Scramjet Research with Flight-Like Inflow Conditions

DTIC Science & Technology

2013-07-01

AFRL-RQ-WP-TR-2013-0163 SCRAMJET RESEARCH WITH FLIGHT-LIKE INFLOW CONDITIONS Mark A. Hagenmaier, John Boles, and Ryan T. Milligan...TITLE AND SUBTITLE SCRAMJET RESEARCH WITH FLIGHT-LIKE INFLOW CONDITIONS 5a. CONTRACT NUMBER In-house 5b. GRANT NUMBER 5c. PROGRAM ELEMENT...Clearance Date: 19 Aug 2013. This report contains color. 14. ABSTRACT Studies of flow distortion on fundamental scramjet flows have been performed

Surgical treatment of haemorrhoidal disease – the current situation in Poland

PubMed Central

Dziki, Lukasz; Trzcinski, Radzislaw; Buczynski, Jaroslaw; Kreisel, Anna; Skoneczny, Mariusz; Dziki, Adam

2016-01-01

Introduction In cases of haemorrhoidal disease resistant to conservative treatment, surgical treatment is necessary to relieve the symptoms. Aim To investigate the current methods used by Polish surgeons. Material and methods Surveys were distributed to members of the Association of Polish Surgeons (APS), in which participants were asked a number of closed-ended questions regarding haemorrhoidal disease and the way they treated suffering patients Results Out of the 1523 members of APS who received questionnaires, responses were received from 807 (52.9%) members. The Milligan-Morgan technique was indicated by 72.5% of surgeons as a leading surgical treatment, followed by Ligasure (15.5%), Ferguson (3.5%), DGHL (3.5%), other methods (3.5%), Parks (1.7%), and Longo (0%). The majority of participants (93%) indicated from 0 to 1 life threatening complications, 5% – from 2 to 3, and 2% > 4. A total of 83% of participants use a single dose of antibiotics prior to surgery. Conclusions The Milligan-Morgan technique is the preferred method. The majority of procedures are performed in regional hospitals and university departments, and less commonly in private practices. The vast majority of surgeons in Poland are not convinced about the stapler technique, justifying this fact with the possibility of developing serious complications PMID:27350838

Effect of hemorrhoidectomy on anorectal physiology.

PubMed

Vyslouzil, Kamil; Zboril, Pavel; Skalický, Pavel; Vomácková, Katherine

2010-02-01

The aim of this study was to determine whether overactivity of the anal sphincter in patients with hemorhhoids is primary or secondary and thus assess indication of lateral internal sphincterotomy to surgical treatment of hemorrhoids. Tonic contraction of the sphincter muscle in patients with advanced stages of hemorrhoids is considered by many authors as a primary cause, and therefore, they complete hemorrhoid surgery with lateral internal sphincteroomy. If hypertension of anal sphincter is secondary during hemorrhoid disease, lateral internal sphincterotomy is not indicated. Although examinations made immediately after sphincterotomy proved no changes of anal continence, certain sequelae of lateral internal sphincterotomy cannot be excluded and may later negatively affect patient's anal continence. The prospective study comprised 385 patients treated in 2002-2006 by Hemoron or surgery according to Milligan-Morgan or Longo. Patients with history of another disease of the anal canal, radiotherapy of pelvis, Crohn's disease or ulcerous colitis were excluded. Manometry was performed before and after surgery at intervals of 1, 3, 6 and 12 months after operation using a perfusion flow method, six-channels catheter with radial arrangement of channel tips. In all three groups (Hemoron, sec. Milligan-Morgan, sec. Longo), there were 60-65% of patients with third degree hemorrhoids. Normal resting anal pressure before surgery was recorded in only 25% of men and 30% of women. Patients with advanced hemorrhoid degrees were found to have significant hypertension of the anal sphincter. The most significantly improved state of sphincter overactivity was observed after surgery according to Longo and application of Hemoron. After surgery, according to Milligan-Morgan, recovery of anal sphincter tension was the longest; even 6 months after operation, a mean increased resting anal pressure persisted (91-110 mmHg) in 25% of men and 19% of women. After 12 months, recovery of anal

Ship Routing Utilizing Strong Ocean Currents

DTIC Science & Technology

2013-01-01

303–309. Behrenfeld, M. J ., O’Malley, R. T., Siegel, D. A., McClain, C. R., Sarmiento , J . L., Feldman, G. C., Milligan, A. J ., Falkowski, P. G...Ichikawa (2004). Estimating the Kuroshio axis south of Japan using combination of satellite altimetry and drifting buoys, J . Oceanogr., 60, 375–382. Barneet...T. P., Adam, J . C. and D. P. Lettenmaier (2005). Potential impacts of a warming climate on water availability in snow-dominated regions, Nature, 438

Solar Flare Studies

DTIC Science & Technology

1982-03-20

Feldman, U., and Dere, K. P.:ý 1978, Astophys. /. 224, 1017. Underwood, J. H., Milligan, !. C., dc Loach , A. C. and Hoover, R. B.:, 1977, Applied... Loach , A. C., Hoose~r, R. B., and MlcGuire, J. P.: 19 75,Solar Phys. 45, 377. N , Sheridan, K. V.. Jackson, B. V., hict-can, EX. I , and Sulk, G. A...Sacramento Peak Observatory, Ken Nicolas at NRL and Dean Jacobs at UCSD. This research was sponsored by the Air Force Office of Scientific Research, Air Force

Diagnosis and treatment of haemorrhoids.

PubMed

Buntzen, Steen; Christensen, Peter; Khalid, Ali; Ljungmann, Ken; Lindholt, Jan; Lundby, Lilli; Walker, Line Rossell; Raahave, Dennis; Qvist, Niels

2013-12-01

These guidelines provide a review of diagnosis, conservative and surgical treatment of haemorrhoids with primary focus on the surgical treatment. In symptomatic hemorrhoids it is recommended, that conservative treatment is used as basic treatment regardless of grading. The vast majority of grade II haemorrhoids are treated conservatively, but surgery may be considered in a few cases with pronounced symptoms. In these cases chirurgia minor, Doppler guided dearterilization procedures or stapled haemorrhoidopexy are recommended. In grade III and IV Doppler guided dearterilization procedures, stapled haemorrhoidopexy (Grade III) or conventional Milligan Morgan haemorrhoidectomy are recommended.

CTD Observations on the North Brazil Shelf During A Multidisciplinary Amazon Shelf SEDiment Study (AMASSEDS)

DTIC Science & Technology

1992-06-01

Milligan, H. Morganne, W. Moore, M. Veiga , G. Negreiros, A. Ogston, R. Portugal, H. Oliveira, R. Paiva, R. Pope, A. Rodrigues, K. Ruttenberg, J. Sarmento...34fCL -12 f ~l -12 1 -16 -20 -20 -2 -L L L - 241 L L0 4 B 12 16 20 24 0 4 8 U2 16 20 24 Time (hr) Time (hr) 57 i i i I 27 tI 6I fL * t *. 2 * . 1 I...Guard R&D Center University of Miami Aver Point Gu4600 Rickenbacker Causewayvery Point Miami, FL 33149 Groton, CT 06340I Maury Oceanographic Library

Reduction of ferredoxin or oxygen by flavin-based electron bifurcation in Megasphaera elsdenii.

PubMed

Chowdhury, Nilanjan P; Kahnt, Jörg; Buckel, Wolfgang

2015-08-01

Over 50 years ago, it was reported that, in the anaerobic rumen bacterium Megasphaera elsdenii, the reduction of crotonyl-CoA to butyryl-CoA by NADH involved an electron transferring flavoprotein (Etf) as mediator [Baldwin RL, Milligan LP (1964) Biochim Biophys Acta 92, 421-432]. Purification and spectroscopic characterization revealed that this Etf contained 2 FAD, whereas, in the Etfs from aerobic and facultative bacteria, one FAD is replaced by AMP. Recently we detected a similar system in the related anaerobe Acidaminococcus fermentans that differed in the requirement of additional ferredoxin as electron acceptor. The whole process was established as flavin-based electron bifurcation in which the exergonic reduction of crotonyl-CoA by NADH mediated by Etf + butyryl-CoA dehydrogenase (Bcd) was coupled to the endergonic reduction of ferredoxin also by NADH. In the present study, we demonstrate that, under anaerobic conditions, Etf + Bcd from M. elsdenii bifurcate as efficiently as Etf + Bcd from A. fermentans. Under the aerobic conditions used in the study by Baldwin and Milligan and in the presence of catalytic amounts of crotonyl-CoA or butyryl-CoA, however, Etf + Bcd act as NADH oxidase producing superoxide and H2 O2 , whereas ferredoxin is not required. We hypothesize that, during bifurcation, oxygen replaces ferredoxin to yield superoxide. In addition, the formed butyryl-CoA is re-oxidized by a second oxygen molecule to crotonyl-CoA, resulting in a stoichiometry of 2 NADH consumed and 2 H2 O2 formed. As a result of the production of reactive oxygen species, electron bifurcation can be regarded as an Achilles' heel of anaerobes when exposed to air. © 2015 FEBS.

Excisional hemorrhoidal surgery and its effect on anal continence

PubMed Central

Li, Yan-Dong; Xu, Jia-He; Lin, Jian-Jiang; Zhu, Wei-Fang

2012-01-01

AIM: To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients. METHODS: Seventy-six consecutive patients (33 men and 43 women) with a mean age of 44 years were included. They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third- and fourth-degree hemorrhoids and failure in conservative treatment for years. Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work. The speed-constant rectal lavage apparatus was prepared in our laboratory. The device could output a pulsed and speed-constant saline stream with a high pressure, which is capable of overcoming any rectal resistance change. The patients were divided into three groups, group A (< 900 mL), group B (900-1200 mL) and group C (> 1200 mL) according to the results of the preoperative liquid continence test. RESULTS: All the patients completed the study. The average number of hemorrhoidal masses excised was 2.4. Most patients presented with hemorrhoidal symptoms for more than one year, including a mean duration of incontinence of 5.2 years. The most common symptoms before surgery were anal bleeding (n = 55), prolapsed lesion (n = 34), anal pain (n = 12) and constipation (n = 17). There were grade III hemorrhoids in 39 (51.3%) patients, and grade IV in 37 (48.7%) patients according to Goligher classification. Five patients had experienced hemorrhoid surgery at least once. Compared with postoperative results, the retained volume in the preoperative liquid continence test was higher in 40 patients, lower in 27 patients, and similar in the other 9 patients. The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL, and postoperative volume was slightly decreased (991.27 ± 42.77 mL), but there was no significant difference (P = 0.057). Difference was significant in the test value before and

[Therapy of hemorrhoidal disease].

PubMed

Herold, A

2006-08-01

Hemorrhoidal disease is one of the most frequent disorders in western countries. The aim of individual therapy is freedom from symptoms achieved by normalisation of anatomy and physiology. Treatment is orientated to the stage of disease: haemorrhoids 1 are treated conservatively. In addition to high-fibre diet, sclerotherapy is used. Haemorrhoids 2 prolapse during defecation and return spontaneously. First-line treatment is rubber band ligation. Haemorrhoids 3 that prolapse during defecation have to be digitally reduced, and the majority need surgery. For segmental disorders, haemorrhoidectomy according to Milligan-Morgan or Ferguson is recommended. In circular disease, Stapler hemorrhoidopexy is now the procedure of choice. Using a therapeutic regime according to the hemorrhoidal disease classification offers high healing rates and low rates of complications and recurrence.

Transmission Challenges and Best Practices for Cost-Effective Renewable Energy Delivery across State and Provincial Boundaries

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

Zhou, Shengru; Hurlbut, David J.; Bird, Lori A.

A strategically planned transmission network is an important source of flexibility for the integration of large-scale renewable energy (RE). Such a network can offer access to a broad geographic diversity of resources, which can reduce flexibility needs and facilitate sharing between neighboring balancing areas. This report builds on two previous NREL technical reports - Advancing System Flexibility for High Penetration Renewable Integration (Milligan et al. 2015) and 'Renewables-Friendly' Grid Development Strategies (Hurlbut et al. 2015) - which discuss various flexibility options and provide an overview of U.S. market models and grid planning. This report focuses on addressing issues with cross-regional/provincialmore » transmission in China with the aim of integrating renewable resources that are concentrated in remote areas and require inter-regional/provincial power exchange.« less

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

Hurlbut, David; Zhou, Ella; Bird, Lori

A strategically planned transmission network is an important source of flexibility for the integration of large-scale renewable energy (RE). Such a network can offer access to a broad geographic diversity of resources, which can reduce flexibility needs and facilitate sharing between neighboring balancing areas. This report builds on two previous NREL technical reports - Advancing System Flexibility for High Penetration Renewable Integration (Milligan et al. 2015) and 'Renewables-Friendly' Grid Development Strategies (Hurlbut et al. 2015) - which discuss various flexibility options and provide an overview of U.S. market models and grid planning. This report focuses on addressing issues with cross-regional/provincialmore » transmission in China with the aim of integrating renewable resources that are concentrated in remote areas and require inter-regional/provincial power exchange.« less

[Stage-adjusted treatment for haemorrhoidal disease].

PubMed

Herold, A

2008-05-01

Haemorrhoidal disease is one of the most frequent disorders in western countries. The aim of individual therapy is eradication of symptoms achieved by normalisation of anatomy and physiology. Treatment is orientated to the stage of the disease: First-degree haemorrhoids are treated conservatively. In addition to high fibre diet, sclerotherapy is used. Haemorrhoids of the 2nd degree prolapse during defecation and return spontaneously. First-line treatment is rubber band ligation. Third-degree haemorrhoids that prolapse during defecation have to be digitally reduced. The majority of these patients need surgery. For segmental disorders haemorrhoidectomy according to Milligan-Morgan or Ferguson is recommended. In circular disease Stapler haemorrhoidopexy is now the procedure of choice. Using a classification orientated therapeutical regime orientated to the classification of haemorrhoidal disease offers high healing rates with a low rate of complications and recurrences.

G-protein-coupled receptors: new approaches to maximise the impact of GPCRS in drug discovery.

PubMed

Davey, John

2004-04-01

IBC's Drug Discovery Technology Series is a group of conferences highlighting technological advances and applications in niche areas of the drug discovery pipeline. This 2-day meeting focused on G-protein-coupled receptors (GPCRs), probably the most important and certainly the most valuable class of targets for drug discovery. The meeting was chaired by J Beesley (Vice President, European Business Development for LifeSpan Biosciences, Seattle, USA) and included 17 presentations on various aspects of GPCR activity, drug screens and therapeutic analyses. Keynote Addresses covered two of the emerging areas in GPCR regulation; receptor dimerisation (G Milligan, Professor of Molecular Pharmacology and Biochemistry, University of Glasgow, UK) and proteins that interact with GPCRs (J Bockaert, Laboratory of Functional Genomics, CNRS Montpellier, France). A third Keynote Address from W Thomsen (Director of GPCR Drug Screening, Arena Pharmaceuticals, USA) discussed Arena's general approach to drug discovery and illustrated this with reference to the development of an agonist with potential efficacy in Type II diabetes.

NASA's Ship-Aircraft Bio-Optical Research (SABOR)

NASA Image and Video Library

2014-08-25

Fixing the "Fish" On July 19, 2014, Wayne Slade of Sequoia Scientific, and Allen Milligan of Oregon State University, made adjustments to the "fish" that researchers used to hold seawater collected from a depth of about 3 meters (10 feet) while the ship was underway. NASA's Ship-Aircraft Bio-Optical Research (SABOR) experiment is a coordinated ship and aircraft observation campaign off the Atlantic coast of the United States, an effort to advance space-based capabilities for monitoring microscopic plants that form the base of the marine food chain. Read more: 1.usa.gov/WWRVzj Credit: NASA/SABOR/Wayne Slade, Sequoia Scientific .NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Conservative and surgical treatment of haemorrhoids.

PubMed

Altomare, Donato F; Giuratrabocchetta, Simona

2013-09-01

The management of haemorrhoids has evolved rapidly during the past few decades. Several new treatments have been proposed with the aim of reducing patients' postoperative pain, time to return to normal life, risk of early and late complications, and recurrence rate. Although conservative treatment based on dietary and lifestyle changes can help the majority of patients, and rubber band ligation and phlebotonic drugs can effectively treat grade I and II haemorrhoids, surgery is required for the most advanced stages. Milligan-Morgan haemorrhoidectomy is considered to be the gold-standard approach for grade IV haemorrhoids. An increasing number of minimally invasive treatment options, including mucopexy with or without mucosal resection and haemorrhoid artery ligation, have now been proposed for the management of grade III haemorrhoids. These approaches aim to correct the underlying pathophysiological mechanisms involved in the aetiology of haemorrhoids. An increased risk of recurrence is the price to pay for these minimally invasive and less painful treatments, but the sparing of the sensitive anoderm and a rapid return to normal life without pain are greatly appreciated by patients. An algorithm for the management of haemorrhoids using evidence-based medicine is also presented here.

A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspension clamp combined with harmonic scalpel.

PubMed

Lin, Guoqiang; Ge, Qiongxiang; He, Xiaokang; Qi, Haixin; Xu, Li

2017-06-01

To compare the efficacy of homemade anal cushion suspension clamp combined with harmonic scalpel (ACS) and Milligan-Morgan hemorrhoidectomy combined with electric knife (MMH) in the treatment of stages III to IV hemorrhoids. We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013. Among them, 51 patients were treated with ACS, while 48 patients received MMH. Data from clinical recording and follow-up included operative time, intraoperative blood loss, hospitalization information, postoperative pain, and postoperative complications. Operative time, intraoperative blood loss and hospitalization time in ACS group were significantly less than those in MMH group (P < .05). Compared with MMH group, ACS group had a lower postoperative static pain score from days 1 to 14 (P < .01). The patients in ACS group exhibited less postoperative defecation pain scores from days 3 to 20 than those of MMH group (P < .05). The incidence of postoperative anal edema and delayed wound healing in ACS group was lower than that in MMH group (P < .05). Compared with MMH, our novel technique ACS was more effective and had fewer postoperative complications in the treatment of stages III to IV hemorrhoids.

Wasatch and Uinta Mountains Ecoregion: Chapter 9 in Status and trends of land change in the Western United States--1973 to 2000

USGS Publications Warehouse

Brooks, Mark S.

2012-01-01

The Wasatch and Uinta Mountains Ecoregion covers approximately 44,176 km2 (17, 057 mi2) (fig. 1) (Omernik, 1987; U.S. Environmental Protection Agency, 1997). With the exception of a small part of the ecoregion extending into southern Wyoming and southern Idaho, the vast majority of the ecoregion is located along the eastern mountain ranges of Utah. The ecoregion is situated between the Wyoming Basin and Colorado Plateaus Ecoregions to the east and south and the Central Basin and Range Ecoregion to the west; in addition, the Middle Rockies, Snake River Basin, and Northern Basin and Range Ecoregions are nearby to the north. Considered the western front of the Rocky Mountains, the two major mountain ranges that define the Wasatch and Uinta Mountains Ecoregion include the north-south-trending Wasatch Range and east-west- trending Uinta Mountains. Both mountain ranges have been altered by multiple mountain building and burial cycles since the Precambrian era 2.6 billion years ago, and they have been shaped by glacial processes as early as 1.6 million years ago. The terrain is defined by sharp ridgelines, glacial lakes, and narrow canyons, with elevations ranging from 1,829 m in the lower canyons to 4,123 m at Kings Peak, the highest point in Utah (Milligan, 2010).

Frequency of operative trauma to anal sphincters: evaluation with endoanal ultrasound.

PubMed

Stamatiadis, Apostolos; Konstantinou, Evangelos; Theodosopoulou, Eleni; Mamoura, Konstantinia

2002-01-01

Sphincter trauma after anorectal surgery is usually asymptomatic. Frequency of trauma cannot be established with the clinical examination only. The frequency of operative sphincter defects and their correlation with disorders of continence was evaluated with the endoanal ultrasound. This study includes 123 subjects who had undergone anorectal surgery in the past and were examined with endoanal ultrasound for various indications such as continence disorders, recurrent fistula, idiopathic perineal pain, or simple postoperative follow-up. No subjects had isolated external anal sphincter defects. Nineteen of 123 patients (15%) had minor or major continence disorders, 55 patients (45%) had no sphincter defects, 42 (34%) had only internal anal sphincter (IAS) defects, and 26 (21%) had simultaneously external and internal anal sphincter (EAS) defects. The incidence of IAS and EAS trauma after Milligan-Morgan hemorrhoidectomy was 1/18 (5.5%) and 0/18 respectively; after fistula repair, 24/42 (57%) and 12/42 (29%); and after anal dilatation, 13/17 (76%) and 4/17 (24%). Sixteen of 26 patients (62%) with EAS trauma and 51/68 patients (75%) with IAS trauma did not report any disorders of continence. In patients with two or more operations, the frequency of IAS trauma was 74%, 30% for EAS trauma, and 26% for continence disorders.

Treatment of haemorrhoids by transanal haemorrhoidal dearterialization. Experience of several specialized units.

PubMed

Noguerales, Fernando; Díaz, Raúl; Salim, Basar; Piniella, Fernando; Landaluce, Aitor; Garcea, Alessandro; de Mata López Pérez, Juan

2015-04-01

Milligan-Morgan and Ferguson haemorrhoidectomy has been the gold standard treatment for symptomatic haemorrhoids for many years. However, escisional techniques are associated with a significant morbidity rate. In recent years, diverse techniques have been described in an attempt to decrease these complications. The guided transanal haemorrhoidal dearterialization THD) doppler is one of these techniques. We report our experience with this new technique. We performed a prospective study of 475 patients from 5 hospitals from the National Health System, in Spain. The majority of these patients suffered from third grade haemorrhoids (256 [56%]) and underwent THD. We analyse and compare preoperative and postoperative results as well as the homogeneity of the technique between hospitals. Spinal anaesthesia was the most elected procedure by the anaesthetist (81.0%). Statistically significant differences were found between pre and postoperative symptoms (P=.03), with an overall improvement after surgery. The average hospitalization was 0.4±0.3 days. The mean number of days of oral analgesics was 8.8±2.7 days. The cumulative complication rate is 16%. THD is a safe and easily reproducible procedure. Postoperative outcomes demonstrated a low rate of morbidity and recurrence together with early discharge; therefore, a rapid incorporation to daily activities was noted. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Manual reduction in acute haemorrhoids.

PubMed

Gaj, F; Candeloro, L; Biviano, I

2016-01-01

In prolapsed internal hemorrhoids exposed outside the anus, manually reducing the prolapse with 48 hours of commencement of anal pain, decreased the progression of thrombosis. The aim of our study was to evaluate the effects of manual reduction of the inflamed piles hemorrhoids. Eleven patients, 7 males and 4 pregnant females (in early post partum) with an average age of 34 years ± 8 (range 23- 52) were enrolled with anal pain cause by haemorrhoidal congestion, but prior to full blown thrombosis. Patients underwent a manual reduction of the external prolapsed haemorrhoidal plexus. In the 48 hours following the procedure, patients were instructed on how to insert any prolapsed hemorrhoid (piles) themselves. Pain intensity was measured using the visual analog scale (VAS) at time of consultation and then 10 days after the reduction. At day 10 following treatment we observed a statistically significant reduction in anal swelling (11 vs 1, n° pzt; p = 0.001), anal pain (11 vs 2, n° pzt; p = 0.001) and VAS score (8.6 ± 0.7 vs 0.4 ± 1.2; p = 0.001). Two patients (18%) underwent surgical haemorrhoidectomy sec. Milligan Morgan and 1 patient (9%) underwent excision of thrombosed external hemorrhoids. 73% of patients did not require surgery. Manual reduction of the prolapsed piles outside the anus decreased pain immediately and it also allows postponement of surgery or any other treatment.

Angiotensin-converting enzyme inhibitor prevents oxidative stress, inflammation, and fibrosis in carbon tetrachloride-treated rat liver.

PubMed

Reza, Hasan Mahmud; Tabassum, Nabila; Sagor, Md Abu Taher; Chowdhury, Mohammed Riaz Hasan; Rahman, Mahbubur; Jain, Preeti; Alam, Md Ashraful

2016-01-01

Hepatic fibrosis is a common feature of chronic liver injury, and the involvement of angiotensin II in such process has been studied earlier. We hypothesized that anti-angiotensin II agents may be effective in preventing hepatic fibrosis. In this study, Long Evans female rats were used and divided into four groups such as Group-I, Control; Group-II, Control + ramipril; Group-III, CCl4; and Group-IV, CCl4 + ramipril. Group II and IV are treated with ramipril for 14 d. At the end of treatment, the livers were removed, and the level of hepatic marker enzymes (aspartate aminotransferase, Alanine aminotransferase, and alkaline phosphatase), nitric oxide, advanced protein oxidation product , catalase activity, and lipid peroxidation were determined. The degree of fibrosis was evaluated through histopathological staining with Sirius red and trichrome milligan staining. Carbon-tetrachloride (CCl4) administration in rats developed hepatic dysfunction and raised the hepatic marker enzymes activities significantly. CCl4 administration in rats also produced oxidative stress, inflammation, and fibrosis in liver. Furthermore, angiotensinogen-inhibitor ramipril normalized the hepatic enzymes activities and improved the antioxidant enzyme catalase activity. Moreover, ramipril treatment ameliorated lipid peroxidation and hepatic inflammation in CCl4-treated rats. Ramipril treatment also significantly reduced hepatic fibrosis in CCl4-administered rats. In conclusion, our investigation suggests that the antifibrotic effect of ramipril may be attributed to inhibition of angiotensin-II mediated oxidative stress and inflammation in liver CCl4-administered rats.

In defence of andragogy. Part 2: An educational process consistent with modern nursing's aims.

PubMed

Milligan, F

1997-12-01

In 1987 the English National Board (1987) made it clear that it supported a move towards an andragogical approach to nurse education. Recently such moves have been questioned as has the validity of andragogy (Darbyshire 1993). In response to such challenges this paper extends some of the arguments made in the article 'In defence of andragogy' (Milligan 1995). It is argued that andragogy provides a framework within which care and other crucial aspects of the nurse-patient/client relationship can be mirrored and thereby facilitated in future practitioners. In the socialization processes inherent in nurse education, care is surely difficult to teach or facilitate unless the philosophy and methods are consistent with such ends. Furthermore, it is frequently argued that as educationalists we need to be consistent in our approach to students with that which we hope to see in their future practice (Bevis & Murray 1990). Andragogy offers a medium through which this can be facilitated. It is essentially a humanistic educational process that values the individual. The power relationship between the educator and student is much more horizontal than is found in the historically common hierarchical educational relationship. An educational process based upon andragogy therefore mirrors important parts of the nurse-patient/client relationship. It offers a theory of education consistent with the aims of modern day nursing practice. We should seek to improve our understanding of andragogy and no longer conceptualize it as one end of a false dichotomy with pedagogy.

Fatty acid 16:4(n-3) stimulates a GPR120-induced signaling cascade in splenic macrophages to promote chemotherapy resistance

PubMed Central

Houthuijzen, Julia M.; Oosterom, Ilse; Hudson, Brian D.; Hirasawa, Akira; Daenen, Laura G. M.; McLean, Chelsea M.; Hansen, Steffen V. F.; van Jaarsveld, Marijn T. M.; Peeper, Daniel S.; Jafari Sadatmand, Sahar; Roodhart, Jeanine M. L.; van de Lest, Chris H. A.; Ulven, Trond; Ishihara, Kenji; Milligan, Graeme; Voest, Emile E.

2017-01-01

Although chemotherapy is designed to eradicate tumor cells, it also has significant effects on normal tissues. The platinum-induced fatty acid 16:4(n-3) (hexadeca-4,7,10,13-tetraenoic acid) induces systemic resistance to a broad range of DNA-damaging chemotherapeutics. We show that 16:4(n-3) exerts its effect by activating splenic F4/80+/CD11blow macrophages, which results in production of chemoprotective lysophosphatidylcholines (LPCs). Pharmacologic studies, together with analysis of expression patterns, identified GPR120 on F4/80+/CD11blow macrophages as the relevant receptor for 16:4(n-3). Studies that used splenocytes from GPR120-deficient mice have confirmed this conclusion. Activation of the 16:4(n-3)-GPR120 axis led to enhanced cPLA2 activity in these splenic macrophages and secretion of the resistance-inducing lipid mediator, lysophosphatidylcholine(24:1). These studies identify a novel and unexpected function for GPR120 and suggest that antagonists of this receptor might be effective agents to limit development of chemotherapy resistance.—Houthuijzen, J. M., Oosterom, I., Hudson, B. D., Hirasawa, A., Daenen, L. G. M., McLean, C. M., Hansen, S. V. F., van Jaarsveld, M. T. M., Peeper, D. S., Jafari Sadatmand, S., Roodhart, J. M. L., van de Lest, C. H. A., Ulven, T., Ishihara, K., Milligan, G., Voest, E. E. Fatty acid 16:4(n-3) stimulates a GPR120-induced signaling cascade in splenic macrophages to promote chemotherapy resistance. PMID:28183801

Geraniol attenuates fibrosis and exerts anti-inflammatory effects on diet induced atherogenesis by NF-κB signaling pathway.

PubMed

Jayachandran, Muthukumaran; Chandrasekaran, Balaji; Namasivayam, Nalini

2015-09-05

Atherosclerosis is now generally accepted as a chronic inflammatory condition. The transcription factor nuclear factor kappa B (NF-κB) is a key regulator of inflammation, immune responses, cell survival and cell proliferation. Tissue remodeling plays a significant role during the phase of inflammation and oxidative stress. In our study we have evaluated the effect of geraniol (GOH), a natural terpenoid on oxidative stress, inflammation and tissue remodeling in experimental animals. Experimental animals (hamsters) were divided into four groups; group 1 were control animals; group 2 were animals fed GOH alone (100mg/kg b.w. p.o); group 3 were animals fed atherogenic diet (standard pellet diet+10% coconut oil+0.25% cholesterol); group 4 animals were fed atherogenic diet as in group 3+GOH (100mg/kg b.w). At the end of the experimental period animals were killed and liver, heart and aorta tissues were analyzed for lipid peroxidation markers, non enzymic antioxidants and collagen distribution using histological studies like Milligan's trichrome and Picrosirius red staining. As inflammation plays a key role in tissue remodeling we also targeted the key inflammatory cytokine, NF-κB. GOH supplementation greatly prevented the remodeling of tissues by enhancing the free radical scavenging and anti-inflammatory effects. Thus in conclusion it can be suggested that GOH (100mg/kg b.w) prevents the atherogenic diet induced fibrosis in experimental hamsters. Copyright © 2015 Elsevier B.V. All rights reserved.

Safety and short-term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial.

PubMed

Giuratrabocchetta, S; Pecorella, G; Stazi, A; Tegon, G; De Fazio, M; Altomare, D F

2013-03-01

Stapled haemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan-Morgan hemorrhoidectomy. The aim was to investigate a new stapler device designed to overcome these side effects. In all, 135 patients (71 men, mean age 42 years) with degree III haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH® staplers (Ethicon EndoSurgery) (63 patients) or with an EEA® stapler (Covidien) (72 patients) in four referral colorectal centres. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in square centimetres) and any postoperative bleeding within 30 days were recorded. The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35.75 ± 17.51 vs 28.05 ± 10.23 cm(2), P = 0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median value 1, vs 3, interquartile range 0-2, vs 2-5, P < 0.0001). Intraoperative haemostasis was better in the EEA group compared with the PPH01 and PPH03 groups. Postoperative bleeding occurred only in two PPH patients. Data suggest that the EEA stapler has better haemostatic properties than the PPH stapler and allows resection of a larger area of mucosal prolapse with potential benefits over the recurrence rate of haemorrhoid prolapse. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

The mediating role of anger in the relationship between PTSD symptoms and impulsivity.

PubMed

Contractor, Ateka A; Armour, Cherie; Wang, Xin; Forbes, David; Elhai, Jon D

2015-03-01

Research indicates a significant relationship between posttraumatic stress disorder (PTSD) and anger (Olatunji, Ciesielski, & Tolin, 2010; Orth & Wieland, 2006). Individuals may seek urgent coping to deal with the distress of anger, which is a mobilizing and action-oriented emotion (Novaco & Chemtob, 2002); possibly in the form of impulsive actions consistent with impulsivity's association with anger (Milligan & Waller, 2001; Whiteside & Lynam, 2001). This could be 1 of the explanations for the relationship between PTSD and impulsivity (Kotler, Julian, Efront, & Amir, 2001; Ledgerwood & Petry, 2006). The present study assessed the mediating role of anger between PTSD (overall scores and subscales of arousal and negative alterations in mood/cognitions) and impulsivity, using gender as a covariate of impulsivity. The PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Dimensions of Anger Reaction scale-5, and the UPPS Impulsivity Scale were administered to a sample of 244 undergraduate students with a trauma history. Results based on 1000 bootstrapped samples indicated significant direct effects of PTSD (overall and 2 subscales) on anger, of anger on impulsivity, and of PTSD (overall and 2 subscales) on impulsivity. Further, anger significantly mediated the relationship between PTSD (overall and 2 subscales) and impulsivity, consistent with the hypothesized models. Results suggest that impulsivity aims at coping with distressing anger, possibly explaining the presence of substance usage, and other impulsive behaviors in people with PTSD. Further, anger probably serves as a mobilizing and action-oriented emotion coupled with PTSD symptoms. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Does stapled anopexy for bleeding haemorrhoids cure associated anaemia?

PubMed

Hidalgo-Grau, L A; Llorca-Cardeñosa, S; Heredia-Budó, A; Estrada-Ferrer, Ò; Del Bas-Rubia, M; García-Torralbo, E M; Suñol-Sala, X

2014-10-01

The aim of this study was to evaluate the effectiveness of stapled anopexy (SA) in patients with chronic bleeding haemorrhoids and secondary anaemia. Our department performed 340 SA procedure per patient for haemorrhoids between January 1999 and December 2011. Fifty (14.7%) of these patients (25 male patients and 25 female patients) had anaemia (haemoglobin concentration < 13 g/dl in male patients and < 12 g/dl in female patients) secondary to chronic haemorrhoidal bleeding. Patients with colorectal bleeding and anaemia not caused by haemorrhoids were excluded. The mean (SD) age was 56.4 (13.9) years and the mean (SD) haemoglobin concentration was 9.2 (1.6) g/dl for male patients and 10.4 (1.2) g/dl for female patients. Five (10%) patients with anaemia had Grade II, 22 (44%) had Grade III and 23 (46%) had Grade IV haemorrhoids. The median (range) duration of postoperative follow-up was six (1-12) years. None of the patients required early postoperative admission or experienced early or late complications related to SA. The procedure was successful (normal haemoglobin concentration and no bleeding at 6 months postsurgery) in 45 (90%) patients. Of the five (10%) patients in whom SA was ineffective, one had Grade II, three had Grade III and one had Grade IV haemorrhoids. All these patients underwent Milligan-Morgan haemorrhoidectomy 3 months after SA. SA is an effective treatment for patients with bleeding haemorrhoids and subsequent anaemia. In our experience, the success rate was satisfactory and there were no serious complications. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Postoperative pain after haemorrhoidectomy: role of impaired evacuation.

PubMed

Puigdollers, A; Cisternas, D; Azpiroz, F

2011-08-01

We hypothesized that obstructive defaecation is associated with more postoperative pain after haemorrhoidectomy. Fifty patients with grade IV haemorrhoids were included in a prospective study. Impaired evacuation was defined as the inability to evacuate a rectal balloon. Perianal sensitivity was evaluated by means of an algometer, and anxiety and depression were assessed by the hospital anxiety and depression (HAD) scale. Over the first 10 days after a Milligan-Morgan haemorrhoidectomy, the following parameters were measured on daily questionnaires: pain (associated with and unrelated to defaecation by means of visual analogue scales), number of bowel movements, faecal consistency and analgesic requirement on demand (tramadol 50 mg p.o., number of doses). Results are expressed as median and interquartile range or mean ± SE. Patients with impaired evacuation (14 women, eight men; age range 28-61 years) experienced more postoperative pain than patients with nonimpaired evacuation (eight women, 20 men; age range 24-70 years): 3.2 (2.1) vs 2.1 (1.8) defaecatory pain, respectively (P = 0.045), and 2.4 (2.3) vs 1.7 (2.3) nondefecatory pain, respectively (P = 0.048). There was no difference between the groups regarding stool consistency, number of bowel movements [12.5 (7.3) vs 15.5 (7.2), respectively; NS] and analgesic requirement [1.0 (6.1) vs 1.0 (5.2) extra doses on demand, respectively; NS] during the 10 postoperative days. No differences related to age, sex, HAD scores or perianal sensitivity were found. Impaired anal evacuation is predictive of postoperative pain after haemorrhoidectomy. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Teleosts as Model Organisms To Understand Host-Microbe Interactions.

PubMed

Lescak, Emily A; Milligan-Myhre, Kathryn C

2017-08-01

Host-microbe interactions are influenced by complex host genetics and environment. Studies across animal taxa have aided our understanding of how intestinal microbiota influence vertebrate development, disease, and physiology. However, traditional mammalian studies can be limited by the use of isogenic strains, husbandry constraints that result in small sample sizes and limited statistical power, reliance on indirect characterization of gut microbial communities from fecal samples, and concerns of whether observations in artificial conditions are actually reflective of what occurs in the wild. Fish models are able to overcome many of these limitations. The extensive variation in the physiology, ecology, and natural history of fish enriches studies of the evolution and ecology of host-microbe interactions. They share physiological and immunological features common among vertebrates, including humans, and harbor complex gut microbiota, which allows identification of the mechanisms driving microbial community assembly. Their accelerated life cycles and large clutch sizes and the ease of sampling both internal and external microbial communities make them particularly well suited for robust statistical studies of microbial diversity. Gnotobiotic techniques, genetic manipulation of the microbiota and host, and transparent juveniles enable novel insights into mechanisms underlying development of the digestive tract and disease states. Many diseases involve a complex combination of genes which are difficult to manipulate in homogeneous model organisms. By taking advantage of the natural genetic variation found in wild fish populations, as well as of the availability of powerful genetic tools, future studies should be able to identify conserved genes and pathways that contribute to human genetic diseases characterized by dysbiosis. Copyright © 2017 Lescak and Milligan-Myhre.

[Effects of electroacupuncture preemptive intervention on postoperative pain of mixed hemorrhoids].

PubMed

Wu, Jing; Zhao, Yu; Yang, Chun-Mei; Xue, Qi-Ming; Li, Ning

2014-03-01

To evaluate clinical efficacy of electroacupuncture at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery on postoperative pain and discomforts in patients with mixed hemorrhoids. One hundred and twenty cases of mixed hemorrhoids who received Milligan-Morgan operation were randomly divided into an electroacupuncture group, a sham electroacupuncture group and a blank group, 40 cases in each one. At the same time of basic treatment, the electroacupuncture was applied at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery in the electroacupuncture group, while shallow needling without electrical stimulation at sham acupoint (1 cm next to acupoint) was applied 30 min before surgery in the sham electroacupuncture group, while no treatment was given before the surgery in the blank group. The total dose of painkillers in the first 24 h after operation, the number of cases who received additional anesthetic in the operation, the self-score of most severity pain in the first 24 h after operation and sleeping time in the night of surgery were observed. The differences of the numbers of cases who received additional anesthetic in the operation had no statistical significance among the three groups (all P > 0.05), but compared with the sham electroacupuncture group and blank group, the total dose of painkillers in the first 24 h after operation was reduced in the electroacupuncture group [(2.43 +/- 1.08) tablets vs (3.23 +/- 1.33) tablets, (3.10 +/- 1.22) tablets], and the score of most severity pain was also decreased (6.65 +/- 1.00 vs 7.48 +/- 0.96, 7.25 +/- 1.19), besides, the sleeping time in the night of surgery was increased [(220.63 +/- 85.50) min vs (162.00 +/- 92.69) min, (151.50 +/- 80.01) min, all P < 0.05]. The electroacupuncture at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery has effects of preemptive analgesia on postoperative pain for patients with mixed hemorrhoids.

Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids.

PubMed

Infantino, A; Altomare, D F; Bottini, C; Bonanno, M; Mancini, S; Yalti, T; Giamundo, P; Hoch, J; El Gaddal, A; Pagano, C

2012-02-01

Doppler-guided transanal haemorrhoid dearterialization (THD) and stapler haemorrhoidopexy (SH) have been demonstrated to be less painful than the Milligan-Morgan procedure. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of third-degree haemorrhoids in an equivalent trial. One hundred and sixty-nine patients with third-degree haemorrhoids were randomized online to receive THD (n = 85) or SH (n = 84) in 10 Colorectal Units in which the staff were well trained in both techniques. The mean follow-up period was 17 (range 15-20) months. Early minor postoperative complications occurred in 30.6% of patients in the THD group and in 32.1% of patients in the SH group. Milder spontaneous pain and pain on defecation were reported in the THD group in the first postoperative week, but this was not statistically significant. Late complications were significantly higher (P = 0.028) in the SH group. Residual haemorrhoids persisted in 12 patients in the THD group and in six patients in the SH group (P = 0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P = 0.34). No differences were found in postoperative incontinence. The obstructed defecation score (ODS) was significantly higher in the SH group (P < 0.02). Improvement in quality of life was similar in both groups. Postoperative in-hospital stay was 1.14 days in the THD group and 1.31 days in the SH group (P = 0.03). Both THD and SH techniques are effective for the treatment of third-degree haemorrhoids in the medium term. THD has a better cost-effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Long-term clinical results of double-pursestring stapled hemorrhoidopexy in a selected group of patients for the treatment of chronic hemorrhoids.

PubMed

Arroyo, Antonio; Pérez-Legaz, Juan; Miranda, Elena; Moya, Pedro; Ruiz-Tovar, Jaime; Lacueva, Francisco-Javier; Candela, Fernando; Calpena, Rafael

2011-05-01

The aim of this prospective controlled trial was to evaluate the long-term clinical and manometric results of stapled hemorrhoidopexy performed by expert surgeons in a selected group of patients for the treatment of chronic hemorrhoids. This study took place in the outpatient clinic and at the Day Surgery Unit attached to the University Hospital of Elche. From March 2003 to May 2005, 200 consecutive patients with third-degree hemorrhoids and treated with double-pursestring stapled hemorrhoidopexy with a PPH33-03 stapler were included in the study. Demographic, manometric, and clinical features were analyzed, as well as the variables related to surgery, postoperative course, and follow-up. Manometry was repeated at the 6-month, 1-year, and 5-year follow-up. Median follow-up was 110 months. Four patients (2%) reported daily rectal bleeding. One patient with active rectal bleeding was taken for reoperation within the first 12 postoperative hours. Seventy percent of patients reported pain ≤ 2 on the first postoperative day, 85% on the fourth postoperative day, and 95% on the seventh postoperative day. Pain was measured with a linear analog scale from 0 to 10 (0 = no pain; 10 = unbearable pain). Seventeen patients (8.5%) reported tenesmus during the first week. Eight patients (4%) reported persistent pain: in 5 patients, the pain resolved within the next 6 months; 2 patients presented with anal fissure; and 1 patient required the removal of the staples. Two patients (1%) reported residual soiling at the 5-year revision. Fourteen patients (7%) experienced recurrence with symptomatic prolapse. Six (3%) underwent further surgery: stapled hemorrhoidopexy was indicated again in 2 patients, and 4 patients underwent a Milligan-Morgan open hemorrhoidectomy, because they did not have a uniform prolapse. Six patients required treatment with rubber band ligation. There were no statistically significant differences between preoperative and postoperative manometric values. The new

Shallow 3-D vertical seismic profiling around a contaminant withdrawal well on the Lawrence Livermore National Laboratory Site

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

Rector, J.; Bainer, R.; Milligan, P.

1997-01-30

One of the major problems associated with ground water contaminant remediation is well placement. Optimal-placement of wells requires an accurate knowledge of geologic structure and stratigraphy in the near surface sediments and rock (0 to 100 m). Without the development of remote imaging provided by geophysical techniques, the required spacing between treatment wells may be less than 2 m in order to be confident that all contaminant reservoirs had been remediated. One method for characterizing geologic structure and stratigraphy in the near surface is vertical seismic profiling (VSP), a technique often used on deep exploration wells to calibrate surface seismicmore » reflection data. For near-surface applications, VSP data can be acquired efficiently using an array of hydrophones lowered into a fluid-filled borehole (Milligan et al, 1997). In this paper we discuss the acquisition and processing of a 3-D VSP collected at a shallow remediation site located on the grounds of the Lawrence Livermore National Laboratory (LLNL) near Livermore, California. The site was used by the United States Navy as an air training base. At this time, initial releases of hazardous materials to the environment occurred in the form of solvents [volatile organic compounds (VOCs)] that were used for the cleaning of airplanes and their parts. Gasoline, diesel and other petroleum-based compounds are also known to have leaked into the ground. California Research and Development Company, a subsidy of Standard Oil, occupied the southeastern portion of the site from 1950 to 1954. The first releases of radioactive materials to the environment occurred at this time, with the beginning of testing of radioactive materials at the site. In 1952, LLNL acquired the site. Additional releases of VOCS, polychlorinated biphenyls (PCBs), metals, radionuclides (primarily tritium), gasoline and pesticides have occurred since. These releases were due to localized spills, landfills, surface impoundments

The role of radiofrequency surgery in the treatment of hemorrhoidal disease.

PubMed

Filingeri, V; Bellini, M I; Gravante, G

2012-04-01

In this article we reported results obtained in our previous studies concerning application of radiofrequency (RF) in proctology and in particular for hemorrhoids treatment. We compared radiofrequency submucosal hemorrhoidectomy (RSH) and conventional Parks' hemorrhoidectomy (CPH) (group 1), radiofrequency open hemorrhoidectomy (ROH) and Milligan-Morgan hemorrhoidectomy (MMH) (group 2), radiofrequency closed hemorrhoidectomy (RCH) and Ferguson hemorrhoidectomy (FH) (group 3), combined hemorrhoidal radiocoagulation (CHR) and rubber band ligation (RBL) (group 4). In this work primary endpoints were determined as evaluation of the grade of pain felt immediately after the procedure and at the first evacuation, bleeding, operation time, readmission to work, incidence of failures and patient's satisfaction. Group 1 - In comparison to Parks' technique, use of radiofrequency scalpel reduced mean operation time (61.2 min, range 50-75, vs. 37.4 min, range 30-51; p < 0.05), first postoperative day pain score (5.9, range 3-10, vs. 4.0, range 1-10; p < 0.05), pain score at first evacuation (5.7, range 2-10, vs 4.2, range 1-8; p < 0.05) and pain score on postoperative days (3.6, range 1-9, vs. 2.8, range 1-8; p < 0.05). Group 2 - Results show a substantial similarity between these techniques, however the procedure lasted 7 minutes less with RF scalpel (18.6 min, range 16-21, vs. 25.55 min, range 20-30; p < 0.05). Group 3 - Patients treated with RF showed significant reduction in surgical time (23 min, range 21-31, vs. 33 min, range 24-35; p < 0.01), in pain at 1st post-operative day (VAS score 3.4 +/- 1.3 vs. 4.8 +/- 1.0; p < 0.05) and at the first evacuation (3.4 +/- 1.0 vs. 5.0 +/- 0.8; p < 0.05). Group 4 - The study confirmed validity of both the used techniques, however CHR seems to allow a reduction in incidence of failures. Results obtained from radiofrequency surgery compared with those achieved with classic surgery for hemorrhoidal disease show in the majority of cases

Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy

PubMed Central

Wang, Zhi-Gang; Zhang, Yong; Zeng, Xian-Dong; Zhang, Tie-Hui; Zhu, Qi-Dong; Liu, De-Long; Qiao, Yun-Yu; Mu, Nan; Yin, Zhi-Tao

2015-01-01

AIM: To compare the effects and postoperative complications between tissue selecting therapy stapler (TST) and Milligan-Morgan hemorrhoidectomy (M-M). METHODS: Four hundred and eighty patients with severe prolapsing hemorrhoids, who were admitted to the Shenyang Coloproctology Hospital between 2009 and 2012, were randomly divided into observation (n = 240) and control (n = 240) groups. Hemorrhoidectomies were performed with TST in the observation group and with the M-M technique in the control group. The therapeutic effects, operation security, and postoperative complications in the two groups were compared. The immediate and long-term complications were assessed according to corresponding criteria. Pain was assessed on a visual analogue scale. The efficacy was assessed by specialized criteria. The follow-up was conducted one year after the operation. RESULTS: The total effective rates of the observation and control groups were 99.5% (217/218) and 98.6% (218/221) respectively; the difference was not statistically significant (P = 0.322). Their were significant differences between observation and control groups in intraoperative blood loss (5.07 ± 1.14 vs 2.45 ± 0.57, P = 0.000), pain (12 h after the surgery: 5.08 ± 1.62 vs 7.19 ± 2.01, P = 0.000; at first dressing change: 2.64 ± 0.87 vs 4.34 ± 1.15, P = 0.000; first defecation: 3.91 ± 1.47 vs 5.63 ± 1.98, P = 0.001), urine retention (n = 22 vs n = 47, P = 0.001), anal pendant expansion after the surgery (2.35 ± 0.56 vs 5.16 ± 1.42, P = 0.000), operation time (18.3 ± 5.6 min vs 29.5 ± 8.2 min, P = 0.000), and the length of hospital stay (5.3 ± 0.6 d vs 11.4 ± 1.8 d, P = 0.000). Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence (n = 3 vs n = 16, P = 0.003), difficult bowel movement (n = 1 vs n = 9, P = 0.011), intractable pain (n = 2 vs n = 12, P = 0.007), and anal discharge (n = 3 vs n = 23, P = 0.000). CONCLUSION: TST for

Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy.

PubMed

Wang, Zhi-Gang; Zhang, Yong; Zeng, Xian-Dong; Zhang, Tie-Hui; Zhu, Qi-Dong; Liu, De-Long; Qiao, Yun-Yu; Mu, Nan; Yin, Zhi-Tao

2015-02-28

To compare the effects and postoperative complications between tissue selecting therapy stapler (TST) and Milligan-Morgan hemorrhoidectomy (M-M). Four hundred and eighty patients with severe prolapsing hemorrhoids, who were admitted to the Shenyang Coloproctology Hospital between 2009 and 2012, were randomly divided into observation (n=240) and control (n=240) groups. Hemorrhoidectomies were performed with TST in the observation group and with the M-M technique in the control group. The therapeutic effects, operation security, and postoperative complications in the two groups were compared. The immediate and long-term complications were assessed according to corresponding criteria. Pain was assessed on a visual analogue scale. The efficacy was assessed by specialized criteria. The follow-up was conducted one year after the operation. The total effective rates of the observation and control groups were 99.5% (217/218) and 98.6% (218/221) respectively; the difference was not statistically significant (P=0.322). Their were significant differences between observation and control groups in intraoperative blood loss (5.07±1.14 vs 2.45±0.57, P=0.000), pain (12 h after the surgery: 5.08±1.62 vs 7.19±2.01, P=0.000; at first dressing change: 2.64±0.87 vs 4.34±1.15, P=0.000; first defecation: 3.91±1.47 vs 5.63±1.98, P=0.001), urine retention (n=22 vs n=47, P=0.001), anal pendant expansion after the surgery (2.35±0.56 vs 5.16±1.42, P=0.000), operation time (18.3±5.6 min vs 29.5±8.2 min, P=0.000), and the length of hospital stay (5.3±0.6 d vs 11.4±1.8 d, P=0.000). Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence (n=3 vs n=16, P=0.003), difficult bowel movement (n=1 vs n=9, P=0.011), intractable pain (n=2 vs n=12, P=0.007), and anal discharge (n=3 vs n=23, P=0.000). TST for severe prolapsing hemorrhoids is a satisfactory technique for more rapid recovery, lower complication rates, and

High-Resolution Infrared Spectrscopy of the Hydroxymethyl Radical in Solid Parahydrogen

NASA Astrophysics Data System (ADS)

Balabanoff, Morgan E.; Anderson, David T.

2016-06-01

based on the rotational constants. M.E. Jacox, D.E. Milligan, J. Mol. Spec. 47, 148-162 (1973) L. Feng, J. Wei, H. Reisler, J. Phys. Chem. A 108, 7903-7908 (2004). M.A. Roberts, E.N. Sharp-Williams, D.J. Nesbitt, J. Phys. Chem. A 117, 7042-7049 (2013).

[Necessary and unnecessary treatment options for hemorrhoids].

PubMed

Zindel, Joel; Inglin, Roman; Brügger, Lukas

2014-12-01

Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the

Precious metals associated with Late Cretaceous-early Tertiary igneous rocks of southwestern Alaska

USGS Publications Warehouse

Bundtzen, Thomas K.; Miller, Marti L.; Goldfarb, Richard J.; Miller, Lance D.

1997-01-01

many of the mineral deposits associated with Late Cretaceous-early tertiary volcanic and plutonic rocks represent geologically and spatially related, vertically zoned hydrothermal systems now exposed at several erosional levels.Polymetallic gold deposits of the Kuskokwim mineral belt are probably related to 77 to 52 Ma plutonism and volcanism associated with a period of rapid, north-directed subduction of the Kula plate. The geologic interpretation suggests that igneous complexes of the Kuskokwim mineral belt formed in an intracontinental back-arc setting during a period of extensional, wrench fault tectonics.The Kuskokwim mineral belt has many geologic and metallogenic features similar to other precious metal-bearing systems associated with arc-related igneous rocks such as the Late Cretaceous-early Tertiary Rocky Mountain alkalic province, the Jurassic Mount Milligan district of central British Columbia, the Andean orogen of South America, and the Okhotsk-Chukotka belt of northeast Asia.

Porphyry deposits of the Canadian Cordillera

USGS Publications Warehouse

McMillan, W.J.; Thompson, J.F.H.; Hart, C.J.R.; Johnston, S.T.

1996-01-01

Porphyry deposits are intrusion-related, large tonnage low grade mineral deposits with metal assemblages that may include all or some of copper, molybdenum, gold and silver. The genesis of these deposits is related to the emplacement of intermediate to felsic, hypabyssal, generally porphyritic intrusions that are commonly formed at convergent plate margins. Porphyry deposits of the Canadian Cordillera occur in association with two distinctive intrusive suites: calc-alkalic and alkalic. In the Canadian Cordillera, these deposits formed during two separate time periods: Late Triassic to Middle Jurassic (early Mesozoic), and Late Cretaceous to Eocene (Mesozoic-Cenozoic). Deposits of the early Mesozoic period occur in at least three different arc terranes (Wrangellia, Stikinia and Quesnellia) with a single deposit occurring in the oceanic assemblage of the Cache Creek terrane. These terranes were located outboard from continental North America during formation of most of their contained early Mesozoic porphyry deposits. Some of the deposits of this early period may have been emplaced during terrane collisions. Metal assemblages in deposits of the calc-alkalic suite include Mo-Cu (Brenda), Cu-Mo (Highland Valley, Gibraltar), Cu-Mo-Au-Ag (Island Copper, Schaft Creek) and Cu-Au (Kemess, Kerr).The alkalic suite deposits are characterized by a Cu-Au assemblage (Copper Mountain, Afton-Ajax, Mt. Milligan, Mount Polley, Galore Creek). Although silver is recovered from calc-alkalic and alkalic porphyry copper mining operations, silver data are seldom included in the published reserve figures. Those available are in the range of 1-2 grams per tonne (g??t-1). Alkalic suite deposits are restricted to the early Mesozoic and display distinctive petrology, alteration and mineralization that suggest a similar tectonic setting for both Quesnellia and Stikinia in Early Jurassic time. The younger deposits, late Mesozoic to Cenozoic in age, formed in an intracontinental setting, after the

Effects of Temporal Wind Patterns on the Value of Wind-GeneratedElectricity at Different Sites in California and the Northwest

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

Fripp, Matthias; Wiser, Ryan

2006-08-04

Wind power production varies on a diurnal and seasonal basis. In this paper, we use wind speed data from three different sources to assess the effects of wind timing on the value of electric power from potential wind farm locations in California and the Northwestern United States. By ''value'', we refer to either the contribution of wind power to meeting the electric system's peak loads, or the financial value of wind power in electricity markets. Sites for wind power projects are often screened or compared based on the annual average power production that would be expected from wind turbines atmore » each site (Baban and Parry 2001; Brower et al. 2004; Jangamshetti and Rau 2001; Nielsen et al. 2002; Roy 2002; Schwartz 1999). However, at many locations, variations in wind speeds during the day and year are correlated with variations in the electric power system's load and wholesale market prices (Burton et al. 2001; Carlin 1983; Kennedy and Rogers 2003; Man Bae and Devine 1978; Sezgen et al. 1998); this correlation may raise or lower the value of wind power generated at each location. A number of previous reports address this issue somewhat indirectly by studying the contribution of individual wind power sites to the reliability or economic operation of the electric grid, using hourly wind speed data (Fleten et al.; Kahn 1991; Kirby et al. 2003; Milligan 2002; van Wijk et al. 1992). However, we have not identified any previous study that examines the effect of variations in wind timing across a broad geographical area on wholesale market value or capacity contribution of those different wind power sites. We have done so, to determine whether it is important to consider wind-timing when planning wind power development, and to try to identify locations where timing would have a more positive or negative effect. The research reported in this paper seeks to answer three specific questions: (1) How large of an effect can the temporal variation of wind power have on

Observations of the Variability of Floc Sizes on the Louisiana Shelf

NASA Astrophysics Data System (ADS)

Sahin, Cihan; Sheremet, Alexandru

2014-05-01

profiles were obtained at each range bin and propagated along the backscattered profile using the implicit iterative approach, which is based on calculation of SSC and mean size iteratively until the values in the last two iterations converge (Sahin, under review). Estimated SSC profiles are in agreement with OBS point measurements with a correlation coefficient of 0.88 and 0.12 kg/m3 RMS error. The range of floc size estimates is consistent with the floc-size measurements in 2006 at the same site. Turbulent shear profiles were estimated using the current velocity profiles measured by the PC-ADP. As a first step, the friction velocities are estimated following Lacy et. al. (2005) by fitting the logarithmic profiles in a least-square sense to the current velocity profiles outside the wave boundary layer (Safak et al., 2013), which can then be used to approximate the dissipation of turbulent kinetic energy and the turbulent shear for each bin. The detailed investigation of the resulting SSC, floc-size and the turbulent shear rate profiles showed that low-to-mid values of shear rate promotes flocculation by increasing cohesive sediment particle collision. However, higher turbulent shear strongly affects large flocs, which have weaker internal bonds than those of the primary particles. These field observations support the findings observed in several previous experimental and numerical studies (Parker et al., 1972; Dyer, 1989). Acknowledgements This research was supported by the Office of Naval Research funding of contracts N00014-10-1-0363 and N00014-11-1-0269. References Berhane, I., Sternberg R.W., Kineke G.C., Milligan T.G., Kranck, K., 1997. The variability of suspended aggregates on the Amazon Continental Shelf. Continental Shelf Research 17, 267-285. Dyer, K. R., 1989. Sediment processes in estuaries: future research requirements. Journal of Geophysical Research 97, 14327-14339. Dyer, K. R., Manning A.J., 1999. Observation of size, settling velocity and effective