, China is conducted to validate the effectiveness and efficiency of the proposed method. Results show that the prediction accuracy can achieve as high as 88% within less than 6 minutes when the model is implemented in a Graphic Processing Unit (GPU)-based parallel computing environment. The predicted congestion evolution patterns can be visualized temporally and spatially through a map-based platform to identify the vulnerable links for proactive congestion mitigation. PMID:25780910

  9. 23 CFR 970.214 - Federal lands congestion management system (CMS).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... experiencing congestion, the NPS shall develop a separate CMS to cover those facilities. Approaches may include... congestion management strategies; (v) Determine methods to monitor and evaluate the performance of the multi... means the level at which transportation system performance is no longer acceptable due to traffic...

  10. 23 CFR 970.214 - Federal lands congestion management system (CMS).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... experiencing congestion, the NPS shall develop a separate CMS to cover those facilities. Approaches may include... congestion management strategies; (v) Determine methods to monitor and evaluate the performance of the multi... means the level at which transportation system performance is no longer acceptable due to traffic...

  11. Pupil Dilation to Explicit and Non-Explicit Sexual Stimuli.

    PubMed

    Watts, Tuesday M; Holmes, Luke; Savin-Williams, Ritch C; Rieger, Gerulf

    2017-01-01

    Pupil dilation to explicit sexual stimuli (footage of naked and aroused men or women) can elicit sex and sexual orientation differences in sexual response. If similar patterns were replicated with non-explicit sexual stimuli (footage of dressed men and women), then pupil dilation could be indicative of automatic sexual response in fully noninvasive designs. We examined this in 325 men and women with varied sexual orientations to determine whether dilation patterns to non-explicit sexual stimuli resembled those to explicit sexual stimuli depicting the same sex or other sex. Sexual orientation differences in pupil dilation to non-explicit sexual stimuli mirrored those to explicit sexual stimuli. However, the relationship of dilation to non-explicit sexual stimuli with dilation to corresponding explicit sexual stimuli was modest, and effect magnitudes were smaller with non-explicit sexual stimuli than explicit sexual stimuli. The prediction that sexual orientation differences in pupil dilation are larger in men than in women was confirmed with explicit sexual stimuli but not with non-explicit sexual stimuli.

  12. 23 CFR 973.214 - Indian lands congestion management system (CMS).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Indian lands congestion management system (CMS). 973.214... HIGHWAYS MANAGEMENT SYSTEMS PERTAINING TO THE BUREAU OF INDIAN AFFAIRS AND THE INDIAN RESERVATION ROADS PROGRAM Bureau of Indian Affairs Management Systems § 973.214 Indian lands congestion management system...

  13. 14 CFR 137.49 - Operations over other than congested areas.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Operations over other than congested areas. 137.49 Section 137.49 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... congested areas below 500 feet above the surface and closer than 500 feet to persons, vessels, vehicles, and...

  14. The Natural History of Idiopathic Scoliosis During Growth: A Meta-Analysis.

    PubMed

    Di Felice, Francesca; Zaina, Fabio; Donzelli, Sabrina; Negrini, Stefano

    2018-05-01

    The aim of the study was to provide a meta-analysis of current literature concerning the natural history of idiopathic scoliosis during growth. A comprehensive search of Medline, Embase, And Scopus databases was conducted up to November 2016. Eligible works were prospective or retrospective studies that enrolled patients with infantile idiopathic scoliosis, juvenile idiopathic scoliosis, or adolescent idiopathic scoliosis, followed up without any treatment from the time of detection. A meta-analysis for proportion was performed. The following studies were grouped per diagnosis: infantile idiopathic scoliosis, juvenile idiopathic scoliosis, and adolescent idiopathic scoliosis. Of the 1797 citations screened, we assessed 61 full-text articles and included 13 of these (2301 participants). Three studies included infantile idiopathic scoliosis patients (347 participants), five studies included a mixed population of juvenile idiopathic scoliosis and adolescent idiopathic scoliosis (1330 participants), and five studies included adolescent idiopathic scoliosis patients only (624 participants). The random pooled estimated progression rate was 49% (95% confidence interval = 1%-97%) for infantile idiopathic scoliosis, 49% in a mixed group of patients affected by juvenile idiopathic scoliosis or adolescent idiopathic scoliosis (95% confidence interval = 19%-79%), and 42% in adolescent idiopathic scoliosis (95% confidence interval = 11%-73%). During growth, idiopathic scoliosis tends to progress in a high percentage of cases. The progression rate varies according to the age at diagnosis, with infantile scoliosis being the most unpredictable. There are many confounders, such as age, Risser sign and baseline Cobb angles that were not consistent among studies, making the data very heterogeneous.

  15. Measuring non-recurrent congestion in small to medium sized urban areas.

    DOT National Transportation Integrated Search

    2013-05-01

    Understanding the relative magnitudes of recurrent vs. non-recurrent congestion in an urban area is critical to the selection of proper countermeasures and the appropriate allocation of resources to address congestion problems. Small to medium sized ...

  16. Liver congestion in heart failure contributes to inappropriately increased serum hepcidin despite anemia.

    PubMed

    Ohno, Yukako; Hanawa, Haruo; Jiao, Shuang; Hayashi, Yuka; Yoshida, Kaori; Suzuki, Tomoyasu; Kashimura, Takeshi; Obata, Hiroaki; Tanaka, Komei; Watanabe, Tohru; Minamino, Tohru

    2015-01-01

    Hepcidin is a key regulator of mammalian iron metabolism and mainly produced by the liver. Hepcidin excess causes iron deficiency and anemia by inhibiting iron absorption from the intestine and iron release from macrophage stores. Anemia is frequently complicated with heart failure. In heart failure patients, the most frequent histologic appearance of liver is congestion. However, it remains unclear whether liver congestion associated with heart failure influences hepcidin production, thereby contributing to anemia and functional iron deficiency. In this study, we investigated this relationship in clinical and basic studies. In clinical studies of consecutive heart failure patients (n = 320), anemia was a common comorbidity (41%). In heart failure patients without active infection and ongoing cancer (n = 30), log-serum hepcidin concentration of patients with liver congestion was higher than those without liver congestion (p = 0.0316). Moreover, in heart failure patients with liver congestion (n = 19), the anemia was associated with the higher serum hepcidin concentrations, which is a type of anemia characterized by induction of hepcidin. Subsequently, we produced a rat model of heart failure with liver congestion by injecting monocrotaline that causes pulmonary hypertension. The monocrotaline-treated rats displayed liver congestion with increase of hepcidin expression at 4 weeks after monocrotaline injection, followed by anemia and functional iron deficiency observed at 5 weeks. We conclude that liver congestion induces hepcidin production, which may result in anemia and functional iron deficiency in some patients with heart failure.

  17. A simulation-optimization-based decision support tool for mitigating traffic congestion.

    DOT National Transportation Integrated Search

    2009-12-01

    "Traffic congestion has grown considerably in the United States over the past twenty years. In this paper, we develop : a robust decision support tool based on simulation optimization to evaluate and recommend congestion-mitigation : strategies to tr...

  18. Congenital duodenal web: successful management with endoscopic dilatation

    PubMed Central

    Poddar, Ujjal; Jain, Vikas; Yachha, Surender Kumar; Srivastava, Anshu

    2016-01-01

    Background and study aims: Congenital duodenal web (CDW) is an uncommon cause of duodenal obstruction and endoscopic balloon dilatation has been reported in just eight pediatric cases to date. Here we are reporting three cases of CDW managed successfully with balloon dilatation. Cases and methods: In 2014 we diagnosed three cases of CDW on the basis of typical radiological and endoscopic findings. Endoscopic balloon dilatation was done under conscious sedation with a through-the-scope controlled radial expansion (CRE) balloon. Results: All three children presented late (median age 8 [range 2 – 9] years) with bilious vomiting, upper abdominal distension, and failure to thrive. One of them had associated Down syndrome and another had horseshoe kidney. In all cases, CDW was observed in the second part of the duodenum beyond the ampulla, causing partial duodenal obstruction. After repeated endoscopic dilatation (2 – 4 sessions), all three patients became asymptomatic. None of the patients experienced complications after balloon dilatation. Conclusions: Duodenal diaphragm should be suspected in patients with abdominal distension with bilious vomiting, even in relatively older children. Endoscopic balloon dilatation is a simple and effective method of treating this condition. PMID:27004237

  19. Limb congestion enhances the synchronization of sympathetic outflow with muscle contraction

    NASA Technical Reports Server (NTRS)

    Mostoufi-Moab, S.; Herr, M. D.; Silber, D. H.; Gray, K. S.; Leuenberger, U. A.; Sinoway, L. I.

    2000-01-01

    In this report, we examined if the synchronization of muscle sympathetic nerve activity (MSNA) with muscle contraction is enhanced by limb congestion. To explore this relationship, we applied signal-averaging techniques to the MSNA signal obtained during short bouts of forearm contraction (2-s contraction/3-s rest cycle) at 40% maximal voluntary contraction for 5 min. We performed this analysis before and after forearm venous congestion; an intervention that augments the autonomic response to sustained static muscle contractions via a local effect on muscle afferents. There was an increased percentage of the MSNA noted during second 2 of the 5-s contraction/rest cycles. The percentage of total MSNA seen during this particular second increased from minute 1 to 5 of contraction and was increased further by limb congestion (control minute 1 = 25.6 +/- 2.0%, minute 5 = 32.8 +/- 2.2%; limb congestion minute 1 = 29.3 +/- 2.1%, minute 5 = 37.8 +/- 3.9%; exercise main effect <0.005; limb congestion main effect P = 0.054). These changes in the distribution of signal-averaged MSNA were seen despite the fact that the mean number of sympathetic discharges did not increase over baseline. We conclude that synchronization of contraction and MSNA is seen during short repetitive bouts of handgrip. The sensitizing effect of contraction time and limb congestion are apparently due to feedback from muscle afferents within the exercising muscle.

  20. Congestive heart failure in subjects with thyrotoxicosis in a black community

    PubMed Central

    Anakwue, R C; Onwubere, B J C; Anisiuba, B C; Ikeh, V O; Mbah, A; Ike, S O

    2010-01-01

    Introduction: Thyroid hormone has profound effects on a number of metabolic processes in virtually all tissues but the cardiovascular manifestations are prominent usually creating a hyperdynamic circulatory state. Thyrotoxicosis is not a common cause of congestive heart failure among black communities. Objectives: To determine the hospital prevalence, clinical characteristics and echocardiographic findings in patients with thyrotoxicosis who present with congestive heart failure (CCF) in the eastern part of Nigeria. Subjects and methods: A total of 50 subjects aged 15 years and above who were diagnosed as thyrotoxic following clinical and thyroid function tests were consecutively recruited. Fifty age- and sex-matched controls with no clinical or biochemical evidence of thyrotoxicosis and no comorbidities were used as controls. Two-dimensional echocardiography was carried out on all the subjects. CCF was determined clinically and echocardiographically. Results: Eight patients (5 females and 3 males) out of a total of 50 thyrotoxic patients presented with congestive heart failure. Conclusion: The study revealed that congestive heart failure can occur in thyrotoxicosis in spite of the associated hyperdynamic condition. The underlying mechanism may include direct damage by autoimmune myocarditis, congestive circulation secondary to excess sodium, and fluid retention. PMID:20730063

  1. Idiopathic Hypersomnia: A Study of 77 Cases

    PubMed Central

    Anderson, Kirstie N.; Pilsworth, Samantha; Sharples, Linda D.; Smith, Ian E.; Shneerson, John M.

    2007-01-01

    Study Objectives: To review the clinical and polysomnographic characteristics of idiopathic hypersomnia as well as the long-term response to treatment. Setting: The Respiratory Support and Sleep Centre at Papworth Hospital, Cambridge, UK. Patients and Design: A large database of more than 6000 patients with sleep disorders was reviewed. A retrospective study of the clinical and polysomnographic characteristics of 77 patients with idiopathic hypersomnia was performed. Comparison with a similar group of patients with narcolepsy was performed. The response to drug treatment was assessed in 61 patients over a mean follow-up of 3.8 years. Measurements and Results: Idiopathic hypersomnia was 60% as prevalent as narcolepsy. Comparison with a similar group of patients with narcolepsy showed that those with idiopathic hypersomnia were more likely to have prolonged unrefreshing daytime naps, a positive family history, increased slow-wave sleep, and a longer sleep latency on the Multiple Sleep Latency Test. The results of the Multiple Sleep Latency Test were not helpful in predicting disease severity or treatment response. The clinical features were heterogeneous and of variable severity. The majority of patients with idiopathic hypersomnia had symptoms that remained stable over many years, but 11% had spontaneous remission, which was never seen in narcolepsy. Two thirds of patients with idiopathic hypersomnolence had a sustained improvement in daytime somnolence with medication, although a third needed high doses or combinations of drugs. Conclusions: Idiopathic hypersomnolence has characteristic clinical and polysomnographic features but the prolonged latency on the Multiple Sleep Latency Test raises doubt about the validity of this test within the current diagnostic criteria. The disease often responds well to treatment and a substantial minority of patients appear to spontaneously improve. Citation: Anderson KN; Pilsworth S; Sharples LD; Smith IE; Shneerson JM. Idiopathic

  2. Congestive heart failure and central sleep apnea.

    PubMed

    Sands, Scott A; Owens, Robert L

    2015-07-01

    Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Congestive Heart Failure and Central Sleep Apnea.

    PubMed

    Sands, Scott A; Owens, Robert L

    2016-03-01

    Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. [Endoscopic contribution in the dilatation of caustic esophagus stenosis].

    PubMed

    Seydou, Togo; Abdoulaye, Ouattara Moussa; Xing, Li; Zi, Sanogo Zimogo; Sekou, Koumaré; Wen, Yang Shang; Ibrahim, Sankare; Sekou, Toure Cheik Ahmed; Boubacar, Maiga Ibrahim; Saye, Jacque; Jerome, Dakouo Dodino; Dantoumé, Toure Ousmane; Sadio, Yena

    2016-01-01

    The aim of this work was to present the contribution of the endoscopy in the management of esophageal dilatation for caustic esophageal stenosis (CES). This was a descriptive and prospective study in the thoracic surgery department at the Hospital of Mali. A total of 46 cases of CES is recorded and divided into 4 groups according to the topography of the esophageal lesions. For the different methods of dilatation the number of performed endoscopic support was determined to understand the contribution of endoscopic means in the success of dilatation for CES. The outcome, complications and mortality in the two methods were compared. Fibroscopy was used in 41.30% of patients with Savary Guillard dilators and in 47.82% of patients with Lerut dilators. Video laryngoscopy was used in 58.69% of patients who underwent dilatation with Lerut dilators. The passage of the guide wire was performed in 39.13% under video laryngoscopy and 58.68% under fibroscopy. In comparison of the two methods, there is a significant difference in the occurrence of complications (p=0.04075), general anesthesia (p=0.02287), accessibility (p=0.04805) and mortality (p=0.00402). The CES is a serious disease and under evaluated in Mali. The endoscopies contribute significantly to the success of esophageal dilatation for caustic stenosis in the different methods we used.

  5. Pore dilation reconsidered

    PubMed Central

    Bean, Bruce P

    2015-01-01

    Previous experiments have suggested that many P2X family channels undergo a time-dependent process of pore dilation when activated by ATP. Li et al. now propose a different interpretation of the key experiments. PMID:26505561

  6. Quantum random walks on congested lattices and the effect of dephasing.

    PubMed

    Motes, Keith R; Gilchrist, Alexei; Rohde, Peter P

    2016-01-27

    We consider quantum random walks on congested lattices and contrast them to classical random walks. Congestion is modelled on lattices that contain static defects which reverse the walker's direction. We implement a dephasing process after each step which allows us to smoothly interpolate between classical and quantum random walks as well as study the effect of dephasing on the quantum walk. Our key results show that a quantum walker escapes a finite boundary dramatically faster than a classical walker and that this advantage remains in the presence of heavily congested lattices.

  7. Quantum random walks on congested lattices and the effect of dephasing

    PubMed Central

    Motes, Keith R.; Gilchrist, Alexei; Rohde, Peter P.

    2016-01-01

    We consider quantum random walks on congested lattices and contrast them to classical random walks. Congestion is modelled on lattices that contain static defects which reverse the walker’s direction. We implement a dephasing process after each step which allows us to smoothly interpolate between classical and quantum random walks as well as study the effect of dephasing on the quantum walk. Our key results show that a quantum walker escapes a finite boundary dramatically faster than a classical walker and that this advantage remains in the presence of heavily congested lattices. PMID:26812924

  8. Salivary gland enlargement during oesophageal stricture dilatation.

    PubMed Central

    Martin, D.

    1980-01-01

    A case of recurrent salivary gland enlargement occurring during fibreoptic oesophagoscopy and oesophageal stricture dilatation with Eder-Puestow dilators is described. The genesis of this condition is discussed and its transient and usually benign nature emphasized. Images Fig. 1 PMID:7393809

  9. Traumatic tracheobronchial stricture treated with the Eder-Puestow dilator.

    PubMed

    Erichsen, H G

    1980-09-01

    A case of tracheobronchial stenosis secondary to trauma is presented. Primary reconstruction resulted in stricture in the distal part of the trachea. Resection and anastomosis was followed by restenosis, which had to be treated endoscopically. Endobronchial resections and forceful dilatations with stiff bronchoscopes were done weekly for about 11 months without lasting benefit. After changing to Eder-Puestow dilators, the dilatations could be done at steadily increasing intervals. This method of dilatation was found to be safe, effective and less traumatic.

  10. Desloratadine and pseudoephedrine combination therapy as a comprehensive treatment for allergic rhinitis and nasal congestion.

    PubMed

    Anolik, Robert

    2009-06-01

    Allergic rhinitis (AR) is rapidly increasing in global prevalence. Symptoms of AR, particularly nasal congestion, can cause quality of life (QoL) impairment. Second-generation antihistamines are a recommended first-line therapy for AR but are not viewed as very effective for the treatment of congestion. Therefore, an antihistamine plus a decongestant, such as the combination of desloratadine and pseudoephedrine, is a convenient and efficacious treatment. To review the clinical evidence on the efficacy and safety of combination desloratadine/pseudoephedrine for the treatment of AR symptoms, particularly nasal congestion. Four large studies found that improvement in nasal congestion is enhanced when patients are treated with combination desloratadine/pseudoephedrine. The combination drug significantly improved mean reflective nasal congestion scores in these studies compared with either component as monotherapy (p congestion were observed by day 2. Mean reductions in nasal congestion scores were comparable between the once- and twice-daily dosing regimens of the combination drug. Comprehensive treatment of AR that effectively relieves nasal congestion can also improve patient QoL. Administration of the second-generation antihistamine desloratadine in combination with the decongestant pseudoephedrine may be regarded as an efficacious and convenient option for patients with AR who are particularly troubled by nasal congestion.

  11. Projecting future landside congestion delays at the BWI Airport : final report.

    DOT National Transportation Integrated Search

    2003-10-01

    This study examines the access to the BWI Airport in detail. Complex density functions are utilized to determine the : congestion curves faced by passengers arriving at the airport. It is found that all lots have congestion during peak : periods and ...

  12. Guidelines for operating congested traffic signals.

    DOT National Transportation Integrated Search

    2010-08-01

    The objective of this project was to develop guidelines for mitigating congestion in traffic signal systems. As : part of the project, researchers conducted a thorough review of literature and developed preliminary : guidelines for combating congesti...

  13. Modeling truck traffic volume growth congestion.

    DOT National Transportation Integrated Search

    2009-05-01

    Modeling of the statewide transportation system is an important element in understanding issues and programming of funds to thwart potential congestion. As Alabama grows its manufacturing economy, the number of heavy vehicles traversing its highways ...

  14. Gastric Necrosis due to Acute Massive Gastric Dilatation.

    PubMed

    Aydin, Ibrahim; Pergel, Ahmet; Yucel, Ahmet Fikret; Sahin, Dursun Ali; Ozer, Ender

    2013-01-01

    Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature.

  15. Gastric Necrosis due to Acute Massive Gastric Dilatation

    PubMed Central

    Pergel, Ahmet; Yucel, Ahmet Fikret; Sahin, Dursun Ali; Ozer, Ender

    2013-01-01

    Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature. PMID:23983714

  16. A resilience-oriented approach for quantitatively assessing recurrent spatial-temporal congestion on urban roads.

    PubMed

    Tang, Junqing; Heinimann, Hans Rudolf

    2018-01-01

    Traffic congestion brings not only delay and inconvenience, but other associated national concerns, such as greenhouse gases, air pollutants, road safety issues and risks. Identification, measurement, tracking, and control of urban recurrent congestion are vital for building a livable and smart community. A considerable amount of works has made contributions to tackle the problem. Several methods, such as time-based approaches and level of service, can be effective for characterizing congestion on urban streets. However, studies with systemic perspectives have been minor in congestion quantification. Resilience, on the other hand, is an emerging concept that focuses on comprehensive systemic performance and characterizes the ability of a system to cope with disturbance and to recover its functionality. In this paper, we symbolized recurrent congestion as internal disturbance and proposed a modified metric inspired by the well-applied "R4" resilience-triangle framework. We constructed the metric with generic dimensions from both resilience engineering and transport science to quantify recurrent congestion based on spatial-temporal traffic patterns and made the comparison with other two approaches in freeway and signal-controlled arterial cases. Results showed that the metric can effectively capture congestion patterns in the study area and provides a quantitative benchmark for comparison. Also, it suggested not only a good comparative performance in measuring strength of proposed metric, but also its capability of considering the discharging process in congestion. The sensitivity tests showed that proposed metric possesses robustness against parameter perturbation in Robustness Range (RR), but the number of identified congestion patterns can be influenced by the existence of ϵ. In addition, the Elasticity Threshold (ET) and the spatial dimension of cell-based platform differ the congestion results significantly on both the detected number and intensity. By tackling

  17. Aetiology of idiopathic granulomatous mastitis.

    PubMed

    Altintoprak, Fatih; Kivilcim, Taner; Ozkan, Orhan Veli

    2014-12-16

    Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail.

  18. Aetiology of idiopathic granulomatous mastitis

    PubMed Central

    Altintoprak, Fatih; Kivilcim, Taner; Ozkan, Orhan Veli

    2014-01-01

    Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail. PMID:25516860

  19. Performance analysis of SS7 congestion controls under sustained overload

    NASA Astrophysics Data System (ADS)

    Manfield, David R.; Millsteed, Gregory K.; Zukerman, Moshe

    1994-04-01

    Congestion controls are a key factor in achieving the robust performance required of common channel signaling (CCS) networks in the face of partial network failures and extreme traffic loads, especially as networks become large and carry high traffic volume. The CCITT recommendations define a number of types of congestion control, and the parameters of the controls must be well set in order to ensure their efficacy under transient and sustained signalling network overload. The objective of this paper is to present a modeling approach to the determination of the network parameters that govern the performance of the SS7 congestion controls under sustained overload. Results of the investigation by simulation are presented and discussed.

  20. Impact of distracted driving on congestion.

    DOT National Transportation Integrated Search

    2011-03-01

    Studies have documented a link between distracted driving and diminished safety; however, an association : between distracted driving and traffic congestion has not been investigated in depth. The present study : examined the behavior of teens and yo...

  1. Congestion control strategy on complex network with privilege traffic

    NASA Astrophysics Data System (ADS)

    Li, Shi-Bao; He, Ya; Liu, Jian-Hang; Zhang, Zhi-Gang; Huang, Jun-Wei

    The congestion control of traffic is one of the most important studies in complex networks. In the previous congestion algorithms, all the network traffic is assumed to have the same priority, and the privilege of traffic is ignored. In this paper, a privilege and common traffic congestion control routing strategy (PCR) based on the different priority of traffic is proposed, which can be devised to cope with the different traffic congestion situations. We introduce the concept of privilege traffic in traffic dynamics for the first time and construct a new traffic model which taking into account requirements with different priorities. Besides, a new factor Ui is introduced by the theoretical derivation to characterize the interaction between different traffic routing selection, furthermore, Ui is related to the network throughput. Since the joint optimization among different kinds of traffic is accomplished by PCR, the maximum value of Ui can be significantly reduced and the network performance can be improved observably. The simulation results indicate that the network throughput with PCR has a better performance than the other strategies. Moreover, the network capacity is improved by 25% at least. Additionally, the network throughput is also influenced by privilege traffic number and traffic priority.

  2. Balloon dilation of the cartilaginous eustachian tube.

    PubMed

    Poe, Dennis S; Silvola, Juha; Pyykkö, Ilmari

    2011-04-01

    (1) To translate techniques developed in a previous cadaver study of balloon dilation of the cartilaginous eustachian tube (ET) into clinical treatment for refractory dilatory dysfunction and (2) to study the safety/efficacy of the technique in a pilot clinical trial. Prospective with subjects as their own historical controls since June 2009. Regional academic center. Eleven consecutive adult patients with longstanding otitis media with effusion (OME) who were unable to autoinsufflate their ET by Valsalva, swallow, or yawn and who had previous tympanostomies (average, 4.7). At the time of intervention, 5 of 11 had a tube; 2 of 11 had a tympanic membrane (TM) perforation. Four of 11 had intact TMs, 2 with OME and tympanogram type B and 2 with TM retraction and tympanogram types B and C. Balloon dilation of the cartilaginous ET was performed with sinus dilation instruments via transnasal endoscopic approach under general anesthesia in a day surgery setting. Inflation was to a maximum of 12 atm for 1 minute. ability to Valsalva, rating of ET mucosal inflammation, tympanogram, and otomicroscopy findings. All cases successfully dilated. Eleven of 11 could self-insufflate by Valsalva (P < .001); tympanograms were A (4/11), C (1/11), or open (6/11). All atelectases resolved. Procedures were well tolerated, without pain or complications related to dilation. Dilation of the cartilaginous ET appeared to be beneficial and without significant adverse effects in the treatment of ET dilatory dysfunction. Larger controlled trials with long-term results are now justified and needed.

  3. [Use of antihypertensive drug therapy and risk of development of congestive heart failure].

    PubMed

    Sobrino, Javier; Plana, Jaume; Felip, Angela; Doménech, Mónica; Reth, Peter; Adrián, María Jesús; de la Sierra, Alejandro

    2004-09-18

    It has been suggested that the use of some antihypertensive agents may favour the development of congestive heart failure. The aim of the present study was to evaluate such a possible association in patients who had a new diagnosis of congestive heart failure. This was a retrospective case-control study of 81 patients who had a first hospital admission with a new diagnosis of congestive heart failure (cases) and 162 patients admitted for other hypertensive complications (controls). Previous antihypertensive drug use was registered and the possible association with congestive heart failure was evaluated. The presence of congestive heart failure was not associated with the use of any antihypertensive drug class. When treatments were grouped in classic (diuretics and betablockers) or modern (calcium channel blockers, angiotensin-converting-enzyme inhibitors, alphablockers or angiotensin receptor blockers), a negative association was observed with the latter group, which was observed in 48.1% of cases and 63.6% of controls (odds ratio: 0.532; 95% confidence interval, 0.310-0.913). This association was lost after adjustment for other cardiovascular risk factors or previous hypertensive complications. The development of congestive heart failure was not associated with the use of any specific antihypertensive drug class. From the present evidence, it is not possible to recommend a specific antihypertensive agent in patients at risk of developing congestive heart failure but without evidence of such disease.

  4. Pouch dilatation following laparoscopic adjustable gastric banding: psychobehavioral factors (can psychiatrists predict pouch dilatation?).

    PubMed

    Poole, Norman; Al Atar, Ashraf; Bidlake, Louise; Fienness, Alberic; McCluskey, Sara; Nussey, S; Bano, Gal; Morgan, John

    2004-01-01

    Laparoscopic adjustable gastric banding is increasingly being performed in morbidly obese individuals for weight loss. Some patients develop pouch dilatation as a postoperative complication that limits the utility of the procedure. Surgical variables are poor predictors of this complication. 5 patients from a series of 157 who underwent LAGB at a single center developed the condition. Psychiatric and surgical case-notes were analyzed retrospectively for the presence of operationally defined psychiatric disorders and compared to 10 controls from the same population. Cases were significantly more likely to have past or current binge eating, emotionally triggered eating with reduced awareness of the link, a history of affective disorder, reduced sexual functioning and successful preoperative weight loss. No difference between groups was observed for compliance with orlistat, childhood sexual abuse, relationships with parents, history of bulimia nervosa, rate of band inflation or preoperative BMI. Psychological factors may be better predictors of pouch dilatation than biomedical variables. Disordered eating can be an attempt to modulate negative emotions. Pouch dilatation may be a consequence of this eating behavior.

  5. Results of Eder-Puestow dilatation in the management of esophageal peptic strictures.

    PubMed

    Rago, E; Boesby, S; Spencer, J

    1983-01-01

    Eder-Puestow dilatation of esophageal strictures is a safe procedure. The treatment is followed by symptomatic improvement, but the effect of dilatation on the patients' nutritional state has so far not been reported. We have reviewed 33 patients with benign esophageal stricture with special regard to the effect of dilatation on body weight. A total of 152 dilatations was carried out. All patients had dysphagia, 32 patients had heartburn and 20 had regurgitation. Hiatus hernia was present in 29 patients. Thirteen patients had antireflux surgery; 10 operations were performed before, and four during the dilatation period. One patient required no further dilatations after operation. Dilators greater than 35 FG were passed in 85% of the dilatations. No serious complications occurred. Patients were followed for up to 5 yr (mean follow-up: 27 months). The mean interval between dilatations was 7 months. Body weight was recorded before and one month after dilatation on 78 occasions. There was a significant overall weight increase of 0.78 kg 1 month after dilatation. The mean weight increase was greater after the first dilatation (1.06 kg) than after subsequent ones (0.6 kg). We found that Eder-Puestow dilatation in patients with benign esophageal stricture led to symptomatic improvement and was followed by an increase in body weight.

  6. Distributive routing and congestion control in wireless multihop ad hoc communication networks

    NASA Astrophysics Data System (ADS)

    Glauche, Ingmar; Krause, Wolfram; Sollacher, Rudolf; Greiner, Martin

    2004-10-01

    Due to their inherent complexity, engineered wireless multihop ad hoc communication networks represent a technological challenge. Having no mastering infrastructure the nodes have to selforganize themselves in such a way that for example network connectivity, good data traffic performance and robustness are guaranteed. In this contribution the focus is on routing and congestion control. First, random data traffic along shortest path routes is studied by simulations as well as theoretical modeling. Measures of congestion like end-to-end time delay and relaxation times are given. A scaling law of the average time delay with respect to network size is revealed and found to depend on the underlying network topology. In the second step, a distributive routing and congestion control is proposed. Each node locally propagates its routing cost estimates and information about its congestion state to its neighbors, which then update their respective cost estimates. This allows for a flexible adaptation of end-to-end routes to the overall congestion state of the network. Compared to shortest-path routing, the critical network load is significantly increased.

  7. Receiver-Assisted Congestion Control to Achieve High Throughput in Lossy Wireless Networks

    NASA Astrophysics Data System (ADS)

    Shi, Kai; Shu, Yantai; Yang, Oliver; Luo, Jiarong

    2010-04-01

    Many applications would require fast data transfer in high-speed wireless networks nowadays. However, due to its conservative congestion control algorithm, Transmission Control Protocol (TCP) cannot effectively utilize the network capacity in lossy wireless networks. In this paper, we propose a receiver-assisted congestion control mechanism (RACC) in which the sender performs loss-based control, while the receiver is performing delay-based control. The receiver measures the network bandwidth based on the packet interarrival interval and uses it to compute a congestion window size deemed appropriate for the sender. After receiving the advertised value feedback from the receiver, the sender then uses the additive increase and multiplicative decrease (AIMD) mechanism to compute the correct congestion window size to be used. By integrating the loss-based and the delay-based congestion controls, our mechanism can mitigate the effect of wireless losses, alleviate the timeout effect, and therefore make better use of network bandwidth. Simulation and experiment results in various scenarios show that our mechanism can outperform conventional TCP in high-speed and lossy wireless environments.

  8. Cervical Dilatation Curves of Spontaneous Deliveries in Pregnant Japanese Females

    PubMed Central

    Inde, Yusuke; Nakai, Akihito; Sekiguchi, Atsuko; Hayashi, Masako; Takeshita, Toshiyuki

    2018-01-01

    Background: Although cervical dilatation curves are crucial for appropriate management of labor progression, abnormal labor progression and obstetric interventions were included in previous and widely-used cervical dilatation curves. We aimed to describe the cervical dilatation curves of normal labor progression in pregnant Japanese females without abnormal labor progression and obstetric interventions. Methods: We completed retrospective obstetric record reviews on 3172 pregnant Japanese females (parity = 0, n = 1047; parity = 1, n = 1083; parity ≥ 2, n = 1042), aged 20 to 39 years old at delivery, with pregravid body mass indices of less than 30. All patients underwent spontaneous deliveries with term, singleton, cephalic and live newborns of appropriate-for-gestational age birthweight, without adverse neonatal outcomes. We characterized labor progression patterns by examining the relationship between elapsed times from the full dilatation and cervical dilatation stages, and labor durations by examining the distribution of time intervals from one cervical dilatation stage, to the next, and ultimately to the full dilatation. Results: Fastest cervical changes occurred at 6 cm (primiparas) and 5 cm (multiparas) of dilatation. The 95%tile of labor progression took over 3 hours to progress from 6 cm to 7 cm (primiparas), and over 2 hours to progress from 5 cm to 6 cm (multiparas). The 5%tile of traverse time to the full dilatation, during the active phase, was less than 1 hour (primiparas) and 0.5 hours (multiparas). At the end of the active phase, no deceleration phase was observed. Conclusions: Active labor may not start until 5 cm of dilatation. At the beginning of the active phase, cervical dilatation was slower than previously described. These results may reduce opportunities for obstetric interventions during labor progression. PMID:29725244

  9. Speed harmonization and peak-period shoulder use to manage urban freeway congestion.

    DOT National Transportation Integrated Search

    2009-10-01

    Traffic congestion is an increasing problem in the nations urban areas, leading to personal inconvenience, : increased pollution, hampered economic productivity, and reduced quality of life. While traffic congestion tends : to continuously increas...

  10. Minnesota : innovative choices for congestion relief.

    DOT National Transportation Integrated Search

    2011-01-01

    Minnesota UPA projects focus on reducing traffic congestion in the I-35W corridor and in downtown Minneapolis. ITS technologies underlie many of the Minnesota UPA projects, including those centered on tolling, real-time traffic and transit informatio...

  11. Evaluation of the public health impacts of traffic congestion: a health risk assessment

    PubMed Central

    2010-01-01

    Background Traffic congestion is a significant issue in urban areas in the United States and around the world. Previous analyses have estimated the economic costs of congestion, related to fuel and time wasted, but few have quantified the public health impacts or determined how these impacts compare in magnitude to the economic costs. Moreover, the relative magnitudes of economic and public health impacts of congestion would be expected to vary significantly across urban areas, as a function of road infrastructure, population density, and atmospheric conditions influencing pollutant formation, but this variability has not been explored. Methods In this study, we evaluate the public health impacts of ambient exposures to fine particulate matter (PM2.5) concentrations associated with a business-as-usual scenario of predicted traffic congestion. We evaluate 83 individual urban areas using traffic demand models to estimate the degree of congestion in each area from 2000 to 2030. We link traffic volume and speed data with the MOBILE6 model to characterize emissions of PM2.5 and particle precursors attributable to congestion, and we use a source-receptor matrix to evaluate the impact of these emissions on ambient PM2.5 concentrations. Marginal concentration changes are related to a concentration-response function for mortality, with a value of statistical life approach used to monetize the impacts. Results We estimate that the monetized value of PM2.5-related mortality attributable to congestion in these 83 cities in 2000 was approximately $31 billion (2007 dollars), as compared with a value of time and fuel wasted of $60 billion. In future years, the economic impacts grow (to over $100 billion in 2030) while the public health impacts decrease to $13 billion in 2020 before increasing to $17 billion in 2030, given increasing population and congestion but lower emissions per vehicle. Across cities and years, the public health impacts range from more than an order of

  12. Evaluation of the public health impacts of traffic congestion: a health risk assessment.

    PubMed

    Levy, Jonathan I; Buonocore, Jonathan J; von Stackelberg, Katherine

    2010-10-27

    Traffic congestion is a significant issue in urban areas in the United States and around the world. Previous analyses have estimated the economic costs of congestion, related to fuel and time wasted, but few have quantified the public health impacts or determined how these impacts compare in magnitude to the economic costs. Moreover, the relative magnitudes of economic and public health impacts of congestion would be expected to vary significantly across urban areas, as a function of road infrastructure, population density, and atmospheric conditions influencing pollutant formation, but this variability has not been explored. In this study, we evaluate the public health impacts of ambient exposures to fine particulate matter (PM2.5) concentrations associated with a business-as-usual scenario of predicted traffic congestion. We evaluate 83 individual urban areas using traffic demand models to estimate the degree of congestion in each area from 2000 to 2030. We link traffic volume and speed data with the MOBILE6 model to characterize emissions of PM2.5 and particle precursors attributable to congestion, and we use a source-receptor matrix to evaluate the impact of these emissions on ambient PM2.5 concentrations. Marginal concentration changes are related to a concentration-response function for mortality, with a value of statistical life approach used to monetize the impacts. We estimate that the monetized value of PM2.5-related mortality attributable to congestion in these 83 cities in 2000 was approximately $31 billion (2007 dollars), as compared with a value of time and fuel wasted of $60 billion. In future years, the economic impacts grow (to over $100 billion in 2030) while the public health impacts decrease to $13 billion in 2020 before increasing to $17 billion in 2030, given increasing population and congestion but lower emissions per vehicle. Across cities and years, the public health impacts range from more than an order of magnitude less to in excess of

  13. Idiopathic Canalicular Inflammatory Disease: New Disease Description of Clinical Patterns, Investigations, Management, and Outcomes.

    PubMed

    Ali, Mohammad Javed

    2018-01-25

    The objective of this perspective is to present a separate disease description of "idiopathic canalicular inflammatory disease" and outline the diagnostic criteria and early experiences with its investigations and management. Retrospective case series of 44 canaliculi of 22 eyes of 11 patients presenting at a tertiary care Dacryology service over a period of 2 years with typical clinical patterns of inflammatory canaliculitis and its outcomes were studied. All the patients underwent microbiological work-up with culture and sensitivity, dacryoendoscopy imaging, serial Fourier domain ocular coherence tomography, and collagen vascular profiles. Stages in the evolution of the disease were studied. All patients were treated initially with topical steroids followed by punctal dilatation and placement of mini-monoka stents. Five patients in addition had a small biopsy from the inflamed portion of the vertical canaliculus. Stents were extubated at 6 weeks. Forty-four canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (81.8%, 9/11) and the mean age at presentation was 57 years. All patients presented with unilateral epiphora without any discharge, pain, or swelling. Collagen vascular profiles and screening for autoimmune diseases were negative. Clinical picture ranged from stages 1 to 5, consisting of edema, progressive centripetal vascularization, pouting of vascularized mucosa, membrane formation, and progressive scarring. The presentation begins in 1 eye and usually involves the other eye at a mean of 6 months. Ocular coherence tomography and dacryoendoscopy were of adjunctive value in the diagnosis. Histopathological examination was suggestive of a chronic inflammation. All patients had relentless progression to end-stage disease, although delayed significantly by steroids and monoka intubation. Idiopathic canalicular inflammatory disease has a distinct and typical clinical behavior and

  14. Acute Idiopathic Scrotal Edema: Systematic Literature Review.

    PubMed

    Santi, Maristella; Lava, Sebastiano A G; Simonetti, Giacomo D; Bianchetti, Mario G; Milani, Gregorio P

    2018-06-01

     Existing information on acute idiopathic scrotal edema relies on small case series and textbooks.  We searched reports with no date limits on acute idiopathic scrotal edema.  Thirty-seven studies were included. Sixteen case series addressed the prevalence of acute idiopathic scrotal edema among males with acute scrotum: among 3,403 cases, the diagnosis of acute idiopathic scrotal edema was made in 413 cases (12%). Twenty-four reports addressed history, findings, management, and course of acute idiopathic scrotal edema in 311 patients. The patients mostly ranged in age from 5 to 8 years, presented with acute scrotal redness and swelling, associated or not with mild pain. Ninety percent or more of the cases developed in patients without atopic diathesis and were not preceded by inguinoscrotal surgery, acute febrile illnesses, or trauma. They were afebrile; in good general condition; and presented without pruritus, nausea or vomiting, or abdominal pain. The lesions were bilateral in two-thirds and unilateral in one-third of the cases. The condition resolved spontaneously within 2 to 3 days without sequelae. Approximately 10% of the cases experienced a recurrence.  Acute idiopathic scrotal edema is a self-limiting condition that accounts for ≥ 10% of cases of acute scrotum in children and adolescents. Georg Thieme Verlag KG Stuttgart · New York.

  15. Treatments for pediatric achalasia: Heller myotomy or pneumatic dilatation?

    PubMed

    Jung, C; Michaud, L; Mougenot, J-F; Lamblin, M-D; Philippe-Chomette, P; Cargill, G; Bonnevalle, M; Boige, N; Bellaïche, M; Viala, J; Hugot, J-P; Gottrand, F; Cezard, J-P

    2010-03-01

    The treatment of achalasia consists of reducing distal esophageal obstruction by either Heller myotomy surgery or endoscopic pneumatic dilatation. The aim of the present study was to evaluate the short- and middle-term results of these procedures in children. For technical reasons, children under six years old (n=8) were treated by surgery only, whereas patients over six years old (n=14) were treated by either Heller myotomy or pneumatic dilatation. Of the children aged under six years, 75% were symptom-free at six months and 83% at 24 months of follow-up. Of the patients aged over six years, complete remission was achieved by Heller myotomy in 44.5% vs. 55.5% by pneumatic dilatation after six months, and in 40% vs. 65%, respectively, after 24 months. Both pneumatic dilatation and Heller myotomy showed significant rates of failure. These results suggest that pneumatic dilatation may be considered a primary treatment in children over six years old. Also, where necessary, Heller myotomy and pneumatic dilatation may be used as complementary treatments.

  16. Dilations of anastomotic strictures over time after repair of esophageal atresia.

    PubMed

    Stenström, Pernilla; Anderberg, Magnus; Börjesson, Anna; Arnbjörnsson, Einar

    2017-02-01

    Anastomotic strictures commonly occur in patients undergoing surgery for esophageal atresia (EA). The primary aim of this study was to determine the age distribution of dilation procedures for anastomotic strictures over the patient's childhood after reconstruction of EA. The secondary aim was to evaluate the effect of postoperative proton pump inhibitors (PPIs) on the frequency of dilations. This observational study was conducted at a single tertiary center of pediatric surgery. The times that dilations of strictures were performed were assessed during three study periods: 1983-1995, 2001-2009, and 2010-2014. PPIs were not used during the first period, and then, respectively, for 3 and 12 months postoperatively. The indications for dilation were signs of obstruction and/or radiological signs of stricture. A total of 131 children underwent esophageal reconstruction, and of those, 60 (46%) required at least 1 dilation procedure for strictures. There were no differences in the frequencies of dilation procedures between the three study periods (28/66, 18/32 and 14/33, respectively; P = 0.42). The overall median number of dilations per patient was 3 (range 1-21) with no differences between the study periods. The differences between ages at which the first dilation was performed during each study period were significant, as follows: 7, 2, and 8 months, respectively (P = 0.03). Fiftyone percent of all dilation procedures were performed during the first year of life, 16% during the second year, and 33% during years 2-15. Four children (2%) underwent >12 dilations. The first year of life was the time of greatest need for dilation of AS after reconstruction of EA; however, dilations were also performed several years later. PPIs did not affect the frequency of dilations during the first year of life.

  17. Idiopathic hypersomnia: a study of 77 cases.

    PubMed

    Anderson, Kirstie N; Pilsworth, Samantha; Sharples, Linda D; Smith, Ian E; Shneerson, John M

    2007-10-01

    To review the clinical and polysomnographic characteristics of idiopathic hypersomnia as well as the long-term response to treatment. The Respiratory Support and Sleep Centre at Papworth Hospital, Cambridge, UK. A large database of more than 6000 patients with sleep disorders was reviewed. A retrospective study of the clinical and polysomnographic characteristics of 77 patients with idiopathic hypersomnia was performed. Comparison with a similar group of patients with narcolepsy was performed. The response to drug treatment was assessed in 61 patients over a mean follow-up of 3.8 years. Idiopathic hypersomnia was 60% as prevalent as narcolepsy. Comparison with a similar group of patients with narcolepsy showed that those with idiopathic hypersomnia were more likely to have prolonged unrefreshing daytime naps, a positive family history, increased slow-wave sleep, and a longer sleep latency on the Multiple Sleep Latency Test. The results of the Multiple Sleep Latency Test were not helpful in predicting disease severity or treatment response. The clinical features were heterogeneous and of variable severity. The majority of patients with idiopathic hypersomnia had symptoms that remained stable over many years, but 11% had spontaneous remission, which was never seen in narcolepsy. Two thirds of patients with idiopathic hypersomnolence had a sustained improvement in daytime somnolence with medication, although a third needed high doses or combinations of drugs. Idiopathic hypersomnolence has characteristic clinical and polysomnographic features but the prolonged latency on the Multiple Sleep Latency Test raises doubt about the validity of this test within the current diagnostic criteria. The disease often responds well to treatment and a substantial minority of patients appear to spontaneously improve.

  18. Improved pupil dilation with medication-soaked pledget sponges.

    PubMed

    Weddle, Celeste; Thomas, Nikki; Dienemann, Jacqueline

    2013-08-01

    Use of multiple preoperative drops for pupil dilation has been shown to be inexact, to delay surgery, and to cause dissatisfaction among perioperative personnel. This article reports on an evidence-based, quality improvement project to locate and appraise research on improved effectiveness and efficiency of mydriasis (ie, pupillary dilation), and the subsequent implementation of a pledget-sponge procedure for pupil dilation at one ambulatory surgery center. Project leaders used an evidence-based practice model to assess the problem, research options for improvement, define goals, and implement a pilot project to test the new dilation technique. Outcomes from the pilot project showed a reduced number of delays caused by poor pupil dilation and a decrease in procedure turnover time. The project team solicited informal feedback from preoperative nurses, which reflected increased satisfaction in preparing patients for cataract procedures. After facility administrators and surgeons accepted the procedure change, it was adopted for preoperative use for all patients undergoing cataract surgery at the ambulatory surgery center. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  19. Autonomous Distributed Congestion Control Scheme in WCDMA Network

    NASA Astrophysics Data System (ADS)

    Ahmad, Hafiz Farooq; Suguri, Hiroki; Choudhary, Muhammad Qaisar; Hassan, Ammar; Liaqat, Ali; Khan, Muhammad Umer

    Wireless technology has become widely popular and an important means of communication. A key issue in delivering wireless services is the problem of congestion which has an adverse impact on the Quality of Service (QoS), especially timeliness. Although a lot of work has been done in the context of RRM (Radio Resource Management), the deliverance of quality service to the end user still remains a challenge. Therefore there is need for a system that provides real-time services to the users through high assurance. We propose an intelligent agent-based approach to guarantee a predefined Service Level Agreement (SLA) with heterogeneous user requirements for appropriate bandwidth allocation in QoS sensitive cellular networks. The proposed system architecture exploits Case Based Reasoning (CBR) technique to handle RRM process of congestion management. The system accomplishes predefined SLA through the use of Retrieval and Adaptation Algorithm based on CBR case library. The proposed intelligent agent architecture gives autonomy to Radio Network Controller (RNC) or Base Station (BS) in accepting, rejecting or buffering a connection request to manage system bandwidth. Instead of simply blocking the connection request as congestion hits the system, different buffering durations are allocated to diverse classes of users based on their SLA. This increases the opportunity of connection establishment and reduces the call blocking rate extensively in changing environment. We carry out simulation of the proposed system that verifies efficient performance for congestion handling. The results also show built-in dynamism of our system to cater for variety of SLA requirements.

  20. The vasovagal tonus index as a prognostic indicator in dogs with dilated cardiomyopathy.

    PubMed

    Pereira, Y Martinez; Woolley, R; Culshaw, G; French, A; Martin, M

    2008-11-01

    To investigate the prognostic and diagnostic value of heart rate variability (HRV) using the vasovagal tonus index (VVTI) in dogs suffering from idiopathic dilated cardiomyopathy (DCM). Electrocardiographic (ECG) recordings of 369 patients presented to a referral centre between 1993 and 2006 were reviewed. VVTI values were calculated from 132 dogs. Lower VVTI values were found in patients in International Small Animal Cardiac Health Council (ISACHC) heart failure (HF) class 2 and 3 compared with class 1. VVTI was found to be positively correlated with survival time (ST) in class 2 and 3 patients. When a cut-off value of 7.59 for VVTI was used, the test could differentiate patients in ISACHC HF class 1 versus 2 and 3 with a sensitivity of 89 per cent and a specificity of 62.5 per cent. The ST for patients with VVTI values less than 7.59 was significantly lower. The VVTI is a useful index, obtained from a standard ECG recording that estimates HRV in dogs and does not require any specific equipment for its calculation. It can be useful as a diagnostic tool to assess the severity of HF and is a useful prognostic tool in dogs with DCM.

  1. [Pneumatic dilation in the treatment of achalasia].

    PubMed

    Ruiz Cuesta, Patricia; Hervás Molina, Antonio José; Jurado García, Juan; Pleguezuelo Navarro, María; García Sánchez, Valle; Casáis Juanena, Luis L; Gálvez Calderón, Carmen; Naranjo Rodríguez, Antonio

    2013-10-01

    Pneumatic dilation and surgical myotomy are currently the procedures of choice to treat achalasia. The selection of one or other treatment depends on the experience of each center and patient preferences. To review the experience of pneumatic dilation in patients with achalasia in our center. We included all patients with a clinical, endoscopic and manometric diagnosis compatible with achalasia who underwent pneumatic dilation in a 19-year period. All dilations were routinely performed with a Rigiflex(®) balloon, usually at pressures of 250, 250 and 300mm Hg in three inflations of one minute, each separated by one minute. The success of the dilation was assessed on the basis of the patient's symptoms, the number of sessions, the need for surgery, and the presence of complications. A total of 171 patients were included, 53.2% men and 46.8% women, with a mean age of 51.53±17.78 years (16-87 years), from June 1993 to October 2012. A 35-mm balloon was used in 157 patients, a 30-mm balloon in 9 patients and a 40-mm balloon in 7 patients. A single dilation session was required in 108 patients, two sessions were required in 56 patients, with a mean time between the first and second sessions of 25.23±43.25 months (1-215 months), and 3 sessions were required in 7 patients with a mean time between the second and third sessions of 6.86±5.33 months (1-15 months). Outcome after dilation was successful in 81% of the patients. Of the 140 responders, 121 had complete response (complete disappearance of symptoms without recurrence) and 19 partial response (initial disappearance of symptoms with subsequent reappearance). Surgery (Heller myotomy) was required in 15.8% of the patients. Perforation occurred in 4 of the 171 patients as a complication of the technique; these perforations were satisfactorily resolved, two by conservative treatment and two by surgery. There was no mortality associated with the technique or its complications. In our series, pneumatic dilation had a

  2. Understanding congestion in China's medical market: an incentive structure perspective.

    PubMed

    Sun, Zesheng; Wang, Shuhong; Barnes, Stephen R

    2016-04-01

    Congestion has become one of the most important factors leading to patient dissatisfaction and doctor-patient conflicts in the medical market of China. In this study, we explore the causes and effects of structural congestion in the Chinese medical market from an incentive structure perspective. Our analysis reveals that prior medical system reforms with price regulation in China have induced hospitals to establish incentives for capital-intensive investments, while ignoring human capital, and have driven medical staff and patients to higher-level hospitals, reinforcing an incentive structure in which congestion in higher-level hospitals and idle resources in lower-level hospitals coexist. The existing incentive structure has led to cost increases and degradation of human capital and specific factor effects. Recent reforms to reduce congestion in the Chinese medical market were not effective. Most of them had no impact on and did not involve the existing distorted incentive structure. Future reforms should consider rebalancing expectations for medical quality, free flow of human capital and price regulation reforms to rebuild a new incentive structure. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  3. Targeting congestion in allergic rhinitis: the importance of intranasal corticosteroids.

    PubMed

    Marple, Bradley F

    2008-01-01

    The cardinal nasal symptoms of allergic rhinitis (AR) are sustained by an underlying inflammatory process. Congestion is one of the most prominent and distressing symptoms for patients and is strongly associated with a broadly deteriorated quality of life and significant losses in productivity. The purpose of this study was to explore the role of intranasal corticosteroids (INSs) in down-regulating the inflammatory response to allergen and their clinical efficacy on AR symptoms, particularly congestion. AR is characterized by an influx of inflammatory cells and mediators into the nasal mucosa after antigen exposure. The response is biphasic, encompassing an early and a late phase. Antigen exposure has a priming effect, decreasing the threshold for subsequent allergic reaction on rechallenge and increasing the responsiveness of the nasal mucosa. INSs are a mainstay of therapy for AR and the most effective intervention for nasal congestion and other nasal symptoms, with established superiority to antihistamines, decongestants, and leukotriene antagonists. In addition to symptom relief, INSs suppress numerous stages of the inflammatory cascade, inhibiting the influx of inflammatory cells and mediators. Topical nasal corticosteroids have a low incidence of local adverse effects, negligible systemic absorption, and excellent safety. Congestion is one of the most bothersome symptoms of AR. INS therapy improves AR symptoms, with particular efficacy in relieving congestion, by attenuating nasal hyperresponsiveness. Pretreatment with INSs has been shown to relieve early and late-phase clinical symptoms of AR. Modification of the disease process results in significant relief of symptoms and leads to fewer disease exacerbations.

  4. A new casemix adjustment index for hospital mortality among patients with congestive heart failure.

    PubMed

    Polanczyk, C A; Rohde, L E; Philbin, E A; Di Salvo, T G

    1998-10-01

    Comparative analysis of hospital outcomes requires reliable adjustment for casemix. Although congestive heart failure is one of the most common indications for hospitalization, congestive heart failure casemix adjustment has not been widely studied. The purposes of this study were (1) to describe and validate a new congestive heart failure-specific casemix adjustment index to predict in-hospital mortality and (2) to compare its performance to the Charlson comorbidity index. Data from all 4,608 admissions to the Massachusetts General Hospital from January 1990 to July 1996 with a principal ICD-9-CM discharge diagnosis of congestive heart failure were evaluated. Massachusetts General Hospital patients were randomly divided in a derivation and a validation set. By logistic regression, odds ratios for in-hospital death were computed and weights were assigned to construct a new predictive index in the derivation set. The performance of the index was tested in an internal Massachusetts General Hospital validation set and in a non-Massachusetts General Hospital external validation set incorporating data from all 1995 New York state hospital discharges with a primary discharge diagnosis of congestive heart failure. Overall in-hospital mortality was 6.4%. Based on the new index, patients were assigned to six categories with incrementally increasing hospital mortality rates ranging from 0.5% to 31%. By logistic regression, "c" statistics of the congestive heart failure-specific index (0.83 and 0.78, derivation and validation set) were significantly superior to the Charlson index (0.66). Similar incrementally increasing hospital mortality rates were observed in the New York database with the congestive heart failure-specific index ("c" statistics 0.75). In an administrative database, this congestive heart failure-specific index may be a more adequate casemix adjustment tool to predict hospital mortality in patients hospitalized for congestive heart failure.

  5. Airport Characterization for the Adaptation of Surface Congestion Management Approaches

    DTIC Science & Technology

    2013-02-01

    Surface Congestion Management Program at New York JFK airport [6,7], the human-in-the-loop simulations of the Spot and Runway Departure Advisor...a surface congestion management technique at New York JFK airport ,” AIAA Aviation Technology, Integration and Operations (ATIO) Conference...Virginia Beach, VA, September 2011. [7] S. Stroiney, H. Khadilkar and H. Balakrishnan, “Ground Management Program at JFK Airport : Implementation and

  6. Using pricing to reduce traffic congestion.

    DOT National Transportation Integrated Search

    2009-03-01

    Highway congestion occurs when a vehicle causes delay to other vehicles on the road, resulting in longer and less reliable travel times, the use of additional fuel, and other costs to the economy. According to one widely cited study, in 2005 highway ...

  7. [Idiopathic facial paralysis in children].

    PubMed

    Achour, I; Chakroun, A; Ayedi, S; Ben Rhaiem, Z; Mnejja, M; Charfeddine, I; Hammami, B; Ghorbel, A

    2015-05-01

    Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Losartan corrects abnormal frequency response of renal vasculature in congestive heart failure.

    PubMed

    DiBona, Gerald F; Sawin, Linda L

    2003-11-01

    In congestive heart failure, renal blood flow is decreased and renal vascular resistance is increased in a setting of increased activity of both the sympathetic nervous and renin-angiotensin systems. The renal vasoconstrictor response to renal nerve stimulation is enhanced. This is associated with an abnormality in the low-pass filter function of the renal vasculature wherein higher frequencies (> or =0.01 Hz) within renal sympathetic nerve activity are not normally attenuated and are passed into the renal blood flow signal. This study tested the hypothesis that excess angiotensin II action mediates the abnormal frequency response characteristics of the renal vasculature in congestive heart failure. In anesthetized rats, the renal vasoconstrictor response to graded frequency renal nerve stimulation was significantly greater in congestive heart failure than in control rats. Losartan attenuated the renal vasoconstrictor response to a significantly greater degree in congestive heart failure than in control rats. In control rats, the frequency response of the renal vasculature was that of a first order (-20 dB/frequency decade) low-pass filter with a corner frequency (-3 dB, 30% attenuation) of 0.002 Hz and 97% attenuation (-30 dB) at > or =0.1 Hz. In congestive heart failure rats, attenuation did not exceed 45% (-5 dB) over the frequency range of 0.001-0.6 Hz. The frequency response of the renal vasculature was not affected by losartan treatment in control rats but was completely restored to normal by losartan treatment in congestive heart failure rats. The enhanced renal vasoconstrictor response to renal nerve stimulation and the associated abnormality in the frequency response characteristics of the renal vasculature seen in congestive heart failure are mediated by the action of angiotensin II on renal angiotensin II AT1 receptors.

  9. Seasonal variation in traffic congestion : a study of three U.S. cities

    DOT National Transportation Integrated Search

    2008-08-01

    Drivers may notice seasonal : changes in patterns of highway : congestion in many urban : areas of the country. These : patterns, however, can be very different for individual cities. : This report looks at congestion patterns over a 3-year period : ...

  10. Integrative Assessment of Congestion in Heart Failure Throughout the Patient Journey.

    PubMed

    Girerd, Nicolas; Seronde, Marie-France; Coiro, Stefano; Chouihed, Tahar; Bilbault, Pascal; Braun, François; Kenizou, David; Maillier, Bruno; Nazeyrollas, Pierre; Roul, Gérard; Fillieux, Ludivine; Abraham, William T; Januzzi, James; Sebbag, Laurent; Zannad, Faiez; Mebazaa, Alexandre; Rossignol, Patrick

    2018-04-01

    Congestion is one of the main predictors of poor patient outcome in patients with heart failure. However, congestion is difficult to assess, especially when symptoms are mild. Although numerous clinical scores, imaging tools, and biological tests are available to assist physicians in ascertaining and quantifying congestion, not all are appropriate for use in all stages of patient management. In recent years, multidisciplinary management in the community has become increasingly important to prevent heart failure hospitalizations. Electronic alert systems and communication platforms are emerging that could be used to facilitate patient home monitoring that identifies congestion from heart failure decompensation at an earlier stage. This paper describes the role of congestion detection methods at key stages of patient care: pre-admission, admission to the emergency department, in-hospital management, and lastly, discharge and continued monitoring in the community. The multidisciplinary working group, which consisted of cardiologists, emergency physicians, and a nephrologist with both clinical and research backgrounds, reviewed the current literature regarding the various scores, tools, and tests to detect and quantify congestion. This paper describes the role of each tool at key stages of patient care and discusses the advantages of telemedicine as a means of providing true integrated patient care. Copyright © 2018. Published by Elsevier Inc.

  11. Segmental dilatation of the intestine.

    PubMed

    Ben Brahim, Mohamed; Belghith, Mohsen; Mekki, Mongi; Jouini, Riadh; Sahnoun, Lassaad; Maazoun, Kaies; Krichene, Imed; Golli, Mondher; Monastiri, Kamel; Nouri, Abdellatif

    2006-06-01

    The aim of this work is to discuss the pathogenesis of the segmental dilatation of the intestine (SDI) and to review its clinical presentation and the ways to confirm the diagnosis. Eight cases of pathologically proven SDI from 1987 to 2003 were reviewed and discussed. There were 7 newborns and a 1-year-old boy. Our patients are 5 boys and 3 girls. In all cases, the diagnosis was not suspected before surgery. Two patients presented with a low neonatal bowel obstruction. Six patients were operated for omphalocele, which was the most frequent associated malformation. The SDI involved the ileum in all patients. The treatment consisted on a resection of the dilated segment with an end-to-end anastomosis. Histological examination demonstrated the presence of ganglion cells in all cases. The muscular layer was hypertrophied in two cases and very thin in one case. A heterotopic gastric mucosa was observed in one case. No anomalies were observed in 5 cases. The postoperative course was uneventful in 6 cases with a mean follow-up of 5 years. Segmental intestinal dilatation is an exceptional pathology with an unknown etiology and a misleading clinical presentation. Several theories were proposed to explain this malformation; however, most authors are rather inclined to an embryological theory incriminating an extrinsic intrauterine intestinal compression. Most cases are neonatal discoveries. The clinical polymorphism and the lack of specificity of radiological investigations explain the difficulties to have a preoperative diagnosis. However, this difficulty is compensated by the favorable evolution after the resection of the dilated segment.

  12. On the Inefficiency of Equilibria in Linear Bottleneck Congestion Games

    NASA Astrophysics Data System (ADS)

    de Keijzer, Bart; Schäfer, Guido; Telelis, Orestis A.

    We study the inefficiency of equilibrium outcomes in bottleneck congestion games. These games model situations in which strategic players compete for a limited number of facilities. Each player allocates his weight to a (feasible) subset of the facilities with the goal to minimize the maximum (weight-dependent) latency that he experiences on any of these facilities. We derive upper and (asymptotically) matching lower bounds on the (strong) price of anarchy of linear bottleneck congestion games for a natural load balancing social cost objective (i.e., minimize the maximum latency of a facility). We restrict our studies to linear latency functions. Linear bottleneck congestion games still constitute a rich class of games and generalize, for example, load balancing games with identical or uniformly related machines with or without restricted assignments.

  13. The Influence of Individual Driver Characteristics on Congestion Formation

    NASA Astrophysics Data System (ADS)

    Wang, Lanjun; Zhang, Hao; Meng, Huadong; Wang, Xiqin

    Previous works have pointed out that one of the reasons for the formation of traffic congestion is instability in traffic flow. In this study, we investigate theoretically how the characteristics of individual drivers influence the instability of traffic flow. The discussions are based on the optimal velocity model, which has three parameters related to individual driver characteristics. We specify the mappings between the model parameters and driver characteristics in this study. With linear stability analysis, we obtain a condition for when instability occurs and a constraint about how the model parameters influence the unstable traffic flow. Meanwhile, we also determine how the region of unstable flow densities depends on these parameters. Additionally, the Langevin approach theoretically validates that under the constraint, the macroscopic characteristics of the unstable traffic flow becomes a mixture of free flows and congestions. All of these results imply that both overly aggressive and overly conservative drivers are capable of triggering traffic congestion.

  14. Esophageal dilation with metal olives under fiberoptic endoscopic control: a new technic.

    PubMed

    Mangla, J C; Kothari, T

    1980-03-01

    Three patients with marked strictures (less than 20 Fr.) of the esophagus are described. It was very difficult to institute any simple program of dilation because mercury-filled Maloney bougies will buckle and rigid endoscopy with dilation carries a great risk of perforation. Using the conventional methods such as Eder-Puestow dilation results in significant waste of time, money and fluoroscopic help. A new technic is described whereby a successful dilation was carried out under direct visual control by endoscopic dilation of the esophagus with Eder-Puestow dilators. Since all these patients require esophagoscopy, the dilation procedure can be done in the same sitting.

  15. The effect of pneumatic dilation in management of postfundoplication dysphagia.

    PubMed

    Sunjaya, D; Podboy, A; Blackmon, S H; Katzka, D; Halland, M

    2017-06-01

    Fundoplication surgery is a commonly performed procedure for gastro-esophageal reflux disease or hiatal hernia repair. Up to 10% of patients develop persistent postoperative dysphagia after surgery. Data on the effectiveness of pneumatic dilation for treatment are limited. The aim of this study was to evaluate clinical outcomes and identify clinical factors associated with successful response to pneumatic dilation among patients with persistent postfundoplication dysphagia (PPFD). We retrospectively evaluated patients who had undergone pneumatic dilation for PPFD between 1999 and 2016. Patients with dysphagia or achalasia prior to fundoplication were excluded. Demographic information, surgical history, severity of dysphagia, and clinical outcomes were collected. Data pertaining to esophagram, manometry, endoscopy, and pneumatic dilation were also collected. We identified 38 patients (82% female, 95% Caucasian, and median age 59 years) with PPFD who completed pneumatic dilation. The median postfundoplication dysphagia score was 2. Eleven patients had abnormal peristalsis on manometry. Seventeen patients reported response (seven complete) with an average decrease of 1 in their dysphagia score. Fifteen patients underwent reoperation due to PPFD. Hiatal hernia repair was the only factor that predicts a higher response rate to pneumatic dilation. Only one patient in our study developed complication (pneumoperitoneum) from pneumatic dilation. We found that pneumatic dilation to be a safe treatment option for PPFD with moderate efficacy. Patients who developed PPFD after a hiatal hernia repair may gain the greatest benefit after pneumatic dilation. We were not able to identify additional clinical, radiological, endoscopic, or manometric parameters that were predictive of response. © 2017 John Wiley & Sons Ltd.

  16. Duodenal adenocarcinoma presenting as a mass with aneurismal dilatation.

    PubMed

    Mama, Nadia; Ben Slama, Aïda; Arifa, Nadia; Kadri, Khaled; Sriha, Badreddine; Ksiaa, Mehdi; Jemni, Hela; Tlili-Graiess, Kalthoum

    2014-01-01

    Duodenal adenocarcinoma is frequent. Aneurysmal dilatation of the small bowel is reported to be a lymphoma characteristic imaging finding. A 57-year-old male was found to have a duodenal adenocarcinoma with aneurismal dilatation on imaging which is an exceptional feature. On laparotomy, the wall thickening of the dilated duodenum extended to the first jejunal loop, with multiple mesenteric lymph nodes and ascites. Segmental palliative resection with gastro-entero-anastomosis was done. Histopathology revealed a moderately differentiated adenocarcinoma with neuro-endocrine differentiation foci. Wide areas of necrosis and vascular emboli were responsible for the radiological feature of the dilated duodenum with wall thickening. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Endoscopic dilation for treatment of anastomotic leaks following transhiatal esophagectomy.

    PubMed

    Bhasin, D K; Sharma, B C; Gupta, N M; Sinha, S K; Singh, K

    2000-06-01

    Anastomotic leak is a known complication after transhiatal esophagectomy (THE) and cervical esophagogastric anastomosis. Conservative management takes a long time to heal such leaks. We assessed the role of endoscopic dilation in patients with anastomotic leak following THE. Eight consecutive patients (seven men, one woman; mean age 51) with anastomotic leak following THE were subjected to endoscopic dilation using Savary Gilliard dilators of 7-15 mm diameter. The mean interval between surgery and detection of leak was 9 days (range 5-22 days) and dilation was performed at a mean interval of 11.4 days (range 1-20 days) after detection of the leak. Drainage from fistulas stopped completely after 1-8 days (mean 3 days). X-ray with water soluble contrast showed closure of the fistula in all cases. Duration of follow-up ranged from 2 to 12 months. Anastomotic strictures developed in three patients. These patients required three sessions each of repeat dilation, and were alive at follow-up periods of 2, 4, and 12 months, respectively. One patient developed recurrence of growth at an anastomotic site. Four patients died because of distant metastasis. Bougie dilation of anastomotic sites is a safe and effective technique for the healing of anastomotic leaks following THE. However there is a need for a prospective randomized trial comparing endoscopic dilation with no dilation in patients with anastomotic leaks following THE.

  18. Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation).

    PubMed

    Allen, Rebecca H; Goldberg, Alisa B

    2016-04-01

    First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Rate of change of heart size before congestive heart failure in dogs with mitral regurgitation.

    PubMed

    Lord, P; Hansson, K; Kvart, C; Häggström, J

    2010-04-01

    The objective of the study was to examine the changes in vertebral heart scale, and left atrial and ventricular dimensions before and at onset of congestive heart failure in cavalier King Charles spaniels with mitral regurgitation. Records and radiographs from 24 cavalier King Charles spaniels with mitral regurgitation were used. Vertebral heart scale (24 dogs), and left atrial dimension and left ventricular end diastolic and end systolic diameters (18 dogs) and their rate of increase were measured at intervals over years to the onset of congestive heart failure. They were plotted against time to onset of congestive heart failure. Dimensions and rates of change of all parameters were highest at onset of congestive heart failure, the difference between observed and chance outcome being highly significant using a two-tailed chi-square test (P<0.001). The left heart chambers increase in size rapidly only in the last year before the onset of congestive heart failure. Increasing left ventricular end systolic dimension is suggestive of myocardial failure before the onset of congestive heart failure. Rate of increase of heart dimensions may be a useful indicator of impending congestive heart failure.

  20. Increased walking variability in elderly persons with congestive heart failure

    NASA Technical Reports Server (NTRS)

    Hausdorff, J. M.; Forman, D. E.; Ladin, Z.; Goldberger, A. L.; Rigney, D. R.; Wei, J. Y.

    1994-01-01

    OBJECTIVES: To determine the effects of congestive heart failure on a person's ability to walk at a steady pace while ambulating at a self-determined rate. SETTING: Beth Israel Hospital, Boston, a primary and tertiary teaching hospital, and a social activity center for elderly adults living in the community. PARTICIPANTS: Eleven elderly subjects (aged 70-93 years) with well compensated congestive heart failure (NY Heart Association class I or II), seven elderly subjects (aged 70-79 years) without congestive heart failure, and 10 healthy young adult subjects (aged 20-30 years). MEASUREMENTS: Subjects walked for 8 minutes on level ground at their own selected walking rate. Footswitches were used to measure the time between steps. Step rate (steps/minute) and step rate variability were calculated for the entire walking period, for 30 seconds during the first minute of the walk, for 30 seconds during the last minute of the walk, and for the 30-second period when each subject's step rate variability was minimal. Group means and 5% and 95% confidence intervals were computed. MAIN RESULTS: All measures of walking variability were significantly increased in the elderly subjects with congestive heart failure, intermediate in the elderly controls, and lowest in the young subjects. There was no overlap between the three groups using the minimal 30-second variability (elderly CHF vs elderly controls: P < 0.001, elderly controls vs young: P < 0.001), and no overlap between elderly subjects with and without congestive heart failure when using the overall variability. For all four measures, there was no overlap in any of the confidence intervals, and all group means were significantly different (P < 0.05).

  1. Allergic rhinitis-induced nasal congestion: its impact on sleep quality.

    PubMed

    Storms, William

    2008-03-01

    Allergic rhinitis (AR) is an extremely common health problem affecting 20 to 40 million Americans and between 10-25% of the world's population. Patients with AR suffer from both nasal symptoms (congestion, rhinorrhea, itching, and sneezing) and ocular symptoms (itching, redness, and tearing). The negative impact on sleep quality and quantity, and consequently on various aspects of the patient's life, is an under-recognised and under-treated component of AR morbidity. Nasal congestion, which is one of the most bothersome and prevalent symptoms of AR, is thought to be the leading symptom responsible for rhinitis-related sleep problems. In addition to reducing clinical symptoms, pharmacologic therapies for AR that specifically reduce inflammatory cells and mediators - and therefore nasal congestion and other symptoms - should also improve sleep quality and overall quality of life (QOL). Intranasal corticosteroids (INS) are the current mainstay of therapy for AR. Results of a number of clinical trials demonstrate that INS effectively reduce nasal congestion and ocular symptoms, improve sleep quality, and decrease daytime somnolence. Intranasal corticosteroids have also proved to be effective in reducing symptoms of acute rhinosinusitis and nasal polyposis, both of which also negatively impact on sleep quality. Intranasal corticosteroids are considered safe due to their low systemic bioavailability.

  2. How Travel Demand Affects Detection of Non-Recurrent Traffic Congestion on Urban Road Networks

    NASA Astrophysics Data System (ADS)

    Anbaroglu, B.; Heydecker, B.; Cheng, T.

    2016-06-01

    Occurrence of non-recurrent traffic congestion hinders the economic activity of a city, as travellers could miss appointments or be late for work or important meetings. Similarly, for shippers, unexpected delays may disrupt just-in-time delivery and manufacturing processes, which could lose them payment. Consequently, research on non-recurrent congestion detection on urban road networks has recently gained attention. By analysing large amounts of traffic data collected on a daily basis, traffic operation centres can improve their methods to detect non-recurrent congestion rapidly and then revise their existing plans to mitigate its effects. Space-time clusters of high link journey time estimates correspond to non-recurrent congestion events. Existing research, however, has not considered the effect of travel demand on the effectiveness of non-recurrent congestion detection methods. Therefore, this paper investigates how travel demand affects detection of non-recurrent traffic congestion detection on urban road networks. Travel demand has been classified into three categories as low, normal and high. The experiments are carried out on London's urban road network, and the results demonstrate the necessity to adjust the relative importance of the component evaluation criteria depending on the travel demand level.

  3. Congestion control and routing over satellite networks

    NASA Astrophysics Data System (ADS)

    Cao, Jinhua

    Satellite networks and transmissions find their application in fields of computer communications, telephone communications, television broadcasting, transportation, space situational awareness systems and so on. This thesis mainly focuses on two networking issues affecting satellite networking: network congestion control and network routing optimization. Congestion, which leads to long queueing delays, packet losses or both, is a networking problem that has drawn the attention of many researchers. The goal of congestion control mechanisms is to ensure high bandwidth utilization while avoiding network congestion by regulating the rate at which traffic sources inject packets into a network. In this thesis, we propose a stable congestion controller using data-driven, safe switching control theory to improve the dynamic performance of satellite Transmission Control Protocol/Active Queue Management (TCP/AQM) networks. First, the stable region of the Proportional-Integral (PI) parameters for a nominal model is explored. Then, a PI controller, whose parameters are adaptively tuned by switching among members of a given candidate set, using observed plant data, is presented and compared with some classical AQM policy examples, such as Random Early Detection (RED) and fixed PI control. A new cost detectable switching law with an interval cost function switching algorithm, which improves the performance and also saves the computational cost, is developed and compared with a law commonly used in the switching control literature. Finite-gain stability of the system is proved. A fuzzy logic PI controller is incorporated as a special candidate to achieve good performance at all nominal points with the available set of candidate controllers. Simulations are presented to validate the theory. An effocient routing algorithm plays a key role in optimizing network resources. In this thesis, we briefly analyze Low Earth Orbit (LEO) satellite networks, review the Cross Entropy (CE

  4. 76 FR 70122 - Plan for Conduct of 2012 Electric Transmission Congestion Study

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-10

    ... preparations for the 2012 Congestion Study, and seeks comments on what publicly-available data and information...), and Microsoft PowerPoint (.ppt). The Department intends to use only data that is publicly available... Study, the Department gathered historical congestion data obtained from existing studies prepared by...

  5. Effective use of congestion in complex networks

    NASA Astrophysics Data System (ADS)

    Echagüe, Juan; Cholvi, Vicent; Kowalski, Dariusz R.

    2018-03-01

    In this paper, we introduce a congestion-aware routing protocol that selects the paths according to the congestion of nodes in the network. The aim is twofold: on one hand, and in order to prevent the networks from collapsing, it provides a good tolerance to nodes' overloads; on the other hand, and in order to guarantee efficient communication, it also incentivize the routes to follow short paths. We analyze the performance of our proposed routing strategy by means of a series of experiments carried out by using simulations. We show that it provides a tolerance to collapse close to the optimal value. Furthermore, the average length of the paths behaves optimally up to the certain value of packet generation rate ρ and it grows in a linear fashion with the increase of ρ.

  6. Can complexity decrease in congestive heart failure?

    NASA Astrophysics Data System (ADS)

    Mukherjee, Sayan; Palit, Sanjay Kumar; Banerjee, Santo; Ariffin, M. R. K.; Rondoni, Lamberto; Bhattacharya, D. K.

    2015-12-01

    The complexity of a signal can be measured by the Recurrence period density entropy (RPDE) from the reconstructed phase space. We have chosen a window based RPDE method for the classification of signals, as RPDE is an average entropic measure of the whole phase space. We have observed the changes in the complexity in cardiac signals of normal healthy person (NHP) and congestive heart failure patients (CHFP). The results show that the cardiac dynamics of a healthy subject is more complex and random compare to the same for a heart failure patient, whose dynamics is more deterministic. We have constructed a general threshold to distinguish the border line between a healthy and a congestive heart failure dynamics. The results may be useful for wide range for physiological and biomedical analysis.

  7. Endoscopic electrocautery dilation of benign anastomotic colonic strictures: a single-center experience.

    PubMed

    Bravi, Ivana; Ravizza, Davide; Fiori, Giancarla; Tamayo, Darina; Trovato, Cristina; De Roberto, Giuseppe; Genco, Chiara; Crosta, Cristiano

    2016-01-01

    Benign anastomotic colonic stenosis sometimes occur after surgery and usually require surgical or endoscopic dilation. Endoscopic dilation of anastomotic colonic strictures by using balloon or bougie-type dilators has been demonstrated to be safe and effective in multiple uncontrolled series. However, few data are available on safety and efficacy of endoscopic electrocautery dilation. The aim of our study was to retrospectively investigate safety and efficacy of endoscopic electrocautery dilation of postsurgical benign anastomotic colonic strictures. Sixty patients (37 women; median age 63.6 years, range 22.6-81.7) with benign anastomotic colonic or rectal strictures treated with endoscopic electrocautery dilation between June 2001 and February 2013 were included in the study. Anastomotic stricture was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. Only annular anastomotic strictures were considered suitable for electrocautery dilation which consisted of radial incisions performed with a precut sphincterotome. Treatment was considered successful if the colonic anastomosis could be passed by a standard colonoscope immediately after dilation. Recurrence was defined as anastomotic stricture reappearance during follow-up. The time interval between colorectal surgery and the first endoscopic evaluation or symptoms development was 7.3 months (1.3-60.7). Electrocautery dilation was successful in all the patients. There were no procedure-related complications. Median follow-up was 35.5 months (2.0-144.0). Anastomotic stricture recurrence was observed in three patients who were successfully treated with electrocautery dilation and Savary dilation. Endoscopic electrocautery dilation is a safe and effective treatment for annular benign anastomotic postsurgical colonic strictures.

  8. Effect of pupillary dilatation on glaucoma assessments using optical coherence tomography

    PubMed Central

    Smith, Michael; Frost, Andrew; Graham, Christopher Mark; Shaw, Steven

    2007-01-01

    Aims To examine the effect of pupillary dilatation on the reliability of retinal nerve fibre layer (RNFL) and optic nerve head (ONH) assessments using Stratus OCT in a glaucoma clinic. Methods Observational study of 38 patients attending a glaucoma clinic. The “fast optic disc” and “fast RNFL thickness” programs on Stratus OCT were used to measure the RNFL thickness and ONH cup to disc ratio (CDR). Two scans were done before dilatation and two after dilatation with tropicamide 1% drops. The mean values and reproducibility before and after dilatation were compared, along with the quality of scans as indicated by the “signal strength” score. Results In nine patients (23.7%) no images were obtained undilated but after dilatation examination was possible in all patients. Inability to obtain an undilated scan was associated with smaller pupil size and increasing cataract. The scan quality, as judged by the signal strength score, was higher dilated than undilated for both RNFL thickness (p = 0.011) and ONH CDR (p = 0.007). Reproducibility was higher with dilated scans for RNFL thickness but not for ONH CDR. There were significant differences between the dilated and undilated examinations for three of the five RNFL thickness variables and two of the three ONH CDR categories. Conclusions Acquisition of high quality OCT images was not possible without pupillary dilatation in about 25% of the patients. The dilated scans were more reproducible and of higher quality than the undilated scans. The two methods of examination do not appear to be interchangeable, suggesting that in follow up examinations the pupil should be in the same condition as at baseline. Pupillary dilatation is recommended before glaucoma assessments using Stratus OCT. PMID:17556429

  9. Pravastatin reduces Marfan aortic dilation.

    PubMed

    McLoughlin, Darren; McGuinness, Jonathan; Byrne, John; Terzo, Eloisa; Huuskonen, Vilhelmiina; McAllister, Hester; Black, Alexander; Kearney, Sinead; Kay, Elaine; Hill, Arnold D K; Dietz, Harry C; Redmond, J Mark

    2011-09-13

    The sequelae of aortic root dilation are the lethal consequences of Marfan syndrome. The root dilation is attributable to an imbalance between deposition of matrix elements and metalloproteinases in the aortic medial layer as a result of excessive transforming growth factor-beta signaling. This study examined the efficacy and mechanism of statins in attenuating aortic root dilation in Marfan syndrome and compared effects to the other main proposed preventative agent, losartan. Marfan mice heterozygous for a mutant allele encoding a cysteine substitution in fibrillin-1 (C1039G) were treated daily from 6 weeks old with pravastatin 0.5 g/L or losartan 0.6 g/L. The end points of aortic root diameter (n=25), aortic thickness, and architecture (n=10), elastin volume (n=5), dp/dtmax (maximal rate of change of pressure) (cardiac catheter; n=20), and ultrastructural analysis with stereology (electron microscopy; n=5) were examined. The aortic root diameters of untreated Marfan mice were significantly increased in comparison to normal mice (0.161 ± 0.001 cm vs 0.252 ± 0.004 cm; P<0.01). Pravastatin (0.22 ± 0.003 cm; P<0.01) and losartan (0.221 ± 0.004 cm; P<0.01) produced a significant reduction in aortic root dilation. Both drugs also preserved elastin volume within the medial layer (pravastatin 0.23 ± 0.02 and losartan 0.29 ± 0.03 vs untreated Marfan 0.19 ± 0.02; P=0.01; normal mice 0.27 ± 0.02). Ultrastructural analysis showed a reduction of rough endoplasmic reticulum in smooth muscle cells with pravastatin (0.022 ± 0.004) and losartan (0.013 ± 0.001) compared to untreated Marfan mice (0.035 ± 0.004; P<0.01). Statins are similar to losartan in attenuating aortic root dilation in a mouse model of Marfan syndrome. They appear to act through reducing the excessive protein manufacture by vascular smooth muscle cells, which occurs in the Marfan aorta. As a drug that is relatively well-tolerated for long-term use, it may be useful clinically.

  10. Risk of venous congestion in live donors of extended right liver graft

    PubMed Central

    Radtke, Arnold; Sgourakis, George; Molmenti, Ernesto P; Beckebaum, Susanne; Cicinnati, Vito R; Schmidt, Hartmut; Peitgen, Heinz-Otto; Broelsch, Christoph E; Malagó, Massimo; Schroeder, Tobias

    2015-01-01

    AIM: To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV). METHODS: There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnant-volume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CV-index). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV. RESULTS: MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%. Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFS-remnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4% (range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants

  11. Innovative contracting methods and construction traffic congestion.

    DOT National Transportation Integrated Search

    2012-01-01

    Increasing travel demand and lack of sufficient highway capacity are serious problems in most : major metropolitan areas in the United States. Large metropolitan cities have been experiencing : increased traffic congestion problems over the past seve...

  12. Atlanta congestion reduction demonstration national evaluation plan.

    DOT National Transportation Integrated Search

    2011-04-01

    This report provides an analytic framework for evaluating the Atlanta Congestion Reduction Demonstration (CRD) under the United States Department of Transportation (U.S. DOT) Urban Partnership Agreement (UPA) and CRD Programs. The Atlanta CRD project...

  13. A Michigan toolbox for mitigating traffic congestion.

    DOT National Transportation Integrated Search

    2011-09-30

    "Researchers created A Michigan Toolbox for Mitigating Traffic Congestion to be a useful desk reference : for practitioners and an educational tool for elected officials acting through public policy boards to better : understand the development, plan...

  14. Temporary endoscopic metallic stent for idiopathic esophageal achalasia.

    PubMed

    Coppola, Franco; Gaia, Silvia; Rolle, Emanuela; Recchia, Serafino

    2014-02-01

    Idiopathic achalasia is a motor disorder of the esophagus of unknown etiology caused by loss of motor neurons determining an altered motility. It may determine severe symptoms such as progressive dysphagia, regurgitations, and pulmonary aspirations. Many therapeutic options may be offered to patients with achalasia, from surgery to endoscopic treatments such as pneumatic dilation, botulinum injection, peroral endoscopic myotomy, or endoscopic stenting. Recently, temporary placement of a stent was proposed by Cheng as therapy for achalasia disorders, whereas no Western authors have dealt with it up to date. The present study reports our preliminary experience in 7 patients with achalasia treated with a temporary stent. Partially covered self-expanding metallic stents (Micro-Tech, Nanjin, China) 80 mm long and 30 mm wide were placed under fluoroscopic control and removed after 6 days. Clinical follow-up was scheduled to check endoscopic success, symptoms release, and complications. The placement and the removal of the stents were obtained in all patients without complications. Mean clinical follow-up was 19 months. Five out of 7 patients referred total symptoms release and 2 experienced significant improvement of dysphagia. The procedure was not time consuming and was safe; no mild or severe complications were registered. In conclusion, our results may suggest a possible safe and effective endoscopic alternative treatment in patients with achalasia; however, further larger studies are necessary to confirm these promising, but very preliminary, data.

  15. Substance P contributes to rapidly adapting receptor responses to pulmonary venous congestion in rabbits.

    PubMed

    Bonham, A C; Kott, K S; Ravi, K; Kappagoda, C T; Joad, J P

    1996-05-15

    1. This study tested the hypothesis that substance P stimulates rapidly adapting receptors (RARs), contributes to the increase in RAR activity produced by mild pulmonary congestion, and evokes an augmented response from RARs when combined with near-threshold levels of pulmonary congestion. 2. RAR activity, peak tracheal pressure, arterial blood pressure and left atrial pressure were measured in paralysed, anaesthetized and ventilated rabbits. Substance P was given i.v. in one-half log incremental doses to a maximum of 3 micrograms kg-1. Mild pulmonary congestion was produced by inflating a balloon in the left atrium to increase left atrial pressure by 5 mmHg. Near-threshold levels of pulmonary congestion were produced by increasing left atrial pressure by 2 mmHg. 3. Substance P produced dose-dependent increases in RAR activity. The highest dose given increased the activity from 1.3 +/- 0.5 to 11.0 +/- 3.1 impulses bin-1. Increases in left atrial pressure of 5 mmHg increased RAR activity from 3.8 +/- 1.4 to 14.7 +/- 3.9 impulses bin-1. Blockade of NK1 receptors with CP 96345 significantly attenuated RAR responses to substance P and to mild pulmonary congestion. 4. Doses of substance P, which alone had no effect, stimulated the RARs when delivered during near-threshold levels of pulmonary congestion. 5. The findings suggest that substance P augments the stimulatory effect of mild pulmonary congestion on RAR activity, most probably by enhancing hydraulically induced microvascular leak.

  16. Juvenile idiopathic arthritis

    MedlinePlus

    ... www.ncbi.nlm.nih.gov/pubmed/21452260 . Long AR, Rouster-Stevens KA. The role of exercise therapy ... nlm.nih.gov/pubmed/21131338 . Wu EY, Bryan AR, Rabinovich CE. Juvenile idiopathic arthritis. In: Kliegman RM, ...

  17. Pupils dilate for vocal or familiar music.

    PubMed

    Weiss, Michael W; Trehub, Sandra E; Schellenberg, E Glenn; Habashi, Peter

    2016-08-01

    Previous research reveals that vocal melodies are remembered better than instrumental renditions. Here we explored the possibility that the voice, as a highly salient stimulus, elicits greater arousal than nonvocal stimuli, resulting in greater pupil dilation for vocal than for instrumental melodies. We also explored the possibility that pupil dilation indexes memory for melodies. We tracked pupil dilation during a single exposure to 24 unfamiliar folk melodies (half sung to la la, half piano) and during a subsequent recognition test in which the previously heard melodies were intermixed with 24 novel melodies (half sung, half piano) from the same corpus. Pupil dilation was greater for vocal melodies than for piano melodies in the exposure phase and in the test phase. It was also greater for previously heard melodies than for novel melodies. Our findings provide the first evidence that pupillometry can be used to measure recognition of stimuli that unfold over several seconds. They also provide the first evidence of enhanced arousal to vocal melodies during encoding and retrieval, thereby supporting the more general notion of the voice as a privileged signal. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  18. Congested traffic states in empirical observations and microscopic simulations

    NASA Astrophysics Data System (ADS)

    Treiber, Martin; Hennecke, Ansgar; Helbing, Dirk

    2000-08-01

    We present data from several German freeways showing different kinds of congested traffic forming near road inhomogeneities, specifically lane closings, intersections, or uphill gradients. The states are localized or extended, homogeneous or oscillating. Combined states are observed as well, like the coexistence of moving localized clusters and clusters pinned at road inhomogeneities, or regions of oscillating congested traffic upstream of nearly homogeneous congested traffic. The experimental findings are consistent with a recently proposed theoretical phase diagram for traffic near on-ramps [D. Helbing, A. Hennecke, and M. Treiber, Phys. Rev. Lett. 82, 4360 (1999)]. We simulate these situations with a continuous microscopic single-lane model, the ``intelligent driver model,'' using empirical boundary conditions. All observations, including the coexistence of states, are qualitatively reproduced by describing inhomogeneities with local variations of one model parameter. We show that the results of the microscopic model can be understood by formulating the theoretical phase diagram for bottlenecks in a more general way. In particular, a local drop of the road capacity induced by parameter variations has essentially the same effect as an on-ramp.

  19. Hepatic Histology and Morphometric Measurements in Idiopathic Extrahepatic Portal Vein Thrombosis in Children, Correlated to Clinical Outcome of Meso-Rex Bypass.

    PubMed

    Tantemsapya, Niramol; Superina, Riccardo; Wang, Deli; Kronauer, Grace; Whitington, Peter F; Melin-Aldana, Hector

    2018-06-01

    The aim of this study was to correlate clinical, histologic, and morphometric features of the liver in children with extrahepatic portal vein thrombosis (EHPVT), with surgical outcome after Meso-Rex bypass (MRB). Idiopathic EHPVT, a significant cause of portal hypertension, is surgically corrected by MRB. Correlation of histologic and morphometric features of the liver with outcome has not been reported in children. We retrospectively reviewed clinical and intraoperative data of 45 children with idiopathic EHPVT. Liver samples were obtained at the time of MRB. Morphometric measurements of portal tract structures were performed and correlated with surgical outcome. Median follow-up was 3.65 years after surgery (range 1.5 to 10 years). Thirty-seven (82.2%) children had successful MRB. There was no association between age, sex, and suture material with surgical outcome. Average patient age was higher in patients with postoperative complications (P = NS). Portal fibrosis, bridging, parenchymal nodules, portal inflammation, hepatocellular swelling, steatosis, dilatation of portal lymphatics, and periductal fibrosis did not show a significant difference between the 2 groups. Portal vein and bile duct area index were significantly smaller in the unsuccessful group (P = 0.004 and 0.003, respectively). A portal vein area index <0.08 had a lower chance of successful surgical outcome. Hepatic artery area index was not significantly different. Measured intraoperative portal blood inflow was the only significant clinical factor affecting surgical outcome (P = 0.0003). Low portal vein area index and intraoperative portal blood inflow may be negative prognostic factors for MRB outcome in children with idiopathic EHPVT. Average patient age was higher, although not statistically significant, in patients with postoperative complications.

  20. Mean Field Type Control with Congestion

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

    Achdou, Yves, E-mail: achdou@ljll.univ-paris-diderot.fr; Laurière, Mathieu

    2016-06-15

    We analyze some systems of partial differential equations arising in the theory of mean field type control with congestion effects. We look for weak solutions. Our main result is the existence and uniqueness of suitably defined weak solutions, which are characterized as the optima of two optimal control problems in duality.

  1. Exploring full cervical dilatation caesarean sections-A retrospective cohort study.

    PubMed

    Corry, Edward M A; Ramphul, Meenakshi; Rowan, Ann M; Segurado, Ricardo; Mahony, Rhona M; Keane, Declan P

    2018-05-01

    The rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally. The objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences. Retrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit's electronic database for 2015. The rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80-5.33 kg) vs 3.48 kg (1.53-4.40 kg)). There was no difference in neonatal morbidity. Fetal head malposition is

  2. Mechanics of dual-mode dilative failure in subaqueous sediment deposits

    NASA Astrophysics Data System (ADS)

    You, Yao; Flemings, Peter; Mohrig, David

    2014-07-01

    We introduce dual-mode dilative failure with flume experiments. Dual-mode dilative failure combines slow and steady release of sediments by breaching with periodic sliding, which rapidly releases an internally coherent wedge of sediments. It occurs in dilative sandy deposits. This periodic slope failure results from cyclic evolution of the excess pore pressure in the deposit. Sliding generates large, transient, negative excess pore pressure that strengthens the deposit and allows breaching to occur. During breaching, negative excess pore pressure dissipates, the deposit weakens, and ultimately sliding occurs once again. We show that the sliding frequency is proportional to the coefficient of consolidation. We find that thicker deposits are more susceptible to dual-mode dilative failure. Discovery of dual-mode dilative failure provides a new mechanism to consider when interpreting the sedimentary deposits linked to submarine slope failures.

  3. Frame Transmission Efficiency-Based Cross-Layer Congestion Notification Scheme in Wireless Ad Hoc Networks.

    PubMed

    He, Huaguang; Li, Taoshen; Feng, Luting; Ye, Jin

    2017-07-15

    Different from the traditional wired network, the fundamental cause of transmission congestion in wireless ad hoc networks is medium contention. How to utilize the congestion state from the MAC (Media Access Control) layer to adjust the transmission rate is core work for transport protocol design. However, recent works have shown that the existing cross-layer congestion detection solutions are too complex to be deployed or not able to characterize the congestion accurately. We first propose a new congestion metric called frame transmission efficiency (i.e., the ratio of successful transmission delay to the frame service delay), which describes the medium contention in a fast and accurate manner. We further present the design and implementation of RECN (ECN and the ratio of successful transmission delay to the frame service delay in the MAC layer, namely, the frame transmission efficiency), a general supporting scheme that adjusts the transport sending rate through a standard ECN (Explicit Congestion Notification) signaling method. Our method can be deployed on commodity switches with small firmware updates, while making no modification on end hosts. We integrate RECN transparently (i.e., without modification) with TCP on NS2 simulation. The experimental results show that RECN remarkably improves network goodput across multiple concurrent TCP flows.

  4. Muscles involved in naris dilation and nose motion in rat

    PubMed Central

    Deschênes, Martin; Haidarliu, Sebastian; Demers, Maxime; Moore, Jeffrey; Kleinfeld, David; Ahissar, Ehud

    2016-01-01

    In a number of mammals muscle dilator nasi (naris) is known as a muscle that reduces nasal airflow resistance by dilating the nostrils. Here we show that in rats the tendon of this muscle inserts into the aponeurosis above the nasal cartilage. Electrical stimulation of this muscle lifts the nose and deflects it sideway towards the side of stimulation, but does not change the size of the nares. In the head-fixed alert rat, electromyographic activity of muscle dilator nasi is tightly coupled to nose motion, not to opening of the nares. Yet, contraction of muscle dilator nasi occurs during the pre-inspiratory phase of the respiratory cycle, suggesting a role in sniffing and sampling odorants. We also show that opening of the nares results from contraction of pars maxillaris profunda of the muscle nasolabialis profundus. This muscle attaches to the outer wall of the nasal cartilage and to the plate of the mystacial pad. Contraction of this muscle exerts a dual action: it pulls the lateral nasal cartilage outwardly, thus dilating the naris, and it drags the plate of the mystacial pad rostralward, provoking a slight retraction of the whiskers. On the basis of these results, we propose that muscle dilator nasi of the rat be renamed muscle deflector nasi, and that pars maxillaris profunda of the muscle nasolabialis profundus be named muscle dilator nasi. PMID:25257748

  5. Traffic congestion and blood pressure elevation: A comparative cross-sectional study in Lebanon.

    PubMed

    Bou Samra, Patrick; El Tomb, Paul; Hosni, Mohammad; Kassem, Ahmad; Rizk, Robin; Shayya, Sami; Assaad, Sarah

    2017-12-01

    This comparative cross-sectional study examines the association between traffic congestion and elevation of systolic and/or diastolic blood pressure levels among a convenience sample of 310 drivers. Data collection took place during a gas station pause at a fixed time of day. Higher average systolic (142 vs 123 mm Hg) and diastolic (87 vs 78 mm Hg) blood pressures were detected among drivers exposed to traffic congestion compared with those who were not exposed (P<.001), while controlling for body mass index, age, sex, pack-year smoking, driving hours per week, and occupational driving. Moreover, among persons exposed to traffic congestion, longer exposure time was associated with higher systolic and diastolic blood pressures. Further studies are needed to better understand the mechanisms of the significant association between elevated blood pressure and traffic congestion. ©2017 Wiley Periodicals, Inc.

  6. Chest ultrasound and hidden lung congestion in peritoneal dialysis patients.

    PubMed

    Panuccio, Vincenzo; Enia, Giuseppe; Tripepi, Rocco; Torino, Claudia; Garozzo, Maurizio; Battaglia, Giovanni Giorgio; Marcantoni, Carmelita; Infantone, Lorena; Giordano, Guido; De Giorgi, Maria Loreta; Lupia, Mario; Bruzzese, Vincenzo; Zoccali, Carmine

    2012-09-01

    Chest ultrasound (US) is a non-invasive well-validated technique for estimating extravascular lung water (LW) in patients with heart diseases and in end-stage renal disease. We systematically applied this technique to the whole peritoneal dialysis (PD) population of five dialysis units. We studied the cross-sectional association between LW, echocardiographic parameters, clinical [pedal oedema, New York Heart Association (NYHA) class] and bioelectrical impedance analysis (BIA) markers of volume status in 88 PD patients. Moderate to severe lung congestion was evident in 41 (46%) patients. Ejection fraction was the echocardiographic parameter with the strongest independent association with LW (r = -0.40 P = 0.002). Oedema did not associate with LW on univariate and multivariate analysis. NYHA class was slightly associated with LW (r = 0.21 P = 0.05). Among patients with severe lung congestion, only 27% had pedal oedema and the majority (57%) had no dyspnoea (NYHA Class I). Similarly, the prevalence of patients with BIA, evidence of volume excess was small (11%) and not significantly different (P = 0.79) from that observed in patients with mild or no congestion (9%). In PD patients, LW by chest US reveals moderate to severe lung congestion in a significant proportion of asymptomatic patients. Intervention studies are necessary to prove the usefulness of chest US for optimizing the control of fluid excess in PD patients.

  7. Substance P contributes to rapidly adapting receptor responses to pulmonary venous congestion in rabbits.

    PubMed Central

    Bonham, A C; Kott, K S; Ravi, K; Kappagoda, C T; Joad, J P

    1996-01-01

    1. This study tested the hypothesis that substance P stimulates rapidly adapting receptors (RARs), contributes to the increase in RAR activity produced by mild pulmonary congestion, and evokes an augmented response from RARs when combined with near-threshold levels of pulmonary congestion. 2. RAR activity, peak tracheal pressure, arterial blood pressure and left atrial pressure were measured in paralysed, anaesthetized and ventilated rabbits. Substance P was given i.v. in one-half log incremental doses to a maximum of 3 micrograms kg-1. Mild pulmonary congestion was produced by inflating a balloon in the left atrium to increase left atrial pressure by 5 mmHg. Near-threshold levels of pulmonary congestion were produced by increasing left atrial pressure by 2 mmHg. 3. Substance P produced dose-dependent increases in RAR activity. The highest dose given increased the activity from 1.3 +/- 0.5 to 11.0 +/- 3.1 impulses bin-1. Increases in left atrial pressure of 5 mmHg increased RAR activity from 3.8 +/- 1.4 to 14.7 +/- 3.9 impulses bin-1. Blockade of NK1 receptors with CP 96345 significantly attenuated RAR responses to substance P and to mild pulmonary congestion. 4. Doses of substance P, which alone had no effect, stimulated the RARs when delivered during near-threshold levels of pulmonary congestion. 5. The findings suggest that substance P augments the stimulatory effect of mild pulmonary congestion on RAR activity, most probably by enhancing hydraulically induced microvascular leak. Images Figure 6 PMID:8735708

  8. Intraspinal anomalies in early-onset idiopathic scoliosis.

    PubMed

    Pereira, E A C; Oxenham, M; Lam, K S

    2017-06-01

    In the United Kingdom, lower incidences of intraspinal abnormalities in patients with early onset idiopathic scoliosis have been observed than in studies in other countries. We aimed to determine the rates of these abnormalities in United Kingdom patients diagnosed with idiopathic scoliosis before the age of 11 years. This retrospective study of patients attending an urban scoliosis clinic identified 71 patients satisfying a criteria of: clinical diagnosis of idiopathic scoliosis; age of onset ten years and 11 months or less; MRI screening for intraspinal abnormalities. United Kingdom census data combined with patient referral data was used to calculate incidence. Mean age at diagnosis was six years with 39 right-sided and 32 left-sided curves. Four patients (5.6%) were found to have intraspinal abnormalities on MRI. These consisted of: two combined Arnold-Chiari type 1 malformations with syrinx; one syrinx with a low lying conus; and one isolated syrinx. Overall annual incidence of early onset idiopathic scoliosis was one out of 182 000 (0.0006%). This study reports the lowest rates to date of intraspinal anomalies in patients with early onset idiopathic scoliosis, adding to knowledge regarding current incidences of these abnormalities as well as any geographical variation in the nature of the disease. Cite this article: Bone Joint J 2017;99-B:829-33. ©2017 The British Editorial Society of Bone & Joint Surgery.

  9. Pupil dilation signals uncertainty and surprise in a learning gambling task.

    PubMed

    Lavín, Claudio; San Martín, René; Rosales Jubal, Eduardo

    2013-01-01

    Pupil dilation under constant illumination is a physiological marker where modulation is related to several cognitive functions involved in daily decision making. There is evidence for a role of pupil dilation change during decision-making tasks associated with uncertainty, reward-prediction errors and surprise. However, while some work suggests that pupil dilation is mainly modulated by reward predictions, others point out that this marker is related to uncertainty signaling and surprise. Supporting the latter hypothesis, the neural substrate of this marker is related to noradrenaline (NA) activity which has been also related to uncertainty signaling. In this work we aimed to test whether pupil dilation is a marker for uncertainty and surprise in a learning task. We recorded pupil dilation responses in 10 participants performing the Iowa Gambling Task (IGT), a decision-making task that requires learning and constant monitoring of outcomes' feedback, which are important variables within the traditional study of human decision making. Results showed that pupil dilation changes were modulated by learned uncertainty and surprise regardless of feedback magnitudes. Interestingly, greater pupil dilation changes were found during positive feedback (PF) presentation when there was lower uncertainty about a future negative feedback (NF); and by surprise during NF presentation. These results support the hypothesis that pupil dilation is a marker of learned uncertainty, and may be used as a marker of NA activity facing unfamiliar situations in humans.

  10. Real time driver information for congestion management.

    DOT National Transportation Integrated Search

    2015-07-01

    Traffic demand in the U.S. has grown substantially over the past few years because of the increase in population and : urbanization in large cities. This causes traffic congestion to spread out over U.S. highways and arterials, and subsequently : lea...

  11. Angiopoietin-2 polymorphism in women with idiopathic recurrent miscarriage.

    PubMed

    Pietrowski, Detlef; Tempfer, Clemens; Bettendorf, Hertha; Bürkle, Bernd; Nagele, Fritz; Unfried, Gertrud; Keck, Christoph

    2003-10-01

    To investigate the relationship between idiopathic recurrent miscarriage and a polymorphism of the gene encoding for angiopoietin-2 (ANGPT2), an autochthonous modulator of angiogenesis during pregnancy. Prospective case control study. Academic research institution. One hundred thirty-one women with a history of three or more consecutive pregnancy losses before 20 weeks' gestation, and 125 healthy, postmenopausal controls with at least two live births and no history of pregnancy loss. Peripheral venous puncture. Polymerase chain reaction and restriction fragment length polymorphism analysis were performed to identify the different ANGPT2 alleles. No association between mutant (mt) allele and the occurrence of idiopathic recurrent miscarriage was found. Between women with primary and secondary idiopathic recurrent miscarriage, no statistically significant differences with respect to allele frequencies were observed. This is the first report on the ANGPT2 gene polymorphism in women with idiopathic recurrent miscarriage, demonstrating that the investigated polymorphism is not associated with idiopathic recurrent miscarriage in a white population.

  12. Endoscopic Balloon Dilatation of Benign Esophageal Stricture—A Nonhazardous Procedure?

    PubMed Central

    Borgström, Anders; Fork, Frans-Thomas; Lövdahl, Eje

    1994-01-01

    Balloon dilatation of benign esophageal strictures has been widely used since its introduction. We have performed 224 dilatation procedures in 52 patients. Dilatation was done as an outpatient procedure. Strictures were due to reflux esophagitis in 25 patients, anastomatic stenosis in 6, achalasia in 5, complications of sclerotherapy in 5, corrosive lesions in 3, and long-standing nasogastric intubation in 2. The cause was unknown in 6 cases. The intention was to dilate all strictures up to 20 mm. Three major complications occurred, and one of these patients died. The risk of perforation seems to be higher after repeated procedures than during the first one. PMID:18493348

  13. Novel use of tissue expander for dilation of oropharyngeal stenosis.

    PubMed

    Banerjee, Debdeep; Wang, James C; Demke, Joshua C

    2014-11-01

    Naso/oropharyngeal stenoses are uncommon surgical complications. We present a child having undergone previous adenoidectomy without complication who developed naso/oropharyngeal scarring after subsequent tonsillectomy. She presented with nasal obstruction and frequent gasping at night worrisome for obstructive sleep apnea. Scar was initially excised and the defect allografted. Conventional esophageal dilators were undersized, and ultimately a tissue expander was used intraoperatively as a balloon dilator. The patient's symptoms and sleep apnea resolved. We found use of a tissue expander as a balloon dilator to be at least minimally effective in dilating the oropharynx when all other methods at our disposal proved ineffective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Traffic Congestion Detection System through Connected Vehicles and Big Data

    PubMed Central

    Cárdenas-Benítez, Néstor; Aquino-Santos, Raúl; Magaña-Espinoza, Pedro; Aguilar-Velazco, José; Edwards-Block, Arthur; Medina Cass, Aldo

    2016-01-01

    This article discusses the simulation and evaluation of a traffic congestion detection system which combines inter-vehicular communications, fixed roadside infrastructure and infrastructure-to-infrastructure connectivity and big data. The system discussed in this article permits drivers to identify traffic congestion and change their routes accordingly, thus reducing the total emissions of CO2 and decreasing travel time. This system monitors, processes and stores large amounts of data, which can detect traffic congestion in a precise way by means of a series of algorithms that reduces localized vehicular emission by rerouting vehicles. To simulate and evaluate the proposed system, a big data cluster was developed based on Cassandra, which was used in tandem with the OMNeT++ discreet event network simulator, coupled with the SUMO (Simulation of Urban MObility) traffic simulator and the Veins vehicular network framework. The results validate the efficiency of the traffic detection system and its positive impact in detecting, reporting and rerouting traffic when traffic events occur. PMID:27136548

  15. Traffic Congestion Detection System through Connected Vehicles and Big Data.

    PubMed

    Cárdenas-Benítez, Néstor; Aquino-Santos, Raúl; Magaña-Espinoza, Pedro; Aguilar-Velazco, José; Edwards-Block, Arthur; Medina Cass, Aldo

    2016-04-28

    This article discusses the simulation and evaluation of a traffic congestion detection system which combines inter-vehicular communications, fixed roadside infrastructure and infrastructure-to-infrastructure connectivity and big data. The system discussed in this article permits drivers to identify traffic congestion and change their routes accordingly, thus reducing the total emissions of CO₂ and decreasing travel time. This system monitors, processes and stores large amounts of data, which can detect traffic congestion in a precise way by means of a series of algorithms that reduces localized vehicular emission by rerouting vehicles. To simulate and evaluate the proposed system, a big data cluster was developed based on Cassandra, which was used in tandem with the OMNeT++ discreet event network simulator, coupled with the SUMO (Simulation of Urban MObility) traffic simulator and the Veins vehicular network framework. The results validate the efficiency of the traffic detection system and its positive impact in detecting, reporting and rerouting traffic when traffic events occur.

  16. Characterization of canine mitochondrial protein expression in natural and induced forms of idiopathic dilated cardiomyopathy.

    PubMed

    Lopes, Rosana; Solter, Philip F; Sisson, D David; Oyama, Mark A; Prosek, Robert

    2006-06-01

    To map canine mitochondrial proteins and identify qualitative and quantitative differences in heart mitochondrial protein expression between healthy dogs and dogs with naturally occurring and induced dilated cardiomyopathy (DCM). Left ventricle samples were obtained from 7 healthy dogs, 7 Doberman Pinschers with naturally occurring DCM, and 7 dogs with induced DCM. Fresh and frozen mitochondrial fractions were isolated from the left ventricular free wall and analyzed by 2-dimensional electrophoresis. Protein spots that increased or decreased in density by >or= 2-fold between groups were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or quadrupole selecting, quadrupole collision cell, time-of-flight mass spectrometry. Within narrow pH gradients of control canine heart mitochondrial samples, a total of 1,528 protein spots were revealed. Forty subunits of heart mitochondrial proteins that differ significantly from control tissues were altered in tissue specimens from dogs with naturally occurring and induced forms of DCM. The most affected heart mitochondrial proteins in both groups were those of oxidative phosphorylation (55%). Upregulation of manganese superoxide dismutase was suggestive of heart oxidative injury in tissue specimens from dogs with both forms of DCM. Evidence of apoptosis was associated with overexpression of the heart mitochondrial voltage-dependent anion channel-2 protein and endonuclease G in tissue specimens from dogs with induced DCM. Alterations of heart mitochondrial proteins related to oxidative phosphorylation dysfunction were more prevalent in tissue specimens from dogs with induced or naturally occurring DCM, compared with those of control dogs.

  17. Pupil dilation during recognition memory: Isolating unexpected recognition from judgment uncertainty.

    PubMed

    Mill, Ravi D; O'Connor, Akira R; Dobbins, Ian G

    2016-09-01

    Optimally discriminating familiar from novel stimuli demands a decision-making process informed by prior expectations. Here we demonstrate that pupillary dilation (PD) responses during recognition memory decisions are modulated by expectations, and more specifically, that pupil dilation increases for unexpected compared to expected recognition. Furthermore, multi-level modeling demonstrated that the time course of the dilation during each individual trial contains separable early and late dilation components, with the early amplitude capturing unexpected recognition, and the later trailing slope reflecting general judgment uncertainty or effort. This is the first demonstration that the early dilation response during recognition is dependent upon observer expectations and that separate recognition expectation and judgment uncertainty components are present in the dilation time course of every trial. The findings provide novel insights into adaptive memory-linked orienting mechanisms as well as the general cognitive underpinnings of the pupillary index of autonomic nervous system activity. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Fibre-endoscopic dilatation of peptic oesophageal strictures.

    PubMed

    Salo, J A; Ala-Kulju, K; Kalima, T

    1987-01-01

    51 patients with dysphagia caused by peptic oesophageal stricture due to primary or secondary reflux oesophagitis were treated by fibre-endoscope and Eder-Puestow dilatations under local anaesthesia and sedation, between 1976 and 1984. There was one death (2%) attributable to the procedure (perforation) and complications arose in three (6%) patients (perforation, pneumonia). The dilatation was successful in 96% but two patients (4%) had to be operated on because of undilatable stricture. Follow-up data was available for the other 44 patients for periods of one to eight (mean 2.8) years later. The stricture was cured by dilatation and antireflux treatment (conservative or operative) in all patients and 98% of them were able to eat solid food and improve their nutritional status. During follow-up 22 patients (50%) were asymptomatic and 22 (50%) had dysphagia or/and reflux symptoms. At endoscopy oesophagitis was healed with conservative or operative treatment in 25 patients (57%). It is concluded that fibre-endoscopic dilatation of peptic oesophageal strictures with the Eder-Puestow system combined with conservative or operative antireflux treatment, is a simple and safe procedure and gives good results in almost all patients. Surgical procedures aimed at total correction of the stricture are indicated only rarely in intractable cases.

  19. Diagnosis and Treatment of Depression in Patients With Congestive Heart Failure: A Review of the Literature

    PubMed Central

    Stern, Theodore A.; Hebert, Kathy A.; Musselman, Dominique L.

    2013-01-01

    Context: Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. Objective: We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. Data Sources: A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. Study Selection: We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. Data Extraction: The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. Results: MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart

  20. Dilation of fusion pores by crowding of SNARE proteins

    PubMed Central

    Wu, Zhenyong; Bello, Oscar D; Thiyagarajan, Sathish; Auclair, Sarah Marie; Vennekate, Wensi; Krishnakumar, Shyam S; O'Shaughnessy, Ben; Karatekin, Erdem

    2017-01-01

    Hormones and neurotransmitters are released through fluctuating exocytotic fusion pores that can flicker open and shut multiple times. Cargo release and vesicle recycling depend on the fate of the pore, which may reseal or dilate irreversibly. Pore nucleation requires zippering between vesicle-associated v-SNAREs and target membrane t-SNAREs, but the mechanisms governing the subsequent pore dilation are not understood. Here, we probed the dilation of single fusion pores using v-SNARE-reconstituted ~23-nm-diameter discoidal nanolipoprotein particles (vNLPs) as fusion partners with cells ectopically expressing cognate, 'flipped' t-SNAREs. Pore nucleation required a minimum of two v-SNAREs per NLP face, and further increases in v-SNARE copy numbers did not affect nucleation rate. By contrast, the probability of pore dilation increased with increasing v-SNARE copies and was far from saturating at 15 v-SNARE copies per face, the NLP capacity. Our experimental and computational results suggest that SNARE availability may be pivotal in determining whether neurotransmitters or hormones are released through a transient ('kiss and run') or an irreversibly dilating pore (full fusion). DOI: http://dx.doi.org/10.7554/eLife.22964.001 PMID:28346138

  1. Fluoroscopically guided large balloon dilatation for treating congenital esophageal stenosis in children.

    PubMed

    Hu, Hong-Tao; Shin, Ji Hoon; Kim, Jin-Hyoung; Jang, Jong Keon; Park, Jung-Hoon; Kim, Tae-Hyung; Nam, Deok Ho; Song, Ho-Young

    2015-07-01

    We aimed to evaluate the safety and clinical effectiveness of fluoroscopically guided large balloon dilatation for treating congenital esophageal stenosis in children. Our study included seven children (mean age 4.0 years) who underwent a total of ten balloon dilatation sessions. The initial balloon diameters were 10-15 mm. The technical success, clinical success (improved food intake and reduced dysphagia within 1 month following the first balloon dilatation), dysphagia recurrence, and complications were retrospectively evaluated. Technical and clinical success rates were 100 %. During the mean 38-month follow-up period after the first balloon dilatation, 3 (43 %) patients underwent only one additional balloon dilatation 4-5 months after the first balloon dilatation for dysphagia recurrence. Two of them showed improvement without further recurrence, while the remaining one underwent partial esophagectomy. Well-contained transmural esophageal rupture (type 2) occurred in two (29 %, 2/7) patients and during two (20 %, 2/10) balloon dilatation sessions. All ruptures were successfully treated conservatively. Our study showed that fluoroscopically guided large balloon dilatation seems to be a simple and effective primary treatment technique for congenital esophageal stenosis in children. Esophageal ruptures were not uncommon although they were not fatal.

  2. [Results of percutaneous transluminal dilatation of cerebral vascular stenoses].

    PubMed

    Kachel, R; Ritter, H; Grossmann, K; Glaser, F H

    1986-03-01

    The present paper is a review of 37 successful catheter dilatations of supra-aortic vascular stenoses. There were sixteen patients with a total of 21 stenoses of the internal carotid, vertebral artery or common carotid artery and sixteen patients with subclavian stenoses. Amongst the patients with stenoses of the cerebral vessels, there were ten with multiple lesions and six with a single stenosis. Three patients had successful dilatations of bilateral stenoses. The indications, technique, and complications of catheter dilatation of lesions of the cerebral vessels are described and discussed.

  3. Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease.

    PubMed

    Yamada, S; Ishikawa, M; Yamamoto, K

    2016-07-01

    CSF volumes in the basal cistern and Sylvian fissure are increased in both idiopathic normal pressure hydrocephalus and Alzheimer disease, though the differences in these volumes in idiopathic normal pressure hydrocephalus and Alzheimer disease have not been well-described. Using CSF segmentation and volume quantification, we compared the distribution of CSF in idiopathic normal pressure hydrocephalus and Alzheimer disease. CSF volumes were extracted from T2-weighted 3D spin-echo sequences on 3T MR imaging and quantified semi-automatically. We compared the volumes and ratios of the ventricles and subarachnoid spaces after classification in 30 patients diagnosed with idiopathic normal pressure hydrocephalus, 10 with concurrent idiopathic normal pressure hydrocephalus and Alzheimer disease, 18 with Alzheimer disease, and 26 control subjects 60 years of age or older. Brain to ventricle ratios at the anterior and posterior commissure levels and 3D volumetric convexity cistern to ventricle ratios were useful indices for the differential diagnosis of idiopathic normal pressure hydrocephalus or idiopathic normal pressure hydrocephalus with Alzheimer disease from Alzheimer disease, similar to the z-Evans index and callosal angle. The most distinctive characteristics of the CSF distribution in idiopathic normal pressure hydrocephalus were small convexity subarachnoid spaces and the large volume of the basal cistern and Sylvian fissure. The distribution of the subarachnoid spaces in the idiopathic normal pressure hydrocephalus with Alzheimer disease group was the most deformed among these 3 groups, though the mean ventricular volume of the idiopathic normal pressure hydrocephalus with Alzheimer disease group was intermediate between that of the idiopathic normal pressure hydrocephalus and Alzheimer disease groups. The z-axial expansion of the lateral ventricle and compression of the brain just above the ventricle were the common findings in the parameters for differentiating

  4. Pupil dilation signals uncertainty and surprise in a learning gambling task

    PubMed Central

    Lavín, Claudio; San Martín, René; Rosales Jubal, Eduardo

    2014-01-01

    Pupil dilation under constant illumination is a physiological marker where modulation is related to several cognitive functions involved in daily decision making. There is evidence for a role of pupil dilation change during decision-making tasks associated with uncertainty, reward-prediction errors and surprise. However, while some work suggests that pupil dilation is mainly modulated by reward predictions, others point out that this marker is related to uncertainty signaling and surprise. Supporting the latter hypothesis, the neural substrate of this marker is related to noradrenaline (NA) activity which has been also related to uncertainty signaling. In this work we aimed to test whether pupil dilation is a marker for uncertainty and surprise in a learning task. We recorded pupil dilation responses in 10 participants performing the Iowa Gambling Task (IGT), a decision-making task that requires learning and constant monitoring of outcomes’ feedback, which are important variables within the traditional study of human decision making. Results showed that pupil dilation changes were modulated by learned uncertainty and surprise regardless of feedback magnitudes. Interestingly, greater pupil dilation changes were found during positive feedback (PF) presentation when there was lower uncertainty about a future negative feedback (NF); and by surprise during NF presentation. These results support the hypothesis that pupil dilation is a marker of learned uncertainty, and may be used as a marker of NA activity facing unfamiliar situations in humans. PMID:24427126

  5. CCS_WHMS: A Congestion Control Scheme for Wearable Health Management System.

    PubMed

    Kafi, Mohamed Amine; Ben Othman, Jalel; Bagaa, Miloud; Badache, Nadjib

    2015-12-01

    Wearable computing is becoming a more and more attracting field in the last years thanks to the miniaturisation of electronic devices. Wearable healthcare monitoring systems (WHMS) as an important client of wearable computing technology has gained a lot. Indeed, the wearable sensors and their surrounding healthcare applications bring a lot of benefits to patients, elderly people and medical staff, so facilitating their daily life quality. But from a research point of view, there is still work to accomplish in order to overcome the gap between hardware and software parts. In this paper, we target the problem of congestion control when all these healthcare sensed data have to reach the destination in a reliable manner that avoids repetitive transmission which wastes precious energy or leads to loss of important information in emergency cases, too. We propose a congestion control scheme CCS_WHMS that ensures efficient and fair data delivery while used in the body wearable system part or in the multi-hop inter bodies wearable ones to get the destination. As the congestion detection paradigm is very important in the control process, we do experimental tests to compare between state of the art congestion detection methods, using MICAz motes, in order to choose the appropriate one for our scheme.

  6. Mechanisms of hypoxia-induced cerebrovascular dilation in the newborn pig.

    PubMed

    Leffler, C W; Smith, J S; Edrington, J L; Zuckerman, S L; Parfenova, H

    1997-03-01

    The hypothesis that endothelium-dependent components contribute to the cerebromicrovascular dilation to hypoxia in the newborn pig was addressed. Piglets anesthetized with ketamine-acepromazine and maintained on alpha-chloralose were equipped with closed cranial windows. Injury to the endothelium of pial arterioles was produced by light activation of fluorescein dye. Light/dye injury reduced the pial arteriolar dilation to hypoxia (5 min, arterial PO2 approximately 30 mmHg) from 57 +/- 9 to 19 +/- 5%. Light/dye injury abolished the pial arteriolar dilation to hypercapnia but did not affect dilation to sodium nitroprusside. The pial arteriolar dilation to hypoxia was not affected by tetrodotoxin, N(omega)-nitro-L-arginine, glibenclamide, iberiotoxin, charybdotoxin, tetraethylammonium, or 8-phenyltheophylline. Hypoxia caused increases in the cerebral cortical production of adenosine 3',5'-cyclic monophosphate and guanosine 3',5'-cyclic monophosphate. Cerebral vasodilation to hypoxia was inhibited by 5,8,11,14-eicosatetraynoic acid but was not greatly affected by cyclooxygenase or lipoxygenase inhibitors. In contrast, the cytochrome P-450 epoxygenase inhibitor miconazol decreased cerebral vasodilation to hypoxia from 45 +/- 5 to 17 +/- 4%. Therefore, the vascular endothelium appears to participate in cerebral microvascular dilation to hypoxia in newborn pigs. The mechanism may include cytochrome P-450 epoxygenase metabolites of arachidonic acid.

  7. Laparoscopic Heller Myotomy for Non-Dilated Esophageal Achalasia in Children with Intraoperative Stepped Dilation Under Image Guidance: Attempting Complete Myotomy.

    PubMed

    Miyano, Go; Miyake, Hiromu; Koyama, Mariko; Morita, Keiichi; Kaneshiro, Masakatsu; Nouso, Hiroshi; Yamoto, Masaya; Fukumoto, Koji; Urushihara, Naoto

    2016-05-01

    This study presents a modified surgical approach to laparoscopic myotomy for achalasia using stepped dilation with a Rigiflex balloon and contrast medium under image guidance. A 10-year-old boy with persistent dysphagia and vomiting had ingested only liquids for 3 months, losing >10 kg in body weight. Barium swallow and esophageal manometry diagnosed esophageal achalasia with mild esophageal dilatation. After failed pneumatic dilatation, laparoscopic Heller myotomy with Dor fundoplication was performed. Prior to surgery, a Rigiflex balloon dilator was placed within the esophagus near the diaphragmatic hiatus. A four-port technique was used, and mobilization of the esophagus was limited to the anterior aspect. A 5-cm Heller myotomy was performed, extending another 2 cm onto the anterior gastric wall. During myotomy, the Rigiflex balloon was serially dilated from 30 to 50 mL, and filled with contrast medium under fluoroscopic image guidance in order to maintain appropriate tension on the esophagus to facilitate myotomy, and to confirm adequate myotomy with sufficient release of lower esophageal sphincter by resecting residual circular muscle fibers. Residual circular muscle fibers can be simultaneously visualized under both fluoroscopic image guidance and direct observation through the laparoscope, and they were cut precisely until the residual notch fully disappeared. Dor fundoplication was completed. The operative time was 180 minutes, and oral intake was started after esophagography on postoperative day 1. As of the 12-month follow-up, the patient has not shown any symptoms, and his postoperative course appeared satisfactory.

  8. Congestion estimation technique in the optical network unit registration process.

    PubMed

    Kim, Geunyong; Yoo, Hark; Lee, Dongsoo; Kim, Youngsun; Lim, Hyuk

    2016-07-01

    We present a congestion estimation technique (CET) to estimate the optical network unit (ONU) registration success ratio for the ONU registration process in passive optical networks. An optical line terminal (OLT) estimates the number of collided ONUs via the proposed scheme during the serial number state. The OLT can obtain congestion level among ONUs to be registered such that this information may be exploited to change the size of a quiet window to decrease the collision probability. We verified the efficiency of the proposed method through simulation and experimental results.

  9. Retrospective evaluation of the incidence and prognostic significance of spontaneous echocardiographic contrast in relation to cardiac disease and congestive heart failure in cats: 725 cases (2006-2011).

    PubMed

    Peck, Courtney M; Nielsen, Lindsey K; Quinn, Rebecca L; Laste, Nancy J; Price, Lori Lyn

    2016-09-01

    To determine whether the presence of spontaneous echocardiographic contrast (SEC) in cats with cardiomyopathy is associated with increased mortality. To establish whether specific types of cardiomyopathy are more often associated with SEC in an attempt to provide a risk-stratification scheme for cats with increased risk of thromboembolic events. Retrospective study 2006-2011. Tertiary referral and teaching hospital. Seven hundred twenty-five client-owned cats undergoing echocardiographic evaluation. Patient characteristics, including age, breed, clinical signs, type of cardiovascular disease, presence of SEC, and survival time were recorded. Thyroxine, HCT, and blood pressure were recorded when available. Among cats diagnosed with cardiac abnormalities based on echocardiographic findings, those with SEC were at significantly increased risk of death as compared to those without SEC. Cats with dilated cardiomyopathy, unclassified cardiomyopathy, and hypertrophic cardiomyopathy were significantly more likely to have SEC compared to cats with other types of cardiac disease. Cats with cardiomyopathy and SEC have an increased risk of death compared to cats without SEC, although other previously identified factors such as the presence of congestive heart failure and increased left atrium to aorta ratio remain important determinants of mortality. Cats with hypertrophic cardiomyopathy, unclassified cardiomyopathy, and dilated cardiomyopathy may benefit from anticoagulant therapy due to the increased risk of SEC in these subpopulations. © Veterinary Emergency and Critical Care Society 2016.

  10. Total plasma proANP increases with atrial dilatation in horses.

    PubMed

    Van Der Vekens, N; Hunter, I; Timm, A; Decloedt, A; De Clercq, D; Deprez, P; Goetze, J P; van Loon, G

    2015-12-19

    Equine atrial natriuretic peptide (ANP) plasma concentrations are correlated with left atrial size. However, species-specific assays are lacking and the results from human assays are poorly reproducible. A new methodology called processing independent analysis (PIA) that measures the total proANP product in plasma has proven to be successful in human medicine, but has never been used in horses. The aims were to establish an equine proANP reference interval by measurement of the total proANP product using PIA and to examine the proANP concentrations in horses with atrial dilatation. Sample stability was studied by comparison of storage at -80°C and -20°C. Plasma samples were obtained from 23 healthy horses, 12 horses with moderate or severe valvular regurgitation without atrial dilatation and 42 horses with valvular regurgitation and atrial dilatation. The proANP concentration was significantly (P<0.001) higher in horses with atrial dilatation (761.4 (442.1-1859.1) pmol/l) than in healthy horses (491.6 (429.5-765.9) pmol/l; P<0.001) or horses with cardiac disease but without atrial dilatation (544.4 (457.0-677.6) pmol/l). A cut-off value (573.8 pmol/l) for detection of atrial dilatation was calculated. Sample storage at -80°C did not differ from sample storage at -20°C. The measurement of total proANP in plasma detects atrial dilatation in horses and may be useful for clinical evaluation in equine medicine. British Veterinary Association.

  11. Nonsurgical Management of Adolescent Idiopathic Scoliosis.

    PubMed

    Gomez, Jaime A; Hresko, M Timothy; Glotzbecker, Michael P

    2016-08-01

    Pediatric patient visits for spinal deformity are common. Most of these visits are for nonsurgical management of scoliosis, with approximately 600,000 visits for adolescent idiopathic scoliosis (AIS) annually. Appropriate management of scoliotic curves that do not meet surgical indication parameters is essential. Renewed enthusiasm for nonsurgical management of AIS (eg, bracing, physical therapy) exists in part because of the results of the Bracing in Adolescent Idiopathic Scoliosis Trial, which is the only randomized controlled trial available on the use of bracing for AIS. Bracing is appropriate for idiopathic curves between 20° and 40°, with successful control of these curves reported in >70% of patients. Patient adherence to the prescribed duration of wear is essential to maximize the effectiveness of the brace. The choice of brace type must be individualized according to the deformity and the patient's personality as well as the practice setting and brace availability.

  12. Long Island Transportation Plan to Manage Congestion: Framework for Developing and Evaluating Improvement Strategies

    DOT National Transportation Integrated Search

    2002-04-20

    The Long Island Transportation Plan to Manage Congestion (LITP 2000) will establish an integrated, multi-modal transportation program of cost-effective strategies to manage congestion and improve the movement of people and goods in Nassau and Suffolk...

  13. Lessons learned from international experience in congestion pricing.

    DOT National Transportation Integrated Search

    2008-08-01

    Large road pricing projects have been implemented in U.K., France, Norway, Sweden, : Germany, Switzerland, Singapore and Australia over the past three decades. Additionally, : congestion pricing has been analyzed and evaluated through numerous studie...

  14. Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure.

    PubMed

    Pellicori, Pierpaolo; Cleland, John G F; Zhang, Jufen; Kallvikbacka-Bennett, Anna; Urbinati, Alessia; Shah, Parin; Kazmi, Syed; Clark, Andrew L

    2016-12-01

    Diuretics are the mainstay of treatment for congestion but concerns exist that they adversely affect prognosis. We explored whether the relationship between loop diuretic use and outcome is explained by the underlying severity of congestion amongst patients referred with suspected heart failure. Of 1190 patients, 712 had a left ventricular ejection fraction (LVEF) ≤50 %, 267 had LVEF >50 % with raised plasma NTproBNP (>400 ng/L) and 211 had LVEF >50 % with NTproBNP ≤400 ng/L; respectively, 72 %, 68 % and 37 % of these groups were treated with loop diuretics including 28 %, 29 % and 10 % in doses ≥80 mg furosemide equivalent/day. Compared to patients with cardiac dysfunction (either LVEF ≤50 % or NT-proBNP >400 ng/L) but not taking a loop diuretic, those taking a loop diuretic were older and had more clinical evidence of congestion, renal dysfunction, anaemia and hyponatraemia. During a median follow-up of 934 (IQR: 513-1425) days, 450 patients were hospitalized for HF or died. Patients prescribed loop diuretics had a worse outcome. However, in multi-variable models, clinical, echocardiographic (inferior vena cava diameter), and biochemical (NTproBNP) measures of congestion were strongly associated with an adverse outcome but not the use, or dose, of loop diuretics. Prescription of loop diuretics identifies patients with more advanced features of heart failure and congestion, which may account for their worse prognosis. Further research is needed to clarify the relationship between loop diuretic agents and outcome; imaging and biochemical measures of congestion might be better guides to diuretic dose than symptoms or clinical signs.

  15. Occurrence of idiopathic pulmonary fibrosis during immunosuppressive treatment: a case report.

    PubMed

    Cerri, Stefania; Sgalla, Giacomo; Richeldi, Luca; Luppi, Fabrizio

    2016-05-25

    Immunosuppressive therapy has been-until the recent release of new guidelines on diagnosis and management-the recommended treatment for idiopathic pulmonary fibrosis. However, its efficacy in patients with idiopathic pulmonary fibrosis has always been a matter of debate. We report the occurrence of idiopathic pulmonary fibrosis in a white man receiving chronic immunosuppressive treatment following a heart transplant. This case report suggests that the immune mechanisms targeted by azathioprine and cyclosporine do not play a role in the pathogenesis of idiopathic pulmonary fibrosis.

  16. Heart rate variability enhances the prognostic value of established parameters in patients with congestive heart failure.

    PubMed

    Krüger, C; Lahm, T; Zugck, C; Kell, R; Schellberg, D; Schweizer, M W F; Kübler, W; Haass, M

    2002-12-01

    This prospective study evaluated whether heart rate variability (HRV) assessed from Holter ECG has prognostic value in addition to established parameters in patients with congestive heart failure (CHF). The study included 222 patients with CHF due to dilated or ischemic cardiomyopathy (left ventricular ejection fraction LVEF 21+/-1%; mean+/-SEM). During a mean follow-up of 15+/-1 months, 38 (17%) patients died and 45 (20%) were hospitalized due to worsening of CHF. The HRV parameter SDNN (standard deviation of all intervals between normal beats) was significantly lower in non-surviving or hospitalized than in event-free patients (118+/-6 vs 142+/-5 ms), as were LVEF (18+/-1 vs 23+/-1%), and peak oxygen uptake during exercise (peak VO(2)) (12.8+/-0.5 vs 15.6+/-0.5 ml/min/kg). While each of these parameters was a risk predictor in univariate analysis, multivariate analysis revealed that HRV provides both independent and additional prognostic information with respect to the risk 'cardiac mortality or deterioration of CHF'. It is concluded that the determination of HRV enhances the prognostic power given by the most widely used parameters LVEF and peak VO(2) in the prediction of mortality or deterioration of CHF and thus enables to improve risk stratification.

  17. Successful balloon dilatation of both orifices in a case of double-orifice mitral valve with severe rheumatic stenosis.

    PubMed

    Nath, Ranjit Kumar; Soni, Dheeraj Kumar

    2016-08-01

    A 24-year-old female patient presented to us with progressive dyspnea on exertion for last three year. She was not a known case of rheumatic heart disease. Her physical examination showed regular pulse and her blood pressure was 100/76 mm Hg. Cardiac palpation showed grade 3 parasternal heave and auscultation revelled an accentuated first heart sound, loud P2 and mid-diastolic long rumbling murmur at apex and pansystolic murmur of tricuspid regurgitation at lower left sterna border. Chest X-ray showed evidence of grade 3 pulmonary venous congestion. Transthoracic and transesophageal two-dimensional echocardiography revealed a double-orifice mitral valve of complete bridge type at the leaflet level. Both orifice sizes were unequal, with the anterolateral orifice being smaller than its counterpart. There was moderate subvalvular fusion and both commisures were fused. Color doppler examination showed two separate mitral diastolic flows with mean gradients of 22 mm and 20 mm of Hg, respectively. There was no mitral regurgitation and no left atrial or appendage clot was seen by transesophageal echocardiography. Transseptal puncture was done by the modified fluoroscopic method. Posteromedial orifice was crossed with a 24 mm Inoue balloon and dilated using the stepwise dilation technique. Anterolateral orifice was not crossed by Inuoe balloon after multiple attempts. A TYSHAK (NuMAD Canada Inc.) balloon (16 × 40mm) was taken over the wire and inflated successfully across the anterolateral orifice with the help of transthoracic echocardiography guidance. Mean gradient become 9 and 8 mm across the medial and lateral orifice. Patient was discharged in stable condition after two day. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  18. Adapting End Host Congestion Control for Mobility

    NASA Technical Reports Server (NTRS)

    Eddy, Wesley M.; Swami, Yogesh P.

    2005-01-01

    Network layer mobility allows transport protocols to maintain connection state, despite changes in a node's physical location and point of network connectivity. However, some congestion-controlled transport protocols are not designed to deal with these rapid and potentially significant path changes. In this paper we demonstrate several distinct problems that mobility-induced path changes can create for TCP performance. Our premise is that mobility events indicate path changes that require re-initialization of congestion control state at both connection end points. We present the application of this idea to TCP in the form of a simple solution (the Lightweight Mobility Detection and Response algorithm, that has been proposed in the IETF), and examine its effectiveness. In general, we find that the deficiencies presented are both relatively easily and painlessly fixed using this solution. We also find that this solution has the counter-intuitive property of being both more friendly to competing traffic, and simultaneously more aggressive in utilizing newly available capacity than unmodified TCP.

  19. Dilated cardiomyopathy and sinoatrial dysfunction in an Estrela mountain dog.

    PubMed

    Lobo, Luis; Pinheiro-Vieira, António; Gomes, João L; Canada, Nuno; Ribeiro, Lenio; Costa, Paulo D; Oliveira, Pedro; Bussadori, Claudio

    2012-01-01

    A 1 yr old male Estrela mountain dog was evaluated as a part of a screening program for dilated cardiomyopathy. The dog came from a family with a history of dilated cardiomyopathy but was asymptomatic. Occult dilated cardiomyopathy and sino-atrial dysfunction were diagnosed based on echocardiography and electrocardiography. These two disorders may be associated given that related dogs have been diagnosed with the same disorders. The dog has remained asymptomatic for 4 years following initial evaluation.

  20. IgG abnormality in narcolepsy and idiopathic hypersomnia.

    PubMed

    Tanaka, Susumu; Honda, Makoto

    2010-03-05

    A close association between narcolepsy and the Human Leukocyte Antigen (HLA)-DQB1*0602 allele suggests the involvement of the immune system, or possibly an autoimmune process. We investigated serum IgG levels in narcolepsy. We measured the serum total IgG levels in 159 Japanese narcolepsy-cataplexy patients positive for the HLA-DQB1*0602 allele, 28 idiopathic hypersomnia patients with long sleep time, and 123 healthy controls (the HLA-DQB1*0602 allele present in 45 subjects). The serum levels of each IgG subclass were subsequently measured. The distribution of serum IgG was significantly different among healthy controls negative for the HLA-DQB1*0602 allele (11.66+/-3.55 mg/ml), healthy controls positive for the HLA-DQB1*0602 allele (11.45+/-3.43), narcolepsy patients (9.67+/-3.38), and idiopathic hypersomnia patients (13.81+/-3.80). None of the following clinical variables, age, disease duration, Epworth Sleepiness Scale, smoking habit and BMI at the time of blood sampling, were associated with IgG levels in narcolepsy or idiopathic hypersomnia. Furthermore we found the decrease in IgG1 and IgG2 levels, stable expression of IgG3, and the increase in the proportion of IgG4 in narcolepsy patients with abnormally low IgG levels. The increase in the proportion of IgG4 levels was also found in narcolepsy patients with normal serum total IgG levels. Idiopathic hypersomnia patients showed a different pattern of IgG subclass distribution with high IgG3 and IgG4 level, low IgG2 level, and IgG1/IgG2 imbalance. Our study is the first to determine IgG abnormalities in narcolepsy and idiopathic hypersomnia by measuring the serum IgG levels in a large number of hypersomnia patients. The observed IgG abnormalities indicate humoral immune alterations in narcolepsy and idiopathic hypersomnia. Different IgG profiles suggest immunological differences between narcolepsy and idiopathic hypersomnia.

  1. Launching automated rotary parking system: Towards traffic congestion free Dhaka city

    NASA Astrophysics Data System (ADS)

    Islam, Mohummad Shariful; Tithi, Afshana Morshed; Hossain, Farzad; Shetu, Rifat Sultana; Amin, S. M. Abdullah Al; Chowdhury, Shakia Zannatul Ferdous

    2017-12-01

    Bangladesh is the most densely populated city in the whole world, which is visible more in the capital city Dhaka. People have to suffer and valuable times are being wasted for this chronic quandary. Lack of proper planning of the city, different speed vehicles on the same road, over population, inadequate road space, unplanned stoppage or parking etc. are responsible for causing the traffic congestion in Dhaka City. Among those insufficient/unplanned parking system is one of the main reasons for causing traffic congestion. The automated rotary car parking system is the best and suitable because of its less utilization of space compared to other systems. It is a friendly parking system due to the non-utilization of noise/pollution related mechanism. The aim of this paper is to develop an automated car parking system with a minimum cost for reducing congestion in Dhaka city.

  2. Cerebral Venous Congestion as Indication for Thrombolytic Treatment

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

    Tsai, Fong Y., E-mail: ftsai@uci.edu; Kostanian, Varoujan; Rivera, Monica

    Purpose. To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods. Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 tomore » 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent's effect. Results. The first 10 patients received only anticoagulation therapy with heparin and warfarin for

  3. Pathology of idiopathic non-cirrhotic portal hypertension.

    PubMed

    Guido, Maria; Sarcognato, Samantha; Sacchi, Diana; Colloredo, Guido

    2018-04-12

    Idiopathic non-cirrhotic portal hypertension is an under-recognized vascular liver disease of unknown etiology, characterized by clinical signs of portal hypertension in the absence of cirrhosis. By definition, any disorder known to cause portal hypertension in the absence of cirrhosis and any cause of chronic liver disease must be excluded to make a diagnosis of idiopathic non-cirrhotic portal hypertension. However, the diagnosis is often difficult because the disease resembles cirrhosis and there is no gold standard test. Liver biopsy is an essential tool: it is able to exclude cirrhosis and other causes of portal hypertension and it allows the identification of the characteristic lesions. Nonetheless, the histological diagnosis of idiopathic non-cirrhotic portal hypertension is not always straightforward, in particular by needle biopsy samples, because there is no pathognomonic lesion, but rather a variety of vascular changes which are unevenly distributed, very subtle, and not all necessarily identified in a single specimen. Pathologists should be able to recognize several patterns of injury, involving portal/periportal areas as well as parenchymal structures.The histological features of idiopathic non-cirrhotic portal hypertension are described in this review, focusing on their interpretation in needle biopsy specimens.

  4. Importance of anatomical dominance in the evaluation of coronary dilatation in Kawasaki disease.

    PubMed

    Dionne, Audrey; Hanna, Baher; Trinh Tan, Frédérick; Desjardins, Laurent; Lapierre, Chantale; Déry, Julie; Fournier, Anne; Dahdah, Nagib

    2017-07-01

    Introduction In Kawasaki disease, although coronary dilatation is attributed to vasculitis, the effect of myocardial inflammation is underestimated. Coronary dilatations are determined by Z-scores, which do not take into account dominance. The aim of the present study was to describe the impact of coronary dominance on dilatation in Kawasaki disease. We performed a retrospective analysis of coronary dilatations according to angiography categorisation of dominance. Of 28 patients (2.6 [0.2-10.1] years), right dominance was present in 15 patients and left in 13. Early dilatation was present in all patients, of whom 11 were ipsilateral to the dominant segment and 17 contralateral. Ipsilateral dilatations were present at diagnosis (9/11 versus 6/17, p=0.02) compared with contralateral dilatations, which developed 2 weeks after diagnosis (9/11 versus 16/17, p=0.29). Coronary artery Z-scores of patients with contralateral dilatation increased at 2 weeks, before returning to baseline values (2.0±2.2 at diagnosis, 4.1±1.8 at 2 weeks, 1.8±1.2 at 3-6 months, p=0.001), compared with patients with ipsilateral dilatation in whom Z-scores were maximal at diagnosis and remained stable (3.0±0.9, 2.7±1.1 and 2.6±1.5, respectively, p=0.13). Dominant coronary artery Z-scores were higher compared with non-dominant segments at diagnosis (3.0±0.9 versus 1.0±0.8, p<0.001) and at late follow-up (2.6±1.5 versus 0.4±1.4, p=0.002) in patients with ipsilateral dilatation. Progression of coronary dilatation after diagnosis may be a sign of dilatation secondary to vasculitis, as opposed to regression of Z-scores in ipsilateral dilatations, probably related to physiological vasodilatation in response to carditis. This needs to be validated in larger studies against vasculitic and myocardial inflammatory markers.

  5. Dilatancy of Shear Transformations in a Colloidal Glass

    NASA Astrophysics Data System (ADS)

    Lu, Y. Z.; Jiang, M. Q.; Lu, X.; Qin, Z. X.; Huang, Y. J.; Shen, J.

    2018-01-01

    Shear transformations, as fundamental rearrangement events operating in local regions, hold the key of plastic flow of amorphous solids. Despite their importance, the dynamic features of shear transformations are far from clear, which is the focus of the present study. Here, we use a colloidal glass under shear as the prototype to directly observe the shear-transformation events in real space. By tracing the colloidal-particle rearrangements, we quantitatively determine two basic properties of shear transformations: local shear strain and dilatation (or free volume). It is revealed that the local free volume undergoes a significantly temporary increase prior to shear transformations, eventually leading to a jump of local shear strain. We clearly demonstrate that shear transformations have no memory of the initial free volume of local regions. Instead, their emergence strongly depends on the dilatancy ability of these local regions, i.e., the dynamic creation of free volume. More specifically, the particles processing the high dilatancy ability directly participate in subsequent shear transformations. These results experimentally enrich Argon's statement about the dilatancy nature of shear transformations and also shed insight into the structural origin of amorphous plasticity.

  6. [Adolescent idiopathic scoliosis].

    PubMed

    2016-12-01

    Adolescent idiopathic scoliosis is a 3D spinal deformity in frontal, sagittal and axial planes, with high relevance in the pediatric population especially in adolescents and females between 10 years of age and the end of growth spurt and skeletal maturity. The radiographic manifestation is a curve greater than 10° measured by Cobb method associated with vertebral rotation. "Idiopathic" diagnosis has to be done after neuroanatomical anomalies of the posterior cerebral fosa and spinal canal have been ruled out. The physical finding of a thoracic or lumbar hump is the clinical manifestation of vertebral rotation seen in a forward bending test (Adam's Test). It is recommended that all curves with a magnitude greater than 20° have to be controlled and treated by a spinal surgeon being observation, bracing and surgery the different treatment options based on the extent, progression of deformity and basically the clinical condition of the patient. Sociedad Argentina de Pediatría.

  7. Idiopathic pulmonary fibrosis.

    PubMed

    Xaubet, Antoni; Ancochea, Julio; Molina-Molina, María

    2017-02-23

    Idiopathic pulmonary fibrosis is a fibrosing interstitial pneumonia associated with the radiological and/or histological pattern of usual interstitial pneumonia. Its aetiology is unknown, but probably comprises the action of endogenous and exogenous micro-environmental factors in subjects with genetic predisposition. Its diagnosis is based on the presence of characteristic findings of high-resolution computed tomography scans and pulmonary biopsies in absence of interstitial lung diseases of other aetiologies. Its clinical evolution is variable, although the mean survival rate is 2-5 years as of its clinical presentation. Patients with idiopathic pulmonary fibrosis may present complications and comorbidities which modify the disease's clinical course and prognosis. In the mild-moderate disease, the treatment consists of the administration of anti-fibrotic drugs. In severe disease, the best therapeutic option is pulmonary transplantation. In this paper we review the diagnostic and therapeutic aspects of the disease. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  8. Idiopathic toe walking.

    PubMed

    Oetgen, Matthew E; Peden, Sean

    2012-05-01

    Toe walking is a bilateral gait abnormality in which a normal heel strike is absent and most weight bearing occurs through the forefoot. This abnormality may not be pathologic in patients aged <2 years, but it is a common reason for referral to an orthopaedic surgeon. Toe walking can be caused by several neurologic and developmental abnormalities and may be the first sign of a global developmental problem. Cases that lack a definitive etiology are categorized as idiopathic. A detailed history, with careful documentation of the developmental history, and a thorough physical examination are required in the child with a primary report of toe walking. Treatment is based on age and the severity of the abnormality. Management includes observation, stretching, casting, bracing, chemodenervation, and surgical lengthening of the gastrocnemius-soleus complex and/or Achilles tendon. An understanding of idiopathic toe walking as well as treatment options and their outcomes can help the physician individualize treatment to achieve optimal results.

  9. Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation

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

    Orsi, Franco; Penco, Silvia; Matei, Victor

    2007-09-15

    Background. Ureterointestinal anastomotic strictures (UAS) complicate 10-15% of surgeries for urinary diversion and are the main cause of deterioration in renal function. Treatments are surgical revision, management with autostatic stent, balloon dilatation, endoscopic incision, and percutaneous transrenal diathermy (Acucise). A new option is cryoplastic dilatation (Polar-Cath). Purpose. To assess the feasibility, complications, and preliminary results of UAS treatment using the Acucise and Polar-Cath systems. Methods. Nineteen UAS, diagnosed by ultrasonography or computed tomography and sequential renal scintigraphy, occurred in 15 cancer patients after radical cystectomy and urinary diversion. Fifteen were managed with balloon diathermy and 4 by balloon cryoplasty inmore » a three-stage procedure-percutaneous nephrostomy, diathermal or cryoplastic dilatation, and transnephrostomic control with nephrostomy removal-each separated by 15 days. All patients gave written informed consent. Results. Dilatations were successful in all cases. The procedure is simple and rapid (about 45 min) under fluoroscopic control and sedation. Procedural complications occurred in 1 (5%) patient with UAS after Wallace II uretero-ileocutaneostomy: a common iliac artery lesion was induced by diathermal dilatation, evident subsequently, and required surgical repair. Patency with balloon diathermy was good, with two restenoses developing over 12 months (range 1-22) of follow-up. With balloon cryoplastic dilatation, one restenosis developed in the short term; follow-up is too brief to assess the long-term efficacy. Conclusion. Our short-term results with diathermal and cryoplastic dilatation to resolve UAS are good. If supported by longer follow-up, the techniques may be considered as first-choice approaches to UAS. Surgery should be reserved for cases in which this minimally invasive technique fails.« less

  10. Vasopressin, cortisol, and catecholamine concentrations in dogs with dilated cardiomyopathy.

    PubMed

    Tidholm, Anna; Häggström, Jens; Hansson, Kerstin

    2005-10-01

    To evaluate plasma concentrations and urinary excretion of vasopressin and cortisol and urinary excretion of catecholamines in dogs with dilated cardiomyopathy (DCM). 15 dogs with clinical signs of DCM, 15 dogs with preclinical DCM, and 15 control dogs. Physical examinations, thoracic radiography, ECG, and echocardiography were performed on all dogs. Blood and urine samples were collected. Plasma concentration of vasopressin and the urine cortisol-to-urine creatinine ratio were significantly increased in dogs with clinical signs of DCM and dogs with preclinical DCM, compared with control dogs. Plasma vasopressin concentration was significantly higher in dogs with clinical signs of DCM, compared with dogs with preclinical DCM. Urine vasopressin-to-urine creatinine ratio was significantly increased in dogs with clinical signs of DCM, compared with dogs with preclinical DCM and control dogs. Urine epinephrine-to-urine creatinine ratio and urine norepinephrine-to-urine creatinine ratio were significantly increased in dogs with clinical signs of DCM, compared with control dogs. Plasma concentration of cortisol and urine dopamine-to-urine creatinine ratio did not differ significantly among groups. According to this study, the neuroendocrine pattern is changed in dogs with preclinical DCM. These changes are even more pronounced in dogs with clinical signs of DCM. Analysis of concentrations of vasopressin, cortisol, and catecholamines may aid in identification of the clinical stages of DCM. These findings may also provide a basis for additional studies of the possible beneficial effects of vasopressin antagonists and beta-adrenergic receptor antagonists in the treatment of dogs with congestive heart failure and DCM.

  11. CLINICAL CHARACTERISTICS OF IDIOPATHIC FOVEOMACULAR RETINOSCHISIS.

    PubMed

    Maruko, Ichiro; Morizane, Yuki; Kimura, Shuhei; Shiode, Yusuke; Hosokawa, Mio; Sekiryu, Tetsuju; Iida, Tomohiro; Shiraga, Fumio

    2016-08-01

    To describe the clinical features of idiopathic foveomacular retinoschisis not in association with myopia, glaucoma, optic disk pit, or juvenile retinoschisis. Retrospective observational case series. Five eyes of five patients with idiopathic foveomacular retinoschisis were included. The patients were 2 men and 3 women (average age, 75.2 years; range, 71-78 years). The average spherical equivalent was +2.40 diopters (range, +0.88 to +5.75 diopters), and the average axial length was 22.0 mm (range, 21.1-23.1 mm). All patients had retinoschisis from the macula to the optic disk in the affected eye. No patients had retinoschisis in the fellow eye. The average best-corrected visual acuity was 20/44 (68 Early Treatment Diabetic Retinopathy Study letter score). Idiopathic foveomacular retinoschisis is not inherited or associated with myopia, vitreomacular traction syndrome, optic pit, or glaucoma but is associated with older age, unilaterality, hyperopia with short axial length, complete posterior vitreous detachment, and weak leakage from the optic disk on fluorescein angiography.

  12. The congestion control algorithm based on queue management of each node in mobile ad hoc networks

    NASA Astrophysics Data System (ADS)

    Wei, Yifei; Chang, Lin; Wang, Yali; Wang, Gaoping

    2016-12-01

    This paper proposes an active queue management mechanism, considering the node's own ability and its importance in the network to set the queue threshold. As the network load increases, local congestion of mobile ad hoc network may lead to network performance degradation, hot node's energy consumption increase even failure. If small energy nodes congested because of forwarding data packets, then when it is used as the source node will cause a lot of packet loss. This paper proposes an active queue management mechanism, considering the node's own ability and its importance in the network to set the queue threshold. Controlling nodes buffer queue in different levels of congestion area probability by adjusting the upper limits and lower limits, thus nodes can adjust responsibility of forwarding data packets according to their own situation. The proposed algorithm will slow down the send rate hop by hop along the data package transmission direction from congestion node to source node so that to prevent further congestion from the source node. The simulation results show that, the algorithm can better play the data forwarding ability of strong nodes, protect the weak nodes, can effectively alleviate the network congestion situation.

  13. Optimal management of idiopathic scoliosis in adolescence

    PubMed Central

    Kotwicki, Tomasz; Chowanska, Joanna; Kinel, Edyta; Czaprowski, Dariusz; Tomaszewski, Marek; Janusz, Piotr

    2013-01-01

    Idiopathic scoliosis is a three-dimensional deformity of the growing spine, affecting 2%–3% of adolescents. Although benign in the majority of patients, the natural course of the disease may result in significant disturbance of body morphology, reduced thoracic volume, impaired respiration, increased rates of back pain, and serious esthetic concerns. Risk of deterioration is highest during the pubertal growth spurt and increases the risk of pathologic spinal curvature, increasing angular value, trunk imbalance, and thoracic deformity. Early clinical detection of scoliosis relies on careful examination of trunk shape and is subject to screening programs in some regions. Treatment options are physiotherapy, corrective bracing, or surgery for mild, moderate, or severe scoliosis, respectively, with both the actual degree of deformity and prognosis being taken into account. Physiotherapy used in mild idiopathic scoliosis comprises general training of the trunk musculature and physical capacity, while specific physiotherapeutic techniques aim to address the spinal curvature itself, attempting to achieve self-correction with active trunk movements developed in a three-dimensional space by an instructed adolescent under visual and proprioceptive control. Moderate but progressive idiopathic scoliosis in skeletally immature adolescents can be successfully halted using a corrective brace which has to be worn full time for several months or until skeletal maturity, and is able to prevent more severe deformity and avoid the need for surgical treatment. Surgery is the treatment of choice for severe idiopathic scoliosis which is rapidly progressive, with early onset, late diagnosis, and neglected or failed conservative treatment. The psychologic impact of idiopathic scoliosis, a chronic disease occurring in the psychologically fragile period of adolescence, is important because of its body distorting character and the onerous treatment required, either conservative or surgical

  14. Dilated Canine Hearts: A Specimen for Teaching Cardiac Anatomy

    ERIC Educational Resources Information Center

    Cope, Lee Anne

    2008-01-01

    Dilated canine hearts were used to teach undergraduate students internal and external cardiac anatomy. The specimens were dilated using hydrostatic pressure and then fixed using 5% formalin. These specimens provided the students with an alternative to prepackaged embalmed hearts and anatomical models for studying the external and internal cardiac…

  15. Congestive cardiomyopathy and endobronchial granulomas as manifestations of Churg-Strauss syndrome.

    PubMed Central

    Alvarez-Sala, R.; Prados, C.; Armada, E.; Del Arco, A.; Villamor, J.

    1995-01-01

    Churg-Strauss syndrome is a systemic vasculitis. Its most frequent complications are heart diseases and asthma. Usually, cardiological manifestations are pericarditis, cardiac failure and myocardial infarction. Endobronchial granulomas identified by bronchoscopy are unusual. We present the case of a man with congestive cardiomyopathy and endobronchial granulomas macroscopically visible at bronchoscopy. After a review of medical literature, we found one case of congestive cardiomyopathy and no cases of endobronchial granulomas observed by bronchoscopy associated with Churg-Strauss syndrome. Images Figure PMID:7644400

  16. The Enright phenomenon. Stereoscopic distortion of perceived driving speed induced by monocular pupil dilation.

    PubMed

    Carkeet, Andrew; Wood, Joanne M; McNeill, Kylie M; McNeill, Hamish J; James, Joanna A; Holder, Leigh S

    The Enright phenomenon describes the distortion in speed perception experienced by an observer looking sideways from a moving vehicle when viewing with interocular differences in retinal image brightness, usually induced by neutral density filters. We investigated whether the Enright phenomenon could be induced with monocular pupil dilation using tropicamide. We tested 17 visually normal young adults on a closed road driving circuit. Participants were asked to travel at Goal Speeds of 40km/h and 60km/h while looking sideways from the vehicle with: (i) both eyes with undilated pupils; (ii) both eyes with dilated pupils; (iii) with the leading eye only dilated; and (iv) the trailing eye only dilated. For each condition we recorded actual driving speed. With the pupil of the leading eye dilated participants drove significantly faster (by an average of 3.8km/h) than with both eyes dilated (p=0.02); with the trailing eye dilated participants drove significantly slower (by an average of 3.2km/h) than with both eyes dilated (p<0.001). The speed, with the leading eye dilated, was faster by an average of 7km/h than with the trailing eye dilated (p<0.001). There was no significant difference between driving speeds when viewing with both eyes either dilated or undilated (p=0.322). Our results are the first to show a measurable change in driving behaviour following monocular pupil dilation and support predictions based on the Enright phenomenon. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  17. A Study of the Effects of Congestion Information and a Priority Boarding Pass in a Theme Park with Multi-Agents

    NASA Astrophysics Data System (ADS)

    Tone, Tetsuya; Kohara, Kazuhiro

    We have investigated ways to reduce congestion in a theme park with multi-agents. We constructed a theme park model called Digital Park 1.0 with twenty-three attractions similar in form to Tokyo Disney Sea. We consider not only congestion information (number of vistors standing in line at each attraction) but also the advantage of a priority boarding pass, like Fast Pass which is used at Tokyo Disney Sea. The congestion-information-usage ratio, which reflects the ratio of visitors who behave according to congestion information, was changed from 0% to 100% in both models, with and without priority boarding pass. The “mean stay time of visitors" is a measure of satisfaction. The smaller mean stay time, the larger degree of satisfaction. Here, a short stay time means a short wait time. The resluts of each simulation are averaged over ten trials. The main results are as follows. (1) When congestion-information-usage ratio increased, the mean stay time decreases. When 20% of visitors behaved according to congestion information, the mean stay time was reduced by 30%. (2) A priority boarding pass reduced congestion, and mean stay time was reduced by 15%. (3) When visitors used congestion information and a priority boarding pass, mean stay time was further reduced. When the congestion-information-usage ratio was 20%, mean stay time was reduced by 35%. (4) When congestion-information-usage ratio was over 50%, the congestion reduction effects reached saturation.

  18. Treatment of the idiopathic scoliosis with brace and physiotherapy.

    PubMed

    Hundozi-Hysenaj, Hajrije; Dallku, Iliriana Boshnjaku; Murtezani, Ardiana; Rrecaj, Shkurte

    2009-01-01

    Scoliosis is a three-dimensional deformation of the spine with a lateral curvature or deviation greater than 10 degrees and associated with vertebral rotation. Many conservative treatments are available for adolescents with idiopathic scoliosis, but the evidence for their effectiveness is still questioned. The objective of this study was to define the effectiveness of braces and individual physiotherapy for the comprehensive treatment of idiopathic scoliosis in adolescents. A retrospective study of 57 children with idiopathic thoracic dextroscoliosis with the magnitude of the thoracic curve between 20 degrees-35 degrees, treated in Orthopedic and Physiatrist Clinic as well as National Ortho-prosthetic Center within University Clinical Center of Kosova in Prishtina, during the period of 2003-2006. Inclusion of kinesitherapy in the comprehensive management of idiopathic scoliosis varied in the improvement of the muscle strength (satisfied and moderate) in almost 80% of the children while the correction of the curve was small in approximately 42.1% of cases. For children with idiopathic scoliosis, who require braces, an exercise program helps chest mobility, muscle strength, proper breathing flexibility in the spine, correct posture and keeps muscles in tone so that the transition period after brace removal is easier.

  19. Acute exacerbation of idiopathic pulmonary fibrosis triggered by Aspergillus empyema.

    PubMed

    Suzuki, Atsushi; Kimura, Tomoki; Kataoka, Kensuke; Matsuda, Toshiaki; Yokoyama, Toshiki; Mori, Yuta; Kondoh, Yasuhiro

    2018-01-01

    Acute exacerbation (AE) is a severe and life-threatening complication of idiopathic pulmonary fibrosis (IPF). In 2016, the definition and diagnostic criteria for AE-IPF were updated by an international working group. The new definition includes any acute, clinically significant respiratory deterioration (both idiopathic and triggered events) characterized by evidence of new widespread alveolar abnormality in patients with IPF. There are no currently proven beneficial management strategies for idiopathic and triggered AE-IPF. This is the first report describing AE-IPF triggered by Aspergillus empyema, which was improved by a combination of corticosteroid, systemic antifungal therapy, local antifungal therapy, and additional pharmacological therapies. Future research may reveal optimal strategies for both idiopathic and triggered AE-IPF.

  20. Idiopathic intracranial hypertension and sickle cell disease: two case reports.

    PubMed

    Segal, Laura; Discepola, Marino

    2005-12-01

    Two patients with sickle cell disease presented with headaches and visual disturbances, typical complaints of this disorder. However, prompt diagnosis of idiopathic intracranial hypertension and initiation of medical therapy lead to improved symptoms and restored vision. Ophthalmologists should consider sickle cell disease to be an independent risk factor for idiopathic intracranial hypertension when a patient is being assessed for visual disturbances. Although a rare condition, idiopathic intracranial hypertension has several key signs useful in establishing a diagnosis. It is critical to recognize the warning signs and symptoms to prevent devastating ophthalmologic complications. We report the first cases of idiopathic intracranial hypertension in patients with the novel Quebec-Chori beta-chain variant of sickle cell disease.

  1. Guidelines for the medical treatment of idiopathic pulmonary fibrosis.

    PubMed

    Xaubet, Antoni; Molina-Molina, María; Acosta, Orlando; Bollo, Elena; Castillo, Diego; Fernández-Fabrellas, Estrella; Rodríguez-Portal, José Antonio; Valenzuela, Claudia; Ancochea, Julio

    2017-05-01

    Idiopathic pulmonary fibrosis is defined as chronic fibrosing interstitial pneumonia limited to the lung, with poor prognosis. The incidence has been rising in recent years probably due to improved diagnostic methods and increased life expectancy. In 2013, the SEPAR guidelines for the diagnosis and treatment for idiopathic pulmonary fibrosis were published. Since then, clinical trials and meta-analyses have shown strong scientific evidence for the use of pirfenidone and nintedanib in the treatment of idiopathic pulmonary fibrosis. In 2015, the international consensus of 2011 was updated and new therapeutic recommendations were established, prompting us to update our recommendation for the medical treatment of idiopathic pulmonary fibrosis accordingly. Diagnostic aspects and non-pharmacological treatment will not be discussed as no relevant developments have emerged since the 2013 guidelines. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Investigation of solutions to recurring congestion on freeways.

    DOT National Transportation Integrated Search

    2009-01-01

    Persistent daily congestion, which has been increasing in recent years, is commonly experienced for several hours or more during the morning and evening on Virginia's urban freeways. Many of these roadways are at or near capacity, which causes severe...

  3. Maternal asthma and idiopathic preterm labor.

    PubMed

    Kramer, M S; Coates, A L; Michoud, M C; Dagenais, S; Moshonas, D; Davis, G M; Hamilton, E F; Nuwayhid, B; Joshi, A K; Papageorgiou, A

    1995-11-15

    Previous studies suggest that women with asthma are at increased risk of preterm birth. Moreover, drugs (especially beta-agonists) used to treat asthma are also used to treat preterm labor. The authors carried out a case-control study of 555 women from three hospital centers with idiopathic preterm labor (< 37 weeks), including two overlapping (i.e., non-mutually exclusive) subsamples: cases with early idiopathic preterm labor (< 34 weeks) and cases with idiopathic recurrent preterm labor (< 37 weeks plus a previous history of preterm delivery or second-trimester miscarriage). Controls were matched to cases according to race and smoking history prior to and during pregnancy. All subjects responded in person to questions about atopic, respiratory, obstetric, and sociodemographic histories. Subjects in the early and recurrent preterm labor subsamples were also asked to undergo spirometric testing with methacholine challenge 6-12 weeks after delivery. Cases were significantly more likely to report histories of asthma symptoms and physician-diagnosed asthma (matched odds ratios of 2-3) than controls, particularly those cases with recurrent preterm labor. No significant associations were observed, however, with methacholine responsiveness. These results could not be explained by residual confounding by smoking or other variables, nor by selective recall of asthma symptoms and histories by cases. Women with asthma are at increased risk of idiopathic preterm labor. The fact that no such association was seen with methacholine responsiveness suggests that nonatopic, noncholinergic mechanisms may link bronchial and uterine smooth muscle lability.

  4. Temporal evolution of intraocular pressure elevation after pupillary dilation in pigment dispersion syndrome.

    PubMed

    Jewelewicz, Daniel A; Radcliffe, Nathan M; Liebmann, Jeffrey; Ritch, Robert

    2009-03-01

    To report 4 patients with pigment dispersion syndrome (PDS) who had delayed intraocular pressure (IOP) spikes after pharmacologic pupillary dilation. Four patients with a diagnosis of PDS with documented IOP spike after pharmacologic pupillary dilation were included. Study patients were examined before and after pupillary dilation. The amount of pigment present in the anterior chamber and the IOP were measured at hourly intervals. Although maximal pigment liberation occurred immediately after maximal dilation, the IOP continued to elevate for at least 1.5 hours. The increase in IOP after pupillary dilation may not occur simultaneously with maximal pigment liberation but may follow it after the pigment has settled out of the anterior chamber. This has implications for monitoring patients with PDS after dilation to detect and treat rises in IOP.

  5. Altered Regional Cerebral Blood Flow in Idiopathic Hypersomnia.

    PubMed

    Boucetta, Soufiane; Montplaisir, Jacques; Zadra, Antonio; Lachapelle, Francis; Soucy, Jean-Paul; Gravel, Paul; Dang-Vu, Thien Thanh

    2017-10-01

    Idiopathic hypersomnia is characterized by excessive daytime sleepiness, despite normal or long sleep time. Its pathophysiological mechanisms remain unclear. This pilot study aims at characterizing the neural correlates of idiopathic hypersomnia using single photon emission computed tomography. Thirteen participants with idiopathic hypersomnia and 16 healthy controls were scanned during resting wakefulness using a high-resolution single photon emission computed tomography scanner with 99mTc-ethyl cysteinate dimer to assess cerebral blood flow. The main analysis compared regional cerebral blood flow distribution between the two groups. Exploratory correlations between regional cerebral blood flow and clinical characteristics evaluated the functional correlates of those brain perfusion patterns. Significance was set at p < .05 after correction for multiple comparisons. Participants with idiopathic hypersomnia showed regional cerebral blood flow decreases in medial prefrontal cortex and posterior cingulate cortex and putamen, as well as increases in amygdala and temporo-occipital cortices. Lower regional cerebral blood flow in the medial prefrontal cortex was associated with higher daytime sleepiness. These preliminary findings suggest that idiopathic hypersomnia is characterized by functional alterations in brain areas involved in the modulation of vigilance states, which may contribute to the daytime symptoms of this condition. The distribution of regional cerebral blood flow changes was reminiscent of the patterns associated with normal non-rapid-eye-movement sleep, suggesting the possible presence of incomplete sleep-wake transitions. These abnormalities were strikingly distinct from those induced by acute sleep deprivation, suggesting that the patterns seen here might reflect a trait associated with idiopathic hypersomnia rather than a non-specific state of sleepiness. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep

  6. Idiopathic Hypersomnia: Clinical Features and Response to Treatment

    PubMed Central

    Ali, Mohsin; Auger, R. Robert; Slocumb, Nancy L.; Morgenthaler, Timothy I.

    2009-01-01

    Objective: A recent American Academy of Sleep Medicine publication identified a need for research regarding idiopathic hypersomnia. We describe various clinical and polysomnographic features of patients with idiopathic hypersomnia, with an emphasis on response to pharmacotherapy. Methods: A retrospective review of our database initially identified 997 patients, utilizing “idiopathic hypersomnia,” “hypersomnia NOS,” and “primary hypersomnia” as keywords. The charts of eligible patients were examined in detail, and data were abstracted and analyzed. Response to treatment was graded utilizing an internally developed scale. Results: Eighty-five patients were ultimately identified (65% female). Median (interquartile range) ages of onset and diagnosis were 19.6 (15.5) and 33.7 (15.5), respectively. During a median follow-up duration of 2.4 (4.7) years, 65% of patients demonstrated a “complete response” to pharmacotherapy as assessed by the authors' grading schema. Methylphenidate was most commonly used as a first-line agent prior to December 1998, but subsequently, modafinil became the most common first drug. At the last recorded follow-up visit, 92% of patients were on monotherapy, with greater representation of methylphenidate versus modafinil (51% vs. 32%). Among these patients, methylphenidate produced a higher percentage of “complete” or “partial” responses than modafinil, although statistical significance was not reached (38/40 [ 95%] vs 22/25 [88%], respectively, p = 0.291). Conclusions: The majority of patients with idiopathic hypersomnia respond well to treatment. Methylphenidate is chosen more often than modafinil as final monotherapy in the treatment of idiopathic hypersomnia, despite the fact that it is less commonly used initially. Further prospective comparisons of medications should be explored. Citation: Ali M; Auger RR; Slocumb NL; Morgenthaler TI. Idiopathic hypersomnia: clinical features and response to treatment. J Clin Sleep

  7. The economics of time shared computing: Congestion, user costs and capacity

    NASA Technical Reports Server (NTRS)

    Agnew, C. E.

    1982-01-01

    Time shared systems permit the fixed costs of computing resources to be spread over large numbers of users. However, bottleneck results in the theory of closed queueing networks can be used to show that this economy of scale will be offset by the increased congestion that results as more users are added to the system. If one considers the total costs, including the congestion cost, there is an optimal number of users for a system which equals the saturation value usually used to define system capacity.

  8. Treatment of idiopathic pulmonary fibrosis with losartan: a pilot project.

    PubMed

    Couluris, Marisa; Kinder, Brent W; Xu, Ping; Gross-King, Margaret; Krischer, Jeffrey; Panos, Ralph J

    2012-10-01

    Idiopathic pulmonary fibrosis is a progressive interstitial lung disease with no current effective therapies. Treatment has focused on antifibrotic agents to stop proliferation of fibroblasts and collagen deposition in the lung. We present the first clinical trial data on the use of losartan, an antifibrotic agent, to treat idiopathic pulmonary fibrosis. The primary objective was to evaluate the effect of losartan on progression of idiopathic pulmonary fibrosis measured by the change in percentage of predicted forced vital capacity (%FVC) after 12 months. Secondary outcomes included the change in forced expiratory volume at 1 second, diffusing capacity of carbon monoxide, 6-minute walk test distance, and baseline/transition dyspnea index. Patients with idiopathic pulmonary fibrosis and a baseline %FVC of ≥50 % were treated with losartan 50 mg by mouth daily for 12 months. Pulmonary function testing, 6-minute walk, and breathlessness indices were measured every 3 months. Twenty participants with idiopathic pulmonary fibrosis were enrolled and 17 patients were evaluable for response. Twelve patients had a stable or improved %FVC at study month 12. Similar findings were observed in secondary end-point measures, including 58, 71, and 65 % of patients with stable or improved forced expiratory volume at 1 second, diffusing capacity for carbon monoxide, and 6-minute walk test distance, respectively. No treatment-related adverse events that resulted in early study discontinuation were reported. Losartan stabilized lung function in patients with idiopathic pulmonary fibrosis over 12 months. Losartan is a promising agent for the treatment of idiopathic pulmonary fibrosis and has a low toxicity profile.

  9. Risk factors associated with refractoriness to esophageal dilatation for benign dysphagia.

    PubMed

    Rodrigues-Pinto, Eduardo; Pereira, Pedro; Ribeiro, Armando; Lopes, Susana; Moutinho-Ribeiro, Pedro; Silva, Marco; Peixoto, Armando; Gaspar, Rui; Macedo, Guilherme

    2016-06-01

    Benign esophageal strictures need repeated dilatations to relieve dysphagia. Literature is scarce on the risk factors for refractoriness of these strictures. This study aimed to assess the risk factors associated with refractory strictures. This is a retrospective study of patients with benign esophageal strictures who were referred for esophageal dilatation over a period of 3 years. A total of 327 esophageal dilatations were performed in 103 patients; 53% of the patients reported dysphagia for liquids. Clinical success was achieved in 77% of the patients. There was a need for further dilatations in 54% of patients, being more frequent in patients with dysphagia for liquids [78 vs. 64%, P=0.008, odds ratio (OR) 1.930], in those with caustic strictures (89 vs. 70%, P=0.007, OR 3.487), and in those with complex strictures (83 vs. 70%, P=0.047, OR 2.132). Caustic strictures, peptic strictures, and complex strictures showed statistical significance in the multivariate analysis. Time until subsequent dilatations was less in patients with dysphagia for liquids (49 vs. 182 days, P<0.001), in those with peptic strictures (49 vs. 98 days, P=0.004), in those with caustic strictures (49 vs. 78 days, P=0.005), and in patients with complex strictures (47 vs. 80 days P=0.009). In multivariate analysis, further dilatations occurred earlier in patients with dysphagia for liquids [hazard ratio (HR) 1.506, P=0.004], in those with peptic strictures (HR 1.644, P=0.002), in those with caustic strictures (HR 1.581, P=0.016), and in patients with complex strictures (HR 1.408, P=0.046). Caustic, peptic, and complex strictures were associated with a greater need for subsequent dilatations. Time until subsequent dilatations was less in patients with dysphagia for liquids and in those with caustic, peptic, and complex strictures.

  10. Brain MRI findings in patients with idiopathic hypersomnia.

    PubMed

    Trotti, Lynn Marie; Bliwise, Donald L

    2017-06-01

    Proper diagnosis of idiopathic hypersomnia necessitates the exclusion of neurologic or medical causes of sleepiness that better explain the clinical syndrome. However, there are no formal guidelines regarding the use of neuroimaging to identify such secondary causes of symptoms. We sought to characterize brain MRI findings in a series of patients with idiopathic hypersomnia. We reviewed medical records on a consecutive series of 61 patients diagnosed with idiopathic hypersomnia to determine the frequency and results of brain magnetic resonance imaging (MRI). One-third of patients had undergone brain MRI, with focal neurologic signs or symptoms being the most common indication for neuroimaging. Although seven patients had an identifiable finding on neuroimaging (e.g., chronic microvascular ischemic changes), clinical management was changed as a result of imaging in only three cases. In all three, the imaging finding was predated by clear clinical abnormalities. Neuroimaging may be a complementary part of an idiopathic hypersomnia evaluation, but the decision to pursue imaging should be made on a case-by-case basis. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. The influence of enalapril and spironolactone on electrolyte concentrations in Doberman pinschers with dilated cardiomyopathy.

    PubMed

    Thomason, J D; Rapoport, G; Fallaw, T; Calvert, C A

    2014-12-01

    The combination of an angiotensin-converting enzyme inhibitor (ACEI) with an aldosterone receptor antagonist can increase serum potassium and magnesium and lower serum sodium concentrations. The objective of this study was to retrospectively determine whether an ACEI and spironolactone can be co-administered to Doberman pinschers with occult dilated cardiomyopathy without serious adverse influences on serum electrolyte concentrations. Between 2001 and 2007, 26 client-owned Doberman pinschers were given enalapril, spironolactone, and carvedilol and followed for at least 6 months. Most dogs had been prescribed mexiletine for ventricular tachyarrhythmia suppression. Dogs were treated with pimobendan when congestive heart failure was imminent. Baseline and follow-up (3-10 visits) color-flow Doppler echocardiograms, serum urea nitrogen (SUN), creatinine, sodium, potassium, and magnesium concentration data were tabulated. Compared to baseline data, there were no significant changes in serum sodium or serum creatinine concentrations. Serum magnesium (P = 0.003), serum potassium (P = 0.0001), and SUN (P = 0.0001) concentrations increased significantly with time. Although the combination of ACEI and spironolactone was associated with significant increases in magnesium, potassium, and SUN concentrations, these changes were of no apparent clinical relevance. At the dosages used in this study, this combination of drugs appears safe. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Does rush hour see a rush of emotions? Driver mood in conditions likely to exhibit congestion

    PubMed Central

    Morris, Eric A; Hirsch, Jana A.

    2016-01-01

    Polls show that a large portion of the public considers traffic congestion to be a problem and believes a number of policy interventions would ameliorate it. However, most of the public rejects new taxes and fees to fund these improvements. This may be because of a disconnect between the public's stated antipathy towards congestion and the recalled emotional costs congestion imposes. To explore this, we use a large and representative sample drawn from the American Time Use Survey to examine how drivers experience four emotions (happiness, sadness, stress, and fatigue), plus a constructed composite mood variable, when they travel in peak periods, in large cities, in city centers, and in combinations of these. We also explore the interactions between these indicators and trip duration. We find evidence that drivers in the largest cities at the very peak of rush hour (5:00pm-6:00pm) are in a less positive mood, presumably because of congestion. However, this effect, though significant, is small, and we find no significant results using broader definitions of the peak period. In all, our findings suggest that congestion's impact on drivers as a group is quite limited. This may help explain why the public's attitude toward painful financial trade-offs to address congestion is lukewarm. PMID:27231669

  13. The Physics of Traffic Congestion and Road Pricing in Transportation Planning

    NASA Astrophysics Data System (ADS)

    Levinson, David

    2010-03-01

    This presentation develops congestion theory and congestion pricing theory from its micro- foundations, the interaction of two or more vehicles. Using game theory, with a two- player game it is shown that the emergence of congestion depends on the players' relative valuations of early arrival, late arrival, and journey delay. Congestion pricing can be used as a cooperation mechanism to minimize total costs (if returned to the players). The analysis is then extended to the case of the three- player game, which illustrates congestion as a negative externality imposed on players who do not themselves contribute to it. A multi-agent model of travelers competing to utilize a roadway in time and space is presented. To realize the spillover effect among travelers, N-player games are constructed in which the strategy set includes N+1 strategies. We solve the N-player game (for N = 7) and find Nash equilibria if they exist. This model is compared to the bottleneck model. The results of numerical simulation show that the two models yield identical results in terms of lowest total costs and marginal costs when a social optimum exists. Moving from temporal dynamics to spatial complexity, using consistent agent- based techniques, we model the decision-making processes of users and infrastructure owner/operators to explore the welfare consequence of price competition, capacity choice, and product differentiation on congested transportation networks. Component models include: (1) An agent-based travel demand model wherein each traveler has learning capabilities and unique characteristics (e.g. value of time); (2) Econometric facility provision cost models; and (3) Representations of road authorities making pricing and capacity decisions. Different from small-network equilibrium models in prior literature, this agent- based model is applicable to pricing and investment analyses on large complex networks. The subsequent economic analysis focuses on the source, evolution

  14. Idiopathic granulomatous mastitis: an institutional experience

    PubMed Central

    Prasad, Seetharam; Jaiprakash, Padmapriya; Dave, Aniket; Pai, Deepti

    2017-01-01

    Objective To study idiopathic granulomatous mastitis with respect to its various clinical features, etiologic factors, treatment modalities and complications. Material and methods Retrospective study of all patients who were diagnosed with idiopathic granulomatous mastitis from 1st January 2006 to 31st December 2014 at Kasturba Hospital, Manipal, India (a tertiary care referral centre). The research was performed according to the World Medical Association Declaration of Helsinki. Informed consent was taken from the patient before invasive procedures including surgery. Data was analysed using the Statistical Package for Social Sciences version 16.0 wherever appropriate. Results 73 patients diagnosed with idiopathic granulomatous mastitis during the time period were included. One patient was a male (1.37%), rest were all females (98.63%). The mean age of presentation was 32.67 years (range 23 to 66 years). 70 patients (95.89%) were parous females. Average duration since last childbirth was 4.6 years (range: 3 months to 33 years). 8 patients (10.95%) were lactating. History of oral contraceptive pill use was present in 40 patients (54.79%). The right breast was affected in 44 patients (60.27%), and the left breast in 29 patients (39.73%). None of the patients had bilateral disease. The most common symptom was a painless lump (61.64%). Rest of the patients (38.36%) presented with features of a breast abscess. 19 out of 39 FNACs done (48.72%) were positive for granulomatous mastitis. 59 were primarily managed surgically (lumpectomy/wide excision-33, incision & drainage-26). One patient was treated primarily with prednisolone. 13 patients did not receive specific treatment, and were only kept on regular follow-up. Patients managed with lumpectomy/wide excision had the least rate of complications & recurrence (18.18%). Conclusion Patients with idiopathic granulomatous mastitis can present with a wide variety of symptoms which mimic other more common conditions. Surgical

  15. Idiopathic granulomatous mastitis: a diagnostic dilemma for the breast radiologist.

    PubMed

    Sripathi, Smiti; Ayachit, Anurag; Bala, Archana; Kadavigere, Rajagopal; Kumar, Sandeep

    2016-08-01

    Idiopathic granulomatous mastitis is a chronic inflammatory disease of the breast, which is often difficult to differentiate both clinically and radiologically from infectious aetiologies such as tuberculosis, fungal infections, and also from malignancy, thus posing a diagnostic dilemma. We present a pictorial review of the commonly encountered imaging findings in idiopathic granulomatous mastitis on mammography and ultrasound. Mammographic and ultrasound findings of histopathologically proven cases of granulomatous mastitis are discussed. Idiopathic granulomatous mastitis has varied and non-specific appearances on ultrasound and mammography. Histopathology is essential to establish diagnosis. • Idiopathic granulomatous mastitis often poses a diagnostic dilemma for the radiologist by mimicking malignancy. • It has varied and non-specific appearances on mammography and ultrasound. • Histopathology is mandatory to establish the diagnosis and decide management.

  16. Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population

    PubMed Central

    Goyal, Abhinav; Chatterjee, Kshitij; Yadlapati, Sujani; Singh, Shailender

    2017-01-01

    Background/Aims Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown. Methods We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation. Results There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated. Conclusions Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures. PMID:28301921

  17. Idiopathic scrotal elephantiasis.

    PubMed

    Hornberger, Brad J; Elmore, James M; Roehrborn, Claus G

    2005-02-01

    Scrotal lymphedema (scrotal elephantiasis) is a condition that has historically been described in areas endemic to filariasis. We present a unique case of a 22-year-old man with idiopathic lymphedema isolated to the scrotum. After acquired causes of lymphedema were ruled out, the patient was treated with scrotectomy and scrotal reconstruction.

  18. Intermittent self-dilatation for urethral stricture disease in males.

    PubMed

    Jackson, Matthew J; Veeratterapillay, Rajan; Harding, Chris K; Dorkin, Trevor J

    2014-12-19

    Intermittent urethral self-dilatation is sometimes recommended to reduce the risk of recurrent urethral stricture. There is no consensus as to whether it is a clinically effective or cost-effective intervention in the management of this disease. The purpose of this review is to evaluate the clinical effectiveness and cost-effectiveness of intermittent self-dilatation after urethral stricture surgery in males compared to no intervention. We also compared different programmes of, and devices for, intermittent self-dilatation. . We searched the Cochrane Incontinence Group Specialised Register (searched 7 May 2014), CENTRAL (2014, Issue 4), MEDLINE (1 January 1946 to Week 3 April 2014), PREMEDLINE (covering 29 April 2014), EMBASE (1 January 1947 to Week 17 2014), CINAHL (31 December 1981 to 30 April 2014) OpenGrey (searched 6 May 2014), ClinicalTrials.gov (6 May 2014), WHO International Clinical Trials Registry Platform (6 May 2014), Current Controlled Trials (6 May 2014) and the reference lists of relevant articles. Randomised and quasi-randomised trials where one arm was a programme of intermittent self-dilatation for urethral stricture were identified. Studies were excluded if they were not randomised or quasi-randomised trials, or if they pertained to clean intermittent self-catheterisation for bladder emptying. Two authors screened the records for relevance and methodological quality. Data extraction was performed according to predetermined criteria using data extraction forms. Analyses were carried out in Cochrane Review Manager (RevMan 5). The primary outcomes were patient-reported symptoms and health-related quality of life, and risk of recurrence; secondary outcomes were adverse events, acceptability of the intervention to patients and cost-effectiveness. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Eleven trials were selected for inclusion in the review, including a total of 776

  19. Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm?

    PubMed

    Crausman, Robert S; Summerhill, Eleanor M; McCool, F Dennis

    2009-01-01

    Idiopathic diaphragm paralysis is probably more common and responsible for more morbidity than generally appreciated. Bell's palsy, or idiopathic paralysis of the seventh cranial nerve, may be seen as an analogous condition. The roles of zoster sine herpete and herpes simplex have increasingly been recognized in Bell's palsy, and there are some data to suggest that antiviral therapy is a useful adjunct to steroid therapy. Thus, we postulated that antiviral therapy might have a positive impact on the course of acute idiopathic diaphragm paralysis which is likely related to viral infection. Three consecutive patients with subacute onset of symptomatic idiopathic hemidiaphragm paralysis were empirically treated with valacyclovir, 1,000 mg twice daily for 1 week. Prior to therapy, diaphragmatic function was assessed via pulmonary function testing and two-dimensional B-mode ultrasound, with testing repeated 1 month later. Diaphragmatic function pre- and post-treatment was compared to that of a historical control group of 16 untreated patients. All three subjects demonstrated ultrasound recovery of diaphragm function 4-6 weeks following treatment with valacyclovir. This recovery was accompanied by improvements in maximum inspiratory pressure (PI(max)) and vital capacity (VC). In contrast, in the untreated cohort, diaphragm recovery occurred in only 11 subjects, taking an average of 14.9 +/- 6.1 months (mean +/- SD). The results of this small, preliminary study suggest that antiviral therapy with valacyclovir may be helpful in the treatment of idiopathic diaphragm paralysis induced by a viral infection.

  20. Congestion Pricing for Aircraft Pushback Slot Allocation

    PubMed Central

    Zhang, Yaping

    2017-01-01

    In order to optimize aircraft pushback management during rush hour, aircraft pushback slot allocation based on congestion pricing is explored while considering monetary compensation based on the quality of the surface operations. First, the concept of the “external cost of surface congestion” is proposed, and a quantitative study on the external cost is performed. Then, an aircraft pushback slot allocation model for minimizing the total surface cost is established. An improved discrete differential evolution algorithm is also designed. Finally, a simulation is performed on Xinzheng International Airport using the proposed model. By comparing the pushback slot control strategy based on congestion pricing with other strategies, the advantages of the proposed model and algorithm are highlighted. In addition to reducing delays and optimizing the delay distribution, the model and algorithm are better suited for use for actual aircraft pushback management during rush hour. Further, it is also observed they do not result in significant increases in the surface cost. These results confirm the effectiveness and suitability of the proposed model and algorithm. PMID:28114429

  1. Texture classification using non-Euclidean Minkowski dilation

    NASA Astrophysics Data System (ADS)

    Florindo, Joao B.; Bruno, Odemir M.

    2018-03-01

    This study presents a new method to extract meaningful descriptors of gray-scale texture images using Minkowski morphological dilation based on the Lp metric. The proposed approach is motivated by the success previously achieved by Bouligand-Minkowski fractal descriptors on texture classification. In essence, such descriptors are directly derived from the morphological dilation of a three-dimensional representation of the gray-level pixels using the classical Euclidean metric. In this way, we generalize the dilation for different values of p in the Lp metric (Euclidean is a particular case when p = 2) and obtain the descriptors from the cumulated distribution of the distance transform computed over the texture image. The proposed method is compared to other state-of-the-art approaches (such as local binary patterns and textons for example) in the classification of two benchmark data sets (UIUC and Outex). The proposed descriptors outperformed all the other approaches in terms of rate of images correctly classified. The interesting results suggest the potential of these descriptors in this type of task, with a wide range of possible applications to real-world problems.

  2. Dilatancy and shear thickening of particle suspensions

    NASA Astrophysics Data System (ADS)

    Bonn, Daniel

    2013-03-01

    Shear thickening is a fascinating subject, as 99.9% of complex fluids are thinning; thickening systems thus are the ``exception to the rule'' that needs to be understood. Moreover, such tunable systems show very promising applications, e.g. to block large underground pores in oil recovery to maintain a constant oil flow by plugging water filled pores (an approach used in oil recovery by e.g. Shell), or to manufacture bulletproof vests that are comfortable to wear, but stop bullets nonetheless. We study the rheology of non-Brownian particle suspensions (notably, cornstarch) that exhibit shear thickening. Using magnetic resonance imaging (MRI), the local properties of the flow are obtained by the determination of local velocity profiles and concentrations in a Couette cell. We also perform macroscopic rheology experiments in different geometries. The results suggest that the shear thickening is a consequence of dilatancy: the system under flow attempts to dilate but instead undergoes a jamming transition, because it is confined. This proposition is confirmed by an independent measurement of the dilation of the suspension as a function of the shear rate.

  3. Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

    PubMed Central

    Chandrasekhara, Vinay; Koh, Joyce; Lattimer, Lakshmi; Dunbar, Kerry B; Ravich, William J; Clarke, John O

    2017-01-01

    AIM To evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement. METHODS All balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES). RESULTS Four hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker’s diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques (P = 0.5). Successful symptom resolution was also not significantly affected by dilator size

  4. Slip and Dilation Tendency Analysis of the Tuscarora Geothermal Area

    DOE Data Explorer

    Faulds, James E.

    2013-12-31

    Critically stressed fault segments have a relatively high likelihood of acting as fluid flow conduits (Sibson, 1994). As such, the tendency of a fault segment to slip (slip tendency; Ts; Morris et al., 1996) or to dilate (dilation tendency; Td; Ferrill et al., 1999) provides an indication of which faults or fault segments within a geothermal system are critically stressed and therefore likely to transmit geothermal fluids. The slip tendency of a surface is defined by the ratio of shear stress to normal stress on that surface: Ts = τ / σn (Morris et al., 1996). Dilation tendency is defined by the stress acting normal to a given surface: Td = (σ1-σn) / (σ1-σ3) (Ferrill et al., 1999). Slip and dilation were calculated using 3DStress (Southwest Research Institute). Slip and dilation tendency are both unitless ratios of the resolved stresses applied to the fault plane by ambient stress conditions. Values range from a maximum of 1, a fault plane ideally oriented to slip or dilate under ambient stress conditions to zero, a fault plane with no potential to slip or dilate. Slip and dilation tendency values were calculated for each fault in the focus study areas at, McGinness Hills, Neal Hot Springs, Patua, Salt Wells, San Emidio, and Tuscarora on fault traces. As dip is not well constrained or unknown for many faults mapped in within these we made these calculations using the dip for each fault that would yield the maximum slip tendency or dilation tendency. As such, these results should be viewed as maximum tendency of each fault to slip or dilate. The resulting along-fault and fault-to-fault variation in slip or dilation potential is a proxy for along fault and fault-to-fault variation in fluid flow conduit potential. Stress Magnitudes and directions Stress field variation within each focus area was approximated based on regional published data and the world stress database (Hickman et al., 2000; Hickman et al., 1998 Robertson-Tait et al., 2004; Hickman and Davatzes

  5. Right ventricular systolic dysfunction and vena cava dilatation precede alteration of renal function in adult patients undergoing cardiac surgery: An observational study.

    PubMed

    Guinot, Pierre Grégoire; Abou-Arab, Osama; Longrois, Dan; Dupont, Herve

    2015-08-01

    with a subsequent increase of sCr and that the mechanism involved is congestion (vena cava dilatation/elevated CVP) rather than decreased CI.

  6. Predictability of Road Traffic and Congestion in Urban Areas

    PubMed Central

    Wang, Jingyuan; Mao, Yu; Li, Jing; Xiong, Zhang; Wang, Wen-Xu

    2015-01-01

    Mitigating traffic congestion on urban roads, with paramount importance in urban development and reduction of energy consumption and air pollution, depends on our ability to foresee road usage and traffic conditions pertaining to the collective behavior of drivers, raising a significant question: to what degree is road traffic predictable in urban areas? Here we rely on the precise records of daily vehicle mobility based on GPS positioning device installed in taxis to uncover the potential daily predictability of urban traffic patterns. Using the mapping from the degree of congestion on roads into a time series of symbols and measuring its entropy, we find a relatively high daily predictability of traffic conditions despite the absence of any priori knowledge of drivers' origins and destinations and quite different travel patterns between weekdays and weekends. Moreover, we find a counterintuitive dependence of the predictability on travel speed: the road segment associated with intermediate average travel speed is most difficult to be predicted. We also explore the possibility of recovering the traffic condition of an inaccessible segment from its adjacent segments with respect to limited observability. The highly predictable traffic patterns in spite of the heterogeneity of drivers' behaviors and the variability of their origins and destinations enables development of accurate predictive models for eventually devising practical strategies to mitigate urban road congestion. PMID:25849534

  7. [Physical therapy for idiopathic scoliosis].

    PubMed

    Steffan, K

    2015-11-01

    The objective is the description and summary of the current state of idiopathic scoliosis treatment with physical therapy based on new scientific knowledge and concluded from more than 15 years of experience as a leading physician in two well-known clinics specializing in the conservative treatment of scoliosis. Based on current scientific publications on physical therapy in scoliosis treatment and resulting from the considerable personal experience gained working with conservative treatment and consulting scoliosis patients (as inpatients and outpatients), the current methods of physical therapy have been compared and evaluated. Physical therapy according to Schroth and Vojta therapy are at present the most common and effective methods in the physical treatment of idiopathic scoliosis. These methods can be applied during inpatient or outpatient treatment or intensified in the practice of specialized therapists. As there are only a few scientific studies on this subject, the author's findings are based mainly on his own experiences of the conservative treatment of idiopathic scoliosis. Athough these experiences are the results of over 15 years of working in the field of therapy, and the Schroth method in combination with corrective bracing presents highly promising results, it would nevertheless be desirable to conduct detailed scientific studies to verify the effectiveness of conservative treatment.

  8. [Tracheotomy-endoscop for dilatational percutaneous tracheotomy (TED)].

    PubMed

    Klemm, Eckart

    2006-09-01

    While surgical tracheotomies are currently performed using state-of-the-art operative techniques, percutaneous dilatational tracheostomy (PDT) is in a rapidly evolving state with regard to its technology and the number of techniques available. This has resulted in a range of new complications that are difficult to quantify on a scientific basis, given the fact that more than half of the patients who are tracheotomized in intensive care units die from their underlying disease. The new Tracheotomy Endoscope (TED) is designed to help prevent serious complications in dilatational tracheotomies and facilitate their management. The endoscope has been specifically adapted to meet the require-ments of percutaneous dilatational tracheotomies. It is fully compatible with all current techniques of PDT. The method is easy to learn. The percutaneous dilatational tracheotomy with the Tracheotomy Endoscope is a seven-step procedure: Advantages of the Tracheotomy Endoscope: Injuries to the posterior tracheal wall ar impossible (tracheoesophageal fistulas, pneumothorax). Minor bleeding sites on the tracheal mucosa can be controlled with a specially curved suction-coagulation tube introudeced through the Tracheotomy Endoscope. In cases with heavy bleeding and a risk of aspiration, the rigid indwelling Tracheotomy Endoscope provides a secure route for reintubating the patient with a cuffed endotracheal tube. It also allows for rapid conversion to an open surgical procedure if necessary. All the parts are easy to clean and are autoclavable. This type of endoscopically guided PDT creates an optimal link between the specialties of intensive care medicine and otorhinolaryngology. The Tracheotomy Endoscope (TED) increases the standard of safety in PDT.

  9. Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients.

    PubMed

    Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet

    2015-11-01

    Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to

  10. Urban partnership agreement and congestion reduction demonstration programs : lessons learned on congestion pricing from the Seattle and Atlanta household travel behavior surveys.

    DOT National Transportation Integrated Search

    2014-04-01

    This paper presents lessons learned from household traveler surveys administered in Seattle and Atlanta as part of the evaluation of the Urban Partnership Agreement and Congestion Reduction Demonstration Programs. The surveys use a two-stage panel su...

  11. Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial.

    PubMed

    Walter, Daisy; van den Berg, Maarten W; Hirdes, Meike M; Vleggaar, Frank P; Repici, Alessandro; Deprez, Pierre H; Viedma, Bartolomé L; Lovat, Laurence B; Weusten, Bas L; Bisschops, Raf; Haidry, Rehan; Ferrara, Elisa; Sanborn, Keith J; O'Leary, Erin E; van Hooft, Jeanin E; Siersema, Peter D

    2018-06-08

    Dilation is the standard of care for recurrent benign esophageal strictures (BES). Biodegradable stents may prolong the effect of dilation and reduce recurrences. Efficacy and safety of dilation and biodegradable stent placement early in the treatment algorithm of recurrent BES were compared.  This multicenter, randomized study enrolled patients with BES treated with previous dilations to ≥ 16 mm. The primary end point was number of repeat endoscopic dilations for recurrent stricture within 3 and 6 months. Secondary outcomes through 12 months included safety, time to first dilation for recurrent stricture, dysphagia, and level of activity.  At 3 months, the biodegradable stent group (n = 32) underwent significantly fewer endoscopic dilations for recurrent stricture compared with the dilation group (n = 34; P  < 0.001). By 6 months, the groups were similar. The number of patients experiencing adverse events was similar between the groups. Two patients in the biodegradable stent group died after developing tracheoesophageal fistulas at 95 and 96 days post-placement; no deaths were attributed to the stent. Median time to first dilation of recurrent stricture for the biodegradable stent group was significantly longer (106 vs. 41.5 days; P  = 0.003). Dysphagia scores improved for both groups. Patients in the biodegradable stent group had a significantly higher level of activity through 12 months ( P  < 0.001).  Biodegradable stent placement is associated with temporary reduction in number of repeat dilations and prolonged time to recurrent dysphagia compared with dilation. Additional studies are needed to better define the exact role of biodegradable stent placement to treat recurrent BES. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Congestion and flow control in signaling system no. 7: Impacts of intelligent networks and new services

    NASA Astrophysics Data System (ADS)

    Zepf, Joachim; Rufa, Gerhard

    1994-04-01

    This paper focuses on the transient performance analysis of the congestion and flow control mechanisms in CCITT Signaling System No. 7 (SS7). Special attention is directed to the impacts of the introduction of intelligent services and new applications, e.g., Freephone, credit card services, user-to-user signaling, etc. In particular, we show that signaling traffic characteristics like signaling scenarios or signaling message length as well as end-to-end signaling capabilities have a significant influence on the congestion and flow control and, therefore, on the real-time signaling performance. One important result of our performance studies is that if, e.g., intelligent services are introduced, the SS7 congestion and flow control does not work correctly. To solve this problem, some reinvestigations into these mechanisms would be necessary. Therefore, some approaches, e.g., modification of the Signaling Connection Control Part (SCCP) congestion control, usage of the SCCP relay function, or a redesign of the MTP flow control procedures are discussed in order to guarantee the efficacy of the congestion and flow control mechanisms also in the future.

  13. Stress-Dilatancy of Cambria Sand for Triaxial Tests at High Pressures

    NASA Astrophysics Data System (ADS)

    Szypcio, Zenon

    2017-12-01

    In this paper, the stress-dilatancy relationship of Cambria sand for drained triaxial compression and extension tests at high stress level is investigated. The stress dilatancy relationship is obtained by use of frictional state theory and experimental tests data published in literature. It is shown that stress-dilatancy relationship is bilinear, described by three parameters of frictional state theory: critical frictional angle and two other parameters. It is accepted that critical friction angle is independent of confining pressure. The two additional parameters are strongly dependent on confining pressure and different for initial and advanced stages. The point at which the values of these parameters change is termed as Transformation Shear Point. This point is not simply visible either in stress ratio-strain or the volume strain-shear strain relationship which are traditionally shown in soil mechanics papers. Transformation Shear Point is very characteristic in stress ratio-plastic dilatancy plane. Thus, stress ratio- plastic dilatancy is very important for describing stress-strain behaviour of soils. The relationship shown in the paper can be used in soil modelling in the future.

  14. Image compression using quad-tree coding with morphological dilation

    NASA Astrophysics Data System (ADS)

    Wu, Jiaji; Jiang, Weiwei; Jiao, Licheng; Wang, Lei

    2007-11-01

    In this paper, we propose a new algorithm which integrates morphological dilation operation to quad-tree coding, the purpose of doing this is to compensate each other's drawback by using quad-tree coding and morphological dilation operation respectively. New algorithm can not only quickly find the seed significant coefficient of dilation but also break the limit of block boundary of quad-tree coding. We also make a full use of both within-subband and cross-subband correlation to avoid the expensive cost of representing insignificant coefficients. Experimental results show that our algorithm outperforms SPECK and SPIHT. Without using any arithmetic coding, our algorithm can achieve good performance with low computational cost and it's more suitable to mobile devices or scenarios with a strict real-time requirement.

  15. Impact of traffic congestion on road accidents: a spatial analysis of the M25 motorway in England.

    PubMed

    Wang, Chao; Quddus, Mohammed A; Ison, Stephen G

    2009-07-01

    Traffic congestion and road accidents are two external costs of transport and the reduction of their impacts is often one of the primary objectives for transport policy makers. The relationship between traffic congestion and road accidents however is not apparent and less studied. It is speculated that there may be an inverse relationship between traffic congestion and road accidents, and as such this poses a potential dilemma for transport policy makers. This study aims to explore the impact of traffic congestion on the frequency of road accidents using a spatial analysis approach, while controlling for other relevant factors that may affect road accidents. The M25 London orbital motorway, divided into 70 segments, was chosen to conduct this study and relevant data on road accidents, traffic and road characteristics were collected. A robust technique has been developed to map M25 accidents onto its segments. Since existing studies have often used a proxy to measure the level of congestion, this study has employed a precise congestion measurement. A series of Poisson based non-spatial (such as Poisson-lognormal and Poisson-gamma) and spatial (Poisson-lognormal with conditional autoregressive priors) models have been used to account for the effects of both heterogeneity and spatial correlation. The results suggest that traffic congestion has little or no impact on the frequency of road accidents on the M25 motorway. All other relevant factors have provided results consistent with existing studies.

  16. Intermittent dysphagia for solids associated with a multiringed esophagus: clinical features and response to dilatation.

    PubMed

    Lee, Greta Shao-Chu; Craig, Philip Ian; Freiman, John Saul; de Carle, David; Cook, Ian James

    2007-01-01

    The entity of the multiringed esophagus, generally presenting in adults as intermittent dysphagia for solids, is relatively uncommon and its pathogenesis is unknown. The goal of this study was to describe the demographic, clinical, and endoscopic features of patients presenting with this condition, their response to esophageal dilatation, and the relationship of multiple esophageal rings to eosinophilic esophagitis. Between 1989 and June 2004, 32 patients at this adult hospital fulfilled the following inclusion criteria: (1) intermittent dysphagia for solids, (2) multiple esophageal rings at endoscopy, and (3) esophageal dilatation(s) performed. Response to esophageal dilatation was measured by need for subsequent dilatations. Seventy-five percent of the patients were male. Median age at onset of dysphagia was 21 years and at presentation 36.5 years. All had multiple rings in the proximal or midesophagus on endoscopy and had undergone a total of 73 esophageal dilatations with no esophageal perforations. Median maximal dilator size was 15 mm; however, 16% developed significant esophageal mucosal tears even with 11-mm dilators. Sixty-six percent required repeat dilatation, with the median time interval before recurrence being 8 months. Eosinophilic esophagitis (mucosal eosinophil count > 20/HPF) was present in 50% of this cohort. From this study we conclude that a multiringed esophagus causing intermittent dysphagia occurs predominantly in young males, responds well to dilatation, but repeated dilatations are often necessary. Dilatation can lead to extensive mucosal tears and should be performed with caution. Eosinophilic esophagitis is commonly but not invariably associated with this entity. Frequent relapse of dysphagia highlights the need for effective pharmacotherapy.

  17. Videofluoroscopy-guided balloon dilatation for treatment of severe pharyngeal dysphagia.

    PubMed

    Yabunaka, Koichi; Konishi, Hideki; Nakagami, Gojiro; Matsuo, Jyunko; Noguchi, Atsushi; Sanada, Hiromi

    2015-01-01

    Balloon dilatation is a widely accepted technique in the management of esophageal and other types of gastrointestinal strictures, but it is rarely used for the treatment of pharyngeal dysphagia. Therefore, the aim of our prospective study was to evaluate the use of videofluoroscopy-guided balloon dilatation (VGBD) for the treatment of severe pharyngeal dysphagia. The study included 32 stroke patients who had been diagnosed with oral and/or pharyngeal dysphagia. All patients underwent dilatation of the esophageal inlet using a balloon catheter under videofluoroscopic guidance during one or more sessions. Following esophageal dilatation, manual feeding was provided twice weekly. VGBD was effective in 10 out of 32 patients; however, the remaining 22 patients were unable to attempt oral food consumption because aspiration was not completely resolved on videofluoroscopy. According to this case series, VGBD may provide treatment for patients with severe pharyngeal dysphagia, who have not consumed food orally for a long period of time.

  18. Left coronary aneurysmal dilation and subaortic stenosis in a dog.

    PubMed

    Hernandez, Juan L; Bélanger, Marie-Claude; Benoit-Biancamano, Marie-Odile; Girard, Christiane; Pibarot, Philippe

    2008-06-01

    A 6-month-old German shepherd dog was referred for evaluation of a cardiac murmur. Upon physical examination, the auscultated heart rate was 120 beats/min, and a grade IV/VI systolic heart murmur with a point of maximal intensity over the left heart base radiating up the neck was heard. The standard echocardiographic examination showed subaortic stenosis and an anechoic tubular structure extending from the sinus of Valsalva to the left ventricular posterior wall. Aneurysmal left coronary artery (CA) was confirmed by angiography. The dog was euthanized and post-mortem examination showed severe dilatation of the proximal left CA and confirmed the subaortic stenosis. Histopathology did not demonstrate abnormalities in the walls of the CA, aorta or pulmonary artery. The exact cause of the CA aneurysmal dilation remains unknown. Subaortic stenosis, elevated coronary vascular resistance or a congenital anomaly may have contributed to the dilation. To our knowledge, coronary aneurysmal dilation has never been described in dogs. Standard echocardiography provides reliable information on coronary anatomy.

  19. Aortic dilatation in patients with Turner's syndrome without structural cardiac anomaly.

    PubMed

    Alami Laroussi, Nassiba; Dahdah, Nagib; Dallaire, Frédéric; Thérien, Johanne; Fournier, Anne

    2016-03-01

    Dilatation of the ascending aorta is described in Turner's syndrome with variable prevalence (6.8-32%). Reported series typically include patients with associated cardiac anomalies. To characterise the prevalence, age of onset, and the progress of dilatation of the ascending aorta in Turner's syndrome patients free of structural cardiac anomalies. Potential risk factors such as karyotype and growth hormone therapy were analysed for correlation with aortic dilatation. We carried out a retrospective study with data collected from medical records and echocardiography studies. Patients with Tuner's syndrome followed-up between 1992 and 2010 with at least two echocardiography studies were eligible. Patients with previous cardiac surgery or under anti-hypertensive medication were excluded. Ascending aorta diameter measurements were adjusted for body surface area, and dilatation was defined as Z-score>2. The study population consisted of 44 patients, aged 11.9±7.4 years at the first echocardiogram and 17.9±7.3 years at the last follow-up, with a follow-up duration of 6.0±3.7 years. A total of 13 (29.5%) patients exhibited aortic dilatation during follow-up, suggesting an actuarial estimate of the freedom from aortic dilatation dropping from 86 to 70% and then to 37% at 10, 20, and 30 years of age, respectively. There was no statistically significant impact of karyotype or growth hormone therapy on aortic Z-score progression. The prevalence of dilatation of the ascending aorta in Turner's syndrome patients free of structural aortic anomalies is comparable with published data with associated lesions. Growth hormone therapy and karyotype had no significant impact; however, longitudinal follow-up is warranted.

  20. Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation

    PubMed Central

    Takuma, Kensuke; Kamisawa, Terumi; Tabata, Taku; Hara, Seiichi; Kuruma, Sawako; Inaba, Yoshihiko; Kurata, Masanao; Honda, Goro; Tsuruta, Koji; Horiguchi, Shin-ichiro; Igarashi, Yoshinori

    2012-01-01

    AIM: To clarify the strategy for early diagnosis of pancreaticobiliary maljunction (PBM) without biliary dilatation and to pathologically examine gallbladder before cancer develops. METHODS: The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography (ERCP). Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having PBM. Of these, patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary dilatation. The process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively investigated. Histopathological analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was conducted. RESULTS: Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain (n = 16) or jaundice (n = 12). Radical surgery for gallbladder cancer was only possible in 11 patients (31%) and only 4 patients (11%) survived for 5 years. Eight patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography (MRCP). The median age of these 8 patients was younger by a decade than PBM patients with gallbladder cancer. All 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not occurred. Wall thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls, and hyperplastic changes, hypertrophic muscular layer, subserosal fibrosis, and adenomyomatosis were detected in 7 (88%), 5 (63%), 7 (88%) and 5 (63%) patients, respectively. Ki-67 labeling index was high and K-ras mutation was detected in 3 of 6 patients

  1. 'X-ray'-free balloon dilation for totally ultrasound-guided percutaneous nephrolithotomy.

    PubMed

    Zhou, Tie; Chen, Guanghua; Gao, Xiaofeng; Zhang, Wei; Xu, Chuanliang; Li, Lei; Sun, Yinghao

    2015-04-01

    The objective of the study was to evaluate the feasibility and safety of balloon dilation for 'X-ray'-free ultrasound-guided percutaneous nephrolithotomy (PCNL). From January 2012 to December 2012, patients underwent 'X-ray'-free ultrasound-guided PCNL with Amplatz dilator (Group A). From January 2013 to April 2014, patients underwent 'X-ray'-free ultrasound-guided PCNL with balloon dilator (Group B). For balloon dilation, a 10 F fascial dilator was used to dilate the tract. Subsequently, the 6 F nephrostomy balloon (8 mm in diameter) was indwelled along the guidewire with a marked length equal to the dilation depth. Under the monitoring of ultrasound, the location of balloon was secured and disappearance of balloon waist was confirmed when the balloon was inflated at a pressure of 20 atm. A total of 163 patients were involved in this study. Of 81 procedures in Group A, 45 procedures were performed by a senior urologist while 36 procedures by a resident. Of 82 patients in Group B, 47 procedures were performed by the same senior urologist while 35 procedures by another resident. For the senior urologist, there was no statistically significant difference between two groups in calyx of entry, stone-free rate, decline of hemoglobin and hematocrit, operation time and hospitalization. But for the residents, there was less decline of hemoglobin and hematocrit, tract development time and hospitalization in Group B compared to Group A (0.6 vs. 1.7 g/dl, p = 0.001; 2.3% vs. 5.5%, p = 0.003; 10.1 vs. 11.0 min, p = 0.027; 7.8 vs. 13.9 days, p < 0.001). Balloon dilation method introduced in this study is compensable for tract development when 'X-ray'-free ultrasound-guided PCNL is performed. Modified techniques make totally ultrasound guidance for PCNL feasible, easy and safe. In addition, such a procedure is preferable for initial operators because of less hemorrhage complication.

  2. Reflex tracheal contraction during pulmonary venous congestion in the dog.

    PubMed Central

    Kappagoda, C T; Man, G C; Ravi, K; Teo, K K

    1988-01-01

    1. The effect of pulmonary venous congestion on tracheal tone was studied in dogs anaesthetized with alpha-chloralose. Pulmonary venous congestion was produced by partial obstruction of the mitral valve to increase left atrial pressure by 10 mmHg. Tracheal tone was measured in vivo by an isometric force displacement method. 2. Tracheal tone increased by 6.3 +/- 0.3 g from a control level of 91.6 +/- 2.8 g when left atrial pressure was increased by 10.5 +/- 0.3 mmHg. This response was abolished by cooling the cervical vagi to 8 degrees C at a point caudal to the origin of the superior laryngeal nerves. Also, sectioning the superior laryngeal nerves abolished this increase in tracheal tone. 3. Afferent activity recorded from rapidly adapting receptors of the airways increased significantly during pulmonary venous congestion. This increase in activity was abolished by cooling the vagi caudal to the recording site to 8-9 degrees C. 4. Administration of propranolol (0.5 mg/kg) failed to abolish this increase in tracheal tone while atropine (3 mg/kg) did so. 5. Stimulation of left atrial receptors without an increase in left atrial pressure and stimulation of right atrial receptors with and without increases in right atrial pressure did not cause any change in tracheal tone. 6. It is suggested that pulmonary venous congestion is associated with a reflex increase in tracheal tone, the afferent limb of which is formed by pulmonary receptors discharging into myelinated fibres in the cervical vagi and the efferent limb by parasympathetic cholinergic fibres in the superior laryngeal nerves. The afferent receptors are likely to be the rapidly adapting receptors. This reflex may be of importance in the development of the respiratory symptoms associated with left ventricular failure. PMID:3236242

  3. Crack Damage Parameters and Dilatancy of Artificially Jointed Granite Samples Under Triaxial Compression

    NASA Astrophysics Data System (ADS)

    Walton, G.; Alejano, L. R.; Arzua, J.; Markley, T.

    2018-06-01

    A database of post-peak triaxial test results was created for artificially jointed planes introduced in cylindrical compression samples of a Blanco Mera granite. Aside from examining the artificial jointing effect on major rock and rock mass parameters such as stiffness, peak strength and residual strength, other strength parameters related to brittle cracking and post-yield dilatancy were analyzed. Crack initiation and crack damage values for both the intact and artificially jointed samples were determined, and these damage envelopes were found to be notably impacted by the presence of jointing. The data suggest that with increased density of jointing, the samples transition from a combined matrix damage and joint slip yielding mechanism to yield dominated by joint slip. Additionally, post-yield dilation data were analyzed in the context of a mobilized dilation angle model, and the peak dilation angle was found to decrease significantly when there were joints in the samples. These dilatancy results are consistent with hypotheses in the literature on rock mass dilatancy.

  4. Long-term effect of urethral dilatation and internal urethrotomy for urethral strictures.

    PubMed

    Veeratterapillay, Rajan; Pickard, Rob S

    2012-11-01

    Urethral dilatation and direct visual internal urethrotomy (DVIU) are widely used minimally invasive options to manage men with urethral strictures. Advances in open urethroplasty with better long-term cure rates have fuelled the continuing debate as to which treatment is best for primary and recurrent urethral strictures. We reviewed recent literature to identify contemporary practice of urethral dilatation and DVIU and the long-term outcome of these procedures. Systematic literature search for the period January 2010 to December 2011 showed that urethral dilatation and DVIU remain frequently used treatment options as confirmed by surveys of urologists in the USA and the Netherlands. Multiple reports of laser DVIU confirm the safety of this approach but long-term data were lacking. Stricture free rates from urethra dilatation and DVIU vary from 10 to 90% at 12 months, although adjunctive intermittent self-dilatation can reduce time to recurrence. Although quality-of-life benefit appears good in the short term, repeated procedures may harm sexual function in the long-term. Urethral dilatation and DVIU remain widely used in urethral stricture management but high-level comparative evidence of benefit and harms against urethroplasty in the short and long-term is still lacking.

  5. Dilatation of aortic grafts over time: what to expect and when to be concerned.

    PubMed

    Schroeder, Torben V; Eldrup, Nikolaj; Just, Sven; Hansen, Marc; Nyhuus, Bo; Sillesen, Henrik

    2009-06-01

    Dilatation of aortic prosthetic grafts is commonly reported, but most reports are anecdotal, with little objective data in the literature. We performed a prospective trial of 303 patients who underwent prosthetic graft repair for aortic aneurysm or occlusive disease, randomizing patients between insertion of a woven polyester or expanded polytetrafluoroethylene (ePTFE) graft. Patients were followed with computed tomography and ultrasonography for up to 5 years in order to assess the frequency and magnitude of postoperative dilatation. Graft dilatation was documented in patients with polyester grafts at 12 months. Thereafter and up to 60 months, polyester grafts did not dilate further. After 5 years, polyester prostheses had dilated by 25% and ePTFE by 12.5%, as determined by computed tomography imaging. These observations suggest that dilatation of prosthetic grafts is more frequent with knitted polyester grafts compared with ePTFE. Dilatation occurs within the first year after implantation and can be, in part, explained by a discrepancy between the initial nominal graft diameter and its diameter after clamp release, probably due to an in vivo adaptation of the textile structure. Interestingly, graft dilatation did not appear to be associated with an increased frequency of graft-related complications.

  6. Fluorescein photodiagnosis of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome: A case report and long-term outcome of photocoagulation therapy.

    PubMed

    Xia, Yonghui; Su, Yu; Wong, Ian Hin Yat; Ma, Xiaoli; Hua, Rui

    2016-12-01

    Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a disease characterized by multiple retinal macroaneurysms, neuroretinitis and peripheral capillary non-perfusion, leading to irreversible visual loss. It includes five stages and has previously been rarely reported. IRVAN syndrome is especially rare in Asia. In this report, we describe laser diagnosis and therapy in an Asian patient with IRVAN syndrome over two years of follow-up. We observed non-perfusion retina and dilated retinal capillaries in the contralateral eye. Photocoagulation is an effective therapy to control retinal macroaneurysms and nonperfusions and to prevent visual loss, particularly in the early stages of IRVAN syndrome (stages 2 & 3). To the best of our knowledge, this is the first long-term observation of photocoagulation in IRVAN syndrome. We discovered the early signs of such lesions, which may be beneficial for clinical diagnosis and therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. [Vitrectomy for idiopathic and secondary preretinal macular membrane].

    PubMed

    Oficjalska-Młyńczak, Jolanta; Jamrozy-Witkowska, Agnieszka

    2004-01-01

    To evaluate the results of pars plana vitrectomy and membrane stripping for idiopathic and secondary preretinal macular membrane (PMM). Twenty one consecutive subjects (21 eyes) ranging in age from 40 to 78 (mean 66.9) with PMM underwent vitrectomy and membrane peeling. 17 cases had membranes that were considered idiopathic, and 4 cases were associated with other disorders: 3 occurred after successful retinal reattachment surgery, 1--after laserotherapy in the course of diabetic retinopathy. Visual acuity (VA), Amsler grid, and postoperative complications were assessed. The follow-up was 1 to 22 months, mean 5.7. Visual acuity improved postoperatively in 15 eyes (71.4%), at least two lines on the Snellen chart in 8 eyes (38.1%), entirely in patients with idiopathic PMM. It remained unchanged in 3 eyes (14.3%) and deteriorated in 3 eyes (14.3%). Eyes with transparent membrane showed greater visual improvement than opaque ones. The preoperative Amsler test was positive in 15 patients (71.4%), postoperatively--in 4 cases (19%). 2 idiopathic cases with VA of 0.7 showed postoperatively VA of 1.0. Complications included retinal detachment in 2 eyes (1 in idiopathic and 1 in secondary PMM), and development of nuclear sclerotic cataract in 2 eyes. At 6 months of follow-up, a residual membrane formation in 1 cases appeared. Macular pseudohole was observed in 1 eye with no impact on visual results. 1. Vitrectomy with membrane peeling for preretinal macular membrane provides improvement in visual acuity and reduces metamorphopsia 2. Thin, cellophane-like appearance of the membrane gives a better prognosis of visual function improvement.

  8. Idiopathic hypersomnia: clinical features and response to treatment.

    PubMed

    Ali, Mohsin; Auger, R Robert; Slocumb, Nancy L; Morgenthaler, Timothy I

    2009-12-15

    A recent American Academy of Sleep Medicine publication identified a need for research regarding idiopathic hypersomnia. We describe various clinical and polysomnographic features of patients with idiopathic hypersomnia, with an emphasis on response to pharmacotherapy. A retrospective review of our database initially identified 997 patients, utilizing "idiopathic hypersomnia", "hypersomnia NOS", and "primary hypersomnia" as keywords. The charts of eligible patients were examined in detail, and data were abstracted and analyzed. Response to treatment was graded utilizing an internally developed scale. Eighty-five patients were ultimately identified (65% female). Median (interquartile range) ages of onset and diagnosis were 19.6 (15.5) and 33.7 (15.5), respectively. During a median follow-up duration of 2.4 (4.7) years, 65% of patients demonstrated a "complete response" to pharmacotherapy as assessed by the authors' grading schema. Methylphenidate was most commonly used as a first-line agent prior to December 1998, but subsequently, modafinil became the most common first drug. At the last recorded follow-up visit, 92% of patients were on monotherapy, with greater representation of methylphenidate versus modafinil (51% vs. 32%). Among these patients, methylphenidate produced a higher percentage of "complete" or "partial" responses than modafinil, although statistical significance was not reached (38/40 [95%] vs. 22/25 [88%], respectively, p = 0.291). The majority of patients with idiopathic hypersomnia respond well to treatment. Methylphenidate is chosen more often than modafinil as final monotherapy in the treatment of idiopathic hypersomnia, despite the fact that it is less commonly used initially. Further prospective comparisons of medications should be explored.

  9. FATAL GASTRIC DILATION IN TWO ADULT BLACK-FOOTED FERRETS (MUSTELA NIGRIPES).

    PubMed

    Hinton, Jenna D; Aitken-Palmer, Copper; Joyner, Priscilla H; Ware, Lisa; Walsh, Timothy F

    2016-03-01

    Acute gastric dilation resulting in death was identified in two adult black-footed ferrets (Mustela nigripes) housed at the Smithsonian Conservation Biology Institute in Front Royal, Virginia. Both individuals were adult males (3 and 5 yr) and previously clinically healthy prior to the event. The etiology of gastric dilation in both cases could not be definitively determined, and necropsy revealed severe cardiovascular compromise secondary to bloat. Limited literature is available regarding a syndrome of this type in adult black-footed ferrets. Differential diagnoses considered included gastric dilatation volvulus (GDV), severe gastric distention of unknown origin, and gastric outflow obstruction. Given the severity of this syndrome and the findings in these two cases, acute gastric dilation should be considered in black-footed ferrets presenting with acute abdominal distention, respiratory distress, and cardiovascular compromise.

  10. Algorithm and data support of traffic congestion forecasting in the controlled transport

    NASA Astrophysics Data System (ADS)

    Dmitriev, S. V.

    2015-06-01

    The topicality of problem of the traffic congestion forecasting in the logistic systems of product movement highways is considered. The concepts: the controlled territory, the highway occupancy by vehicles, the parking and the controlled territory are introduced. Technical realizabilityof organizing the necessary flow of information on the state of the transport system for its regulation has been marked. Sequence of practical implementation of the solution is given. An algorithm for predicting traffic congestion in the controlled transport system is suggested.

  11. Idiopathic inflammatory myopathies overlapping with systemic diseases

    PubMed Central

    Lepreux, Sébastien; Hainfellner, Johannes A.; Vital, Anne

    2018-01-01

    A muscle biopsy is currently requested to assess the diagnosis of an idiopathic inflammatory myopathy overlapping with a systemic disease. During the past few years, the classification of inflammatory myopathy subtypes has been revisited progressively on the basis of correlations between clinical phenotypes, autoantibodies and histological data. Several syndromic entities are now more clearly defined, and the aim of the present review is to clarify the contribution of muscle biopsy in a setting of idiopathic inflammatory myopathies overlapping with systemic diseases. PMID:29154752

  12. Nitroglycerin mediated dilation evaluated by ultrasound is associated with sTWEAK in hemodialysis patients.

    PubMed

    Rusu, Crina Claudia; Ghervan, Liviu; Racasan, Simona; Kacsa, Ina; Moldovan, Diana; Potra, Alina; Bondor, Cosmina; Anton, Florin; Patiu, Ioan Mihai; Caprioara, Mirela Gherman

    2016-03-01

    The main cause of death in hemodialysis (HD) patients is cardiovascular disease. Ultrasound assessment of the brachial artery dysfunction is easily achievable and can non-invasively detect atherosclerosis in various stages. In HD patients the cardiovascular risk profile is different and the determinants of brachial arterial function can be distinct comparing with general population. The aim of the study is to assess the determinants of arterial brachial function (flow-mediated and nitroglycerin-mediated dilation) evaluated by ultrasound in HD patients and their relation with tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) described as atherosclerotic marker in chronic kidney disease patients. We conducted a cross-sectional observational study on 54 hemodialysis patients. We recorded clinical and biological data and we measured sTWEAK serum levels by ELISA. We evaluated the arterial brachial function by measurement of flow-mediated and nitroglycerin-mediated dilation, using B mode ultrasound. The determinants of flow-mediated dilation were: Kt/V (r=0.47, p<0.001), LDL-cholesterol (r=0.29, p=0.04), and total cholesterol (r=0.31, p=0.02). Flow-mediated dilation correlated with nitroglycerin-mediated dilation (r=0.70, p<0.001). In multivariate analysis kt/V was the only significant predictor for flow-mediated dilation (p=0.04). Nitroglycerin-mediated dilation correlates with sTWEAK (r=-0.30, p=0.03), systolic blood pressure (r=-0.28, p=0.04) and pulse pressure (r=-0.31, p=0.02). In multivariate analysis sTWEAK was the only significant predictor for nitroglycerin-mediated dilation (p=0.04). The main determinant of nitroglycerin-mediated dilation was sTWEAK. In addition, decreased nitroglycerin-mediated dilation was associated with higher systolic blood pressure and pulse pressure. The main determinant of FMD was Kt/V. Increased flow-mediated dilation was associated with better dialysis efficiency and high total cholesterol and LDL-cholesterol.

  13. Office-based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis.

    PubMed

    Howell, Rebecca J; Schopper, Melissa A; Giliberto, John Paul; Collar, Ryan M; Khosla, Sid M

    2018-02-08

    To review experience, safety, and cost of office-based esophageal dilation in patients with history of head and neck cancer (HNCA). The medical records of patients undergoing esophageal dilation in the office were retrospectively reviewed between August 2015 and May 2017. Patients were given nasal topical anesthesia. Next, a transnasal esophagoscopy (TNE) was performed. If the patient tolerated TNE, we proceeded with esophageal dilation using Seldinger technique with the CRE™ Boston Scientific (Boston Scientific Corp., Marlborough, MA) balloon system. Patients were discharged directly from the outpatient clinic. Forty-seven dilations were performed in 22 patients with an average of 2.1 dilations/patient (range 1-10, standard deviation [SD] ± 2.2). Seventeen patients (77%) were male. The average age was 67 years (range 35-78 years, SD ± 8.5). The most common primary site of cancer was oral cavity/oropharynx (n = 10), followed by larynx (n = 6). All patients (100%) had history of radiation treatment. Four patients were postlaryngectomy. The indication for esophageal dilation was esophageal stricture and progressive dysphagia. All dilations occurred in the proximal esophagus. There were no major complications. Three focal, superficial lacerations occurred. Two patients experienced mild, self-limited epistaxis. One dilation was poorly tolerated due to discomfort. One patient required pain medication postprocedure. Office-based esophageal dilation generated $15,000 less in health system charges compared to traditional operating room dilation on average per episode of care. In patients with history of HNCA and radiation, office-based TNE with esophageal dilation appears safe, well-tolerated, and cost-effective. In a small cohort, the technique has low complication rate and is feasible in an otolaryngology outpatient office setting. 4. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Slip and Dilation Tendency Anlysis of McGinness Hills Geothermal Area

    DOE Data Explorer

    Faulds, James E.

    2013-12-31

    Slip and Dilation Tendency in focus areas Critically stressed fault segments have a relatively high likelihood of acting as fluid flow conduits (Sibson, 1994). As such, the tendency of a fault segment to slip (slip tendency; Ts; Morris et al., 1996) or to dilate (dilation tendency; Td; Ferrill et al., 1999) provides an indication of which faults or fault segments within a geothermal system are critically stressed and therefore likely to transmit geothermal fluids. The slip tendency of a surface is defined by the ratio of shear stress to normal stress on that surface: Ts = τ / σn (Morris et al., 1996). Dilation tendency is defined by the stress acting normal to a given surface: Td = (σ1-σn) / (σ1-σ3) (Ferrill et al., 1999). Slip and dilation were calculated using 3DStress (Southwest Research Institute). Slip and dilation tendency are both unitless ratios of the resolved stresses applied to the fault plane by ambient stress conditions. Values range from a maximum of 1, a fault plane ideally oriented to slip or dilate under ambient stress conditions to zero, a fault plane with no potential to slip or dilate. Slip and dilation tendency values were calculated for each fault in the focus study areas at, McGinness Hills, Neal Hot Springs, Patua, Salt Wells, San Emidio, and Tuscarora on fault traces. As dip is not well constrained or unknown for many faults mapped in within these we made these calculations using the dip for each fault that would yield the maximum slip tendency or dilation tendency. As such, these results should be viewed as maximum tendency of each fault to slip or dilate. The resulting along-fault and fault-to-fault variation in slip or dilation potential is a proxy for along fault and fault-to-fault variation in fluid flow conduit potential. Stress Magnitudes and directions Stress field variation within each focus area was approximated based on regional published data and the world stress database (Hickman et al., 2000; Hickman et al., 1998

  15. Obesity is a significant susceptibility factor for idiopathic AA amyloidosis.

    PubMed

    Blank, Norbert; Hegenbart, Ute; Dietrich, Sascha; Brune, Maik; Beimler, Jörg; Röcken, Christoph; Müller-Tidow, Carsten; Lorenz, Hanns-Martin; Schönland, Stefan O

    2018-03-01

    To investigate obesity as susceptibility factor in patients with idiopathic AA amyloidosis. Clinical, biochemical and genetic data were obtained from 146 patients with AA amyloidosis. Control groups comprised 40 patients with long-standing inflammatory diseases without AA amyloidosis and 56 controls without any inflammatory disease. Patients with AA amyloidosis had either familial Mediterranean fever (FMF) or long-standing rheumatic diseases as underlying inflammatory disease (n = 111, median age 46 years). However, in a significant proportion of patients with AA amyloidosis no primary disease was identified (idiopathic AA; n = 37, median age 60 years). Patients with idiopathic AA amyloidosis were more obese and older than patients with AA amyloidosis secondary to FMF or rheumatic diseases. Serum leptin levels correlated with the body mass index (BMI) in all types of AA amyloidosis. Elevated leptin levels of more than 30 µg/l were detected in 18% of FMF/rheumatic + AA amyloidosis and in 40% of patients with idiopathic AA amyloidosis (p = .018). Finally, the SAA1 polymorphism was confirmed as a susceptibility factor for AA amyloidosis irrespective of the type of the disease. Obesity, age and the SAA1 polymorphism are susceptibility factors for idiopathic AA amyloidosis. Recent advances in treatment of FMF and rheumatic disorders will decrease the incidence of AA amyloidosis due to these diseases. Idiopathic AA, however, might be an emerging problem in the ageing and increasingly obese population.

  16. Traffic control strategies for congested freeways and work zones.

    DOT National Transportation Integrated Search

    2008-10-01

    The primary objective of the research was to identify and evaluate effective ways of improving traffic operations and : safety on congested freeways. There was particular interest in finding condition-responsive traffic control solutions : for the fo...

  17. The impact law of confining pressure and plastic parameter on Dilatancy of rock

    NASA Astrophysics Data System (ADS)

    Wang, Bin; Zhang, Zhenjie; Zhu, Jiebing

    2017-08-01

    Based on cyclic loading-unloading triaxle test of marble, the double parameter dilation angle model is established considering confining pressure effect and plastic parameter. Research shows that not only the strength but also the militancy behavior is highly depended on its confining pressure and plastic parameter during process of failure. Dilation angle evolution law shows obvious nonlinear characteristic almost with a rapid increase to the peak and then decrease gradually with plastic increasing, and the peak dilation angle value is inversely proportional with confining pressure. The proposed double parameter nonlinear dilation angle model can be used to well describe the Dilatancy of rock, which helps to understand the failure mechanism of surrounding rock mass and predict the range of plastic zone.

  18. Segmental dilatation of the ileum covered almost entirely by gastric mucosa: report of a case.

    PubMed

    Kobayashi, Tsutomu; Uchida, Nobuyuki; Shiojima, Masayuki; Sasamoto, Hajime; Shimura, Tatsuo; Takahasi, Atsusi; Kuwano, Hiroyuki

    2007-01-01

    A 13-year-old boy was referred to our hospital for investigation of intermittent abdominal colic pain and vomiting. He underwent an emergency laparotomy, which revealed a volvulus and segmental dilatation of the ileum. The dilated intestine was not associated with poor intestinal circulation. Because the dilated ileum did not seem to be the cause of the volvulus, we simply released the volvulus. However, after surgery, the patient still suffered from persistent abdominal pain, further episodes of volvulus, and invagination of the dilated ileum. Thus, we performed a second operation to resect the segmental dilatation of the ileum. Pathological examination revealed that most of the mucosa of the dilated ileum was composed of ectopic gastric mucosa. We postulate that the ectopic gastric mucosa led to the formation of segmental dilatation of the ileum.

  19. Placental villous hypermaturation is associated with idiopathic preterm birth

    PubMed Central

    Morgan, Terry K.; Tolosa, Jorge E.; Mele, Lisa; Wapner, Ronald J.; Spong, Catherine Y.; Sorokin, Yoram; Dudley, Donald J.; Peaceman, Alan M.; Mercer, Brian M.; Thorp, John M.; O’Sullivan, Mary Jo; Ramin, Susan M.; Rouse, Dwight J.; Sibai, Baha

    2014-01-01

    Objective Pregnancy complications such as intra-amniotic infection, preeclampsia, and fetal intrauterine growth restriction (IUGR) account for most cases of preterm birth (PTB), but many spontaneous PTB cases do not have a clear etiology. We hypothesize that placental insufficiency may be a potential cause of idiopathic PTB. Methods Secondary analysis of 82 placental samples from women with PTB obtained from a multicenter trial of repeat versus single antenatal corticosteroids. Samples were centrally reviewed by a single placental pathologist masked to clinical outcomes. The histopathologic criterion for infection was the presence of acute chorioamnionitis defined as neutrophils marginating into the chorionic plate. Placental villous hypermaturation (PVH) was defined as a predominance of terminal villi (similar to term placenta) with extensive syncytial knotting. Idiopathic PTB comprised a group without another known etiology such as preeclampsia, IUGR or infection. Results Acute chorioamnionitis was observed in 33/82 (40%) cases. Other known causes of PTB were reported in 18/82 (22%). The remaining 31/82 (38%) were idiopathic. The frequency of PVH in idiopathic PTB (26/31=84%) was similar to cases with IUGR or preeclampsia (16/ 18=89%), but significantly more common than PVH in the group with acute chorioamnionitis (10/33=30%) (p<0.001). Conclusions PVH, which is a histologic marker of relative placental insufficiency, is a common finding in idiopathic PTB. PMID:23130816

  20. Allelic variation of the FRMD7 gene in congenital idiopathic nystagmus.

    PubMed

    Self, James E; Shawkat, Fatima; Malpas, Crispin T; Thomas, N Simon; Harris, Christopher M; Hodgkins, Peter R; Chen, Xiaoli; Trump, Dorothy; Lotery, Andrew J

    2007-09-01

    To perform a genotype-phenotype correlation study in an X-linked congenital idiopathic nystagmus pedigree (pedigree 1) and to assess the allelic variance of the FRMD7 gene in congenital idiopathic nystagmus. Subjects from pedigree 1 underwent detailed clinical examination including nystagmology. Screening of FRMD7 was undertaken in pedigree 1 and in 37 other congenital idiopathic nystagmus probands and controls. Direct sequencing confirmed sequence changes. X-inactivation studies were performed in pedigree 1. The nystagmus phenotype was extremely variable in pedigree 1. We identified 2 FRMD7 mutations. However, 80% of X-linked families and 96% of simplex cases showed no mutations. X-inactivation studies demonstrated no clear causal link between skewing and variable penetrance. We confirm profound phenotypic variation in X-linked congenital idiopathic nystagmus pedigrees. We demonstrate that other congenital nystagmus genes exist besides FRMD7. We show that the role of X inactivation in variable penetrance is unclear in congenital idiopathic nystagmus. Clinical Relevance We demonstrate that phenotypic variation of nystagmus occurs in families with FRMD7 mutations. While FRMD7 mutations may be found in some cases of X-linked congenital idiopathic nystagmus, the diagnostic yield is low. X-inactivation assays are unhelpful as a test for carrier status for this disease.

  1. Management of infected urethral diverticulum with urethral dilation.

    PubMed

    Lazarou, George; Andrikopoulou, Maria; Cho, Sylvia

    2015-01-01

    Urethral diverticula are rare but underdiagnosed entities that may cause a variety of urinary and pelvic symptoms in women. Management can be very challenging, especially in cases of chronic infection. A 69-year-old gravida 4, para 2 woman with a history of type 2 diabetes and hypothyroidism presented with long history of a painful midline 3-cm suburethral cystic mass, recurrent urinary tract infections, dysuria, dyspareunia, and incomplete voiding. The diagnosis was consistent with an infected urethral diverticulum unresponsive to multiple courses of oral antibiotics. Given the patient's comorbidities and the persistence of infection of the diverticulum, conservative treatment with urethral dilation was performed before surgical treatment. Urethral dilation successfully alleviated the patient's symptoms; the surgical treatment was not ultimately required, and the patient continues to be completely asymptomatic well over 17 months later. We present a unique case of infected urethral diverticulum, which was conservatively treated with dilatation and resulted in resolution of all symptoms, and there is no need for further surgical management.

  2. Percutaneous dilatational tracheostomy following total artificial heart implantation.

    PubMed

    Spiliopoulos, Sotirios; Dimitriou, Alexandros Merkourios; Serrano, Maria Rosario; Guersoy, Dilek; Autschbach, Ruediger; Goetzenich, Andreas; Koerfer, Reiner; Tenderich, Gero

    2015-07-01

    Coagulation disorders and an immune-altered state are common among total artificial heart patients. In this context, we sought to evaluate the safety of percutaneous dilatational tracheostomy in cases of prolonged need for mechanical ventilatory support. We retrospectively analysed the charts of 11 total artificial heart patients who received percutaneous dilatational tracheostomy. We focused on early and late complications. We observed no major complications and no procedure-related deaths. Early minor complications included venous oozing (45.4%) and one case of local infection. Late complications, including subglottic stenosis, stomal infection or infections of the lower respiratory tract, were not observed. In conclusion, percutaneous dilatational tracheostomy in total artificial heart patients is safe. Considering the well-known benefits of early tracheotomy over prolonged translaryngeal intubation, we advocate early timing of therapy in cases of prolonged mechanical ventilation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. Packet Traffic Dynamics Near Onset of Congestion in Data Communication Network Model

    NASA Astrophysics Data System (ADS)

    Lawniczak, A. T.; Tang, X.

    2006-05-01

    The dominant technology of data communication networks is the Packet Switching Network (PSN). It is a complex technology organized as various hierarchical layers according to the International Standard Organization (ISO) Open Systems Interconnect (OSI) Reference Model. The Network Layer of the ISO OSI Reference Model is responsible for delivering packets from their sources to their destinations and for dealing with congestion if it arises in a network. Thus, we focus on this layer and present an abstraction of the Network Layer of the ISO OSI Reference Model. Using this abstraction we investigate how onset of traffic congestion is affected for various routing algorithms by changes in network connection topology. We study how aggregate measures of network performance depend on network connection topology and routing. We explore packets traffic spatio-temporal dynamics near the phase transition point from free flow to congestion for various network connection topologies and routing algorithms. We consider static and adaptive routings. We present selected simulation results.

  4. Physical training improves flow-mediated dilation in patients with the polymetabolic syndrome.

    PubMed

    Lavrencic, A; Salobir, B G; Keber, I

    2000-02-01

    Endothelial dysfunction that can be detected as impaired flow-mediated dilation by ultrasonography is an early event in atherogenesis and has been demonstrated in healthy subjects with risk factors for atherosclerosis many years before the appearance of atheromatous plaques. We examined the influence of physical training on flow-mediated dilation in patients with the polymetabolic syndrome. Twenty-nine asymptomatic men aged 40 to 60 years with the polymetabolic syndrome were randomly divided between the control group and the training group, which trained 3 times a week for 12 weeks. On high-resolution ultrasound images, the diameter of the brachial artery was measured at rest, after reactive hyperemia (causing flow-mediated, endothelium-dependent dilation), and after sublingual glyceryltrinitrate (causing endothelium-independent vasodilation) in all subjects before and after the training period. The training program induced an increase of 18% in physical fitness. Flow-mediated dilation increased from 5.3+/-2.8% to 7.3+/-2.7% (P<0. 05). There was no change in body mass index, blood pressure, insulin resistance, lipids, and big endothelin-1 in either group. Flow-mediated dilation measured before training was negatively correlated with resting heart rate, waist-to-hip ratio, and insulin resistance. Resting heart rate emerged as the only independent determinant, which explained 22% of the variation in flow-mediated dilation. In conclusion, our findings suggest that a 3-month physical training program, which improved maximal exercise capacity, enhances flow-mediated dilation in patients with the polymetabolic syndrome.

  5. Study on Treatment with Respect to Idiopathic Scoliosis

    NASA Astrophysics Data System (ADS)

    Takeuchi, Kenzen; Azegami, Hideyuki; Murachi, Shunji; Kitoh, Junzoh; Ishida, Yoshito; Kawakami, Noriaki; Makino, Mitsunori

    A hypothesis that the thoracic idiopathic scoliosis is buckling phenomenon of the fourth mode induced by the growth of thoracic vertebral bodies was presented in the previous work by the authors using numerical simulations with finite element model of the spine. If the hypothesis is acceptable, sensitivity function with respect to the critical growth of thoracic vertebrae on the maximization problem of buckling load with the fourth buckling mode gives us useful information to improve and develop treatments for the idiopathic scoliosis. The numerical results analyzed by the finite element method demonstrated that the sensitivity function is high at the articular capsules of the intervertebral joints, the intervertebral disks, the costotransverse joints and the constovertebral joints around the apex of the curvature in the case of the thoracic idiopathic scoliosis.

  6. Eder Puestow dilatation of benign rectal stricture following anterior resection.

    PubMed

    Woodward, A; Tydeman, G; Lewis, M H

    1990-01-01

    Benign anastomotic stricture following anterior resection can be difficult to manage when the stricture is proximal. The acceptable surgical options are either a redo low resection with its accompanying hazards or, alternatively, the formation of a permanent colostomy. Although dilatation of such strictures is possible by blind passage of metal bougies, the authors believe that this technique must be regarded as hazardous. A technique of dilatation is described that is usually reserved for esophageal stricture, namely, Eder Puestow dilatation over a guide wire inserted under direct vision. Although this technique may not be without risk, this readily available equipment may be valuable in making a further resection unnecessary.

  7. Dilatation-dissipation corrections for advanced turbulence models

    NASA Technical Reports Server (NTRS)

    Wilcox, David C.

    1992-01-01

    This paper analyzes dilatation-dissipation based compressibility corrections for advanced turbulence models. Numerical computations verify that the dilatation-dissipation corrections devised by Sarkar and Zeman greatly improve both the k-omega and k-epsilon model predicted effect of Mach number on spreading rate. However, computations with the k-gamma model also show that the Sarkar/Zeman terms cause an undesired reduction in skin friction for the compressible flat-plate boundary layer. A perturbation solution for the compressible wall layer shows that the Sarkar and Zeman terms reduce the effective von Karman constant in the law of the wall. This is the source of the inaccurate k-gamma model skin-friction predictions for the flat-plate boundary layer. The perturbation solution also shows that the k-epsilon model has an inherent flaw for compressible boundary layers that is not compensated for by the dilatation-dissipation corrections. A compressibility modification for k-gamma and k-epsilon models is proposed that is similar to those of Sarkar and Zeman. The new compressibility term permits accurate predictions for the compressible mixing layer, flat-plate boundary layer, and a shock separated flow with the same values for all closure coefficients.

  8. Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

    PubMed Central

    Chuah, Seng-Kee; Wu, Keng-Liang; Hu, Tsung-Hui; Tai, Wei-Chen; Changchien, Chi-Sin

    2010-01-01

    Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future. PMID:20101764

  9. Slip and Dilation Tendency Analysis of the Patua Geothermal Area

    DOE Data Explorer

    Faulds, James E.

    2013-12-31

    Critically stressed fault segments have a relatively high likelihood of acting as fluid flow conduits (Sibson, 1994). As such, the tendency of a fault segment to slip (slip tendency; Ts; Morris et al., 1996) or to dilate (dilation tendency; Td; Ferrill et al., 1999) provides an indication of which faults or fault segments within a geothermal system are critically stressed and therefore likely to transmit geothermal fluids. The slip tendency of a surface is defined by the ratio of shear stress to normal stress on that surface: Ts = τ / σn (Morris et al., 1996). Dilation tendency is defined by the stress acting normal to a given surface: Td = (σ1-σn) / (σ1-σ3) (Ferrill et al., 1999). Slip and dilation were calculated using 3DStress (Southwest Research Institute). Slip and dilation tendency are both unitless ratios of the resolved stresses applied to the fault plane by ambient stress conditions. Values range from a maximum of 1, a fault plane ideally oriented to slip or dilate under ambient stress conditions to zero, a fault plane with no potential to slip or dilate. Slip and dilation tendency values were calculated for each fault in the focus study areas at, McGinness Hills, Neal Hot Springs, Patua, Salt Wells, San Emidio, and Tuscarora on fault traces. As dip is not well constrained or unknown for many faults mapped in within these we made these calculations using the dip for each fault that would yield the maximum slip tendency or dilation tendency. As such, these results should be viewed as maximum tendency of each fault to slip or dilate. The resulting along-fault and fault-to-fault variation in slip or dilation potential is a proxy for along fault and fault-to-fault variation in fluid flow conduit potential. Stress Magnitudes and directions Stress field variation within each focus area was approximated based on regional published data and the world stress database (Hickman et al., 2000; Hickman et al., 1998 Robertson-Tait et al., 2004; Hickman and Davatzes

  10. Echocardiographic evaluation of diastolic parameters in dogs with dilated cardiomyopathy.

    PubMed

    Garncarz, M A

    2007-01-01

    Echocardiography is a valuable tool for the evaluation of systolic and diastolic cardiac function. A high correlation between measurements of diastolic mitral inflow parameters analyzed with Doppler echocardiography and invasive methods makes the former valuable. The aim of this study was to ascertain if significant differences occur in diastolic myocardial parameters between dogs with no heart disease and dogs with subclinical or clinical dilated cardiomyopathy. Furthermore the aim of the study was to determine whether heart failure in dilated cardiomypathy is a result of systolic dysfunction alone or both systolic and diastolic dysfunction. Eleven parameters were analyzed: E wave, E-AT, E-DT, E time, A wave, A-AT, A-DT, A time, E+A time, E/A ratio, and IVRT. The study confirmed the value of noninvasive echocardiographic assessment of diastolic function in dogs with dilated cardiomyopathy. Significant differences were found in E wave, E-AT, E time, E/A ratio and IVRT between healthy dogs and dogs with dilated cardiomyopathy. All are characterized by a significant decrease compared to healthy dogs after taking into account age and body weight except for the E/A ratio, which significantly increased in value. There were no significant changes in any of the Doppler parameters for diastolic evaluation in subclinical cases of DCM. Advanced heart failure in dilated cardiomyopathy entails systolic and diastolic dysfunction.

  11. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... and weighted with mercury or a metal olive-shaped weight that slides on a guide, such as a string or... esophageal or gastrointestinal bougies and the esophageal dilator (metal olive). (b) Classification. Class II...

  12. Telehealth Protocol to Prevent Readmission Among High-Risk Patients With Congestive Heart Failure.

    PubMed

    Rosen, Daniel; McCall, Janice D; Primack, Brian A

    2017-11-01

    Congestive heart failure is the leading cause of hospital readmissions. We aimed to assess adherence to and effectiveness of a telehealth protocol designed to prevent hospital admissions for congestive heart failure. We recruited a random sample of 50 patients with congestive heart failure (mean age 61 years) from a managed care organization. We developed a telehealth platform allowing for daily, real-time reporting of health status and video conferencing. We defined adherence as the percentage of days on which the patient completed the daily check-in protocol. To assess efficacy, we compared admission and readmission rates between the 6-month intervention period and the prior 6 months. Primary outcomes were admissions and readmissions due to congestive heart failure, and secondary outcomes were admissions and readmissions due to any cause. Forty-eight patients (96%) completed the protocol. Approximately half (46%) were at high risk for readmission according to standardized measures. Median 120-day adherence was 96% (interquartile range, 92%-98%), and adherence did not significantly differ across sex, race, age, living situation, depression, cognitive ability, or risk for readmission. Approximately equal proportions of patients were admitted for all causes during the 6-month intervention period versus the comparison period (37% vs 43%; P = .32). Half as many patients were admitted for congestive heart failure during the 6-month intervention period compared with the comparison period (12% vs 25%; P = .11). Adherence to this telehealth protocol was excellent and consistent, even among high-risk patients. Future research should test the protocol using a more rigorous randomized design. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Serial cardiac MRIs in adult Fontan patients detect progressive hepatic enlargement and congestion.

    PubMed

    Lewis, Matthew J; Hecht, Elizabeth; Ginns, Jonathan; Benton, Joshua; Prince, Martin; Rosenbaum, Marlon S

    2017-03-01

    The progression of hepatic disease in adult Fontan patients is not well understood. They reviewed the experience with serial cardiac MRIs (CMR) in adult Fontan patients to determine if hepatic anatomic markers of prolonged Fontan exposure were present and if clinical predictors of progressive hepatic congestion could be identified. A retrospective cohort study of all adult Fontan patients who had undergone at least two CMRs was performed. Hepatic dimensions, inferior vena cava (IVC) size, right hepatic vein (RHV) size and spleen diameter were determined from images acquired at the time of clinically guided CMR. Two radiologists with expertise in hepatic imaging graded congestion and liver size independently using post-gadolinium contrast sequences. Twenty-seven patients met inclusion criteria. Over a mean time of 5.1 years between CMRs, there was a significant increase in mean lateral-medial hepatic dimension (P = .005), mean RHV diameter (P = .004), and mean splenic diameter (P = .001). Serial post-gadolinium imaging was available in 25/27 (93%) patients of which 15/27 (55%) showed evidence of progressive hepatic congestion across serial studies. Progressive hepatic congestion was associated with single ventricle ejection fraction (SVEF) less than 50% (P = .008), and larger indexed end-diastolic (EDVI) and end-systolic volume (ESVI). RHV diameter was the only anatomic variable significantly correlated with time from Fontan completion (P = .004). Serial CMRs detected progressive liver and hepatic vein enlargement in our cohort of adult Fontan patients over a mean time of 5.2 years. Progressive hepatic congestion occurs in a significant number of adult Fontan patients and may be associated with ventricular enlargement and decreased ventricular function by CMR. © 2016 Wiley Periodicals, Inc.

  14. Tetralogy of Fallot and aortic root dilation: a long-term outlook.

    PubMed

    Nagy, Christian D; Alejo, Diane E; Corretti, Mary C; Ravekes, William J; Crosson, Jane E; Spevak, Philip J; Ringel, Richard; Carson, Kathryn A; Khalil, Sara; Dietz, Harry C; Cameron, Duke E; Vricella, Luca A; Traill, Thomas A; Holmes, Kathryn W

    2013-04-01

    Dilation of the sinus of Valsalva (SoV) has been increasingly observed after repaired tetralogy of Fallot (TOF). We estimate the prevalence of SoV dilation in adults with repaired TOF and analyze possible factors related to aortic disease. Adults with TOF [n = 109, median age 33.2 years (range 18.1 to 69.5)] evaluated at Johns Hopkins Hospital from 2001 to 2009 were reviewed in an observational retrospective cohort study. Median follow-up was 27.3 (range 0.1-48.8) years. SoV dilation was defined as >95 % confidence interval adjusted for age and body surface area (z-score > 2). The prevalence of SoV dilation was 51 % compared with that of a normal population with a mean z-score of 2.03. Maximal aortic diameters were ≥ 4 cm in 39 % (42 of 109), ≥ 4.5 cm in 21 % (23 of 109), ≥ 5 cm in 8 % (9 of 109), and ≥ 5.5 cm in 2 % (2 of 109). There was no aortic dissection or death due contributable to aortic disease. Aortic valve replacement was performed in 1.8 % and aortic root or ascending aorta (AA) replacement surgery in 2.8 % of patients. By multivariate logistic regression analysis, aortic regurgitation (AR) [odds ratio (OR) = 3.09, p = 0.005], residual ventricular septal defect (VSD) (OR = 4.14, p < 0.02), and TOF with pulmonary atresia (TOF/PA) (OR = 6.75, p = 0.03) were associated with increased odds of dilated aortic root. SoV dilation after TOF repair is common and persists with aging. AR, residual VSD, and TOF/PA are associated with increased odds of dilation. AA evaluation beyond the SoV is important. Indexed values are imperative to avoid bias on the basis of age and body surface area.

  15. Initial clinical experience of real-time three-dimensional echocardiography in patients with ischemic and idiopathic dilated cardiomyopathy

    NASA Technical Reports Server (NTRS)

    Shiota, T.; McCarthy, P. M.; White, R. D.; Qin, J. X.; Greenberg, N. L.; Flamm, S. D.; Wong, J.; Thomas, J. D.

    1999-01-01

    The geometry of the left ventricle in patients with cardiomyopathy is often sub-optimal for 2-dimensional ultrasound when assessing left ventricular (LV) function and localized abnormalities such as a ventricular aneurysm. The aim of this study was to report the initial experience of real-time 3-D echocardiography for evaluating patients with cardiomyopathy. A total of 34 patients were evaluated with the real-time 3D method in the operating room (n = 15) and in the echocardiographic laboratory (n = 19). Thirteen of 28 patients with cardiomyopathy and 6 other subjects with normal LV function were evaluated by both real-time 3-D echocardiography and magnetic resonance imaging (MRI) for obtaining LV volumes and ejection fractions for comparison. There were close relations and agreements for LV volumes (r = 0.98, p <0.0001, mean difference = -15 +/- 81 ml) and ejection fractions (r = 0.97, p <0.0001, mean difference = 0.001 +/- 0.04) between the real-time 3D method and MRI when 3 cardiomyopathy cases with marked LV dilatation (LV end-diastolic volume >450 ml by MRI) were excluded. In these 3 patients, 3D echocardiography significantly underestimated the LV volumes due to difficulties with imaging the entire LV in a 60 degrees x 60 degrees pyramidal volume. The new real-time 3D echocardiography is feasible in patients with cardiomyopathy and may provide a faster and lower cost alternative to MRI for evaluating cardiac function in patients.

  16. Mechanisms of flow and ACh-induced dilation in rat soleus arterioles are altered by hindlimb unweighting

    NASA Technical Reports Server (NTRS)

    Schrage, William G.; Woodman, Christopher R.; Laughlin, M. Harold

    2002-01-01

    The purpose of this study was to test the hypothesis that endothelium-dependent dilation (flow-induced dilation and ACh-induced dilation) in rat soleus muscle arterioles is impaired by hindlimb unweighting (HLU). Male Sprague-Dawley rats (approximately 300 g) were exposed to HLU or weight-bearing control (Con) conditions for 14 days. Soleus first-order (1A) and second-order (2A) arterioles were isolated, cannulated, and exposed to step increases in luminal flow at constant pressure. Flow-induced dilation was not impaired by HLU in 1A or 2A arterioles. The cyclooxygenase inhibitor indomethacin (Indo; 50 microM) did not alter flow-induced dilation in 1As or 2As. Inhibition of nitric oxide synthase (NOS) with N(omega)-nitro-L-arginine (L-NNA; 300 microM) reduced flow-induced dilation by 65-70% in Con and HLU 1As. In contrast, L-NNA abolished flow-induced dilation in 2As from Con rats but had no effect in HLU 2As. Combined treatment with L-NNA + Indo reduced tone in 1As and 2As from Con rats, but flow-induced dilation in the presence of L-NNA + Indo was not different from responses without inhibitors in either Con or HLU 1As or 2As. HLU also did not impair ACh-induced dilation (10(-9)-10(-4) M) in soleus 2As. L-NNA reduced ACh-induced dilation by approximately 40% in Con 2As but abolished dilation in HLU 2As. Indo did not alter ACh-induced dilation in Con or HLU 2As, whereas combined treatment with L-NNA + Indo abolished ACh-induced dilation in 2As from both groups. We conclude that flow-induced dilation (1As and 2As) was preserved after 2 wk HLU, but HLU decreased the contribution of NOS in mediating flow-induced dilation and increased the contribution of a NOS- and cyclooxygenase-independent mechanism (possibly endothelium-derived hyperpolarizing factor). In soleus 2As, ACh-induced dilation was preserved after 2-wk HLU but the contribution of NOS in mediating ACh-induced dilation was increased.

  17. Containing air pollution and traffic congestion: Transport policy and the environment in Singapore

    NASA Astrophysics Data System (ADS)

    Chin, Anthony T. H.

    Land transportation remains one of the main contributors of noise and air pollution in urban areas. This is in addition to traffic congestion and accidents which result in the loss of productive activity. While there is a close relationship between traffic volumes and levels of noise and air pollution, transport authorities often assume that solving traffic congestion would reduce noise and air pollutant levels. Tight control over automobile ownership and use in Singapore has contributed in improving traffic flows, travel speeds and air quality. The adoption of internationally accepted standards on automobile emissions and gasoline have been effective in reducing air pollution from motor vehicles. Demand management measures have largely focused on controlling the source of traffic congestion, i.e. private automobile ownership and its use especially within the Central Business District during the day. This paper reviews and analyzes the effectiveness of two measures which are instrumental in controlling congestion and automobile ownership, i.e. road pricing and the vehicle quota scheme (VQS). While these measures have been successful in achieving desired objectives, it has also led to the spreading of traffic externalities to other roads in the network, loss in consumer welfare and rent seeking by automobile traders.

  18. Plasmapheresis affects responses of slowly and rapidly adapting airway receptors to pulmonary venous congestion in dogs.

    PubMed Central

    Kappagoda, C T; Ravi, K

    1989-01-01

    1. The effects of plasmapheresis on the responses of rapidly adapting receptors (RARs) and slowly adapting receptors (SARs) of the airways to pulmonary venous congestion were examined in dogs anaesthetized with alpha-chloralose. Pulmonary venous congestion was produced in a graded manner by partial obstruction of the mitral valve sufficient to raise the mean left atrial pressure by 5, 10 and 15 mmHg. Plasmapheresis was performed by withdrawing 10% of blood volume twice. 2. Both RARs (n = 11) and SARs (n = 5) responded to pulmonary venous congestion by increasing their activities. The responses of the former were proportionately greater. 3. After plasmapheresis which reduced the concentration of plasma proteins by 12.3 +/- 1.0%, the responses of the RARs to pulmonary venous congestion were enhanced significantly. There was no significant change in the responses of SARs. 4. In another set of six RARs, the effects of graded pulmonary venous congestion were investigated twice with an interval of 45 min between the two observations. No significant differences were noted between the two responses. 5. Collection of lymph from the tracheobronchial lymph duct (n = 6) showed that after plasmapheresis, there was an increase in the control lymph flow. In addition, the lymph flow was enhanced during pulmonary venous congestion (mean left atrial pressure increased by 10 mmHg). 6. It is suggested that a natural stimulus for the excitation of the RAR is a function of the fluid fluxes in the pulmonary extravascular space. PMID:2607464

  19. Congestion and flow control in signaling system No. 7: Impacts of intelligent networks and new services

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

    Zepf, J.; Rufa, G.

    1994-04-01

    This paper focuses on the transient performance analysis of the congestion and flow control mechanisms in CCITT Signaling System No. 7 (SS7). Special attention is directed to the impacts of the introduction of intelligent services and new applications, e.g., Freephone, credit card services, user-to-user signaling, etc. In particular, we show that signaling traffic characteristics like signaling scenarios or signaling message length as well as end-to-end signaling capabilities have a significant influence on the congestion and flow control and, therefore, on the real-time signaling performance. One important result of our performance studies is that if, e.g., intelligent services are introduced, themore » SS7 congestion and flow control does not work correctly. To solve this problem, some reinvestigations into these mechanisms would be necessary. Therefore, some approaches, e.g., modification of the Signaling Connection Control Part (SCCP) congestion control, usage of the SCCP relay function, or a redesign of the MTP flow control procedures are discussed in order to guarantee the efficacy of the congestion and flow control mechanisms also in the future. 16 refs.« less

  20. Idiopathic orbital inflammatory disease successfully treated with rituximab.

    PubMed

    Schafranski, Marcelo Derbli

    2009-02-01

    We report a case of a 66-year-old Caucasian female with a diagnosis of idiopathic orbital inflammatory disease (OID) refractory to azathioprine therapy. The coexistence of diabetes mellitus represented a relative contraindication to chronic prednisone use. After two infusions of rituximab, a chimeric anti-CD20+ antibody, ophthalmic signs and symptoms remarkably improved. To our knowledge, this is the first case of idiopathic OID successfully treated with rituximab.

  1. Aortic dilatation in Turner syndrome: the role of MRI in early recognition.

    PubMed

    Chalard, François; Ferey, Solène; Teinturier, Cécile; Kalifa, Gabriel

    2005-03-01

    Aortic dilatation and dissection are rare but important complications of Turner syndrome that increase the risk of sudden death in young patients. To assess the value of aortic MRI in patients with Turner syndrome; in particular to demonstrate early aortic dilatation. A total of 21 patients with Turner syndrome underwent MRI of the thoracic aorta with measurement of vessel diameter at four levels. Measurements were normal for age in 15 cases, two patients presented with values at the upper limit of normal and four had obvious dilatation of the ascending aorta. All were symptom free. MRI allows the non-invasive demonstration of early aortic dilatation, which may lead to earlier surgery in asymptomatic individuals.

  2. Improving UDP/IP Transmission Without Increasing Congestion

    NASA Technical Reports Server (NTRS)

    Burleigh, Scott

    2006-01-01

    Datagram Retransmission (DGR) is a computer program that, within certain limits, ensures the reception of each datagram transmitted under the User Datagram Protocol/Internet Protocol. [User Datagram Protocol (UDP) is considered unreliable because it does not involve a reliability-ensuring connection-initiation dialogue between sender and receiver. UDP is well suited to issuing of many small messages to many different receivers.] Unlike prior software for ensuring reception of UDP datagrams, DGR does not contribute to network congestion by retransmitting data more frequently as an ever-increasing number of messages and acknowledgements is lost. Instead, DGR does just the opposite: DGR includes an adaptive timeout-interval- computing component that provides maximum opportunity for reception of acknowledgements, minimizing retransmission. By monitoring changes in the rate at which message-transmission transactions are completed, DGR detects changes in the level of congestion and responds by imposing varying degrees of delay on the transmission of new messages. In addition, DGR maximizes throughput by not waiting for acknowledgement of a message before sending the next message. All DGR communication is asynchronous, to maximize efficient utilization of network connections. DGR manages multiple concurrent datagram transmission and acknowledgement conversations.

  3. Lagged segmented Poincaré plot analysis for risk stratification in patients with dilated cardiomyopathy.

    PubMed

    Voss, Andreas; Fischer, Claudia; Schroeder, Rico; Figulla, Hans R; Goernig, Matthias

    2012-07-01

    The objectives of this study were to introduce a new type of heart-rate variability analysis improving risk stratification in patients with idiopathic dilated cardiomyopathy (DCM) and to provide additional information about impaired heart beat generation in these patients. Beat-to-beat intervals (BBI) of 30-min ECGs recorded from 91 DCM patients and 21 healthy subjects were analyzed applying the lagged segmented Poincaré plot analysis (LSPPA) method. LSPPA includes the Poincaré plot reconstruction with lags of 1-100, rotating the cloud of points, its normalized segmentation adapted to their standard deviations, and finally, a frequency-dependent clustering. The lags were combined into eight different clusters representing specific frequency bands within 0.012-1.153 Hz. Statistical differences between low- and high-risk DCM could be found within the clusters II-VIII (e.g., cluster IV: 0.033-0.038 Hz; p = 0.0002; sensitivity = 85.7 %; specificity = 71.4 %). The multivariate statistics led to a sensitivity of 92.9 %, specificity of 85.7 % and an area under the curve of 92.1 % discriminating these patient groups. We introduced the LSPPA method to investigate time correlations in BBI time series. We found that LSPPA contributes considerably to risk stratification in DCM and yields the highest discriminant power in the low and very low-frequency bands.

  4. Balloon dilatation in esophageal strictures in epidermolysis bullosa and the role of anesthesia.

    PubMed

    Gollu, Gulnur; Ergun, Ergun; Ates, Ufuk; Can, Ozlem S; Dindar, Huseyin

    2017-02-01

    Esophageal involvement, which causes stricture, is a complication in epidermolysis bullosa. This causes dysphagia and malnutrition and leads to deterioration of skin lesions in these patients. The charts of 11 patients with epidermolysis bullosa and esophageal stricture who were included into dilatation program between 2003 and 2015 were retrospectively reviewed. Seven of the patients were female and four were male. The median age was 14 (2-32) years. The mean body weight of patients was 27.8 (9-51) kg. The location and number of strictured parts of the esophagus were previously evaluated with upper gastrointestinal contrast study and after that flexible endoscopy was used for dilatation. Eight patients had middle esophageal, three patients had proximal esophageal and one of them had both proximal and middle esophageal strictures. The strictures were dilated 56 times in total (mean 5 times). One patient underwent gastrostomy and was medically followed-up after a perforation occurrence during the dilatation procedure. In a 32-year-old female patient, colon interposition was performed after four dilatations since optimal nutritional and developmental status could not be achieved. The dilatation program of nine patients is still in progress. Seven of them can easily swallow solid food but two of them have some difficulties in swallowing between dilatations. One patient rejected the program and quitted, while one patient refused colon interposition and died because of complications related to amyloidosis during the dilatation program. After resolution of the swallowing problem, skin lesions were observed to heal quickly. Epidermolysis bullosa is a rare cause of dysphagia. Esophageal balloon dilatation with flexible endoscopy is a safe and efficient method in patients with this condition. © 2016 International Society for Diseases of the Esophagus.

  5. Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum.

    PubMed

    Yamamoto, Natsuyo; Isayama, Hiroyuki; Sasahira, Naoki; Tsujino, Takeshi; Nakai, Yousuke; Miyabayashi, Koji; Mizuno, Suguru; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2014-08-01

    A subpopulation of patients with pancreas divisum experience symptomatic events such as recurrent acute pancreatitis and chronic pancreatitis. Minor papilla sphincterotomy has been reported as being an effective treatment. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation for the minor papilla. Between 2000 and 2012, 16 patients were retrospectively included in this study. After endoscopic balloon dilation for the minor papilla was received, a pancreatic stent or a nasal pancreatic drainage catheter was placed for 1 week. If a stricture or obstruction was evident, it was treated with balloon dilation followed by long-term stent placement (1 year). When an outflow of pancreatic juice was disturbed by a pancreatic stone, endoscopic stone extraction was performed. Balloon dilation and stent placement were achieved and were successful in all the cases (16/16; 100%). Clinical improvement was achieved in 7 (84.7%) of the 9 patients with recurrent acute pancreatitis and in 6 (85.7%) of the 7 patients with chronic pancreatitis. Early complications were observed in 1 (6.3%) patient. Pancreatitis or bleeding related to balloon dilation was not observed. Endoscopic balloon dilation for the minor papilla is feasible for the management of symptomatic pancreas divisum.

  6. Pathogenesis, Newly Recognized Etiologies, and Management of Idiopathic Anaphylaxis

    PubMed Central

    Kuhlen, James L.; Virkud, Yamini V.

    2018-01-01

    Idiopathic anaphylaxis (IA) is a life-threatening allergic disease and the most common diagnosis given to patients following an anaphylactic event. The inability of the healthcare provider and the patient to identify the trigger for anaphylaxis makes standard allergen avoidance measures ineffectual. IA is diagnosed after other causes of anaphylaxis have been excluded. Mast cell activation syndromes (MCAS), mastocytosis, IgE to galactose-alpha-1,3-galactose (α-gal), and certain medications have recently been recognized as causes of anaphylaxis that were previously labeled idiopathic. This review will describe the epidemiology and proposed theories of pathogenesis for IA, its diagnostic approach, its clinical management, and examine newly recognized disorders that were previously labeled as idiopathic anaphylaxis. PMID:25725228

  7. Reducing Traffic Congestion: Using Market Prices to Enhance Mobility

    DOT National Transportation Integrated Search

    1998-01-01

    This is the Department of Transportation's 1997 biennial report on the Congestion Pricing Pilot Program, as required by Section 1012(b) of the Intermodal Surface Transportation Efficiency Act of 1991, P.L. 102-240. The report highlights the significa...

  8. Agent-based real-time signal coordination in congested networks.

    DOT National Transportation Integrated Search

    2014-01-01

    This study is the continuation of a previous NEXTRANS study on agent-based reinforcement : learning methods for signal coordination in congested networks. In the previous study, the : formulation of a real-time agent-based traffic signal control in o...

  9. Impaired activity of adherens junctions contributes to endothelial dilator dysfunction in ageing rat arteries.

    PubMed

    Chang, Fumin; Flavahan, Sheila; Flavahan, Nicholas A

    2017-08-01

    Ageing-induced endothelial dysfunction contributes to organ dysfunction and progression of cardiovascular disease. VE-cadherin clustering at adherens junctions promotes protective endothelial functions, including endothelium-dependent dilatation. Ageing increased internalization and degradation of VE-cadherin, resulting in impaired activity of adherens junctions. Inhibition of VE-cadherin clustering at adherens junctions (function-blocking antibody; FBA) reduced endothelial dilatation in young arteries but did not affect the already impaired dilatation in old arteries. After junctional disruption with the FBA, dilatation was similar in young and old arteries. Src tyrosine kinase activity and tyrosine phosphorylation of VE-cadherin were increased in old arteries. Src inhibition increased VE-cadherin at adherens junctions and increased endothelial dilatation in old, but not young, arteries. Src inhibition did not increase dilatation in old arteries treated with the VE-cadherin FBA. Ageing impairs the activity of adherens junctions, which contributes to endothelial dilator dysfunction. Restoring the activity of adherens junctions could be of therapeutic benefit in vascular ageing. Endothelial dilator dysfunction contributes to pathological vascular ageing. Experiments assessed whether altered activity of endothelial adherens junctions (AJs) might contribute to this dysfunction. Aortas and tail arteries were isolated from young (3-4 months) and old (22-24 months) F344 rats. VE-cadherin immunofluorescent staining at endothelial AJs and AJ width were reduced in old compared to young arteries. A 140 kDa VE-cadherin species was present on the cell surface and in TTX-insoluble fractions, consistent with junctional localization. Levels of the 140 kDa VE-cadherin were decreased, whereas levels of a TTX-soluble 115 kDa VE-cadherin species were increased in old compared to young arteries. Acetylcholine caused endothelium-dependent dilatation that was decreased in old

  10. Early endoscopic balloon dilation in caustic-induced gastric injury.

    PubMed

    Kochhar, Rakesh; Poornachandra, Kuchhangi Sureshchandra; Dutta, Usha; Agrawal, Amit; Singh, Kartar

    2010-04-01

    There are no reports on endoscopic balloon dilation (EBD) for caustic-induced gastric outlet obstruction (GOO) in the acute or subacute phase. To study the efficacy of early EBD in patients with caustic-induced gastric injury. Tertiary care center in India. Retrospective analysis of data. Out of 41 patients with caustic-induced GOO who reported to us in the subacute phase between January 2001 and December 2008, 31 were treated by EBD. All 31 had ingested an acid 14.39 +/- 4.65 days earlier. EBD was achieved by using wire-guided balloons under endoscopic guidance. The balloon was negotiated across the narrowed segment and inflated for 60 seconds using a pressure gun. Balloons of incremental diameter, up to a maximum of 3 sizes, were used in each sitting. Procedural success was defined as reaching the end point of dilation (15 mm) and absence of symptoms. All 31 patients (18 male, mean age 32.06 +/- 11.04 years) could be successfully dilated. All but 1 underwent successful dilations to achieve the end point of 15 mm, requiring a median of 9 (range 3-18) dilations over a period of 7 (range 1.5-16) weeks. Complications included self-limiting pain (n = 10), bleeding at the time of the procedure (n = 9), and perforation in 1 patient (3.2%) who required surgery. Thirty patients were followed up for a median of 21 (range 3-72) months with no recurrence. Early EBD by an expert endoscopist is a safe and effective treatment modality in the management of caustic-induced GOO. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  11. Commuting, congestion, and pollution : the employer-paid parking connection

    DOT National Transportation Integrated Search

    1992-09-01

    Urban areas increasingly face problems associated with traffic congestion and vehicle air emissions. Employer-paid parking--a form of matching grant whereby an employer offers to pay the cost of parking if employees are willing to pay all other costs...

  12. Dilatancy Criteria for Salt Cavern Design: A Comparison Between Stress- and Strain-Based Approaches

    NASA Astrophysics Data System (ADS)

    Labaune, P.; Rouabhi, A.; Tijani, M.; Blanco-Martín, L.; You, T.

    2018-02-01

    This paper presents a new approach for salt cavern design, based on the use of the onset of dilatancy as a design threshold. In the proposed approach, a rheological model that includes dilatancy at the constitutive level is developed, and a strain-based dilatancy criterion is defined. As compared to classical design methods that consist in simulating cavern behavior through creep laws (fitted on long-term tests) and then using a criterion (derived from short-terms tests or experience) to determine the stability of the excavation, the proposed approach is consistent both with short- and long-term conditions. The new strain-based dilatancy criterion is compared to a stress-based dilatancy criterion through numerical simulations of salt caverns under cyclic loading conditions. The dilatancy zones predicted by the strain-based criterion are larger than the ones predicted by the stress-based criteria, which is conservative yet constructive for design purposes.

  13. MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood

    PubMed Central

    Higgins, J; Gillard, J; Owler, B; Harkness, K; Pickard, J

    2004-01-01

    Background: Venous sinus disease must be excluded before diagnosing idiopathic intracranial hypertension but is found only rarely in typical cases. Magnetic resonance venography (MRV) is the technique of choice for investigating this, and provides images that are diagnostic and easy to interpret. However, recent work using more invasive techniques has documented pressure gradients and stenoses in the lateral venous sinuses in many cases of idiopathic intracranial hypertension. Objective: To examine the reason for this discrepancy and to establish whether there are characteristic appearances on MRV in idiopathic intracranial hypertension that are routinely overlooked in clinical practice. Methods: MRVs from 20 patients with idiopathic intracranial hypertension were reviewed, unblinded, by two neuroradiologists, and their appearances rated for focal narrowings and signal gaps. A control group of 40 asymptomatic volunteers, matched for age and sex with the patient group, was recruited prospectively for MRV, and their scans rated in the same way. Results: The lateral sinuses presented a range of appearances with quite different distributions in the two groups (p<0.001). Bilateral lateral sinus flow gaps were seen in 13 of 20 patients with idiopathic intracranial hypertension and in none of 40 controls. Conclusions: A historical failure to use normal healthy controls to establish the boundaries between imaging artefact, normal anatomical variant, and disease means that the pathological significance of the different appearances of the lateral sinuses on MRV has not so far been appreciated. PMID:15026510

  14. Primary obstructive megaureter: the role of high pressure balloon dilation.

    PubMed

    Romero, Rosa M; Angulo, Jose Maria; Parente, Alberto; Rivas, Susana; Tardáguila, Ana Rosa

    2014-05-01

    There is a growing interest in minimally invasive treatment of primary obstructive megaureter (POM) in children. The absence of long-term follow-up data, however, makes it difficult to establish the indication for an endoscopic approach. The aim of our study is to determine the long-term efficacy of endourologic high-pressure balloon dilation of the vesicoureteral junction (VUJ) in children with POM that necessitates surgical treatment. We retrospectively reviewed the clinical records from children with POM who were treated with endourologic high-pressure balloon dilation of the VUJ from March 2003 to April 2010. To determine the long-term, a cohort study was conducted in November 2011. Endourologic dilation of the VUJ was performed with a semicompliant high-pressure balloon (2.7 FG) with a minimum balloon size of 3 mm, followed by placement of a Double-J stent. We have treated 29 (32 renal units, left [n=16], right [n=10] and bilateral [n=3]) children with a diagnosis of POM within this period. The median age at the time of the endourologic treatment was 4.04 months (range 1.6-39 months). In three cases, an open ureteral reimplantation was needed, in two cases because of intraoperative technical failure and postoperative Double-J stent migration in one patient. The 26 children (29 renal units) who had a successful endourologic dilation of the VUJ were followed with ultrasonography and MAG-3-Lasix (furosemide) studies that showed a progressive improvement of both the ureterohydronephrosis and drainage in the first 18 months in 20 patients (23 renal units) (69%). In two patients who were treated with a 3 mm balloon, a further dilation was needed, with an excellent outcome. The cohort study (at a median follow-up of 47 months) showed that in all patients who had a good outcome at the 18-month follow-up after endourologic balloon dilation remained asymptomatic with resolution of ureterohydronephrosis on the US and good drainage on the renogram, in the children

  15. Slip and Dilation Tendency Anlysis of Neal Hot Springs Geothermal Area

    DOE Data Explorer

    Faulds, James E.

    2013-12-31

    Slip and Dilation Tendency in focus areas Critically stressed fault segments have a relatively high likelihood of acting as fluid flow conduits (Sibson, 1994). As such, the tendency of a fault segment to slip (slip tendency; Ts; Morris et al., 1996) or to dilate (dilation tendency; Td; Ferrill et al., 1999) provides an indication of which faults or fault segments within a geothermal system are critically stressed and therefore likely to transmit geothermal fluids. The slip tendency of a surface is defined by the ratio of shear stress to normal stress on that surface: Ts = τ / σn (Morris et al., 1996). Dilation tendency is defined by the stress acting normal to a given surface: Td = (σ1-σn) / (σ1-σ3) (Ferrill et al., 1999). Slip and dilation were calculated using 3DStress (Southwest Research Institute). Slip and dilation tendency are both unitless ratios of the resolved stresses applied to the fault plane by ambient stress conditions. Values range from a maximum of 1, a fault plane ideally oriented to slip or dilate under ambient stress conditions to zero, a fault plane with no potential to slip or dilate. Slip and dilation tendency values were calculated for each fault in the focus study areas at, McGinness Hills, Neal Hot Springs, Patua, Salt Wells, San Emidio, and Tuscarora on fault traces. As dip is not well constrained or unknown for many faults mapped in within these we made these calculations using the dip for each fault that would yield the maximum slip tendency or dilation tendency. As such, these results should be viewed as maximum tendency of each fault to slip or dilate. The resulting along-fault and fault-to-fault variation in slip or dilation potential is a proxy for along fault and fault-to-fault variation in fluid flow conduit potential. Stress Magnitudes and directions Stress field variation within each focus area was approximated based on regional published data and the world stress database (Hickman et al., 2000; Hickman et al., 1998

  16. Slip and Dilation Tendency Analysis of the San Emidio Geothermal Area

    DOE Data Explorer

    Faulds, James E.

    2013-12-31

    Critically stressed fault segments have a relatively high likelihood of acting as fluid flow conduits (Sibson, 1994). As such, the tendency of a fault segment to slip (slip tendency; Ts; Morris et al., 1996) or to dilate (dilation tendency; Td; Ferrill et al., 1999) provides an indication of which faults or fault segments within a geothermal system are critically stressed and therefore likely to transmit geothermal fluids. The slip tendency of a surface is defined by the ratio of shear stress to normal stress on that surface: Ts = τ / σn (Morris et al., 1996). Dilation tendency is defined by the stress acting normal to a given surface: Td = (σ1-σn) / (σ1-σ3) (Ferrill et al., 1999). Slip and dilation were calculated using 3DStress (Southwest Research Institute). Slip and dilation tendency are both unitless ratios of the resolved stresses applied to the fault plane by ambient stress conditions. Values range from a maximum of 1, a fault plane ideally oriented to slip or dilate under ambient stress conditions to zero, a fault plane with no potential to slip or dilate. Slip and dilation tendency values were calculated for each fault in the focus study areas at, McGinness Hills, Neal Hot Springs, Patua, Salt Wells, San Emidio, and Tuscarora on fault traces. As dip is not well constrained or unknown for many faults mapped in within these we made these calculations using the dip for each fault that would yield the maximum slip tendency or dilation tendency. As such, these results should be viewed as maximum tendency of each fault to slip or dilate. The resulting along-fault and fault-to-fault variation in slip or dilation potential is a proxy for along fault and fault-to-fault variation in fluid flow conduit potential. Stress Magnitudes and directions Stress field variation within each focus area was approximated based on regional published data and the world stress database (Hickman et al., 2000; Hickman et al., 1998 Robertson-Tait et al., 2004; Hickman and Davatzes

  17. Slip and Dilation Tendency Analysis of the Salt Wells Geothermal Area

    DOE Data Explorer

    Faulds, James E.

    2013-12-31

    Critically stressed fault segments have a relatively high likelihood of acting as fluid flow conduits (Sibson, 1994). As such, the tendency of a fault segment to slip (slip tendency; Ts; Morris et al., 1996) or to dilate (dilation tendency; Td; Ferrill et al., 1999) provides an indication of which faults or fault segments within a geothermal system are critically stressed and therefore likely to transmit geothermal fluids. The slip tendency of a surface is defined by the ratio of shear stress to normal stress on that surface: Ts = τ / σn (Morris et al., 1996). Dilation tendency is defined by the stress acting normal to a given surface: Td = (σ1-σn) / (σ1-σ3) (Ferrill et al., 1999). Slip and dilation were calculated using 3DStress (Southwest Research Institute). Slip and dilation tendency are both unitless ratios of the resolved stresses applied to the fault plane by ambient stress conditions. Values range from a maximum of 1, a fault plane ideally oriented to slip or dilate under ambient stress conditions to zero, a fault plane with no potential to slip or dilate. Slip and dilation tendency values were calculated for each fault in the focus study areas at, McGinness Hills, Neal Hot Springs, Patua, Salt Wells, San Emidio, and Tuscarora on fault traces. As dip is not well constrained or unknown for many faults mapped in within these we made these calculations using the dip for each fault that would yield the maximum slip tendency or dilation tendency. As such, these results should be viewed as maximum tendency of each fault to slip or dilate. The resulting along-fault and fault-to-fault variation in slip or dilation potential is a proxy for along fault and fault-to-fault variation in fluid flow conduit potential. Stress Magnitudes and directions Stress field variation within each focus area was approximated based on regional published data and the world stress database (Hickman et al., 2000; Hickman et al., 1998 Robertson-Tait et al., 2004; Hickman and Davatzes

  18. Traffic Congestion on a University Campus: A Consideration of Unconventional Remedies to Nontraditional Transportation Patterns

    ERIC Educational Resources Information Center

    Kaplan, Dave; Clapper, Thomas

    2007-01-01

    U.S. transportation data suggest that the number of vehicle miles traveled has far surpassed new capacity, resulting in increased traffic congestion in many communities throughout the country. This article reports on traffic congestion around a university campus located within a small town. The mix of trip purposes varies considerably in this…

  19. Primary intestinal lymphangiectasia: Minireview

    PubMed Central

    Ingle, Sachin B; Hinge (Ingle), Chitra R

    2014-01-01

    Primary idiopathic intestinal lymphangiectasia is an unusual disease featured by the presence of dilated lymphatic channels which are located in the mucosa, submucosa or subserosa leading to protein loosing enteropathy.Most often affected were children and generally diagnosed before third year of life but may be rarely seen in adults too. Bilateral pitting oedema of lower limb is the main clinical manifestation mimicking the systemic disease and posing a real diagnostic dilemma to the clinicians to differentiate it from other common systemic diseases like Congestive cardiac failure, Nephrotic Syndrome, Protein Energy Malnutrition, etc. Diagnosis can be made on capsule endoscopy which can localise the lesion but unable to take biopsy samples. Thus, recently double-balloon enteroscopy and biopsy in combination can be used as an effective diagnostic tool to hit the correct diagnosis. Patients respond dramatically to diet constituting low long chain triglycerides and high protein content with supplements of medium chain triglyceride. So early diagnosis is important to prevent untoward complications related to disease or treatment for the sake of accurate pathological diagnosis. PMID:25325063

  20. Effect of acute gastric dilatation on gastric myoelectic and motor activity in dogs.

    PubMed

    Hall, J A; Solie, T N; Seim, H B; Twedt, D C

    1999-05-01

    To investigate the effects of experimentally induced acute gastric dilatation on electrical and mechanical activities of the stomach in dogs. 7 healthy dogs. Electrodes and strain-gauge force transducers were implanted on the serosal surface of the antrum and pylorus. Eight days later, baseline gastric electrical and contractile activities were recorded. The dogs were anesthetized and mechanically ventilated to maintain normocapnia while the stomach was distended (intragastric pressure, 30 mm Hg) for 180 minutes, using a thin compliant bag. Gastric electrical and contractile activities were recorded again on days 1 and 10 after dilatation. Recordings were analyzed to determine gastric slow-wave frequency, slow-wave dysrhythmia, propagation velocity of slow-waves, coupling of contractions to slow waves, motility index on the basis of relative contractile amplitudes, and onset of contractions after a standardized meal. Electrical or contractile activities were not significantly different 18 hours after acute gastric dilatation (day 1). Arrhythmias were evident before and after gastric dilatation in dogs from which food was withheld and in dogs after consumption of a meal. Variables for assessing gastric electrical and contractile activities were unaffected 18 hours after acute gastric dilatation. Analysis of results of this study indicated that altered electrical and contractile activities in dogs with short-term gastric dilatation are not likely to be secondary to the process of acute gastric dilatation.

  1. Pulmonary Vascular Congestion: A Mechanism for Distal Lung Unit Dysfunction in Obesity.

    PubMed

    Oppenheimer, Beno W; Berger, Kenneth I; Ali, Saleem; Segal, Leopoldo N; Donnino, Robert; Katz, Stuart; Parikh, Manish; Goldring, Roberta M

    2016-01-01

    Obesity is characterized by increased systemic and pulmonary blood volumes (pulmonary vascular congestion). Concomitant abnormal alveolar membrane diffusion suggests subclinical interstitial edema. In this setting, functional abnormalities should encompass the entire distal lung including the airways. We hypothesize that in obesity: 1) pulmonary vascular congestion will affect the distal lung unit with concordant alveolar membrane and distal airway abnormalities; and 2) the degree of pulmonary congestion and membrane dysfunction will relate to the cardiac response. 54 non-smoking obese subjects underwent spirometry, impulse oscillometry (IOS), diffusion capacity (DLCO) with partition into membrane diffusion (DM) and capillary blood volume (VC), and cardiac MRI (n = 24). Alveolar-capillary membrane efficiency was assessed by calculation of DM/VC. Mean age was 45±12 years; mean BMI was 44.8±7 kg/m2. Vital capacity was 88±13% predicted with reduction in functional residual capacity (58±12% predicted). Despite normal DLCO (98±18% predicted), VC was elevated (135±31% predicted) while DM averaged 94±22% predicted. DM/VC varied from 0.4 to 1.4 with high values reflecting recruitment of alveolar membrane and low values indicating alveolar membrane dysfunction. The most abnormal IOS (R5 and X5) occurred in subjects with lowest DM/VC (r2 = 0.31, p<0.001; r2 = 0.34, p<0.001). Cardiac output and index (cardiac output / body surface area) were directly related to DM/VC (r2 = 0.41, p<0.001; r2 = 0.19, p = 0.03). Subjects with lower DM/VC demonstrated a cardiac output that remained in the normal range despite presence of obesity. Global dysfunction of the distal lung (alveolar membrane and distal airway) is associated with pulmonary vascular congestion and failure to achieve the high output state of obesity. Pulmonary vascular congestion and consequent fluid transudation and/or alterations in the structure of the alveolar capillary membrane may be considered often

  2. Idiopathic scrotal calcinosis.

    PubMed

    Celik, Orcun; Ipekci, Tumay; Kazimoglu, Hatem

    2013-12-01

    Idiopathic scrotal calcinosis is a rare scrotal benign disease. Its distinct features are painless, non-pruritic, semi-soft palpable calcific transdermal nodules. We report a 42-year-old-man with asymptomatic multiple calcified scrotal skin nodules for 10 years. Under spinal anesthesia, the affected scrotal skin was excised and the nodules removed. We aim to explain the etiology, pathophysiology, diagnosis, and treatment modalities of this rare disease.

  3. Shape of the dilated aorta in children with bicuspid aortic valve

    PubMed Central

    Mart, Christopher R; McNerny, Bryn E

    2013-01-01

    Background: The dilated aorta in adults with bicuspid aortic valve has been shown to have different shapes, but it is not known if this occurs in children. This observational study was performed to determine if there are different shapes of the dilated aorta in children with bicuspid aortic valve and their association with age, gender, hemodynamic alterations, and degree of aortic enlargement. Methods: One hundred and eighty-seven echocardiograms done on pediatric patients (0 – 18 years) for bicuspid aortic valve, during 2008, were reviewed. Aortic valve morphology, shape/size of the aorta, and pertinent hemodynamic alterations were documented. Aortic dilation was felt to be present when at least one aortic segment had a z-score > 2.0; global aortic enlargement was determined by summing the aortic segment z-scores. The aortic shape was assessed by age, gender, valve morphology, and hemodynamic alterations. Results: Aortic dilation was present in 104/187 patients. The aorta had six different shapes designated from S1 through S6. There was no association between the aortic shape and gender, aortic valve morphology, or hemodynamic abnormalities. S3 was the most common after the age of six years and was associated with the most significant degree of global aortic enlargement. Conclusions: The shape of the dilated aorta in children with bicuspid aortic valve does not occur in a uniform manner and multiple shapes are seen. S2 and S3 are most commonly seen. As aortic dilation becomes more significant, a single shape (S3) becomes the dominant pattern. PMID:24688228

  4. Providers' Experiences with Vaginal Dilator Training for Patients with Vaginal Agenesis.

    PubMed

    Patel, Vrunda; Hakim, Julie; Gomez-Lobo, Veronica; Amies Oelschlager, Anne-Marie

    2018-02-01

    To examine providers' experiences with vaginal dilator training for patients with vaginal agenesis. Anonymous electronic survey. Members of the North American Society for Pediatric and Adolescent Gynecology. How providers learn about vaginal dilator training, common techniques, and methods used for patient training, assessment of patient readiness, common patient complaints, issues leading to early discontinuation. There were a total of 55 completed survey responses of which 31 respondents (56%) had been in practice for more than 10 years. Forty-nine were gynecologists (89%), 20 had completed a fellowship in pediatric and adolescent gynecology (36%), and 6 were reproductive endocrinologists (11%). Thirty-one respondents had first learned about vaginal dilator training through lectures (56%) whereas only 9 through mentorship and fellowship (16%). According to respondents, the most common issue leading to early discontinuation was lack of patient motivation and readiness (n = 42; 76%). The most common complication was pain or discomfort (n = 45; 82%). More than half of respondents determined dilator therapy was successful when patients reported comfortable sexual intercourse (n = 30; 55%) and 65% (n = 35) did not delineate any restrictions to initiation of sexual intercourse. Most respondents (87%) requested further vaginal dilator training at either a clinical meeting (n = 26; 47%) or with a training video (n = 22; 40%). Our study in an experienced cohort of pediatric gynecology providers highlights the need for further research and training on vaginal dilation education. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  5. Association of systemic-onset juvenile idiopathic arthritis and celiac disease - a case report.

    PubMed

    Michelin, Cintia Maria; Aikawa, Nadia Emi; Diniz, João Carlos; Jesus, Adriana Almeida; Koda, Yu Kar; Silva, Clovis Artur

    2011-01-01

    In a 28-year period, 5508 patients were followed at our Paediatric Rheumatology Division and 712 (13%) patients had juvenile idiopathic arthritis (JIA) (ILAR criteria). One (0.14%) of them had association with celiac disease (CD), with predominance of gastrointestinal manifestations and this case was described herein. A 10-years-old female patient was hospitalized with persistent fever, weight loss, asthenia, anorexia and an evanescent pink macular rash. After one week, she presented arthritis of left knee and ankle with duration of 75 days. The initial laboratory exams revealed anemia and elevation of inflammatory markers. Immunological tests were positive for anti-endomysial antibodies IgA and anti-thyroglobulin antibody. The diagnosis of systemic JIA was established and indomethacin (2.0 mg/kg/day) was started with improvement of arthritis. The patient evolved with vomiting, diarrhea and abdominal pain and upper gastrointestinal barium study showed areas of small bowel dilatation and thickening of folds, suggestive of malabsorption syndrome. Colonoscopy was normal and small intestinal biopsy was compatible with CD. We reported a case of a rare association of early diagnosis of systemic JIA occurring simultaneously with CD. This study reinforces the importance of taking into account the possible association of organ-specific autoimmune diseases during JIA course.

  6. Biomechanical analysis of wrapping of the moderately dilated ascending aorta.

    PubMed

    Plonek, Tomasz; Rylski, Bartosz; Dumanski, Andrzej; Siedlaczek, Przemyslaw; Kustrzycki, Wojciech

    2015-08-01

    External wrapping is a surgical method performed to prevent the dilatation of the aorta and to decrease the risk of its dissection and rupture. However, it is also believed to cause degeneration of the aortic wall. A biomechanical analysis was thus performed to assess the stress of the aortic wall subjected to external wrapping. A stress analysis using the finite elements method was carried out on three models: a non-dilated aorta, a moderately dilated aorta and a wrapped aorta. The models were subjected to a pulsatile flow (120/80 mmHg) and a systolic aortic annulus motion of 11 mm. The finite elements analysis showed that the stress exerted on the outer surface of the ascending aorta in the wrapping model (0.05-0.8 MPa) was similar to that observed in the normal aorta (0.03-0.7 MPa) and was lower than in the model of a moderately dilated aorta (0.06-1.4 MPa). The stress on the inner surface of the ascending aorta ranged from 0.2 MPa to 0.4 MPa in the model of the normal aorta, from 0.3 to 1.3 MPa in the model of the dilated aorta and from 0.05 MPa to 0.4 MPa in the wrapping model. The results of this study suggest that the aortic wall is subjected to similar stress following a wrapping procedure to the one present in the normal aorta.

  7. Surveying traffic congestion based on the concept of community structure of complex networks

    NASA Astrophysics Data System (ADS)

    Ma, Lili; Zhang, Zhanli; Li, Meng

    2016-07-01

    In this paper, taking the traffic of Beijing city as an instance, we study city traffic states, especially traffic congestion, based on the concept of network community structure. Concretely, using the floating car data (FCD) information of vehicles gained from the intelligent transport system (ITS) of the city, we construct a new traffic network model which is with floating cars as network nodes and time-varying. It shows that this traffic network has Gaussian degree distributions at different time points. Furthermore, compared with free traffic situations, our simulations show that the traffic network generally has more obvious community structures with larger values of network fitness for congested traffic situations, and through the GPSspg web page, we show that all of our results are consistent with the reality. Then, it indicates that network community structure should be an available way for investigating city traffic congestion problems.

  8. A prosthesis for banding the main pulmonary artery, capable of serial dilatation by balloon angioplasty.

    PubMed

    Vince, D J; Culham, J A

    1989-03-01

    A prosthesis constructed with a fatigued steel helix encased in a silicone rubber shield was used to band the main pulmonary artery in 10 dogs. After a mean duration of 138 days the banded site was dilated with a 20 mm diameter angioplasty catheter. This dilatation produced a mean increase of 44.3% in the cross-sectional area. A further mean increase of 2.2% in the cross-sectional area was measured 137 days after the dilatation. In five uncomplicated experiments a second dilatation was performed with a 23 mm diameter angioplasty catheter after a mean interval of 140 days. The second dilatation produced a further 21% increase in the cross-sectional area. In the five experiments in which two dilatations were performed, there was a total increase in the mean cross-sectional area of 94% produced 273 days after banding. This prosthesis maintains banding of the main pulmonary artery and can be serially dilated by balloon angioplasty.

  9. Myocardial Adiponectin Isoform Shift in Dogs with Congestive Heart Failure—A Comparison to Hibernating Brown Bears (Ursus arctos horribilis)

    PubMed Central

    Nelson, O. Lynne; Wood, Rachael M.; Häggström, Jens; Kvart, Clarence; Robbins, Charles T.

    2017-01-01

    Adiponectin is the most abundant plasma adipokine, and is well known for its role in energy homeostasis and cardiac protection. In humans with dilated cardiomyopathy, myocardial adiponectin protein expression is reduced compared to normal hearts and has been implicated in the pathology of cardiomyopathy. Serum adiponectin levels are often conflicting, with higher levels associated with poor survival in humans with congestive heart failure (CHF). We evaluated adiponectin serum concentrations and myocardial protein expression in dogs with naturally occurring myxomatous mitral valve disease and CHF. We compared the findings to active and hibernating brown bears as bears are adapted to endure an extreme period of low cardiac output during their annual hibernation. Bears exhibited largely the active high-molecular weight (HMW) versus the low-molecular weight isoforms of myocardial adiponectin (HMW:LMW = 6.3) during both the active period and hibernation, while healthy dogs exhibited a more balanced mix of isoforms. Dogs with CHF expressed predominately HMW isoforms of adiponectin (HMW:LMW = 12.5), appearing more similar to bears. In contrast to humans, serum adiponectin was significantly lower in dogs with CHF and lowest levels in the severest CHF class. In both dogs and bears, myocardial adiponectin was expressed independent of circulating adiponectin concentrations, suggesting a local regulatory mechanism within the heart. PMID:29056695

  10. Dilatancy induced ductile-brittle transition of shear band in metallic glasses.

    PubMed

    Zeng, F; Jiang, M Q; Dai, L H

    2018-04-01

    Dilatancy-generated structural disordering, an inherent feature of metallic glasses (MGs), has been widely accepted as the physical mechanism for the primary origin and structural evolution of shear banding, as well as the resultant shear failure. However, it remains a great challenge to determine, to what degree of dilatation, a shear banding will evolve into a runaway shear failure. In this work, using in situ acoustic emission monitoring, we probe the dilatancy evolution at the different stages of individual shear band in MGs that underwent severely plastic deformation by the controlled cutting technology. A scaling law is revealed that the dilatancy in a shear band is linearly related to its evolution degree. A transition from ductile-to-brittle shear bands is observed, where the formers dominate stable serrated flow, and the latter lead to a runaway instability (catastrophe failure) of serrated flow. To uncover the underlying mechanics, we develop a theoretical model of shear-band evolution dynamics taking into account an atomic-scale deformation process. Our theoretical results agree with the experimental observations, and demonstrate that the atomic-scale volume expansion arises from an intrinsic shear-band evolution dynamics. Importantly, the onset of the ductile-brittle transition of shear banding is controlled by a critical dilatation.

  11. Dilatancy induced ductile-brittle transition of shear band in metallic glasses

    NASA Astrophysics Data System (ADS)

    Zeng, F.; Jiang, M. Q.; Dai, L. H.

    2018-04-01

    Dilatancy-generated structural disordering, an inherent feature of metallic glasses (MGs), has been widely accepted as the physical mechanism for the primary origin and structural evolution of shear banding, as well as the resultant shear failure. However, it remains a great challenge to determine, to what degree of dilatation, a shear banding will evolve into a runaway shear failure. In this work, using in situ acoustic emission monitoring, we probe the dilatancy evolution at the different stages of individual shear band in MGs that underwent severely plastic deformation by the controlled cutting technology. A scaling law is revealed that the dilatancy in a shear band is linearly related to its evolution degree. A transition from ductile-to-brittle shear bands is observed, where the formers dominate stable serrated flow, and the latter lead to a runaway instability (catastrophe failure) of serrated flow. To uncover the underlying mechanics, we develop a theoretical model of shear-band evolution dynamics taking into account an atomic-scale deformation process. Our theoretical results agree with the experimental observations, and demonstrate that the atomic-scale volume expansion arises from an intrinsic shear-band evolution dynamics. Importantly, the onset of the ductile-brittle transition of shear banding is controlled by a critical dilatation.

  12. A procedure to detect abnormal sensorimotor control in adolescents with idiopathic scoliosis.

    PubMed

    Pialasse, Jean-Philippe; Mercier, Pierre; Descarreaux, Martin; Simoneau, Martin

    2017-09-01

    This work identifies, among adolescents with idiopathic scoliosis, those demonstrating impaired sensorimotor control through a classification procedure comparing the amplitude of their vestibular-evoked postural responses. The sensorimotor control of healthy adolescents (n=17) and adolescents with idiopathic scoliosis (n=52) with either mild (Cobb angle≥15° and ≤30°) or severe (Cobb angle >30°) spine deformation was assessed through galvanic vestibular stimulation. A classification procedure sorted out adolescents with idiopathic scoliosis whether the amplitude of their vestibular-evoked postural response was dissimilar or similar to controls. Compared to controls, galvanic vestibular stimulation evoked larger postural response in adolescents with idiopathic scoliosis. Nonetheless, the classification procedure revealed that only 42.5% of all patients showed impaired sensorimotor control. Consequently, identifying patients with sensorimotor control impairment would allow to apply personalized treatments, help clinicians to establish prognosis and hopefully improve the condition of patients with adolescent idiopathic scoliosis. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Idiopathic hemifacial spasm responsive to zonisamide: a case report.

    PubMed

    Siniscalchi, Antonio; Gallelli, Luca; Palleria, Caterina; De Sarro, Giovambattista

    2009-01-01

    We describe a patient with idiopathic hemifacial spasm (HFS) that was responsive to zonisamide treatment. A 65-year-old woman presented with a 4-year history of left-sided HFS developing gradually, starting from the upper facial muscles. After several analyses, the diagnosis of idiopathic HFS was made, and the clonazepam treatment (0.5 mg every 8 hours) was started, without a complete remission of symptoms. Therefore, zonisamide (150 mg twice a day for a 6-week period) was added, with a complete resolution. The rechallenge with zonisamide after its dechallenge confirmed its effectiveness. During follow-up, the patient remained symptom-free, with no adverse drug reactions. We suggest that zonisamide could represent a useful therapeutic option in the treatment of idiopathic HFS.

  14. Constraining friction, dilatancy and effective stress with earthquake rates in the deep crust

    NASA Astrophysics Data System (ADS)

    Beeler, N. M.; Thomas, A.; Burgmann, R.; Shelly, D. R.

    2015-12-01

    Similar to their behavior on the deep extent of some subduction zones, families of recurring low-frequency earthquakes (LFE) within zones of non-volcanic tremor on the San Andreas fault in central California show strong sensitivity to stresses induced by the tides. Taking all of the LFE families collectively, LFEs occur at all levels of the daily tidal stress, and are in phase with the very small, ~200 Pa, shear stress amplitudes while being uncorrelated with the ~2 kPa tidal normal stresses. Following previous work we assume LFE sources are small, persistent regions that repeatedly fail during shear within a much larger scale, otherwise aseismically creeping fault zone and that the correlation of LFE occurrence reflects modulation of the fault creep rate by the tidal stresses. We examine the predictions of laboratory-observed rate-dependent dilatancy associated with frictional slip. The effect of dilatancy hardening is to damp the slip rate, so high dilatancy under undrained pore pressure reduces modulation of slip rate by the tides. The undrained end-member model produces: 1) no sensitivity to the tidal normal stress, as first suggested in this context by Hawthorne and Rubin [2010], and 2) fault creep rate in phase with the tidal shear stress. Room temperature laboratory-observed values of the dilatancy and friction coefficients for talc, an extremely weak and weakly dilatant material, under-predict the observed San Andreas modulation at least by an order of magnitude owing to too much dilatancy. This may reflect a temperature dependence of the dilatancy and friction coefficients, both of which are expected to be zero at the brittle-ductile transition. The observed tidal modulation constrains the product of the friction and dilatancy coefficients to be at most 5 x 10-7 in the LFE source region, an order of magnitude smaller than observed at room temperature for talc. Alternatively, considering the predictions of a purely rate-dependent talc friction would

  15. Functional and prognostic effects when emphysema complicates idiopathic pulmonary fibrosis.

    PubMed

    Jacob, Joseph; Bartholmai, Brian J; Rajagopalan, Srinivasan; Kokosi, Maria; Maher, Toby M; Nair, Arjun; Karwoski, Ronald; Renzoni, Elisabetta; Walsh, Simon L F; Hansell, David M; Wells, Athol U

    2017-07-01

    This study aimed to investigate whether the combination of fibrosis and emphysema has a greater effect than the sum of its parts on functional indices and outcome in idiopathic pulmonary fibrosis (IPF), using visual and computer-based (CALIPER) computed tomography (CT) analysis.Consecutive patients (n=272) with a multidisciplinary IPF diagnosis had the extent of interstitial lung disease (ILD) scored visually and by CALIPER. Visually scored emphysema was subcategorised as isolated or mixed with fibrotic lung. The CT scores were evaluated against functional indices forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide ( D LCO ), transfer coefficient of the lung for carbon monoxide ( K CO ), composite physiologic index (CPI)) and mortality.The presence and extent of emphysema had no impact on survival. Results were maintained following correction for age, gender, smoking status and baseline severity using D LCO , and combined visual emphysema and ILD extent. Visual emphysema quantitation indicated that relative preservation of lung volumes (FVC) resulted from tractionally dilated airways within fibrotic lung, ventilating areas of admixed emphysema (p<0.0001), with no independent effect on FVC from isolated emphysema. Conversely, only isolated emphysema (p<0.0001) reduced gas transfer ( D LCO ).There is no prognostic impact of emphysema in IPF, beyond that explained by the additive extents of both fibrosis and emphysema. With respect to the location of pulmonary fibrosis, emphysema distribution determines the functional effects of emphysema. Copyright ©ERS 2017.

  16. Adaptive mechanism-based congestion control for networked systems

    NASA Astrophysics Data System (ADS)

    Liu, Zhi; Zhang, Yun; Chen, C. L. Philip

    2013-03-01

    In order to assure the communication quality in network systems with heavy traffic and limited bandwidth, a new ATRED (adaptive thresholds random early detection) congestion control algorithm is proposed for the congestion avoidance and resource management of network systems. Different to the traditional AQM (active queue management) algorithms, the control parameters of ATRED are not configured statically, but dynamically adjusted by the adaptive mechanism. By integrating with the adaptive strategy, ATRED alleviates the tuning difficulty of RED (random early detection) and shows a better control on the queue management, and achieve a more robust performance than RED under varying network conditions. Furthermore, a dynamic transmission control protocol-AQM control system using ATRED controller is introduced for the systematic analysis. It is proved that the stability of the network system can be guaranteed when the adaptive mechanism is finely designed. Simulation studies show the proposed ATRED algorithm achieves a good performance in varying network environments, which is superior to the RED and Gentle-RED algorithm, and providing more reliable service under varying network conditions.

  17. [Conservative treatment of benign esophageal strictures using dilation. Analysis of 500 cases].

    PubMed

    Andreollo, N A; Lopes, L R; Inogutti, R; Brandalise, N A; Leonardi, L S

    2001-01-01

    The benign esophageal stenoses (BES) are common complications owing to many etiologies: gastroesophageal reflux, ingestion of corrosive agents, esophageal surgery, radiotherapy, postendoscopic variceal sclerotherapy, drug ingestion, prolonged nasogastric intubation, extrinsic compression and esophageal webs. Esophageal dilatations are worldwide recommended to treat this complication, employing dilators of many types and diameters and facilitating the food ingestion. Evaluation of the results and advantages of the conservative treatment of the BES using esophageal dilatations, in outpatient service of upper digestive endoscopy. During the period from 1981 to 1999, 500 patients with BES were treated and followed up at the Gastrocenter - UNICAMP, in an individually Program of Esophageal Dilatation for each case. The highest number of cases was under ages from 31 to 60 years old (52,8%), and males (59,2%). The most predominant etiologies were: peptic stenosis (30,4%), caustic ingestion (23,6%), anastomosis (23,2%), megaesophagus (8,0%) and prolonged nasogastric ingestion entubation (6,4%), totalizing 91,6% of the BES. Most of patients (94,2%) were submitted to the maximum of 25 dilations. Dilators from 10,5 to 16 mm were employed in 95,6% of the cases. The duration of the treatment was 24 months in 76,2% of the BES. Esophageal perforations occurred in 6 patients (1,2%), without mortality. Were considered excellent, good and bad results, respectively in 76,2%, 18,2% and 5,6% of the cases. On the other hand, excellent results were recorded in 81,0% of the peptic stenosis, 66,1% of the caustic stenosis and 82,7% of the anastomotic stenosis. The conservative treatment failed in 9,3% of the caustic stenosis, 4,3% of the anastomotic stenosis and 3,9% of the peptic stenosis. Thus, the caustic stenosis were unsuccessfull in the highest percentage of unsuccessful. The conservative treatment using guidewire dilators (Savary-Gilliard and Eder-Puestow) is the first choice in the

  18. Psychological and Neural Mechanisms of Subjective Time Dilation

    PubMed Central

    van Wassenhove, Virginie; Wittmann, Marc; Craig, A. D. (Bud); Paulus, Martin P.

    2011-01-01

    For a given physical duration, certain events can be experienced as subjectively longer in duration than others. Try this for yourself: take a quick glance at the second hand of a clock. Immediately, the tick will pause momentarily and appear to be longer than the subsequent ticks. Yet, they all last exactly 1 s. By and large, a deviant or an unexpected stimulus in a series of similar events (same duration, same features) can elicit a relative overestimation of subjective time (or “time dilation”) but, as is shown here, this is not always the case. We conducted an event-related functional magnetic neuroimaging study on the time dilation effect. Participants were presented with a series of five visual discs, all static and of equal duration (standards) except for the fourth one, a looming or a receding target. The duration of the target was systematically varied and participants judged whether it was shorter or longer than all other standards in the sequence. Subjective time dilation was observed for the looming stimulus but not for the receding one, which was estimated to be of equal duration to the standards. The neural activation for targets (looming and receding) contrasted with the standards revealed an increased activation of the anterior insula and of the anterior cingulate cortex. Contrasting the looming with the receding targets (i.e., capturing the time dilation effect proper) revealed a specific activation of cortical midline structures. The implication of midline structures in the time dilation illusion is here interpreted in the context of self-referential processes. PMID:21559346

  19. UK guidelines on oesophageal dilatation in clinical practice

    PubMed Central

    Sami, Sarmed S; Haboubi, Hasan N; Ang, Yeng; Boger, Philip; Bhandari, Pradeep; de Caestecker, John; Griffiths, Helen; Haidry, Rehan; Patel, Praful; Paterson, Stuart; Ragunath, Krish; Watson, Peter; Siersema, Peter D; Attwood, Stephen E

    2018-01-01

    These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques—including stents—will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop­ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made. PMID:29478034

  20. Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs.

    PubMed

    Maki, Lynn C; Males, Kristina N; Byrnes, Madeline J; El-Saad, Anthony A; Coronado, George S

    2017-12-01

    There is contradicting information in the veterinary literature regarding canine splenectomy and the increased risk for subsequent gastric dilatation-volvulus. The main purpose of this study was to determine the rate of occurrence of gastric dilatation-volvulus following splenectomy in medium to large breed dogs compared with a control group undergoing other abdominal procedures. Follow-up was performed by reviewing the medical records and conducting phone interviews. Weight, gender, and presence of a hemoabdomen at the time of surgery were not significantly associated with occurrence of gastric dilatation-volvulus, while increasing age was. Ten of 238 (4%) dogs in the splenectomy group and 3/209 (1.4%) dogs in the control group subsequently developed gastric dilatation-volvulus, which was not significantly different ( P = 0.08). While the findings approach significance and support a need for future investigation, the current recommendation for gastropexy at time of splenic removal should be made on a case by case basis and while considering previously documented risk factors.

  1. Controlled dilatation of the uterine cervix--an experimental visceral pain model.

    PubMed

    Bajaj, Priti; Drewes, Asbjørn M; Gregersen, Hans; Petersen, Poul; Madsen, Hans; Arendt-Nielsen, Lars

    2002-10-01

    Pain originating from the female reproductive organs is a substantial clinical problem to treat. Experimental models may be a tool for the study of visceral pain mechanisms and hence provide information to aid in formulating new treatment strategies. The aim was to develop and evaluate the performance and safety of a model for nociceptive stimulation of the uterine cervix by balloon dilatation using impedance planimetry. Three consecutive (repeated) dilatations at 1 ml/min, an isovolumetric and a fast dilatation at 2 ml/min were performed. Pilot studies were conducted in vitro on hysterectomy specimens, followed by application of the model in 14 healthy females. Subjects indicated the quality of perception and pain during dilatations by verbal reports and the McGill Pain Questionnaire (MPQ), and the intensity by a continuous electronic visual analog scale. The pain location was marked on an anatomical map. The balloon cross-sectional area (CSA) was measured simultaneously. The experimental procedure was atraumatic. Pain was evoked in all subjects, with referral to the hypogastric and low back regions. The word descriptors on the MPQ and the areas of referred sensations were similar to that seen clinically in abortion, labor and menstrual pain. The pain intensity correlated with balloon CSA (r=0.9, P<0.001). No significant differences were found for the balloon volumes (4.2, 3.8 and 3.9 ml) or CSA (163, 122 and 123 mm(2)) to pain threshold (PT) for repeated dilatations, suggesting the reliability of the model. There was significant correlation between the balloon volume and CSA to reach the PT for single and repeated cervical dilatations. During isovolumetric distension, greater overall pain intensity was demonstrated for the prolonged as compared to the shorter duration cervical stimulation. In conclusion, this is the first human experimental pain model for dilatation of the uterine cervix, providing a safe, controlled, quantifiable stimulus that evoked reliable

  2. Improved test of time dilation in special relativity.

    PubMed

    Saathoff, G; Karpuk, S; Eisenbarth, U; Huber, G; Krohn, S; Muñoz Horta, R; Reinhardt, S; Schwalm, D; Wolf, A; Gwinner, G

    2003-11-07

    An improved test of time dilation in special relativity has been performed using laser spectroscopy on fast ions at the heavy-ion storage-ring TSR in Heidelberg. The Doppler-shifted frequencies of a two-level transition in 7Li+ ions at v=0.064c have been measured in the forward and backward direction to an accuracy of Deltanu/nu=1 x 10(-9) using collinear saturation spectroscopy. The result confirms the relativistic Doppler formula and sets a new limit of 2.2 x 10(-7) for deviations from the time dilation factor gamma(SR)=(1-v2/c2)(-1/2).

  3. Idiopathic central diabetes Insipidus.

    PubMed

    Grace, Mary; Balachandran, Venu; Menon, Sooraj

    2011-10-01

    Idiopathic central diabetes insipidus (CDI) is a rare disorder characterized clinically by polyuria and polydipsia, and an abnormal urinary concentration without any identified etiology. We report a case of central diabetes insipidus in a 60-year-old lady in the absence of secondary causes like trauma, infection, and infiltrative disorders of brain.

  4. Estimating teat canal cross-sectional area to determine the effects of teat-end and mouthpiece chamber vacuum on teat congestion.

    PubMed

    Penry, J F; Upton, J; Mein, G A; Rasmussen, M D; Ohnstad, I; Thompson, P D; Reinemann, D J

    2017-01-01

    The primary objective of this experiment was to assess the effect of mouthpiece chamber vacuum on teat-end congestion. The secondary objective was to assess the interactive effects of mouthpiece chamber vacuum with teat-end vacuum and pulsation setting on teat-end congestion. The influence of system vacuum, pulsation settings, mouthpiece chamber vacuum, and teat-end vacuum on teat-end congestion were tested in a 2×2 factorial design. The low-risk conditions for teat-end congestion (TEL) were 40 kPa system vacuum (Vs) and 400-ms pulsation b-phase. The high-risk conditions for teat-end congestion (TEH) were 49 kPa Vs and 700-ms b-phase. The low-risk condition for teat-barrel congestion (TBL) was created by venting the liner mouthpiece chamber to atmosphere. In the high-risk condition for teat-barrel congestion (TBH) the mouthpiece chamber was connected to short milk tube vacuum. Eight cows (32 quarters) were used in the experiment conducted during 0400 h milkings. All cows received all treatments over the entire experimental period. Teatcups were removed after 150 s for all treatments to standardize the exposure period. Calculated teat canal cross-sectional area (CA) was used to assess congestion of teat tissue. The main effect of the teat-end treatment was a reduction in CA of 9.9% between TEL and TEH conditions, for both levels of teat-barrel congestion risk. The main effect of the teat-barrel treatment was remarkably similar, with a decrease of 9.7% in CA between TBL and TBH conditions for both levels of teat-end congestion risk. No interaction between treatments was detected, hence the main effects are additive. The most aggressive of the 4 treatment combinations (TEH plus TBH) had a CA estimate 20% smaller than for the most gentle treatment combination (TEL plus TBL). The conditions designed to impair circulation in the teat barrel also had a deleterious effect on circulation at the teat end. This experiment highlights the importance of elevated mouthpiece

  5. Evaluation of Urinary Tract Dilation Classification System for Grading Postnatal Hydronephrosis.

    PubMed

    Hodhod, Amr; Capolicchio, John-Paul; Jednak, Roman; El-Sherif, Eid; El-Doray, Abd El-Alim; El-Sherbiny, Mohamed

    2016-03-01

    We assessed the reliability and validity of the Urinary Tract Dilation classification system as a new grading system for postnatal hydronephrosis. We retrospectively reviewed charts of patients who presented with hydronephrosis from 2008 to 2013. We included patients diagnosed prenatally and those with hydronephrosis discovered incidentally during the first year of life. We excluded cases involving urinary tract infection, neurogenic bladder and chromosomal anomalies, those associated with extraurinary congenital malformations and those with followup of less than 24 months without resolution. Hydronephrosis was graded postnatally using the Society for Fetal Urology system, and then the management protocol was chosen. All units were regraded using the Urinary Tract Dilation classification system and compared to the Society for Fetal Urology system to assess reliability. Univariate and multivariate analyses were performed to assess the validity of the Urinary Tract Dilation classification system in predicting hydronephrosis resolution and surgical intervention. A total of 490 patients (730 renal units) were eligible to participate. The Urinary Tract Dilation classification system was reliable in the assessment of hydronephrosis (parallel forms 0.92). Hydronephrosis resolved in 357 units (49%), and 86 units (12%) were managed by surgical intervention. The remainder of renal units demonstrated stable or improved hydronephrosis. Multivariate analysis revealed that the likelihood of surgical intervention was predicted independently by Urinary Tract Dilation classification system risk group, while Society for Fetal Urology grades were predictive of likelihood of resolution. The Urinary Tract Dilation classification system is reliable for evaluation of postnatal hydronephrosis and is valid in predicting surgical intervention. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Urban Partnership Agreement and Congestion Reduction Demonstration : National Evaluation Framework

    DOT National Transportation Integrated Search

    2008-11-21

    This report provides an analytical framework for evaluating six deployments under the United States Department of Transportation (U.S. DOT) Urban Partnership Agreement (UPA) and Congestion Reduction Demonstration (CRD) Programs. The six UPA/CRD sites...

  7. Idiopathic thoracic transdural intravertebral spinal cord herniation

    PubMed Central

    Turel, Mazda K; Wewel, Joshua T; Kerolus, Mena G; O'Toole, John E

    2017-01-01

    Idiopathic spinal cord herniation is a rare and often missed cause of thoracic myelopathy. The clinical presentation and radiological appearance is inconsistent and commonly confused with a dorsal arachnoid cyst and often is a misdiagnosed entity. While ventral spinal cord herniation through a dural defect has been previously described, intravertebral herniation is a distinct entity and extremely rare. We present the case of a 70-year old man with idiopathic thoracic transdural intravertebral spinal cord herniation and discuss the clinico-radiological presentation, pathophysiology and operative management along with a review the literature of this unusual entity. PMID:29021685

  8. Malignant Esophagogastric Junction Obstruction: Efficacy of Balloon Dilation Combined with Chemotherapy and/or Radiation Therapy

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

    Ko, Gi-Young; Song, Ho-Young, E-mail: hysong@amc.seoul.kr; Hong, Heuk-Jin

    2003-04-15

    Purpose: To assess the efficacy of balloon dilation combined with chemotherapy and/or radiation therapy for palliation of dysphagia due to malignant esophagogastric junction strictures. Methods: Fluoroscopically guided balloon dilation was attempted in 20 patients. The causes of strictures were gastric adenocarcinoma (n = 10) and esophageal squamous cell carcinoma (n = 10). Scheduled chemotherapy and/or radiation therapy followed balloon dilation in all patients. Results: There were no technical failures or major complications. After balloon dilation, 15 (75%) patients showed improvement of dysphagia. No patient complained of reflux esophagitis during the follow-up period. Among the 15 patients, seven needed no furthermore » treatment for palliation of dysphagia until their deaths. The remaining eight patients underwent repeat balloon dilation(n = 4) or stent placement (n = 4)3-43 weeks (mean 15 weeks) after the initial balloon dilation because of recurrent dysphagia. Conclusion: Balloon dilation combined with chemotherapy and/or radiation therapy seems to be an easy and reasonably effective palliative treatment for malignant esophagogastric strictures.« less

  9. Medicinal Leech Therapy for Glans Penis Congestion After Primary Bladder Exstrophy-Epispadias Repair in an Infant: A Case Report.

    PubMed

    Wagenheim, Gavin N; Au, Jason; Gargollo, Patricio C

    2016-01-01

    Many postoperative complications have been reported after repair of classic bladder exstrophy. We present a case of medicinal leech therapy for glans penis congestion following exstrophy repair in an infant. A 2-week-old male with classic bladder exstrophy underwent complete primary repair. On postoperative day 1, he developed rapidly worsening glans penis venous congestion. Medicinal leech therapy was instituted with antibiotics and blood transfusions to maintain a hematocrit >30%. After 24 hours, venous congestion improved and therapy was discontinued. The patient's remaining hospital course was uncomplicated. Medicinal leeches are an effective therapy to relieve glans penis venous congestion. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. The Eyes Have It: Sex and Sexual Orientation Differences in Pupil Dilation Patterns

    PubMed Central

    Rieger, Gerulf; Savin-Williams, Ritch C.

    2012-01-01

    Recent research suggests profound sex and sexual orientation differences in sexual response. These results, however, are based on measures of genital arousal, which have potential limitations such as volunteer bias and differential measures for the sexes. The present study introduces a measure less affected by these limitations. We assessed the pupil dilation of 325 men and women of various sexual orientations to male and female erotic stimuli. Results supported hypotheses. In general, self-reported sexual orientation corresponded with pupil dilation to men and women. Among men, substantial dilation to both sexes was most common in bisexual-identified men. In contrast, among women, substantial dilation to both sexes was most common in heterosexual-identified women. Possible reasons for these differences are discussed. Because the measure of pupil dilation is less invasive than previous measures of sexual response, it allows for studying diverse age and cultural populations, usually not included in sexuality research. PMID:22870196

  11. Flicker-induced retinal arteriole dilation is reduced by ambient lighting.

    PubMed

    Noonan, Jonathan E; Dusting, Gregory J; Nguyen, Thanh T; Man, Ryan E K; Best, William J; Lamoureux, Ecosse L

    2014-08-07

    To investigate the impact of ambient room lighting on the magnitude of flicker light-induced retinal vasodilations in healthy individuals. Twenty healthy nonsmokers participated in a balanced 2 × 2 crossover study. Retinal vascular imaging was performed with the dynamic vessel analyzer under reduced or normal ambient lighting, then again after 20 minutes under the alternate condition. Baseline calibers of selected arteriole and venule segments were recorded in measurement units. Maximum percentage dilations from baseline during 20 seconds of luminance flicker were calculated from the mean of three measurement cycles. Within-subject differences were assessed by repeated measures analysis of variance with the assumption of no carryover effects and pairwise comparisons from the fitted model. Mean (SD) maximum arteriole dilations during flicker stimulation under reduced and normal ambient lighting were 4.8% (2.3%) and 4.1% (1.9%), respectively (P = 0.019). Maximum arteriole dilations were (mean ± 95% confidence interval) 0.7% ± 0.6% lower under normal ambient lighting compared with reduced lighting. Ambient lighting had no significant effect on maximum venular dilations during flicker stimulation or on the baseline calibers of arterioles or venules. Retinal arteriole dilation in response to luminance flicker stimulation is reduced under higher ambient lighting conditions. Reduced responses with higher ambient lighting may reflect reduced contrast between the ON and OFF flicker phases. Although it may not always be feasible to conduct studies under reduced lighting conditions, ambient lighting levels should be consistent to ensure that comparisons are valid. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  12. Prognostic Value of Ultrasound Grading Systems in Prenatally Diagnosed Unilateral Urinary Tract Dilatation.

    PubMed

    Scalabre, Aurélien; Demède, Delphine; Gaillard, Ségolène; Pracros, Jean-Pierre; Mouriquand, Pierre; Mure, Pierre-Yves

    2017-04-01

    We compared the prognostic value of anteroposterior intrasinus diameter of the renal pelvis, urinary tract dilatation and the Society for Fetal Urology grading system in children with prenatally diagnosed unilateral urinary tract dilatation. All newborns with prenatally diagnosed unilateral urinary tract dilatation, normal bladder and anteroposterior intrasinus diameter 10 mm or greater on the first postnatal ultrasonography were prospectively enrolled from January 2011 to February 2015. Indications for surgery were recurrent febrile urinary tract infections and/or decrease of relative renal function more than 10% on serial isotope studies and/or increasing anteroposterior intrasinus diameter greater than 20% on serial ultrasounds. Sensitivity, specificity and ROC curves were calculated to evaluate the accuracy of anteroposterior intrasinus diameter, urinary tract dilatation and Society for Fetal Urology grading system in determining which children would need surgery within 24 months. A total of 57 males and 13 females were included. Of the patients 33 required surgery at a median age of 5 months (IQR 3.8 to 6.4). Urinary tract dilatation remained stable in 14 cases and decreased in 23 with a median followup of 42 months (IQR 25 to 67). Anteroposterior intrasinus diameter, urinary tract dilatation and Society for Fetal Urology scores were all correlated with the need for surgery. Anteroposterior intrasinus diameter with a threshold of 20 mm had the best prognostic value, with a sensitivity of 81.8% and a specificity of 91.7%. Our study confirms that the prognostic value was comparable between anteroposterior intrasinus diameter of the renal pelvis, urinary tract dilatation and Society for Fetal Urology grading system in newborns with prenatally diagnosed unilateral urinary tract dilatation. Anteroposterior intrasinus diameter and abnormal parenchymal thickness are the most important ultrasound criteria to identify children at risk for requiring surgery

  13. Multiple idiopathic external apical root resorption: report of four cases.

    PubMed

    Cholia, S S; Wilson, P H R; Makdissi, J

    2005-07-01

    Multiple idiopathic external root resorption is an unusual condition that may present in a cervical or an apical form. In this article, we review the published literature relating to multiple idiopathic external apical root resorption and present four clinical cases. We consider the aetiology of this condition and discuss the various treatment options.

  14. Mendenhall Glacier Visitor Center vehicular and pedestrian traffic congestion study

    DOT National Transportation Integrated Search

    2007-05-01

    The Mendenhall Glacier Visitor Center of Tongass National Forest in Juneau, Alaska is experiencing vehicular and pedestrian congestion. This study was initiated by the United States Forest Service, Alaska Region, in cooperation with Western Federal L...

  15. A Comparison of Over-the-Counter Mechanical Nasal Dilators: A Systematic Review.

    PubMed

    Kiyohara, Nicole; Badger, Christopher; Tjoa, Tjoson; Wong, Brian

    2016-09-01

    The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter mechanical nasal dilators are an alternative to surgical intervention that attempts to improve airflow through the internal nasal valve. To determine the efficacy of over-the-counter mechanical nasal dilators and classify these products by mechanism. A database of 33 available over-the-counter mechanical nasal dilators was generated via a PubMed search as well as an internet search via Amazon.com and Google, conducted from April 1, 2013, through December 31, 2015. Products determined to be unavailable or discontinued were excluded from the database. Of the devices examined in published literature, efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Measures of reported sleep quality or patient perception were excluded. An analysis of each product's mechanism revealed 4 broad classes: external nasal dilator strips, nasal stents, nasal clips, and septal stimulators. A review demonstrated 5 studies supporting the use of external nasal dilator strips, 4 studies supporting the use of nasal clips, 1 study supporting the use of nasal stents, and no studies supporting the use of septal stimulators. Our findings suggest that external nasal dilator strips and nasal clips effectively relieve obstruction of the internal nasal valve and may be an alternative to surgical intervention in some patients.

  16. How congestion shapes cities: from mobility patterns to scaling

    PubMed Central

    Louf, Rémi; Barthelemy, Marc

    2014-01-01

    The recent availability of data for cities has allowed scientists to exhibit scalings which present themselves in the form of a power-law dependence on population of various socio-economical and structural indicators. We propose here a stochastic theory of urban growth which accounts for some of the observed scalings and we confirm these predictions on US and OECD empirical data. In particular, we show that the dependence on population size of the total number of miles driven daily, the total length of the road network, the total traffic delay, the total consumption of gasoline, the quantity of CO2 emitted and the relation between area and population of cities, are all governed by a single parameter which characterizes the sensitivity to congestion. Our results suggest that diseconomies associated with congestion scale superlinearly with population size, implying that –despite polycentrism– cities whose transportation infrastructure rely heavily on traffic sensitive modes are unsustainable. PMID:24990624

  17. Laser-driven short-duration heating angioplasty: dilatation performance in cadaver atherosclerotic femoral arteries

    NASA Astrophysics Data System (ADS)

    Shimazaki, Natsumi; Naruse, Sho; Arai, Tsunenori; Imanishi, Nobuaki; Aiso, Sadakazu

    2013-03-01

    The purpose of this study was to investigate the artery dilatation performance of the short-duration heating balloon catheter in cadaver stenotic arteries. We designed a prototype short-duration heating balloon catheter that can heat artery media to around 60 °C in 15-25 s by a combination of laser-driven heat generation and continuous fluid irrigation in the balloon. We performed ex vivo short-duration heating dilatation in the cadaver atherosclerotic femoral arteries (initial percent diameter stenosis was 36-98%), with the maximum balloon temperature of 65+/-5 °C, laser irradiation duration of 25 s, and balloon dilatation pressure of 3.5 atm. The artery lumen configurations before and after the dilatations were assessed with a commercial IVUS system. After the short-duration heating dilatations, the percent diameter stenosis was reduced below 30% without any artery tears or dissections. We estimated that the artery media temperature was raised to around 60 °C in which plaque thickness was below 0.8 mm by a thermal conduction calculation. The estimated maximum temperature in artery adventitia and surrounding tissue was up to 45 °C. We found that the short-duration heating balloon could sufficiently dilate the cadaver stenotic arteries, without thermal injury in artery adventitia and surroundings.

  18. Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients.

    PubMed

    Mlakar, Miha; Puddu, Paolo Emilio; Somrak, Maja; Bonfiglio, Silvio; Luštrek, Mitja

    2018-01-01

    This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.

  19. Pathologic aneurysmal dilation of the ascending aorta and dilation of the main pulmonary artery in patients with Kabuki syndrome: valve-sparing aortic root replacement.

    PubMed

    Dyamenahalli, Umesh; Abraham, Boban; Fontenot, Eudice; Prasad, Vinay; Imamura, Michiaki

    2007-01-01

    We report the aneurysmal dilation of the ascending aorta and the main pulmonary artery in 2 children with Kabuki syndrome. In 1 patient, there was progressive aneurysmal dilation of the ascending aorta necessitating aortoplasty. Histologic examination of the resected aorta revealed disrupted and fragmented elastic fibers in the medial layer, along with mucinous degeneration of the aortic wall. This is the first recognition and report of these findings as part of the Kabuki syndrome.

  20. Orthodontic treatment in patient with idiopathic root resorption: a case report.

    PubMed

    Rey, Diego; Smit, Rosana Martínez; Gamboa, Liliana

    2015-01-01

    Multiple idiopathic external root resorption is a rare pathological condition usually detected as an incidental radiographic finding. External root resorption of permanent teeth is a multifactorial process related to several local and systemic factors. If an etiological factor cannot be identified for root resorption, the term "idiopathic" is applied. This report presents a case of multiple idiopathic apical root resorption. The condition was found in a young female patient seeking orthodontic treatment due to malocclusion. This kind of resorption starts apically and progresses coronally, causing a gradual shortening and rounding of the remaining root. Patients with this condition are not the ideal candidates for orthodontic treatment; however, the aim of this report is to describe an unusual case of idiopathic root resorption involving the entire dentition, and to present the orthodontic treatment of this patient. It describes the progress and completion of orthodontic therapy with satisfactory end results.