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Sample records for notes hybrid transvaginal

  1. Transvaginal Hybrid NOTES Procedure for Treatment of Gallstone Ileus

    PubMed Central

    Tomizawa, Naoki; Andoh, Tatsumasa; Arakawa, Kazuhisa; Enokida, Yasuaki; Ozawa, Naoya

    2016-01-01

    Gallstone ileus is a rare mechanical bowel obstruction, and previously reported cases have been treated laparoscopically with good results. Although transvaginal hybrid NOTES without a minilaparotomy has been reported to decrease the incidence of surgical wound complications, to our knowledge, this procedure has not been used previously to treat gallstone ileus. We present a case of a 63-year-old woman who underwent transvaginal hybrid NOTES procedure for treatment of gallstone ileus. This case was admitted to our hospital following acute-onset abdominal pain and vomiting. We diagnosed gallstone ileus with cholecystoduodenal fistula by computed tomography and performed totally laparoscopic surgery using only three 5 mm abdominal ports with transvaginal specimen extraction and enterectomy. The patient's postoperative course was uneventful, and laparoscopic cholecystectomy and fistula repair were performed 8 months after the initial surgery. The patient experienced additional pain relief and good cosmetic outcomes. In conclusion, using transvaginal hybrid NOTES may become a future option to minimize the invasiveness of other laparoscopic procedures. PMID:27429831

  2. Transvaginal hybrid-NOTES appendectomy in routine clinical use: prospective analysis of 13 cases and description of the procedure.

    PubMed

    Knuth, Jurgen; Heiss, Markus Maria; Bulian, Dirk Rolf

    2014-09-01

    Access-related abdominal wall injury is part of the operative trauma in laparoscopic appendectomy and accounts for complications. Minimizing this trauma by entering the abdominal cavity by means of natural orifice transluminal surgery (NOTES) may be achieved by a hybrid-appendectomy procedure using the transvaginal route plus a single transumbilical trocar. Thirteen patients were prospectively analyzed following transvaginal-hybrid NOTES appendectomy. For the procedure, rigid instruments are used with the patient in lithotomy position. The procedure is performed with two transvaginal and one transumbilical access-points. The specimen is retrieved transvaginally. All procedures were performed without additional trocars. No conversions to standard laparoscopy or open surgery were necessary. All procedures were performed in acceptable time (mean 52 min). No intraoperative complications and two (15%) postoperative complications, an infected hematoma and an abscess, occurred. They were smoothly treated with standard techniques including one laparoscopic reoperation (8%). Drain placement or resection of a Meckel's diverticulum was easily managed without conversion. Gynecological short-term follow-up revealed one complication, which was vaginal fungal infection. It occurred after a 7-day course of antibiotics. This method is found to be feasible intraoperatively and early postoperatively in terms of possibility to manage a variety of intraoperative findings that may occur during planned appendectomy, low intraoperative complications, and management of postoperative complications using established concepts. We, therefore, consider the procedure safe and continue to offer hybrid-NOTES appendectomy to suitable patients.

  3. Hybrid Transvaginal NOTES and Mini-Laparoscopic Colectomy: Benefit Through Synergy

    PubMed Central

    Gan, Philip S. L.

    2016-01-01

    Background and Objectives: Hybrid-natural orifice surgery combines the advantages of traditional transabdominal laparoscopic surgery, while limiting surgical trauma to the abdominal wall. Among various routes of intra-abdominal access, the transvaginal method is most appealing because of its utility and proven safety. We describe a series of 4 colonic resections performed with this approach, combined with minilaparoscopy and needlescopic approaches, and discuss the technical aspects, efficacy, and applicability of this technique. Methods: Three patients were selected to undergo hybrid transvaginal natural-orifice right hemicolectomy. A fourth patient, who underwent a segmental resection of a splenic flexure carcinoma, was included. Transvaginal port access was obtained via posterior colpotomy, and was used for dissection, vascular ligation, bowel division, and anastomosis. We used a combination of standard laparoscopic, minilaparoscopic, and needlescopic instruments transabdominally, focusing on reduced size and number of access points. Results: Duration of laparoscopy, oncologic outcomes and rate of operative morbidity were comparable to the published literature. Early return of gastrointestinal function and low analgesic requirements was observed in all patients. No morbidity related to transvaginal access was observed and the procedure was performed without difficulty in all cases. Conclusion: Colonic resection performed by hybrid natural-orifice technique offers several advantages over purely transabdominal laparoscopic procedures. Transvaginal access is easy to perform and offers excellent safety, efficacy, and versatility, especially for right hemicolectomy. Techniques to reduce abdominal wall surgical trauma, such as minilaparoscopy and needlescopic graspers, can be combined effectively in colonic resections, and may act synergistically to reduce postoperative pain and improve outcomes. PMID:27904307

  4. Systematic analysis of the safety and benefits of transvaginal hybrid-NOTES cholecystectomy

    PubMed Central

    Bulian, Dirk R; Knuth, Jurgen; Lehmann, Kai S; Sauerwald, Axel; Heiss, Markus M

    2015-01-01

    AIM: To evaluate transvaginal hybrid-NOTES cholecystectomy (TVC) during its clinical establishment and compare it with the traditional laparoscopic technique (LC). METHODS: The specific problems and benefits of TVC were reviewed using a registry analysis, a comparative cohort study and a randomized clinical trial. At first, feasibility, safety and specific complications of the TVC were analyzed based on the first 488 data sets of the German NOTES Registry (GNR). Hereafter, we compared the early postoperative results of our first 50 TVC-patients with those of 50 female LC-patients matched by age, BMI and ASA classification. The same cohort was contacted an average of two years later to evaluate long-term results concerning pain and satisfaction with the aesthetic results and the overall postoperative results as well as sexual intercourse by means of two domains of the German version of the Female Sexual Function Index (FSFI-d). Consequently, we performed a randomized clinical trial comparing 20 TVC-patients with 20 needlescopic/3-trocar cholecystectomies (NC) also concerning the early postoperative results as well as pain, satisfaction and quality of life by means of the Eypasch Gastrointestinal Quality of Life Index (GIQLI) in the later course. Finally, we discussed the results in accordance with other published studies. RESULTS: The complication (3.5%) and conversion rates (4.1%) for TVC were low in the GNR and comparable to those of the LC. Access related intraoperative complications included injuries to the bladder (n = 4; 0.8%) and bowel (n = 3; 0.6%). The study cohort revealed less postoperative pain after TVC comparing to the LC-patients on the day of surgery (NRS, 1.5/10 vs 3.1/10, P = 0.003), in the morning (NRS, 1.9/10 vs 2.8/10, P = 0.047) and in the evening (NRS, 1.1/10 vs 1.8/10, P = 0.025) of postoperative day (POD) one. The randomized clinical trial consistently found less cumulative pain until POD 2 (NRS, 8/40 vs 14/40, P = 0.043), as well as until

  5. Hybrid NOTES transvaginal intraperitoneal onlay mesh in abdominal wall hernias: an alternative to traditional laparoscopic procedures.

    PubMed

    Descloux, Alexandre; Pohle, Sebastian; Nocito, Antonio; Keerl, Andreas

    2015-12-01

    Abdominal wall hernias are increasingly treated by laparoscopic placement of an intraperitoneal onlay mesh (IPOM). We present an alternative technique for women: the laparoscopic-assisted transvaginal IPOM. Before surgery, all patients underwent a gynecological examination. The patients agreed to IPOM repair via a transvaginal approach, and written informed consent for surgery was obtained. Pneumoperitoneum was established with a Veress needle at the umbilicus. This access was subsequently dilated to 5 mm (VersaStep), and a 5-mm laparoscope was inserted. Under laparoscopic view, the transvaginal trocars (12-mm VersaStep and 5-mm flexible accesses) were safely inserted after lifting the uterus with a uterus manipulator. After preparation of the falciform ligament, the ligamentum teres and the preperitoneal fat, a lightweight composite mesh was introduced through the transvaginal access and fixed with absorbable tacks using the double-crown technique. From September 2011 to December 2012, we performed six laparoscopic-assisted transvaginal IPOM procedures (one epigastric, three umbilical, two combined epigastric and umbilical hernias; all were primary hernias). In the initial phase, only patients with small or medium primary abdominal wall hernia were selected (max. 3 cm diameter). Median hospital stay was 3 days (range 2-6 days). One minor complication occurred perioperatively (second-degree skin burn to the labia majora). At 1-year follow-up, we identified one recurrence in a high-risk patient with a body mass index higher than 35 kg/m(2). No infection and no mortality were observed. Although no final conclusion can be made regarding the presumed non-inferiority of this technique in terms of recurrence and mesh infection compared with traditional laparoscopic IPOM, laparoscopic-assisted transvaginal IPOM is a feasible alternative to treat abdominal wall hernias.

  6. Surgical outcome and midterm follow-up after transvaginal NOTES hybrid cholecystectomy: analysis of a prospective clinical series.

    PubMed

    Hensel, Mario; Schernikau, Utz; Schmidt, Axel; Arlt, Georg

    2011-03-01

    In the last 3 years transvaginal hybrid cholecystectomy (TV-ChE) has gained widespread interest as a potential alternative to laparoscopic cholecystectomy. However, substantial doubts about the transvaginal access and possibly associated complaints and complications have been raised. This was a prospective clinical series of 80 consecutive female patients, nonrandomly chosen and without a control group, who underwent a TV-ChE. All patients were evaluated with special regard to outcome data such as surgical complications and gynecological complaints. Perioperative clinical data were collected and a gynecological examination was performed 3 weeks after surgery as well as a follow-up survey 3 months after surgery. The TV-ChE was performed in all patients without conversion to laparoscopy or open surgery. Two surgical complications occurred (1 urinary bladder injury and 1 case of bleeding). No infections of the surgical wound or any other complications were seen in the gynecological follow-up examination 3 weeks after the operation. After a follow-up of 3 months, 4% of the patients under 50 years of age reported slight and temporary problems after transvaginal cholecystectomy (dyspareunia and episodes of unclear lower abdominal pain), whereas such phenomena were seen in about 9% of women over 50 years of age (P < .05). A 33-year-old woman became pregnant 3 weeks after the operation. TV-ChE is a safe and less invasive surgical technique. Doubts about this operating technique with regard to an increased risk of infection or surgical complications as well as subsequent gynecological problems seem to be unfounded.

  7. Early experience in human hybrid transgastric and transvaginal endoscopic cholecystectomy.

    PubMed

    Salinas, Gustavo; Saavedra, Lil; Agurto, Hellen; Quispe, Rosa; Ramírez, Edwin; Grande, José; Tamayo, Juan; Sánchez, Victoria; Málaga, Daniel; Marks, Jeffrey M

    2010-05-01

    Abdominal procedures have been performed for a long time through the anterior abdominal wall. Since the first reports in the 1980s, laparoscopy has become the standard for cholecystectomy, with many advantages over open procedures. Now a natural-orifice approach to the peritoneal cavity may further reduce the invasiveness of surgery by either diminishing or avoiding abdominal incisions. Several orifice routes to the abdominal cavity have been described: transgastric, transvaginal, transvesical, and transcolonic. Although most experiences with the porcine model showed the possibility of these approaches, few surgeons reported experiences with humans. The authors present their complete early experience with transgastric (TG) and transvaginal (TV) cholecystectomies in human beings. Thirty-nine patients (4 males and 35 females) underwent hybrid NOTES procedures from January 2007 to January 2009. The mean age was 46 years (range = 19-83). The body mass index ranged from 20 to 41 and ASA was I-II. Transgastric (TG) cholecystectomy was performed in 27 patients and 12 patients had a transvaginal (TV) cholecystectomy. The mean operative time was 140 min. Although operative times were slightly shorter in the TG group 005B137 +/- 34.6 min (range = 75-195)] compared to the TV route [147 +/- 31.5 min (range = 95-220)], there were no significant differences between the two groups (p = 0.5, Mann-Whitney U test). Patients were started on liquids within 1 h and discharged 2 h later, except the last 11 TG patients, who went home 24 h later because of enrollment in a separate protocol. An overall 20% morbidity rate and no mortality were found. The complication rates for the TG and TV groups were 18% (5/27) and 25% (3/12), respectively, which was not statistically significant (p = 0.6, chi(2) test). Seventy-five percent of complications (6/8) occurred the first year and 25% (2/8) during the second year of our experience. Transgastric and transvaginal cholecystectomies are feasible

  8. Transvaginal ultrasound

    MedlinePlus

    ... Uterine bleeding - transvaginal ultrasound; Menstrual bleeding - transvaginal ultrasound; Infertility - transvaginal ultrasound; Ovarian - transvaginal ultrasound; Abscess - transvaginal ultrasound

  9. Transvaginal Repair of a Large Chronic Porcine Ventral Hernia with Synthetic Mesh Using NOTES

    PubMed Central

    Powell, Ben; Whang, Susan H.; Bachman, Sharon L.; Andres Astudillo, J.; Sporn, Emanuel; Miedema, Brent W.

    2010-01-01

    Background: Ventral incisional hernias still remain a common surgical problem. We tested the feasibility of transvaginal placement of a large synthetic mesh to repair a porcine hernia. Methods: Seven pigs were used in this survival model. Each animal had creation of a 5-cm hernia defect and underwent a transvaginal repair of the defect with synthetic mesh. A single colpotomy was made using a 12-cm trocar for an overtube. The mesh was cut to size and placed through the trocar. A single-channel gastroscope with an endoscopic atraumatic grasper was used for grasping sutures. Further fascial sutures were placed every 5cm. Results: Mesh repair was feasible in all 7 animals. Mean operative time was 133 minutes. Technical difficulties were encountered. No gross contamination was seen at the time of necropsy. However, 5 animals had positive mesh cultures; 7 had positive cultures in the rectouterine space in enrichment broth or on direct culture. Conclusion: Transvaginal placement of synthetic mesh to repair a large porcine hernia using NOTES is challenging but feasible. Future studies need to be conducted to develop better techniques and determine the significance of mesh contamination. PMID:20932375

  10. Transvaginal postpartum manual removal of a prolapsed submucous leiomyoma, initially diagnosed hybrid predominantly intramural.

    PubMed

    Elgonaid, Wael; Belkhir, Reem; Boama, Vincent

    2017-08-11

    We present a rare case of a large infarcted submucous fibroid removed manually after a normal vaginal delivery. This patient was known to have a large postero-fundal hybrid predominantly intramural uterine fibroid, measuring 11 x 10 cm in diameter and diagnosed 2 years prior to last conception. Thirty-five days postpartum, she presented with severe lower abdominal pain and foul smell per vaginum. Abdominal examination revealed a very tender bulky uterus at 24 weeks size, and vaginal examination revealed a big fleshy smelly mass with friable surface just bulging from a dilated cervix. Examination under anaesthesia revealed a very foul smelly large pedunculated submucous fibroid that was felt through a dilated cervix. It was deliverable vaginally, so the submucous leiomyoma was removed manually, a procedure similar to manual removal of placenta. Histopathology examination confirmed an infarcted massive fibroid. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model

    PubMed Central

    Katagiri, Toshio; Horgan, Santiago; Sandler, Bryan J.; Jacobsen, Garth R.; Coker, Alisa M.; Tsuchiya, Masaru; Maeda, Tetsuya; Kaneko, Hironori

    2017-01-01

    Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR). Materials and Methods: Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases. Using hybrid NOTES technique, we placed only 1 umbilical 12-mm umbilical trocar in the abdominal wall, which was used to create pneumoperitoneum. A laparoscope was then advanced to obtain intra-abdominal visualization. A 15-mm vaginal trocar was inserted under direct laparoscopic vision, and a flexible endoscope was introduced through the vaginal trocar. A long, flexible grasper and endocavity retractor were used to stably retract the liver. The liver edge was partially transected using energy devices inserted through the umbilical trocar. To transect the left lateral lobe, a flexible linear stapler was inserted alongside the vaginal trocar. A specimen extraction bag was deployed and extracted transvaginally. Blood loss, bile leakage, operative time, and specimen size were evaluated. Necropsy studies were performed after the procedures. Results: Eighteen transvaginal NOTES partial liver resections and 4 transvaginal NOTES left lateral lobectomies were successfully performed on 9 pigs. Mean operative time was 165.8 minutes, and mean estimated blood loss was 76.6 mL. All TV NOTES LRs were performed without complications or deaths. Necropsy showed no bile leakage from remnant liver. Conclusions: Our porcine model suggests that TV NOTES LR is technically feasible and safe and has the potential for clinical use as a minimally invasive alternative to conventional laparoscopic liver resection. PMID:28030435

  12. Ovariohysterectomy in a dog by a hybrid NOTES technique.

    PubMed

    Brun, Maurício V; Silva, Marco A M; Mariano, Mirandolino B; Motta, Adriana C; Colomé, Lucas M; Feranti, João P S; Pohl, Virgínia L; Ataide, Michelli W; Guedes, Rogério L; Santos, Fabiane R

    2011-06-01

    This report demonstrates the feasibility of an elective ovariosalpingohysterectomy by natural transluminal endoscopic surgery (NOTES) hybrid technique in a dog. A 5-mm abdominal cannula was used in combination with a 10-mm cannula (vaginal access). The patient's quick recovery and the absence of complications are indicative of the effectiveness of this surgery.

  13. Ovariohysterectomy in a dog by a hybrid NOTES technique

    PubMed Central

    Brun, Maurício V.; Silva, Marco A.M.; Mariano, Mirandolino B.; Motta, Adriana C.; Colomé, Lucas M.; Feranti, João P.S.; Pohl, Virgínia L.; Ataide, Michelli W.; Guedes, Rogério L.; Santos, Fabiane R.

    2011-01-01

    This report demonstrates the feasibility of an elective ovariosalpingohysterectomy by natural transluminal endoscopic surgery (NOTES) hybrid technique in a dog. A 5-mm abdominal cannula was used in combination with a 10-mm cannula (vaginal access). The patient’s quick recovery and the absence of complications are indicative of the effectiveness of this surgery. PMID:22131580

  14. Transvaginal ultrasound (image)

    MedlinePlus

    Transvaginal ultrasound is a method of imaging the genital tract in females. A hand held probe is inserted directly ... vaginal cavity to scan the pelvic structures, while ultrasound pictures are viewed on a monitor. The test ...

  15. IMELDA transvaginal approach to ectopic pregnancy: diagnosis by transvaginal hydrolaparoscopy and treatment by transvaginal natural orifice transluminal endoscopic surgery.

    PubMed

    Baekelandt, Jan; Vercammen, Jona

    2017-01-01

    To demonstrate a new minimally invasive approach for the diagnosis and treatment of ectopic pregnancy. Stepwise explanation of the technique using original video footage. Hospital. Since 2014, 15 patients were treated transvaginally for ectopic pregnancy and pregnancy of unknown location (PUL). In case of a diagnosis of ectopic pregnancy on ultrasound, a 2.5-cm colpotomy is made under general anesthesia, and the ectopic pregnancy is treated by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) salpingectomy or salpingostomy. In case of a PUL on ultrasound, transvaginal hydrolaparoscopy (TVHL), an established technique for fertility exploration under local or general anesthesia, is used to investigate. If a tubal pregnancy is confirmed on TVHL, the colpotomy is extended to a 2.5-cm incision, and the ectopic pregnancy is treated transvaginally by vNOTES. If the TVHL investigation of the pelvis is negative (fallopian tubes and ovaries are normal), the procedure is stopped and the patient is followed up further. If the TVHL is inconclusive, the NaCl is drained and CO2 is insufflated (requiring general anesthesia) through the 4-mm TVHL port to improve visualization. Again, an ectopic pregnancy is then treated by vNOTES, and in case of a negative investigation the procedure is stopped and the patient is followed up further. Successful diagnosis and treatment of ectopic pregnancies. All patients were successfully operated without complications or conversions to standard laparoscopy. Twelve patients were treated by vNOTES for ectopic pregnancy. Three TVHL explorations for PUL were negative, and these patients were followed up; two patients developed a normal intrauterine pregnancy, and the third patient was treated with methotrexate for persistent asymptomatic raised hCG levels. Transvaginal hydrolaparoscopy and vNOTES are complementary techniques enabling gynecologic surgeons to explore PUL and treat ectopic pregnancies via minimally invasive

  16. A hybrid system for emotion extraction from suicide notes.

    PubMed

    Nikfarjam, Azadeh; Emadzadeh, Ehsan; Gonzalez, Graciela

    2012-01-01

    The reasons that drive someone to commit suicide are complex and their study has attracted the attention of scientists in different domains. Analyzing this phenomenon could significantly improve the preventive efforts. In this paper we present a method for sentiment analysis of suicide notes submitted to the i2b2/VA/Cincinnati Shared Task 2011. In this task the sentences of 900 suicide notes were labeled with the possible emotions that they reflect. In order to label the sentence with emotions, we propose a hybrid approach which utilizes both rule based and machine learning techniques. To solve the multi class problem a rule-based engine and an SVM model is used for each category. A set of syntactic and semantic features are selected for each sentence to build the rules and train the classifier. The rules are generated manually based on a set of lexical and emotional clues. We propose a new approach to extract the sentence's clauses and constitutive grammatical elements and to use them in syntactic and semantic feature generation. The method utilizes a novel method to measure the polarity of the sentence based on the extracted grammatical elements, reaching precision of 41.79 with recall of 55.03 for an f-measure of 47.50. The overall mean f-measure of all submissions was 48.75% with a standard deviation of 7%.

  17. The hybrid progress note: semiautomating daily progress notes to achieve high-quality documentation and improve provider efficiency.

    PubMed

    Kargul, George J; Wright, Scott M; Knight, Amy M; McNichol, Mary T; Riggio, Jeffrey M

    2013-01-01

    Health care institutions are moving toward fully functional electronic medical records (EMRs) that promise improved documentation, safety, and quality of care. However, many hospitals do not yet use electronic documentation. Paper charting, including writing daily progress notes, is time-consuming and error prone. To improve the quality of documentation at their hospital, the authors introduced a highly formatted paper note template (hybrid note) that is prepopulated with data from the EMR. Inclusion of vital signs and active medications improved from 75.5% and 60% to 100% (P < .001), respectively. The use of unapproved abbreviations in the medication list decreased from 13.3% to 0% (P < .001). Prepopulating data enhances provider efficiency. Interviews of key clinician leaders also suggest that the initiative is well accepted and that documentation quality is enhanced. The hybrid progress note improves documentation and provider efficiency, promotes quality care, and initiates the development of the forthcoming electronic progress note.

  18. Developing Modularized Virtual Reality Simulators for Natural Orifice Translumenal Endoscopic Surgery (NOTES).

    PubMed

    Ahn, Woojin; Dorozhkin, Denis; Schwaitzberg, Steven; Jones, Daniel B; De, Suvranu

    2016-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) procedures are rapidly being developed in diverse surgical fields. We are developing a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™) built on a modularized platform that facilitates rapid development of virtual reality (VR) NOTES simulators. Both the hardware interface and software components consist of independent reusable and customizable modules. The developed modules are integrated to build a VR-NOTES simulator for training in the hybrid transvaginal NOTES cholecystectomy. The simulator was demonstrated and evaluated by expert NOTES surgeons at the 2015 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit.

  19. A Hybrid Approach to Sentiment Sentence Classification in Suicide Notes

    PubMed Central

    Sohn, Sunghwan; Torii, Manabu; Li, Dingcheng; Wagholikar, Kavishwar; Wu, Stephen; Liu, Hongfang

    2012-01-01

    This paper describes the sentiment classification system developed by the Mayo Clinic team for the 2011 I2B2/VA/Cincinnati Natural Language Processing (NLP) Challenge. The sentiment classification task is to assign any pertinent emotion to each sentence in suicide notes. We have implemented three systems that have been trained on suicide notes provided by the I2B2 challenge organizer—a machine learning system, a rule-based system, and a system consisting of a combination of both. Our machine learning system was trained on re-annotated data in which apparently inconsistent emotion assignment was adjusted. Then, the machine learning methods by RIPPER and multinomial Naïve Bayes classifiers, manual pattern matching rules, and the combination of the two systems were tested to determine the emotions within sentences. The combination of the machine learning and rule-based system performed best and produced a micro-average F-score of 0.5640. PMID:22879759

  20. Complications of transvaginal natural orifice transluminal endoscopic surgery: a series of 102 patients.

    PubMed

    Wood, Stephanie G; Panait, Lucian; Duffy, Andrew J; Bell, Robert L; Roberts, Kurt E

    2014-04-01

    To review the complications encountered in our facility and in previously published studies of transvaginal (TV) natural orifice transluminal endoscopic surgery (NOTES) to date. TV NOTES is currently observed with critical eyes from the surgical community, despite encouraging data to suggest improved short-term recovery and pain. All TV NOTES procedures performed in female patients between 18 and 65 years of age were included. The median follow-up was 90 days. The TV appendectomies and ventral hernia repairs were pure NOTES, through a SILS port in the vagina, whereas TV cholecystectomies were hybrid procedures with the addition of a 5-mm port in the umbilicus. A total of 102 TV NOTES procedures, including 72 TV cholecystectomies, 24 TV appendectomies, and 6 TV ventral hernia repairs, were performed. The average age was 37 years old and body mass index was 29 kg/m. Three major and 7 minor complications occurred. The first major complication was a rectal injury during a TV access port insertion. The second major complication was an omental vessel bleed after a TV cholecystectomy. The third complication was an intra-abdominal abscess after a TV appendectomy. Seven minor complications were urinary retention (4), transient brachial plexus injury, dislodgement of an intrauterine device, and vaginal granulation tissue. As techniques in TV surgery are adopted, inevitably, complications may occur due to the inherent learning curve. Laparoscopic instruments, although adaptable to TV approaches, have yet to be optimized. A high index of suspicion is necessary to identify complications and optimize outcomes for patients.

  1. Experimental NOTES in urology: are we moving forward?

    PubMed

    Granberg, Candace F; Gettman, Matthew T

    2012-04-01

    This articles discusses the preclinical development of natural orifice surgery in urology. Rationale for this approach is provided. The description of transvaginal nephrectomy and NOTES prostatectomy is described.

  2. Noted

    ERIC Educational Resources Information Center

    Nunberg, Geoffrey

    2013-01-01

    Considering how much attention people lavish on the technologies of writing--scroll, codex, print, screen--it's striking how little they pay to the technologies for digesting and regurgitating it. One way or another, there's no sector of the modern world that is not saturated with note-taking--the bureaucracy, the liberal professions, the…

  3. Noted

    ERIC Educational Resources Information Center

    Nunberg, Geoffrey

    2013-01-01

    Considering how much attention people lavish on the technologies of writing--scroll, codex, print, screen--it's striking how little they pay to the technologies for digesting and regurgitating it. One way or another, there's no sector of the modern world that is not saturated with note-taking--the bureaucracy, the liberal professions, the…

  4. Transvaginal specimen removal after laparoscopic distal pancreatic resection.

    PubMed

    Mofid, Hamid; Emmermann, Alice; Alm, Margret; Zornig, Carsten

    2013-10-01

    Transvaginal specimen removal has been introduced 20 years ago but then abandoned. With the advent of transvaginal interventions following the introduction of natural orifice transluminal endoscopic surgery, renewed interest was generated for hybrid procedures with minimal access for the intervention and use of transvaginal (TV) specimen removal. We present the first such series after laparoscopic distal pancreatectomy. In seven subsequent women (median age 48 years) with body and tail pancreatic tumors undergoing laparoscopic distal pancreatectomy, the new method of TV specimen removal was applied. The patients' data and the technical successes as well as intra- and postprocedural complications were recorded prospectively. The patients were followed after discharge for gynecological examination. Specimen removal consisting of the pancreas and spleen in five and the pancreas only in two cases was technically successful; no intraoperative complications were encountered. Postoperative complications consisted of one case of intra-abdominal hemorrhage and one case of pancreatic fistula, attributable to the resection and not to TV specimen removal. Gynecological follow-up was normal in all seven patients. The technique of TV specimen removal is feasible and safe also after laparoscopic distal pancreatectomy. It may help to further diminish the access trauma of laparoscopic pancreatic surgery.

  5. Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: early experience in humans.

    PubMed

    Nakajima, Kiyokazu; Nishida, Toshirou; Takahashi, Tsuyoshi; Souma, Yoshihito; Hara, Johji; Yamada, Takuya; Yoshio, Toshiyuki; Tsutsui, Tateki; Yokoi, Takeshi; Mori, Masaki; Doki, Yuichiro

    2009-12-01

    Transvaginal endoscopic gastric surgery is one of the cutting edge procedures in the field of natural orifice translumenal endoscopic surgery (NOTES). Its feasibility has been shown sporadically in bariatric cases but not in oncologic conditions. The authors report their early experience with hybrid transvaginal NOTES gastrectomy for gastric submucosal tumors (SMTs). Two female patients with SMTs in the distal stomach participated in this institutional review board (IRB)-approved study. Surgical indication was determined according to the National Comprehensive Cancer Network (NCCN) sarcoma guidelines, and the study adhered to the following oncologic principles: no direct handling of the lesion, full-thickness resection, and reasonable surgical margins. The study protocol required a minimum of two laparoscopic ports to ensure procedural safety and aforementioned oncologic appropriateness. Under laparoscopic guidance, a transvaginal route was created and secured with a 50-cm flexible overtube. A gastrointestinal endoscope was introduced, and the perigastric dissection was performed using an insulation-tipped diathermy knife (IT knife) and needle knife. This process was assisted with two laparoscopic graspers. After perigastric mobilization, the transvaginal endoscope was replaced with a digital stapling device, and partial gastrectomy was accomplished. The resected specimen was isolated and delivered through the vagina, and the vaginal wound was closed under direct vision. Outcomes measurements included surgical results, pain scoring, and clinical outcomes. Both operations were completed successfully in compliance with the aforementioned oncologic principles. The operating time was 365 and 170 min, respectively. The estimated blood loss was negligible. A minilaparotomy for specimen delivery was successfully avoided in both cases. A minimal vaginal incision was added for one patient at retrieval. Postoperatively, both patients reported no pain and recovered rapidly

  6. Pregnancy outcomes after transvaginal sacrospinous hysteropexy.

    PubMed

    Cavkaytar, Sabri; Kokanalı, Mahmut Kuntay; Tasdemir, Umit; Doganay, Melike; Aksakal, Orhan

    2017-09-01

    To evaluate the pregnancy outcomes in women who underwent transvaginal sacrospinous hysteropexy with the review of the literature STUDY DESIGN: 54 women who underwent transvaginal sacrospinous hysteropexy due to ≥grade 2 uterine prolapse during six-year period were identified from a computer based database. 8 of these who had pregnancy resulted in live birth subsequent to transvaginal sacrospinous hysteropexy were enrolled in this study. They were examined in case of pelvic organ prolapse recurrence and were questioned about their current self satisfaction status and PISQ-12 questionnaire. The median age of women was 36 years (range 29-43 years). All of the women were multiparous and there were no women with a previous cesarean section. All of the subsequent conceptions following operation occured spontaneously. The median time between hysteropexy and conception was 16 months (range 10-30 months). The pregnancies continued at least 37 weeks with only one preterm delivery (due to twin pregnancy). All 8 pregnancies were delivered by cesarean section. The median follow-up period after cesarean section was 45 months (range 7-60 months). Majority of women (7/8, 87.5%) were satisfied with current outcomes of sacrospinous hysteropexy and PISQ12 questionnaire scores revealed improvement in 87.5% (7/8) of women. Transvaginal sacrospinous hysteropexy is an appropriate surgical treatment method for symptomatic uterovaginal descensus in women who wish to preserve their uterine and future childbearing. And cesarean section is a reliable and satisfactory delivery route for women who underwent transvaginal sacrospinous hysteropexy. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Systemic Inflammatory Response After Natural Orifice Translumenal Surgery: Transvaginal Cholecystectomy in a Porcine Model

    PubMed Central

    Fan, Joe K. M.; Tong, Daniel K. H.; HO, David W. Y.; Luk, John; Law, Simon

    2009-01-01

    Objective: We analyzed circulating TNF-α and IL-6 to determine systemic inflammatory responses associated with transvaginal cholecystectomy in a porcine model. Methods: Six female pigs were used for a survival study after transvaginal cholecystectomy (NOTES group) using endoscopic submucosal dissection (ESD) instruments and a single-channel endoscope. Blood was drawn preoperatively and 24 hours and 48 hours postoperatively. Four pigs were used as controls. In addition, laparoscopic cholecystectomy was performed in 2 pigs for laparoscopic control. Results: In all 6 pigs in the NOTES group, no major intraoperative complications occurred. No significant differences were found between control, laparoscopic, and NOTES groups in terms of preoperative IL-6 level (P=0.897) and at 24 hours (P=0.790), and 48 hours postoperatively (P=0.945). Similarly, there was no significant difference in mean preoperative (P=0.349) and mean day 2 postoperative TNF-α levels (P=0.11). But a significant increase in day 1 postoperative TNF-α levels in the laparoscopic group compared with that in the control and NOTES groups was observed (P=0.049). One limitation of our study is that the sample size was relatively small. Conclusion: NOTES is safe in animal models in terms of anatomical and cellular level changes with minimal systemic inflammatory host responses elicited. Further study needs to be carried out in humans before NOTES can be recommended for routine use. PMID:19366533

  8. Systemic inflammatory response after natural orifice translumenal surgery: transvaginal cholecystectomy in a porcine model.

    PubMed

    Fan, Joe K M; Tong, Daniel K H; Ho, David W Y; Luk, John; Law, Wai Lun; Law, Simon

    2009-01-01

    We analyzed circulating TNF-alpha and IL-6 to determine systemic inflammatory responses associated with transvaginal cholecystectomy in a porcine model. Six female pigs were used for a survival study after transvaginal cholecystectomy (NOTES group) using endoscopic submucosal dissection (ESD) instruments and a single-channel endoscope. Blood was drawn preoperatively and 24 hours and 48 hours postoperatively. Four pigs were used as controls. In addition, laparoscopic cholecystectomy was performed in 2 pigs for laparoscopic control. In all 6 pigs in the NOTES group, no major intraoperative complications occurred. No significant differences were found between control, laparoscopic, and NOTES groups in terms of preoperative IL-6 level (P=0.897) and at 24 hours (P=0.790), and 48 hours postoperatively (P=0.945). Similarly, there was no significant difference in mean preoperative (P=0.349) and mean day 2 postoperative TNF-alpha levels (P=0.11). But a significant increase in day 1 postoperative TNF-alpha levels in the laparoscopic group compared with that in the control and NOTES groups was observed (P=0.049). One limitation of our study is that the sample size was relatively small. NOTES is safe in animal models in terms of anatomical and cellular level changes with minimal systemic inflammatory host responses elicited. Further study needs to be carried out in humans before NOTES can be recommended for routine use.

  9. Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

    PubMed Central

    2012-01-01

    Background Some techniques of transvaginal ovarian drilling have been previously described. Nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation seems to be an easier and feasible approach. The aim of this study was to develop a minimally invasive ovarian cauterization technique under transvaginal ultrasound control, and to evaluate the safety of the transvaginal ovarian monopolar cauterization, female sheep at reproductive age were used as an experimental model. Findings An experimental study was performed in a university research center. Seventeen female sheep (15 Corriedale e 2 Suffolk) in reproductive age were submitted to transvaginal ovarian cauterization with a monopolar Valleylab Force 2 electrocautery. Macroscopic and microscopic lesions were assessed. Ovarian size were 1.31 cm2 ± 0,43 (Corriedale) and 3.41 cm2 ± 0,64 (Suffolk). From 30 ovaries from Corriedale sheep punctured, only 3 were cauterized, presenting macroscopic and typical microscopic lesion. In the Suffolk sheep group, only one ovary was cauterized. No lesion could be found in the needle path. Conclusions This is the first experimental animal model described for ovarian cauterization needle guided by transvaginal ultrasound. The sheep does not seem to be the ideal animal model to study this technique. Another animal model, whose ovaries are better identified by transvaginal ultrasound should be sought for this technique, theoretically less invasive, before it could be offered safely to women with polycystic ovary syndrome. PMID:22243998

  10. Transvaginal sling excision: tips and tricks.

    PubMed

    Clifton, Marisa M; Goldman, Howard B

    2017-01-01

    Complications of synthetic midurethral sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is transvaginal mesh removal. The objectives of this video are to present cases of complications after sling placement and describe techniques to help with successful sling removal. Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue transvaginal sling excision. All patients had successful removal of a portion of their synthetic midurethral sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue. Sling excision can be successfully performed with careful surgical technique and dissection.

  11. Note: On the study of metal/oxide hybrid ferromagnets with magneto-optical techniques

    NASA Astrophysics Data System (ADS)

    Lopez-Dominguez, V.; de la Presa, P.; Hernando, A.; García, M. A.

    2017-08-01

    We analyze here the magneto-optical measurements of hybrid materials containing metallic and oxide ferromagnetic phases. We show that the magnetization curves obtained with this technique can be fairly different to those obtained with standard magnetometry techniques and cannot be representative of the contribution of each phase to the magnetization of the material, due to the very different optical properties of metals and oxides. However, a proper numerical analysis of the magneto-optical measurements allows estimating the fraction of each phase present in the material.

  12. Note: On the study of metal/oxide hybrid ferromagnets with magneto-optical techniques.

    PubMed

    Lopez-Dominguez, V; de la Presa, P; Hernando, A; García, M A

    2017-08-01

    We analyze here the magneto-optical measurements of hybrid materials containing metallic and oxide ferromagnetic phases. We show that the magnetization curves obtained with this technique can be fairly different to those obtained with standard magnetometry techniques and cannot be representative of the contribution of each phase to the magnetization of the material, due to the very different optical properties of metals and oxides. However, a proper numerical analysis of the magneto-optical measurements allows estimating the fraction of each phase present in the material.

  13. Towards scar-free surgery: An analysis of the increasing complexity from laparoscopic surgery to NOTES

    PubMed Central

    Chellali, Amine; Schwaitzberg, Steven D.; Jones, Daniel B.; Romanelli, John; Miller, Amie; Rattner, David; Roberts, Kurt E.; Cao, Caroline G.L.

    2014-01-01

    Background NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery. However, no work has been done to compare these techniques from a Human Factors perspective. This study presents a systematic analysis describing and comparing different existing NOTES methods to laparoscopic cholecystectomy. Methods Videos of endoscopic/laparoscopic views from fifteen live cholecystectomies were analyzed to conduct a detailed task analysis of the NOTES technique. A hierarchical task analysis of laparoscopic cholecystectomy and several hybrid transvaginal NOTES cholecystectomies was performed and validated by expert surgeons. To identify similarities and differences between these techniques, their hierarchical decomposition trees were compared. Finally, a timeline analysis was conducted to compare the steps and substeps. Results At least three variations of the NOTES technique were used for cholecystectomy. Differences between the observed techniques at the substep level of hierarchy and on the instruments being used were found. The timeline analysis showed an increase in time to perform some surgical steps and substeps in NOTES compared to laparoscopic cholecystectomy. Conclusion As pure NOTES is extremely difficult given the current state of development in instrumentation design, most surgeons utilize different hybrid methods – combination of endoscopic and laparoscopic instruments/optics. Results of our hierarchical task analysis yielded an identification of three different hybrid methods to perform cholecystectomy with significant variability amongst them. The varying degrees to which laparoscopic instruments are utilized to assist in NOTES methods appear to introduce different technical issues and additional tasks leading to an increase in the surgical time. The

  14. Acrania/encephalocele sequence (exencephaly) associated with 92,XXXX karyotype: early prenatal diagnosis at 9(+5) weeks by 3D transvaginal ultrasound and coelocentesis.

    PubMed

    Tonni, Gabriele; Ventura, Alessandro; Bonasoni, Maria Paola

    2009-09-01

    A 27-year-old pregnant woman was diagnosed by 3D transvaginal ultrasound as carrying a fetus of 9(+5) weeks gestation affected by acrania/encephalocele (exencephaly) sequence. A 2D transvaginal ultrasound-guided aspiration of 5 mL of extra-coelomic fluid was performed under cervical block before uterine suction. Conventional cytogenetic analysis demonstrated a 92,XXXX karyotype. Transvaginal 2D ultrasound-guided coelocentesis for rapid karyotyping can be proposed to women who are near to miscarriage or in cases where a prenatal ultrasound diagnosis of congenital anomaly is performed at an early stage of development. Genetic analysis can be performed using traditional cytogenetic analysis or can be aided by fluorescence in situ hybridization (FISH). Coelocentesis may become an integral part of first trimester armamentarium and may be clinically useful in the understanding of the pathogenesis of early prenatally diagnosed congenital anomalies.

  15. Comparative evaluation of conventional and transvaginal laparoscopic ovariohysterectomy in dogs.

    PubMed

    Bakhtiari, Jalal; Khalaj, Ali Reza; Aminlou, Elham; Niasari-Naslaji, Amir

    2012-08-01

    To evaluate the feasibility and safety of a transvaginal approach for laparoscopic ovariohysterectomy (OVH) in dogs and to compare it with conventional laparoscopic OVH. Prospective study. Adult healthy female mixed breed dogs (n = 24). Dogs (weighing 14-17 kg) were anesthetized and positioned in dorsal recumbency for ovariohysterectomy. Dogs were prepared for either conventional (n = 12) or transvaginal (n = 12) laparoscopic OVH. For conventional laparoscopic OVH, 3 midline abdominal portals were used and for the transvaginal approach, 2 midline abdominal portals and one vaginal portal were used. The transected ovarian pedicles, broad ligament, and uterus were removed through the umbilical region in the conventional method and through the vagina in the transvaginal method. Mean surgical time, intraoperative and postoperative complications, clinical and hematologic findings, and wound complications were compared. OVH was successfully performed without complications using both methods. Mean ± SD surgical times were similar between conventional (34.2 ± 4.03 min) and transvaginal (37.0 ± 3.56 min) methods. No significant differences, hematologic and clinical variables, were found between groups. The vaginal port could limit surgical maneuvers ergonomically during manipulation of the uterine body. Transvaginal approach for laparoscopic OVH is a feasible technique with the advantage of requiring one less abdominal portal. © Copyright 2012 by The American College of VeterinarySurgeons.

  16. The accuracy of transvaginal sonography to detect endometriosis cyst

    NASA Astrophysics Data System (ADS)

    Diantika, M.; Gunardi, E. R.

    2017-08-01

    Endometriosis is common in women of reproductive age. Late diagnosis is still the main concern. Currently, noninvasive diagnostic testing, such as transvaginal sonography, is recommended. The aim of the current study was to evaluate the accuracy of transvaginal sonography in diagnosing endometrial cysts in patients in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. This diagnostic study was carried out at Cipto Mangunkusumo Hospital between January 2014 and June 2015. Outpatients suspected have an endometrial cyst based on the patient history and a clinical examination was recruited. The patients were then evaluated using transvaginal sonography by an experienced sonologist, according to the research protocol. The gold standard test was a histological finding in the removed surgical mass. Ninety-eight patients were analyzed. An endometrial cyst was confirmed by histology in 85 patients (87%). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of transvaginal sonography was established to be 85% (a range of 71-99%), 93%, 77%, 96%, and 63%, respectively. A significantly higher area under the curve was identified using transvaginal sonogpraphy compared to that achieved with a clinical examination alone (85% versus 79%). Transvaginal sonography was useful in diagnosing endometrial cysts in outpatients and is recommended in daily clinical practice.

  17. Hybrid Microscopic-Endoscopic Surgery for Craniopharyngioma in Neurosurgical Suite: Technical Notes.

    PubMed

    Ichikawa, Tomotsugu; Otani, Yoshihiro; Ishida, Joji; Fujii, Kentaro; Kurozumi, Kazuhiko; Ono, Shigeki; Date, Isao

    2016-01-01

    The best chance of curing craniopharyngioma is achieved by microsurgical total resection; however, its location adjacent to critical structures hinders complete resection without neurologic deterioration. Unrecognized residual tumor within microscopic blind spots might result in tumor recurrences. To improve outcomes, new techniques are necessary to visualize tissue within these blind spots. We examined the success of hybrid microscopic-endoscopic neurosurgery for craniopharyngioma in a neurosurgical suite. Four children with craniopharyngiomas underwent microscopic resection. When the neurosurgeon was confident that most of the visible tumor was removed but was suspicious of residual tumor within the blind spot, he or she used an integrated endoscope-holder system to inspect and remove any residual tumor. Two ceiling monitors were mounted side by side in front of the surgeon to display both microscopic and endoscopic views and to view both monitors simultaneously. Surgery was performed in all patients via the frontobasal interhemispheric approach. Residual tumors were observed in the sella (2 patients), on the ventral surface of the chiasm and optic nerve (1 patient), and in the third ventricle (1 patient) and were resected to achieve total resection. Postoperatively, visual function was improved in 2 patients and none exhibited deterioration related to the surgery. Simultaneous microscopic and endoscopic observation with the use of dual monitors in a neurosurgical suite was ergonomically optimal for the surgeon to perform microsurgical procedures and to avoid traumatizing surrounding vessels or neural tissues. Hybrid microscopic-endoscopic neurosurgery may contribute to safe, less-invasive, and maximal resection to achieve better prognosis in children with craniopharyngioma. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Snake charmer NOTES: a two-luminal access for hybrid NOS operations.

    PubMed

    Lamadé, Wolfram; Rieber, Fabian; Köhler, Peter; Friedrich, Colin; Diederich, Mike; Basar, Tarkan; Ulmer, Christoph; Thon, Klaus Peter; Bernhardt, Jörn

    2011-09-01

    Despite recent advances in NOTES, NOS, SILS and related techniques, the feasibility of performing extensive surgery is still limited. Colon surgery usually requires additional access sites or complex technical means for triangulation and retraction. A method is presented that enables single-port colon surgery, supported by flexible colonoscopy. Single-port sigmoidectomy was performed in five cases on the porcine model. Flexible colonoscopy was used to manoeuvre the colon and expose its mesentery for dissection. The specimen was retrieved transrectally by invagination. Single-port sigmoidectomy supported by colonoscopy was feasible in all cases. The method provided a fixed framework, excellent organ guidance and exposition of the mesentery and enabled bowel-close mesocolic preparation. The access angle for preparation and visualisation could be altered during the procedure using the colonoscope. During autopsy on day 21, competent anastomotic healing with only rare interenteric adhesions was observed. One animal had a small preperitoneal abscess in the umbilical region while demonstrating completed skin healing. Flexible colonoscopy provided a fixed reference frame that enabled single-port preparation and dissection of the sigmoid colon. Under colonoscopic guidance, the access angle for dissection could be adapted according to the surgeon's needs. The procedures could be performed safely and effectively.

  19. Natural orifice transluminal endoscopic surgery (hybrid) cholecystectomy: The Dhillon technique

    PubMed Central

    Dhillon, Kanwarjit Singh; Awasthi, Divya; Dhillon, Arshbir Singh

    2017-01-01

    INTRODUCTION: This study presents a novel technique to perform cholecystectomy and assess its outcome and feasibility. PATIENTS AND METHODS: This study presents the novel Dhillon technique and experience of hybrid natural orifice transluminal endoscopic surgery (NOTES) technique, that is, laparoscopic-assisted transvaginal cholecystectomy. We have evaluated the outcomes in terms of cosmesis, post-operative recovery and analgesic requirement. The study included 257 patients who underwent hybrid NOTES cholecystectomy at single tertiary hospital. The biographical data, surgical time, pain score on day 1 and 2, need of analgesia, intra- and post-operative complication and aesthetic assessment on day 7 were recorded. RESULTS: Out of a total of 1100 cases of laparoscopic cholecystectomy 257 had hybrid NOTES cholecystectomy. Only two of these cases were converted to standard laparoscopic cholecystectomy. The mean operative time was 31.5 ± 5.1 (25–40) min. None of the patients had any complication or biliary leakage. The mean pain score on day 1 and 2 was 3.6 ± 0.4 (3–4) and 1.0 ± 0.06 (1–2), respectively. The mean paracetamol (analgesic) dose requirement was 6.1 ± 0.6 (4–6.9) g. The aesthetic score was excellent in all the cases. CONCLUSIONS: Using the present technique of hybrid NOTES is beneficial in terms of cosmetic results, lesser need of analgesic and shorter hospital stay. PMID:28607283

  20. Hybrid surgery for scaphocephaly with distraction osteogenesis using skull expanders: technical note.

    PubMed

    Morota, Nobuhito; Ogiwara, Hideki; Kaneko, Tsuyoshi

    2012-09-01

    The authors described their surgical technique for scaphocephaly in relatively older infants who are 5 months old or over. The technique is a kind of hybrid of distraction osteogenesis utilizing skull expanders and a traditional cranial reconstruction procedure. The surgery usually consists of four procedures. The first is to make strip craniotomy over the superior sagittal sinus (SSS) from the major fontanelle to the minor one. The second is the occipital craniotomy for the occipital bossing. The occipital bone flap undergoes barrel stave osteotomy and is repositioned later. The third is placement of skull expander for distraction osteogenesis. Bidirectional small strip craniotomy is made along the coronal and lambdoid sutures, then transverse cutting is added to make a hinge point near the base of the parietal bone. Two to three skull expanders are placed crossing the SSS. The last procedure is radial-oriented osteotomy on the dorsal end of frontal bone to meet the elevated, expanded parietal bone. Skull expansion starts within a week with 5 mm/week base up to 20 to 30 mm. Exposed shafts of the expander are cut at the end of skull expansion. Process of osteogenesis is followed at an outpatient clinic, and the expanders are removed 4 to 6 months later after confirming the sufficient ossification. An advantage of our procedure is that maximum skull expansion is possible with minimum regression after distraction osteogenesis in the long term. Limited craniotomy enables limited blood loss. The skin trouble caused by stretching can be avoided. No postoperative helmet is required. A disadvantage is that the procedure leaves a foreign body on the skull for several months and requires additional surgery for removal.

  1. The Use of Transvaginal Ultrasound in Type II Endometrial Cancer.

    PubMed

    Billingsley, Caroline C; Kenne, Kimberly A; Cansino, Catherine D; Backes, Floor J; Cohn, David E; O'Malley, David M; Copeland, Larry J; Fowler, Jeffrey M; Salani, Ritu

    2015-06-01

    To determine the use of the transvaginal ultrasound (TVUS) in postmenopausal women with type II endometrial cancer. A retrospective review was conducted for 173 women with pathology proven type II endometrial cancer at a single institution. Those who underwent preoperative TVUS were included, and the following data were obtained: endometrial stripe (EMS) measurement, uterine and/or adnexal findings, and uterine size/volume. Clinicopathologic factors were abstracted. Descriptive and regression analyses were performed. Fifty-eight women comprised the cohort, and the median age was 66.5 years (50-85 years). The most commonly reported symptom was postmenopausal bleeding in 53 patients (91.4%). The EMS was reported as thin (≤ 5 mm) or indistinct in 16 patients (27.5%). Approximately 60% of patients had 1 or more ultrasound abnormalities: intracavitary mass (31%), intracavitary fluid (12.1%), myometrial lesion (31.03%), and adnexal mass (12.1%). Poorly differentiated endometrioid cancer (53.45%) represented the predominant histology. Of the 16 (27.5%) women with a thin/indistinct EMS, 5 women (8.6%) did not have any abnormal ultrasound findings whatsoever. Women with type II endometrial cancer had a thin/indistinct EMS on TVUS in approximately 25% of cases. Lack of any ultrasound abnormality, including a thickened EMS, was noted in approximately 10% of patients. The use of TVUS, which has been of value in type I cancer, is limited in type II endometrial cancer. Therefore, endometrial sampling should be included in the evaluation of all women with postmenopausal bleeding, regardless of EMS thickness.

  2. Safety Outcomes of NOTES Cholecystectomy Versus Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

    PubMed Central

    Peng, Cheng; Ling, Yan; Ma, Chi; Ma, Xiaochun; Fan, Wei; Niu, Weibo

    2016-01-01

    Objective: Natural orifice transluminal endoscopic surgery (NOTES) is an endoscopic technique whereby surgical interventions can be performed with a flexible endoscope passed through a natural orifice (mouth, vulva, urethra, anus) then through a transluminal opening of the stomach, vagina, bladder, or colon. Although in the early stage of research and development, NOTES has been clinically applied across the globe, above all the transvaginal cholecystectomy is among the most frequently performed procedures. In the existing 2 types of transvaginal routes, the hybrid NOTES cholecystectomy (NC) is more likely to be accepted. However, there has been controversy regarding the safety outcomes of hybrid NC in comparison with classical laparoscopic cholecystectomy (LC). The primary objective of this meta-analysis is to compare the characteristics between NC and classical LC. Materials and Methods: A meta-analysis of eligible studies comparing NC with classical LC was performed to evaluate the safety outcomes including wound complications, other postoperative complications and intraoperative conversion between the 2 groups. Results: Pooling 3 randomized controlled trials (n=157) and 7 nonrandomized trial (n=593) demonstrated that the rates of wound complications and other postoperative complications in NC group did not significantly differ from those of classical LC group [wound complications: ratio difference (RD)=−0.02, 95% confidence interval (CI) −0.04to 0.01, P=0.23; other postoperative complication: RD=−0.01; 95% CI, −0.03 to 0.02; P=0.6]. The intraoperative conversion rate in NC groups was higher than that of LC groups (RD=0.03; 95% CI, 0.01-0.06; P=0.02). Conclusions: There is no significate difference between the safety of NC and laparoscope cholecystectomy. NC is associated with a higher rate of intraoperative conversion when compared with LC. It is worthy of further promotion and validation in clinical settings. PMID:27557339

  3. Oxidation and degradation of polypropylene transvaginal mesh.

    PubMed

    Talley, Anne D; Rogers, Bridget R; Iakovlev, Vladimir; Dunn, Russell F; Guelcher, Scott A

    2017-04-01

    Polypropylene (PP) transvaginal mesh (TVM) repair for stress urinary incontinence (SUI) has shown promising short-term objective cure rates. However, life-altering complications have been associated with the placement of PP mesh for SUI repair. PP degradation as a result of the foreign body reaction (FBR) has been proposed as a contributing factor to mesh complications. We hypothesized that PP oxidizes under in vitro conditions simulating the FBR, resulting in degradation of the PP. Three PP mid-urethral slings from two commercial manufacturers were evaluated. Test specimens (n = 6) were incubated in oxidative medium for up to 5 weeks. Oxidation was assessed by Fourier Transform Infrared Spectroscopy (FTIR), and degradation was evaluated by scanning electron microscopy (SEM). FTIR spectra of the slings revealed evidence of carbonyl and hydroxyl peaks after 5 weeks of incubation time, providing evidence of oxidation of PP. SEM images at 5 weeks showed evidence of surface degradation, including pitting and flaking. Thus, oxidation and degradation of PP pelvic mesh were evidenced by chemical and physical changes under simulated in vivo conditions. To assess changes in PP surface chemistry in vivo, fibers were recovered from PP mesh explanted from a single patient without formalin fixation, untreated (n = 5) or scraped (n = 5) to remove tissue, and analyzed by X-ray photoelectron spectroscopy. Mechanical scraping removed adherent tissue, revealing an underlying layer of oxidized PP. These findings underscore the need for further research into the relative contribution of oxidative degradation to complications associated with PP-based TVM devices in larger cohorts of patients.

  4. Clinical Outcomes and Urodynamic Effects of Tailored Transvaginal Mesh Surgery for Pelvic Organ Prolapse

    PubMed Central

    Chang, Ting-Chen; Hsiao, Sheng-Mou; Chen, Chi-Hau; Wu, Wen-Yih; Lin, Ho-Hsiung

    2015-01-01

    Objective. To evaluate the clinical outcomes and urodynamic effects of tailored anterior transvaginal mesh surgery (ATVM) and tailored posterior transvaginal mesh surgery (PTVM). Methods. We developed ATVM for the simultaneous correction of cystocele and stress urinary incontinence and PTVM for the simultaneous correction of enterocoele, uterine prolapse, vaginal stump prolapse, and rectocele. Results. A total of 104 women enrolled. The median postsurgical follow-up was 25.5 months. The anatomic cure rate was 98.1% (102/104). Fifty-eight patients underwent urodynamic studies before and after surgeries. The pad weight decreased from 29.3 ± 43.1 to 6.4 ± 20.9 g at 3 months. Among the 20 patients with ATVM, 13 patients had objective stress urinary incontinence (SUI) at baseline while 8 patients came to have no demonstrated SUI (NDSUI), and 2 improved after surgery. Among the 38 patients who underwent ATVM and PTVM, 24 had objective SUI at baseline while 18 came to have NDSUI, and 2 improved after surgery. Mesh extrusion (n = 4), vaginal hematoma (n = 3), and voiding difficulty (n = 2) were noted postoperatively. Quality of life was substantially improved. Conclusions. Our findings document the advantages of these two novel pelvic reconstructive surgeries for pelvic organ prolapse, which had a positive impact on quality of life. ATVM surgery additionally provided an anti-incontinence effect. This clinical trial is registered at ClinicalTrials.gov (NCT02178735). PMID:26634203

  5. Transvaginal Ultrasound for the Diagnosis of Abnormal Uterine Bleeding.

    PubMed

    Wheeler, Karen C; Goldstein, Steven R

    2017-03-01

    Transvaginal ultrasound is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia, and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. In this article we discuss specific ultrasound findings and technical considerations useful in the diagnosis of abnormal uterine bleeding.

  6. Exploration of the retroperitoneum using the transvaginal natural orifice transluminal endoscopic surgery technique.

    PubMed

    Zacharopoulou, Chrysoula; Nassif, Joseph; Allemann, Pierre; Dallemagne, Bernard; Perretta, Silvana; Marescaux, Jacques; Wattiez, Arnaud

    2009-01-01

    We sought to evaluate the feasibility of the retroperitoneum's exploration via natural orifice transluminal endoscopic surgery (NOTES) using transvaginal access in a porcine model, and its possible application in human beings. Six female pigs (25-30 kg) were used to establish anatomic landmarks and technical steps. Six additional pigs were used for the survival study. Under general anesthesia and with the pig supine, a 1-cm posterolateral colpotomy was performed with the double-channel gastroscope's needle knife. The incision was enlarged laterally using blunt dissection while keeping in contact with the psoas muscle. A retroperitoneal tunnel was created using carbon-dioxide dissection and the movements of the gastroscope up to the level of the kidney. The colpotomy site was closed using interrupted sutures (polyglactin 2/0). A follow-up laparoscopy and necropsy were performed 3 weeks postoperatively. Successful access to the retroperitoneum was achieved in all pigs with a mean operative time of 30 minutes. However, in the first 3 pigs used for the acute study, the peritoneum was perforated during the six-pig dissection and the procedure was abandoned because of the space's collapse. No perforation occurred during the survival study. An excellent view of the retroperitoneal space and structures, such as the vascular and lymphatic tissues, the kidney, the adrenal gland, and the ureter, was obtained. No intraoperative complications or bleeding or injury to any of the retroperitoneal structures occurred. The 3-week follow-up laparoscopy showed no adhesions or abscesses. These findings were confirmed at necropsy. The retroperitoneal space can be successfully accessed via NOTES. Transvaginal NOTES access to the retroperitoneum avoids any transparietal trocars, so it could decrease surgical trauma, be better tolerated, and offer better visualization, with the obvious gender limitation. Future clinical application in human beings may include procedures such as

  7. Needs analysis for developing a virtual-reality NOTES simulator.

    PubMed

    Sankaranarayanan, Ganesh; Matthes, Kai; Nemani, Arun; Ahn, Woojin; Kato, Masayuki; Jones, Daniel B; Schwaitzberg, Steven; De, Suvranu

    2013-05-01

    INTRODUCTION AND STUDY AIM: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical technique that requires a cautious adoption approach to ensure patient safety. High-fidelity virtual-reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing the virtual transluminal endoscopic surgery trainer (VTEST) for this purpose. The objective of this study is to conduct a structured needs analysis to identify the design parameters for such a virtual-reality-based simulator for NOTES. A 30-point questionnaire was distributed at the 2011 National Orifice Surgery Consortium for Assessment and Research meeting to obtain responses from experts. Ordinal logistic regression and the Wilcoxon rank-sum test were used for analysis. A total of 22 NOTES experts participated in the study. Cholecystectomy (CE, 68 %) followed by appendectomy (AE, 63 %) (CE vs AE, p = 0.0521) was selected as the first choice for simulation. Flexible (FL, 47 %) and hybrid (HY, 47 %) approaches were equally favorable compared with rigid (RI, 6 %) with p < 0.001 for both FL versus RI and HY versus RI. The transvaginal approach was preferred 3 to 1 to the transgastric. Most participants preferred two-channel (2C) scopes (65 %) compared with single (1C) or three (3C) or more channels with p < 0.001 for both 2C versus 1C and 2C versus 3C. The importance of force feedback and the utility of a virtual NOTES simulator in training and testing new tools for NOTES were rated very high by the participants. Our study reinforces the importance of developing a virtual NOTES simulator and clearly presents expert preferences. The results of this analysis will direct our initial development of the VTEST platform.

  8. Natural orifice translumenal endoscopic surgery (NOTES): emerging trends and specifications for a virtual simulator.

    PubMed

    Schwaitzberg, Steven D; Dorozhkin, Denis; Sankaranarayanan, Ganesh; Matthes, Kai; Jones, Daniel B; De, Suvranu

    2016-01-01

    A virtual translumenal endoscopic surgical trainer (VTEST) is being developed to accelerate the development of natural orifice translumenal endoscopic surgery (NOTES) procedures and devices in a safe and risk-free environment. For a rapidly developing field such as NOTES, a needs analysis must be conducted regularly to discover emerging research trends and areas of potential high impact for a virtual simulator. This paper presents a survey-based study which follows a similar study conducted by this group in 2011 (Sankaranarayanan et al. in Surg Endosc 27:1607-1616, 2013). A 32-point questionnaire was distributed at the 2012 Natural Orifice Surgery Consortium for Assessment and Research annual meeting. These data were subsequently augmented by an identical online survey, targeted at the members of the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons, and analyzed. Twenty-eight NOTES experts participated in the 2012 study. Cholecystectomy (CE) procedure remained the most commonly performed NOTES technique, with 18 positive responses (64%). In contrast to 2011, the popularity of the NOTES appendectomy (AE) was significantly lower, with only 2 (7%) instances (CE vs. AE, p < 0.001), while the number of peroral endoscopic myotomy (POEM, PE) cases had increased significantly, with 11 (39%) positive responses, respectively (PE vs. AE, p = 0.013). Strong preference toward hybrid rather than pure NOTES techniques (82 vs. 11%, p < 0.001) was also expressed. Other responses were similar to those in the 2011 study, with the VTEST™ utility in developing and testing new techniques and instruments ranked particularly high. Based on the results of this study, a decision was made to focus exclusively on the transvaginal hybrid NOTES cholecystectomy procedure, including both rigid and flexible scope techniques. The importance of developing a virtual NOTES simulator was reaffirmed, with POEM identified as a

  9. Efficacy of Electrical Pudendal Nerve Stimulation versus Transvaginal Electrical Stimulation in Treating Female Idiopathic Urgency Urinary Incontinence.

    PubMed

    Wang, Siyou; Lv, Jianwei; Feng, Xiaoming; Lv, Tingting

    2017-06-01

    We compared the efficacy of electrical pudendal nerve stimulation vs transvaginal electrical stimulation to treat female idiopathic urgency urinary incontinence. A total of 120 female patients with idiopathic urgency urinary incontinence refractory to medication were randomized at a ratio of 2:1 to group 1 of 80 patients and group 2 of 40. Groups 1 and 2 were treated with electrical pudendal nerve stimulation and transvaginal electrical stimulation, respectively. To perform electrical pudendal nerve stimulation long acupuncture needles were deeply inserted into 4 sacrococcygeal points and electrified to stimulate pudendal nerves. Outcome measures were the 24-hour pad test and a questionnaire to measure the severity of symptoms and quality of life in women with urgency urinary incontinence. The median severity of symptoms and quality of life score on the urgency urinary incontinence questionnaire (urgency urinary incontinence total score) was 13 (range 7 to 18.75) in group 1 and 11 (range 8 to 16) in group 2 before treatment, which decreased to 2 (range 0 to 6.75) in group 1 and 6.5 (range 3.25 to 10.75) in group 2 (both p <0.01) after the completion of treatment. At the end of treatment in group 1 complete symptom resolution was noted in 34 patients (42.5%), with a 50% or greater symptom improvement rate in 70.1%. In group 2 complete symptom resolution was noted in 1 patient (2.5%) with a 50% or greater symptom improvement rate in 45.0%. The posttreatment urgency urinary incontinence total score was lower and the therapeutic effect was better in group 1 than in group 2 (both p <0.01). Electrical pudendal nerve stimulation is more effective than transvaginal electrical stimulation in treating drug refractory, female idiopathic urgency urinary incontinence. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Transperineal and transvaginal sonography of perianal inflammatory disease.

    PubMed

    Stewart, L K; McGee, J; Wilson, S R

    2001-09-01

    Perianal infection arises in small intersphincteric anal glands predominantly located at the dentate line. Documentation of fluid collections and the relationship of inflammatory tracts to the sphincter mechanism is important for surgical treatment. Transanal sonography for assessment of perianal inflammatory disease is limited because placement of the rigid probe into the anal canal does not allow assessment of disease in the perineal region. The purpose of this study was to validate the use of transperineal sonography in men and both transvaginal and transperineal sonography in women for evaluation of perianal inflammatory disease. Fifty-four patients, 28 men and 26 women, were imaged with transperineal and a combination of transperineal and transvaginal sonography, respectively. All patients were examined in the supine lithotomy and left lateral position with a transvaginal 8-to 4-MHz probe or a linear 12- to 7-MHz transducer. All fluid collections, sinus tracts, and fistulas were described by their location in relation to the sphincter mechanism and perineum. Forty-six of 54 patients had perianal fistulas or sinus tracts: 33 transphincteric, seven intersphincteric, and six extrasphincteric. Fifteen patients had an associated abscess. In the eight remaining patients, there were two anovaginal fistulas, one rectovaginal fistula, one prolapsed internal hemorrhoid, two perianal complex masses, and two vascular perianal or perirectal inflammatory masses. Twenty-six patients underwent surgical procedures involving the anorectal canal or perirectal region, and of these, preoperative sonographic findings were confirmed in 22 (85%) of 26 patients. Three patients refused surgery, and six are awaiting surgery at this writing. Fifteen patients were treated conservatively. Transperineal and transvaginal sonography are accurate, painless, and cost-effective methods for documenting perianal fluid collections and fistulas or sinus tracts or both.

  11. [Synthetic meshes for transvaginal surgical cure of genital prolapse: evaluation in 2005].

    PubMed

    Debodinance, P; Cosson, M; Collinet, P; Boukerrou, M; Lucot, J-P; Madi, N

    2006-09-01

    Since 1996, prosthetic meshes have become increasingly popular for transvaginal surgical cure of genital prolapse. In light of the growing number of proposed techniques and materials we reviewed the experience of the pioneers in order to provide surgeons with the most objective information available. We reviewed the literature indexed in Meline/PubMed and Current Contents retaining all work concerning resorbable and non-resorbable meshes. For the larger class of non-resorbable meshes we also reviewed articles by category of material, each type of mesh being carefully defined: different compositions of polypropylene, polyester, composite meshes and also insertion kits. Resorbable meshes were evaluated in two randomized studies which did not demonstrate better results than with simple folding known to have a high rate of recurrence. For polypropylene meshes, Marlex was studied in six trials which demonstrated a high rate of cure at one year but also a high rate of erosion which reached 25%. Use of Atrium was mentioned in three studies with a 6 to 12% recurrence rate and an erosion rate nearly reaching 20%. The majority of studies used Prolene and Gynemesh. Seventeen authors reported their experience, generally reviewing retrospective series, with recurrence rates of less than 10% for follow-up periods rarely greater than two years. A large variety of forms and sizes have been used, hindering comparisons. The rate of erosion was also quite variable, as high as 45%, demonstrating the need for a precise definition of erosion. Only recently have authors shown interest in the impact of prosthetic meshes on quality of life and sexual activity. An improvement is generally noted for defecation but the rate of dyspareunia has reached as high as 60%. Here again grades of prosthetic retraction should be better defined. Proposed to improve these phenomena, soft Prolene recently used by several authors does not appear to fulfil expectations. Since 2005, several precut

  12. Transvaginal resection of a rectal gastrointestinal stromal tumor.

    PubMed

    Hara, Masayasu; Takayama, Satoru; Arakawa, Atsushi; Sato, Mikinori; Nagasaki, Takaya; Takeyama, Hiromitsu

    2012-09-01

    We herein report a case in which a rectal gastrointestinal stromal tumor (GIST) was resected transvaginally. The patient, a 45-year-old female, had a rectal GIST on the anterior wall of the lower rectum. The tumor was within 6 cm of the anal verge, a location which would normally require performing an ultra-low anterior resection using the Double Staple Technique, and a diverting stoma. To minimize the invasiveness of treatment and to reduce the postoperative morbidity, a transvaginal resection was performed. Under general anesthesia, the posterior vaginal mucosa was incised vertically. The tumor was then excised en bloc with the overlying rectovaginal septum and rectal mesenchymal tissue. The defect was repaired primarily, and a diverting stoma was not required. The procedure was uncomplicated, and the patient was discharged home with an intact anal sphincter function and no abdominal incisions. In female patients, transvaginal resection of low anterior rectal lesions may provide a minimally invasive alternative to the traditional ultra-low anterior resection.

  13. Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse.

    PubMed

    Iglesia, Cheryl B; Hale, Douglass S; Lucente, Vincent R

    2013-03-01

    Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon's audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.

  14. Evaluation of clinical effect of transabdominal sonography and transvaginal sonography in early diagnosis of ectopic gestation

    PubMed Central

    Li, Yinghui; Feng, Tao; Sun, Jiandong

    2017-01-01

    Objective: To analyze the application of transabdominal sonography and transvaginal sonography in early diagnosis of pregnancy and to provide a reference for the selection of diagnosis methods in clinic. Methods: One hundred and eighty patients who were admitted into the hospital from February 2013 to February 2014, received clinical diagnosis and were confirmed as ectopic gestation by surgery were selected as research objects. They were examined by transabdominal sonography, transvaginal sonography, and transabdominal sonography in combination with transvaginal sonography respectively. Besides, the ultrasonic performance was observed and compared with surgical pathological results to analyze and compare diagnostic accordance rate. Results: The positive rate of transabdominal sonography in combination with transvaginal sonography was much higher than that of transabdominal sonography and transvaginal sonography and the differences had statistical significance (P<0.05). The detection rate of different positive characteristics using the combined examination was much higher than that of transabdominal sonography and transvaginal sonography, and the differences had statistical significance (P<0.05). The detection rates of different types of ectopic gestation and different sizes of mass using transabdominal sonography in combination of transvaginal sonography were higher than that of transabdominal sonography and transvaginal sonography (P<0.05). Conclusion: Transabdominal sonography in combination with transvaginal sonography can complement information, improve detection rate, and reduce or avoid misdiagnosis and missed diagnosis, which provides a scientific basis for the formulation of clinical treatment scheme. PMID:28367172

  15. Achondrogenesis type 2 diagnosed by transvaginal ultrasound at 12 weeks' gestation.

    PubMed

    Soothill, P W; Vuthiwong, C; Rees, H

    1993-06-01

    Ultrasound examination at 12 weeks' gestation revealed severe generalised subcutaneous oedema in a pregnancy at risk for achondrogenesis type II. Transvaginal scanning confirmed the oedema and suggested abnormal limb development. The prenatal diagnosis was confirmed by X-ray examination after transvaginal termination.

  16. Note: Hybrid-π model and parameter extraction method for electrode-electrolyte interface characterization with superbly accurate reactance

    NASA Astrophysics Data System (ADS)

    Hong, Yan; Goh, Wang Ling; Wang, Yong

    2017-08-01

    This paper presents an equivalent circuit model for the electrode-electrolyte interface and aims at improving the modeling accuracy of the parasitic effects at frequencies up to 300 MHz. Different from the conventional model, the electrode inductances, body loss capacitances, and body loss resistances are all included in the proposed hybrid-π model. In addition, the S-parameters obtained by a vector network analyzer are innovatively used to extract the parameters of the electrode-electrolyte interface model for a frequency range from 10 Hz to 300 MHz. Since reactance is proportional to frequency, the proposed technique can precisely calculate the parasitic effects at higher frequencies. Verified by experiments, the hybrid-π model presents better accuracies when fitted to both the phases and magnitudes of S11 and S21. The superb modeling accuracy of this work is beneficial for biomedical applications that have an electrode-electrolyte interface.

  17. Covered stent in the superior gluteal artery in a hybrid approach to treat internal iliac artery aneurysm: a technical note.

    PubMed

    Noël-Lamy, Maxime; Teng Tan, Kong; Lindsay, Thomas

    2015-07-01

    This brief report describes a hybrid endovascular and open procedure to treat internal iliac artery (IIA) aneurysms and preserve pelvic blood flow. A covered stent was deployed before surgery in the superior gluteal artery, extending across the IIA aneurysm, with the proximal end in the common iliac artery lumen. During open aortoiliac aneurysm repair, the stent graft was anastomosed in an end-to-side manner to the surgical graft. Four aneurysms were treated in 3 patients. Technical success was achieved in all cases. There were no complications or repeat interventions. Stents were all patent at imaging follow-up (range, 6-25 mo). Patients were free from buttock claudication.

  18. Transvaginal Aspiration of Ovarian Cysts: Long-Term Follow-up

    SciTech Connect

    Duke, D.; Colville, J.; Keeling, A.; Broe, D.; Fotheringham, T.; Lee, M.J.

    2006-06-15

    Background and purpose. Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy. Methods. Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness. Results. Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy. Conclusion. Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is

  19. A transvaginal removal and repair of vesicovaginal fistula due to mesh erosion

    PubMed Central

    Mishra, Vineet V.; Tanvir, Tanvir; Choudhary, Sumesh; Goraniya, Nilesh

    2016-01-01

    Vesicovaginal fistula (VVF) is a devastating social problem. It can either result from obstetric trauma or following gynecological surgeries, malignancy, or radiation. We present a case of a 70-year-old woman who had a VVF following mesh augmentation surgery for anterior compartment prolapse. She required a transvaginal removal of the eroded mesh followed by a transvaginal repair of VVF using a Martius flap, 6 weeks later. Transvaginal removal of mesh is technically feasible and a good approach. Timing and route of surgery should be individualized. PMID:27499600

  20. Technical Note: Determination of the metabolically active fraction of benthic foraminifera by means of Fluorescent In Situ Hybridization (FISH)

    NASA Astrophysics Data System (ADS)

    Borrelli, C.; Sabbatini, A.; Luna, G. M.; Nardelli, M. P.; Sbaffi, T.; Morigi, C.; Danovaro, R.; Negri, A.

    2011-08-01

    Benthic foraminifera are an important component of the marine biota, but protocols for investigating their viability and metabolism are still extremely limited. Classical studies on benthic foraminifera have been based on direct counting under light microscopy. Typically, these organisms are stained with Rose Bengal, which binds proteins and other macromolecules, but does not allow discrimination between viable and recently dead organisms. The fluorescent in situ hybridization technique (FISH) represents a new and useful approach to identify living cells possessing an active metabolism. Our work is the first test of the suitability of the FISH technique, based on fluorescent probes targeting the 18S rRNA, to detect live benthic foraminifera. The protocol was applied on Ammonia group and Miliolids, as well as on agglutinated polythalamous (i.e., Leptohalysis scottii and Eggerella scabra) and soft-shelled monothalamous (i.e., Psammophaga sp. and saccamminid morphotypes) taxa. The results from FISH analyses were compared with those obtained, on the same specimens assayed with FISH, from microscopic analysis of the cytoplasm colour, presence of pigments and pseudopodial activity. Our results indicate that FISH targets only metabolically active foraminifera, and allows discerning from low to high cellular activity, validating the hypothesis that the intensity of the fluorescent signal emitted by the probe is dependent upon the physiological status of cells. These findings support the usefulness of this molecular approach as a key tool for obtaining information on the physiology of living foraminifera, both in field and experimental settings.

  1. Diagnosis of uterine vein thrombosis on transvaginal ultrasound.

    PubMed

    Mavrelos, D; Cohen, H; Pateman, K; Hoo, W; Foo, X; Jurkovic, D

    2013-10-01

    Deep venous thrombosis (DVT) is a potentially serious medical disorder, which may result in pulmonary embolism and death. Compression ultrasound is the investigation modality of choice for the diagnosis of DVT of the lower limb. Diagnosis of proximal thrombosis involving the pelvic veins is difficult and is usually made only after the thrombus extends into the veins of the lower limb. We present six cases of incidental uterine vein thrombosis diagnosed by transvaginal ultrasound. Our aim is to describe the technique of the examination of pelvic veins and criteria that could be used to diagnose uterine vein thrombosis. We also highlight difficulties in the management of women diagnosed with asymptomatic uterine vein thrombi as there is little evidence to guide clinicians in choosing between different treatment options. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

  2. Transvaginal repair of unrecognized bladder injury after transobturator tape surgery

    PubMed Central

    Bayrak, Ömer; Erbağcı, Ahmet; Şen, Haluk; Erturhan, Sakıp; Yağcı, Faruk; Seçkiner, İlker

    2013-01-01

    Currently, minimally invasive surgeries, which are often characterized by reliable and successful results, are preferred for the treatment of stress urinary incontinence. Although all of the currently used surgeries are minimally invasive, morbidities, including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries, are observed. We detected bladder injury in a 42-year-old female patient with complaints of burning and pain during urination who had previously undergone transobturator tape (TOT) surgery. Complete abdominal hysterectomy for a secondary myoma and a TOT procedure had been simultaneously performed 3 months prior to her presentation. Cystoscopy demonstrated a foreign body compatible with sling material in the bladder which was extracted transvaginally. PMID:26328124

  3. [Ultrasound of cervix uteri transvaginal in preterm birth].

    PubMed

    Onofriescu, M; Târnovanu, Mihaela; Scurtu, B; Luca, A; Radu, E; Iftime, Irina

    2006-01-01

    Premature birth is a social problem due to its implications in the natal mortality and morbidity. This is the reason why it is necessary to establish new methods which could identify pregnant women with high risk of premature birth. Besides the measurable biochemical factors such as fetal fibronectin and salivary estriol, I1-6 sonography is a simple method highly efficient and of reasonable financial costs among all the sonographic means of observing the cervix uteri. The transvaginal sonography is the "golden standard", permitting the most faithful assessment of the pursued parameters--the length of the cervix, the aspect of the internal os (funneling), the cervix index. The experience gathered up to now shows that all of these investigations have a predictive value which is more negative than positive, but when used together they could lead to an improved result.

  4. Risk Factors for Mesh Exposure after Transvaginal Mesh Surgery

    PubMed Central

    Niu, Ke; Lu, Yong-Xian; Shen, Wen-Jie; Zhang, Ying-Hui; Wang, Wen-Ying

    2016-01-01

    Background: Mesh exposure after surgery continues to be a clinical challenge for urogynecological surgeons. The purpose of this study was to explore the risk factors for polypropylene (PP) mesh exposure after transvaginal mesh (TVM) surgery. Methods: This study included 195 patients with advanced pelvic organ prolapse (POP), who underwent TVM from January 2004 to December 2012 at the First Affiliated Hospital of Chinese PLA General Hospital. Clinical data were evaluated including patient's demography, TVM type, concomitant procedures, operation time, blood loss, postoperative morbidity, and mesh exposure. Mesh exposure was identified through postoperative vaginal examination. Statistical analysis was performed to identify risk factors for mesh exposure. Results: Two-hundred and nine transvaginal PP meshes were placed, including 194 in the anterior wall and 15 in the posterior wall. Concomitant tension-free vaginal tape was performed in 61 cases. The mean follow-up time was 35.1 ± 23.6 months. PP mesh exposure was identified in 32 cases (16.4%), with 31 in the anterior wall and 1 in the posterior wall. Significant difference was found in operating time and concomitant procedures between exposed and nonexposed groups (F = 7.443, P = 0.007; F = 4.307, P = 0.039, respectively). Binary logistic regression revealed that the number of concomitant procedures and operation time were risk factors for mesh exposure (P = 0.001, P = 0.043). Conclusion: Concomitant procedures and increased operating time increase the risk for postoperative mesh exposure in patients undergoing TVM surgery for POP. PMID:27453227

  5. Transrectal rigid-hybrid NOTES cholecystectomy can be performed without peritoneal contamination: a controlled porcine survival study.

    PubMed

    Müller, Philip C; Senft, Jonas D; Gath, Philip; Steinemann, Daniel C; Nickel, Felix; Billeter, Adrian T; Müller-Stich, Beat P; Linke, Georg R

    2017-08-10

    The risk of infectious complications due to peritoneal contamination is a major concern and inhibits the widespread use of transrectal NOTES. A standardized rectal washout with a reversible colon occlusion device in situ has previously shown potential in reducing peritoneal contamination. The aim of this study was to compare the peritoneal contamination rate and inflammatory reaction for transrectal cholecystectomy after ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE) in a porcine survival experiment. Twenty pigs were randomized to trCCE (n = 10) or lapCCE (n = 10). Before trCCE, rectal washout was performed with saline solution. A colon occlusion device was then inserted and a second washout with povidone-iodine was performed. The perioperative course and the inflammatory reaction (leukocytes, C-reactive protein) were compared. At necropsy, 14 days after surgery the abdominal cavity was screened for infectious complications and peritoneal swabs were obtained for comparison of peritoneal contamination. Peritoneal contamination was lower after trCCE than after lapCCE (0/10 vs. 6/10; p = 0.003). No infectious complications were found at necropsy in either group and postoperative complications did not differ (p = 1.0). Immediately after the procedure, leukocytes were higher after lapCCE (17.0 ± 2.7 vs. 14.6 ± 2.3; p = 0.047). Leukocytes and C-reactive protein showed no difference in the further postoperative course. Intraoperative complications and total operation time (trCCE 114 ± 32 vs. 111 ± 27 min; p = 0.921) did not differ, but wound closure took longer for trCCE (31.5 ± 19 vs. 13 ± 5 min; p = 0.002). After standardized rectal washout with a colon occlusion device in situ, trCCE was associated without peritoneal contamination and without access-related infectious complications. Based on the findings of this study, a randomized controlled clinical study comparing clinical outcomes of trCCE with

  6. A comparison of transvaginal and abdominal ultrasound in visualizing the first trimester conceptus.

    PubMed

    Cullen, M T; Green, J J; Reece, E A; Hobbins, J C

    1989-10-01

    Ultrasound visualization of the first trimester embryo was compared using abdominal and transvaginal sonography. The parameters evaluated included the ability to obtain biometry, the ability to visualize detailed internal anatomy, and a subjective assessment of the overall image clarity. In 120 patients studied, transvaginal sonography was superior to abdominal sonography in obtaining biometric measurements in 51 cases (43%) and for visualizing internal anatomy in 45 cases (38%); also the image clarity of transvaginal sonography was subjectively better in 75 cases (63%). Vaginal sonography was superior to abdominal sonography in gestations less than or equal to 10 weeks, in obese patients, and in patients with retroverted uteri. The major difficulty encountered with transvaginal sonography was the limited maneuverability of the probe to generate specific views. Vaginal sonography can be a valuable tool in imaging the first trimester fetus, complementing, not replacing, abdominal sonography.

  7. Achondrogenesis type I diagnosed by transvaginal ultrasonography at 13 weeks' gestation.

    PubMed

    Meizner, I; Barnhard, Y

    1995-11-01

    We present the first transvaginal first-trimester diagnosis of achondrogenesis type I confirmed by radiographic and histologic studies. The ultrasonographic signs included severe short limb mesomelic dwarfism, large head with decreased ossification, and lack of vertebral ossification.

  8. Transvaginal Ultrasound-Guided Biopsy of Deep Pelvic Masses: How We Do It.

    PubMed

    Plett, Sara K; Poder, Liina; Brooks, Rebecca A; Morgan, Tara A

    2016-06-01

    The purpose of this review is to discuss the rationale and indications for transvaginal ultrasound-guided biopsy. Transvaginal ultrasound-guided biopsy can be a helpful tool for diagnosis and treatment planning in the evaluation of pelvic masses, particularly when the anatomy precludes a transabdominal or posterior transgluteal percutaneous biopsy approach. A step-by-step summary of the technique with preprocedure and postprocedure considerations is included. © 2016 by the American Institute of Ultrasound in Medicine.

  9. Twin transvaginal cervical length at 16-20 weeks and prediction of preterm birth.

    PubMed

    Hester, Ashley E; Ankumah, Nana-Ama E; Chauhan, Suneet P; Blackwell, Sean C; Sibai, Baha M

    2017-09-24

    Our objective was to determine if transvaginal cervical length at 16-20 weeks is predictive of preterm birth < 34 weeks in a large cohort of twin pregnancies. This is a secondary analysis from a randomized trial of 17 alpha-hydroxyprogesterone caproate in twins to prevent preterm birth. Transvaginal cervical length was performed at 16-20-week gestation. The inclusion criteria were nonanomalous twins with transvaginal cervical length at 16-20 weeks. Receiver-operating characteristic (ROC) curves were generated to determine the transvaginal cervical length associated with preterm birth. Of 655 pregnancies, 27% (N = 178) women met our inclusion criteria. The rate of spontaneous preterm birth before 34 weeks was 16% (N = 29). A receiver operator characteristic curve was generated for all preterm birth < 34 weeks (spontaneous and indicated) which demonstrated an area under the curve of 0.51, 95% CI (0.41-0.61). When indicated preterm birth (n = 15) were excluded, the area under the curve was 0.59 (95% CI 0.47-0.70), indicating that transvaginal cervical length values were not a clinically useful test for prediction of spontaneous preterm birth. A transvaginal cervical length of 30 mm from this model would produce a sensitivity of detecting spontaneous preterm birth of 95% and a specificity of 14%. In an asymptomatic twin population, a single transvaginal cervical length between 16-20 weeks was not predictive of spontaneous preterm birth before 34 weeks. Thus, our findings suggest that routine transvaginal cervical length screening of twins should not be performed between 16-20 weeks.

  10. Transvaginal/Transumbilical Hybrid—NOTES—Versus 3-Trocar Needlescopic Cholecystectomy: Short-term Results of a Randomized Clinical Trial

    PubMed Central

    Knuth, Jürgen; Cerasani, Nicola; Sauerwald, Axel; Lefering, Rolf; Heiss, Markus Maria

    2015-01-01

    Objective: For cholecystectomy, both the needlescopic cholecystectomy (NC) 3-trocar technique using 2 to 3 mm trocars and the umbilical-assisted transvaginal cholecystectomy (TVC) technique have found their way into clinical routine. This study compares these 2 techniques in female patients who are in need of an elective cholecystectomy. Background: Natural orifice transluminal endoscopic surgery (NOTES) is a surgical concept permitting scarless intra-abdominal operations through natural orifices, such as the vagina. Because of the lack of an adequately powered trial, we designed this first randomized controlled study for the comparison of TVC and NC. Methods: This prospective, randomized, nonblinded, single-center trial evaluates the safety and effectiveness of TVC (intervention), compared with NC (control) in female patients with symptomatic cholecystolithiasis. The primary endpoint was intensity of pain until the morning of postoperative day (POD) 2. Secondary outcomes were among others intra- and postoperative complications, procedural time, amount of analgesics used, pain intensity until POD 10, duration of hospital stay, satisfaction with the aesthetic result, and quality of life on POD 10 as quantified with the Eypasch Gastrointestinal Quality of Life Index (GIQLI). Results: Between February 2010 and June 2012, 40 patients were randomly assigned to the interventional or control group. All patients completed follow-up. Procedural time, length of postoperative hospital stay, and the rate of intra- and postoperative complications were similar in the 2 groups. However, significant advantages were found for the transvaginal access regarding pain until POD 2, but also until POD 10 (P = 0.043 vs P = 0.010) despite significantly less use of peripheral analgesics (P = 0.019). In the TVC group, patients were significantly more satisfied with the aesthetic result (P < 0.001) and had a significantly better GIQLI (P = 0.028). Conclusions: Although comparable in terms of

  11. First-trimester uterine scar assessment by transvaginal ultrasound.

    PubMed

    Stirnemann, Julien J; Chalouhi, Gihad E; Forner, Sylvana; Saidji, Yasmine; Salomon, Laurent J; Bernard, Jean-Pierre; Ville, Yves

    2011-12-01

    The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan. Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within cervicoisthmic canal (CIC); type 1B, thin above the internal os (IO); type 2A, dehiscent within the CIC; type 2B, dehiscent above the IO. Accuracy of first-trimester TVUS was investigated by blind testing a panel of 14 operators over a web-based dataset. The scar was visualized in 122 of 123 patients enrolled. Types 1A, 1B, 2A, and 2B occurred in 49.2%, 3.3%, 38.3%, and 9.2%, respectively. When blind tested, fetal medicine specialists achieved a median sensitivity of 82% and specificity of 100% for the detection of a scar. These were 83% and 87% for nonspecialists. First-trimester uterine scar assessment may become a valuable tool in early recognition of patients at risk of subsequent perinatal complications. Copyright © 2011 Mosby, Inc. All rights reserved.

  12. Endometrial assessment by transvaginal sonography and histological findings after D & C in women with postmenopausal bleeding.

    PubMed

    Conoscenti, G; Meir, Y J; Fischer-Tamaro, L; Maieron, A; Natale, R; D'Ottavio, G; Rustico, M; Mandruzzato, G

    1995-08-01

    A total of 149 women with postmenopausal bleeding underwent transvaginal sonography, hysteroscopy and dilatation and curettage in order to study the diagnostic accuracy of several ultrasound parameters in assessing endometrial pathology and to determine the most sensitive cut-off value of endometrial thickness for the exclusion of endometrial lesions. In distinguishing pathological from normal endometrium, transvaginal sonography showed a sensitivity of 69.3%, specificity of 82.7%, positive predictive value of 74.1% and negative predictive value of 72.1%. In detecting premalignant and malignant endometrial pathology, transvaginal sonography showed a sensitivity, specificity, positive predictive value and negative predictive value of 55%, 96.1%, 68.7% and 93.2%, respectively. Considering endometrial thickness as a single parameter, the most sensitive cut-off for defining normality was 4 mm; nevertheless, in the group of patients that had an endometrial thickness less than 4 mm, there was one case of malignancy (sensitivity, 95.2%; specificity, 49.4%; positive predictive value, 57.3%; and negative predictive value, 93.5%). Transvaginal sonography combined evaluation (morphology, thickness and color Doppler) showed a poor diagnostic accuracy in detecting endometrial pathology and in differentiating between endometrial benign lesions, endometrial polyps and adenocarcinoma in women with postmenopausal bleeding. Endometrial thickness evaluated with transvaginal sonography was preferable but not sensitive enough to exclude endometrial pathology.

  13. Attitudes toward transvaginal mesh among patients in a urogynecology practice

    PubMed Central

    Dessie, Sybil G.; Hacker, Michele R.; Haviland, Miriam J.; Rosenblatt, Peter L.

    2015-01-01

    Introduction and hypothesis There has been increasing media attention regarding transvaginal mesh (TVM). We hypothesized that new urogynecology patients have limited knowledge and negative opinions of TVM. Methods An anonymous survey was distributed to all new patients presenting to the Mt Auburn Hospital urogynecology practice from 1 November 2012 to 31 January 2013. A total of 146 patients completed the questionnaire. The survey was designed to elicit information on participants’ knowledge and opinions about TVM and knowledge about recent FDA safety communications. All statistical tests were two-sided, and P values <0.05 were considered statistically significant. Results Analyses were restricted to the 77 women who had either heard of TVM or were unsure if they had heard of TVM. A minority (32.5 %) of these women correctly defined TVM, and 33.8 % had a negative impression of TVM. Respondents obtained their information on TVM from the media (48.1 %), the Internet (24.7 %), family or friends (22.1 %), and health care providers (18.2 %). The majority (71.4 %) agreed that they needed more information about TVM before making any decisions about using it to treat their condition. Nearly one quarter of respondents (23.4 %) agreed that they would not want their doctor to use TVM on them for any reason. When asked about recent FDA communications, 27.3 % of patients correctly responded that the FDA had released a safety communication regarding TVM. Conclusions The majority of participants had limited knowledge of TVM; however, only a minority had negative opinions. Given our findings, it is important that providers spend more time during the consent process explaining TVM and its risks and benefits as a treatment option. PMID:25595568

  14. Cervical length measurement: Comparison of transabdominal and transvaginal approach

    PubMed Central

    Pedersen, Lars Henning; Hyett, Jon

    2015-01-01

    Abstract Objective: To compare transabdominal (TA) and transvaginal (TV) ultrasound assessment of cervical length at 16–41 weeks gestation. Methods: TA and TV ultrasound measurements of cervical length were made on 491 pregnancies of 16–41 weeks gestation. Cervical length was measured from internal to external cervical os. Bland‐Altman plots and Wilcoxon signed rank test were used to evaluate differences between TA and TV measurements. Results: The validity of the TA method depended on cervical length. Although the TA method underestimated cervical length by 2.0 mm on average (P < 0.001), Bland Altman plots showed an inverse trend with shorter cervixes. In women with a cervix < 25 mm (n = 30) based on TV scan measurement, TA overestimated cervical length by 12 mm (P < 0.001). The sensitivity and specificity of TA as a test to detect cervical length < 25 mm were 10% (95% CI: 2.1–26%) and 94% (95% CI: 92–96%) respectively; the negative LR was 0.96 (95% CI: 0.84–1.08). The maximum area under the ROC curve would be obtained at a TA cut‐off = 32 mm (to detect a cervix < 25 mm), corresponding to a sensitivity of 77% and a specificity of 58%. Conclusion: TA measurements do not reflect TV assessment accurately, particularly if the cervix is short. At 24–34 weeks, a policy of proceeding to TV scan if TA measurement is < 25 mm will only detect 10% of affected pregnancies and has a poor positive predictive value so is of limited value as a predictive tool for women attending with symptoms and signs of preterm labour > 24 weeks gestation. There is no value in TA assessment of the cervix > 36 weeks. PMID:28191237

  15. Cervical length measurement: Comparison of transabdominal and transvaginal approach.

    PubMed

    Westerway, Susan Campbell; Pedersen, Lars Henning; Hyett, Jon

    2015-02-01

    Objective: To compare transabdominal (TA) and transvaginal (TV) ultrasound assessment of cervical length at 16-41 weeks gestation. Methods: TA and TV ultrasound measurements of cervical length were made on 491 pregnancies of 16-41 weeks gestation. Cervical length was measured from internal to external cervical os. Bland-Altman plots and Wilcoxon signed rank test were used to evaluate differences between TA and TV measurements. Results: The validity of the TA method depended on cervical length. Although the TA method underestimated cervical length by 2.0 mm on average (P < 0.001), Bland Altman plots showed an inverse trend with shorter cervixes. In women with a cervix < 25 mm (n = 30) based on TV scan measurement, TA overestimated cervical length by 12 mm (P < 0.001). The sensitivity and specificity of TA as a test to detect cervical length < 25 mm were 10% (95% CI: 2.1-26%) and 94% (95% CI: 92-96%) respectively; the negative LR was 0.96 (95% CI: 0.84-1.08). The maximum area under the ROC curve would be obtained at a TA cut-off = 32 mm (to detect a cervix < 25 mm), corresponding to a sensitivity of 77% and a specificity of 58%. Conclusion: TA measurements do not reflect TV assessment accurately, particularly if the cervix is short. At 24-34 weeks, a policy of proceeding to TV scan if TA measurement is < 25 mm will only detect 10% of affected pregnancies and has a poor positive predictive value so is of limited value as a predictive tool for women attending with symptoms and signs of preterm labour > 24 weeks gestation. There is no value in TA assessment of the cervix > 36 weeks.

  16. Sexual function in women before and after transvaginal mesh repair for pelvic organ prolapse.

    PubMed

    Sentilhes, Loïc; Berthier, Aurélien; Sergent, Fabrice; Verspyck, Eric; Descamps, Philippe; Marpeau, Loïc

    2008-06-01

    The aim of the study was to assess sexual function in women before and after surgery with transvaginal mesh for pelvic organ prolapse. Women were invited to complete a sexual function questionnaire including the Lemack and the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaires (PISQ-12) before undergoing surgery and 1 year after surgery. Eighty-three complete pre and postoperative questionnaires were analyzed. Mean age was 65.1 years. Forty-six were sexually inactive and 37 were sexually active women. Two sexually active women completed the preoperative PISQ-12 questionnaire retrospectively after surgery. There were no significant differences after surgery in the answers to the Lemack questionnaire and PISQ-12 scores. These results suggest that nonabsorbable transvaginal mesh repair of genital prolapse does not impair sexual function 1 year after surgery. Nevertheless, patients should not necessarily expect a significant improvement in sexual function outcome following transvaginal mesh repair for genital prolapse.

  17. Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.

    PubMed

    Gyang, Anthony N; Feranec, Jessica B; Patel, Rakesh C; Lamvu, Georgine M

    2014-03-01

    In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0 % and 30 % of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions.

  18. Physics Notes.

    ERIC Educational Resources Information Center

    School Science Review, 1980

    1980-01-01

    Presents nine physics notes for British secondary school teachers. Some of these notes are: (1) speed of sound in a steel rod; (2) physics extracts-part four (1978); and (3) a graphical approach to acceleration. (HM)

  19. Apparatus Notes.

    ERIC Educational Resources Information Center

    Eaton, Bruce G., Ed.

    1980-01-01

    Presents four notes that report new equipment and techniques of interest to physics teachers. These notes deal with collosions of atoms in solids, determining the viscosity of a liquid, measuring the speed of sound and demonstrating Doppler effect. (HM)

  20. Apparatus Notes.

    ERIC Educational Resources Information Center

    Eaton, Bruce G., Ed.

    1980-01-01

    Presents four notes that report new equipment and techniques of interest to physics teachers. These notes deal with collosions of atoms in solids, determining the viscosity of a liquid, measuring the speed of sound and demonstrating Doppler effect. (HM)

  1. Diagnosis of Pentalogy of Cantrell in the First Trimester Using Transvaginal Sonography and Color Doppler

    PubMed Central

    Türkçapar, Ayşe Figen; Sargın Oruc, Ayla; Öksüzoglu, Aysegül; Danışman, Nuri

    2015-01-01

    We report the prenatal diagnosis of Cantrell syndrome in the first trimester. During a routine transabdominal ultrasonographic examination, a midline supraumbilical abdominal wall defect including herniated liver and ectopia cordis with a large omphalocele containing the intestines and cystic hygroma was incidentally identified at the 12th week of gestation. A transvaginal sonography examination revealed a severe lumbosacral scoliosis in addition to the inability to visualize the abdominal aorta which was indicative of a severe intracardiac defect. The parents opted for pregnancy to be terminated. In this case report, we discuss the complementary role of transvaginal sonography and Doppler imaging in the diagnosis of Cantrell syndrome in early pregnancy. PMID:25802780

  2. Suicide notes.

    PubMed

    O'Donnell, I; Farmer, R; Catalan, J

    1993-07-01

    Detailed case reports of incidents of suicide and attempted suicide on the London Underground railway system between 1985 and 1989 were examined for the presence of suicide notes. The incidence of note-leaving was 15%. Notes provided little insight into the causes of suicide as subjectively perceived, or strategies for suicide prevention.

  3. Natural orifice transluminal endoscopic wedge hepatic resection with a water-jet hybrid knife in a non-survival porcine model

    PubMed Central

    Shi, Hong; Jiang, Sheng-Jun; Li, Bin; Fu, Deng-Ke; Xin, Pei; Wang, Yong-Guang

    2011-01-01

    AIM: To explore the feasibility of a water-jet hybrid knife to facilitate wedge hepatic resection using a natural orifice transluminal endoscopic surgery (NOTES) approach in a non-survival porcine model. METHODS: The Erbe Jet2 water-jet system allows a needleless, tissue-selective hydro-dissection with a pre-selected pressure. Using this system, wedge hepatic resection was performed through three natural routes (trans-anal, trans-vaginal and trans-umbilical) in three female pigs weighing 35 kg under general anesthesia. Entry into the peritoneal cavity was via a 15-mm incision using a hook knife. The targeted liver segment was marked by an APC probe, followed by wedge hepatic resection performed using a water-jet hybrid knife with the aid of a 4-mm transparent distance soft cap mounted onto the tip of the endoscope for holding up the desired plane. The exposed vascular and ductal structures were clipped with Endoclips. Hemostasis was applied to the bleeding cut edges of the liver parenchyma by electrocautery. After the procedure, the incision site was left open, and the animal was euthanized followed by necropsy. RESULTS: Using the Erbe Jet2 water-jet system, trans-anal and trans-vaginal wedge hepatic resection was successfully performed in two pigs without laparoscopic assistance. Trans-umbilical attempt failed due to an unstable operating platform. The incision for peritoneal entry took 1 min, and about 2 h was spent on excision of the liver tissue. The intra-operative blood loss ranged from 100 to 250 mL. Microscopically, the hydro-dissections were relatively precise and gentle, preserving most vessels. CONCLUSION: The Erbe Jet2 water-jet system can safely accomplish non-anatomic wedge hepatic resection in NOTES, which deserves further studies to shorten the dissection time. PMID:21412502

  4. Natural orifice transluminal endoscopic wedge hepatic resection with a water-jet hybrid knife in a non-survival porcine model.

    PubMed

    Shi, Hong; Jiang, Sheng-Jun; Li, Bin; Fu, Deng-Ke; Xin, Pei; Wang, Yong-Guang

    2011-02-21

    To explore the feasibility of a water-jet hybrid knife to facilitate wedge hepatic resection using a natural orifice transluminal endoscopic surgery (NOTES) approach in a non-survival porcine model. The Erbe Jet2 water-jet system allows a needleless, tissue-selective hydro-dissection with a pre-selected pressure. Using this system, wedge hepatic resection was performed through three natural routes (trans-anal, trans-vaginal and trans-umbilical) in three female pigs weighing 35 kg under general anesthesia. Entry into the peritoneal cavity was via a 15-mm incision using a hook knife. The targeted liver segment was marked by an APC probe, followed by wedge hepatic resection performed using a water-jet hybrid knife with the aid of a 4-mm transparent distance soft cap mounted onto the tip of the endoscope for holding up the desired plane. The exposed vascular and ductal structures were clipped with Endoclips. Hemostasis was applied to the bleeding cut edges of the liver parenchyma by electrocautery. After the procedure, the incision site was left open, and the animal was euthanized followed by necropsy. Using the Erbe Jet2 water-jet system, trans-anal and trans-vaginal wedge hepatic resection was successfully performed in two pigs without laparoscopic assistance. Trans-umbilical attempt failed due to an unstable operating platform. The incision for peritoneal entry took 1 min, and about 2 h was spent on excision of the liver tissue. The intra-operative blood loss ranged from 100 to 250 mL. Microscopically, the hydro-dissections were relatively precise and gentle, preserving most vessels. The Erbe Jet2 water-jet system can safely accomplish non-anatomic wedge hepatic resection in NOTES, which deserves further studies to shorten the dissection time.

  5. Feasibility, effectiveness and safety of transvaginal digoxin administration prior to dilation and evacuation.

    PubMed

    Tocce, Kristina; Sheeder, Jeanelle Leigh; Edwards, Louis Jerry; Teal, Stephanie Beth

    2013-12-01

    This study evaluates the feasibility, efficacy and safety of transvaginal digoxin administration to induce fetal demise prior to dilation and evacuation. This descriptive report from a single center involves a large case series of dilations and evacuations (D&Es) ranging from 18 to 22 weeks of gestation. Transvaginal feticidal injection with digoxin was attempted in 1640 cases; intrafetal, intraamniotic and combined (intrafetal and intraamniotic) injections were administered. Digoxin dosage ranged from 0.5 to 3.0 mg, with the majority receiving 1.0 mg. Cases were reviewed to determine feasibility, efficacy and adverse events. Successful completion of transvaginal injection occurred in 98.5% (1637/1662) of eligible cases, and 1596 cases were evaluable for fetal demise. Demise occurred by the time of D&E in 99.4% of all cases; 99.7% of intrafetal injections resulted in fetal demise. Doses ≥1 mg were equally effective (98.1%-99.6%) regardless of injection site (intraamniotic, combined intrafetal/intraamniotic or intrafetal). Doses <1.0 mg were less successful at inducing demise if not administered intrafetally (p<.001). Rates of ruptured membranes (4.1%), chorioamnionitis (0.49%) and extramural deliveries (0.12%) were low. Patients who experienced complications were more likely to be of greater gestational age and have had a previous cesarean section. Transvaginal digoxin administration is feasible, effective and safe. This study demonstrates the feasibility, effectiveness and safety of transvaginal digoxin administration in a large clinical cohort. Future studies will be needed to determine if this method of administration improves patient satisfaction and outcomes when compared to transabdominal feticidal injections. © 2013.

  6. Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect.

    PubMed

    Wang, Chin-Jung; Huang, Huei-Jean; Chao, Angel; Lin, Yu-Pin; Pan, Yi-Jung; Horng, Shang-Gwo

    2011-02-01

    Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB). The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode. The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p < 0.001). However, only 59.6% of patients (34/57) reported a postoperative improvement in symptoms. A significant postoperative improvement was observed more frequently in patients with anteflexed uteri than in patients with retroflexed uteri, and this difference was significant (90.6% (29/32) and 20.0% (5/25), respectively; p < 0.001). No correlations were found between treatment outcome and age, body weight, parity, number of cesarean deliveries, duration of preoperative menstruation, or operating time. Resectoscopic uterine remodeling is an

  7. Chemistry Notes.

    ERIC Educational Resources Information Center

    School Science Review, 1980

    1980-01-01

    Presents 12 chemistry notes for British secondary school teachers. Some of these notes are: (1) a simple device for testing pH-meters; (2) portable fume cupboard safety screen; and (3) Mass spectroscopy-analysis of a mass peak. (HM)

  8. Chemistry Notes.

    ERIC Educational Resources Information Center

    School Science Review, 1980

    1980-01-01

    Presents 12 chemistry notes for British secondary school teachers. Some of these notes are: (1) a simple device for testing pH-meters; (2) portable fume cupboard safety screen; and (3) Mass spectroscopy-analysis of a mass peak. (HM)

  9. Postoperative endocrine alterations and clinical outcome of infertile women with polycystic ovary syndrome after transvaginal hydrolaparoscopic ovarian drilling.

    PubMed

    Shibahara, Hiroaki; Hirano, Yuki; Kikuchi, Kumiko; Suzuki, Tatsuya; Takamizawa, Satoru; Suzuki, Mitsuaki

    2006-01-01

    Transvaginal hydrolaparoscopic ovarian drilling (THLOD) appears to be an effective minimally invasive procedure to induce ovulation in women with polycystic ovary syndrome (PCOS). Postoperative endocrinological alterations following THLOD show significant decrease of serum LH and testosterone concentrations.

  10. Science Notes.

    ERIC Educational Resources Information Center

    School Science Review, 1987

    1987-01-01

    This section of the journal includes several short notes on science activities and materials for secondary schools. Activities and materials are included that relate to biology, microbiology, microcomputers, chemistry, and physics. (RH)

  11. Chemistry Notes.

    ERIC Educational Resources Information Center

    School Science Review, 1978

    1978-01-01

    Describes experiments, demonstrations, activities and ideas relating to various fields of chemistry to be used in chemistry courses of secondary schools. Three experiments concerning differential thermal analysis are among these notes presented. (HM)

  12. Project Notes

    ERIC Educational Resources Information Center

    School Science Review, 1978

    1978-01-01

    Presents sixteen project notes developed by pupils of Chipping Norton School and Bristol Grammar School, in the United Kingdom. These Projects include eight biology A-level projects and eight Chemistry A-level projects. (HM)

  13. Blue Note

    ScienceCinema

    Murray Gibson

    2016-07-12

    Argonne's Murray Gibson is a physicist whose life's work includes finding patterns among atoms. The love of distinguishing patterns also drives Gibson as a musician and Blues enthusiast."Blue" notes are very harmonic notes that are missing from the equal temperament scale.The techniques of piano blues and jazz represent the melding of African and Western music into something totally new and exciting.

  14. Blue Note

    SciTech Connect

    Murray Gibson

    2007-04-27

    Argonne's Murray Gibson is a physicist whose life's work includes finding patterns among atoms. The love of distinguishing patterns also drives Gibson as a musician and Blues enthusiast."Blue" notes are very harmonic notes that are missing from the equal temperament scale.The techniques of piano blues and jazz represent the melding of African and Western music into something totally new and exciting.

  15. A novel hybrid tobacco product that delivers a tobacco flavour note with vapour aerosol (Part 1): Product operation and preliminary aerosol chemistry assessment.

    PubMed

    Poynton, Simon; Sutton, Joseph; Goodall, Sharon; Margham, Jennifer; Forster, Mark; Scott, Ken; Liu, Chuan; McAdam, Kevin; Murphy, James; Proctor, Christopher

    2017-08-01

    Vapour products have demonstrated potential to be a lower-risk alternative to cigarettes. The present study describes a novel hybrid tobacco product that combines a warm aerosol stream generated by an electronic vaporisation mechanism with tobacco top flavour from cut tobacco. During operation, the aerosol stream released from the vapour cartomiser is passed through a bed of blended cut tobacco by the puffing flow, elevating the tobacco temperature and eluting volatile tobacco flavour components. A preliminary but comprehensive analysis of the aerosol composition of the hybrid tobacco product found that emissions were dominated by the control vapour formulation. In non-targeted chemical screening, no detectable difference in GC scans was observed between the hybrid tobacco product and the control vapour product. However, a sensorially elevated tobacco flavour was confirmed by a consumer sensory panel (P < 0.05). In a targeted analysis of 113 compounds, either identified by regulatory bodies as potential toxicants in cigarette smoke or formed from electronic vapour products, only 26 were quantified. The novel action of tobacco heating and liquid aerosolisation produced classes and levels of toxicants that were similar to those of the control vapour product, but much lower than those of a Kentucky 3R4F reference cigarette. For nine toxicants mandated by the WHO Study Group on Tobacco Product Regulation for reduction in cigarette emissions, the levels were 91%-99% lower per puff in the hybrid tobacco product aerosol than in 3R4F smoke. Overall, the novel hybrid tobacco product provides a sensorially enhanced tobacco flavour, but maintains a toxicant profile similar to its parent vapour product with relatively low levels of known cigarette smoke toxicants. Copyright © 2017 British American Tobacco. Published by Elsevier Ltd.. All rights reserved.

  16. Birth of Siberian tiger (Panthera tigris altaica) cubs after transvaginal artificial insemination.

    PubMed

    Chagas e Silva, J N; Leitão, R M; Lapão, N E; da Cunha, M B; da Cunha, T P; da Silva, J P; Paisana, F C

    2000-12-01

    A captive 9-yr-old female Siberian tiger (Panthera tigris altaica) at the Lisbon Zoo was treated with equine chorionic gonadotropin followed 80 hr later by human chorionic gonadotropin to stimulate follicular development and ovulation, respectively. Forty-one hours after the second hormone administration, the tiger was subjected to transvaginal artificial insemination with diluted fresh semen containing 500 x 10(6) motile spermatozoa obtained from an 8-yr-old male Siberian tiger via electroejaculation. After anesthesia, the female tiger was placed in an inclined position with the hind limbs elevated during and after the insemination and was maintained in this position for 15 min to minimize semen reflux. An anesthetic reversal agent was then administered. After a 103-day gestation, the female gave birth to three apparently healthy cubs that survived 24-48 hr. These results demonstrate that transvaginal artificial insemination can be successfully performed in the Siberian tiger to produce full-term offspring.

  17. [Migration of surgical sponge retained at transvaginal hysterectomy into the bladder: a case report].

    PubMed

    Kato, K; Kawai, T; Suzuki, K; Sai, S; Murase, T

    1998-03-01

    Urge incontinence and frequency, persisting despite oral anticholinergics and antibiotics for four months, brought a 72-year-old woman to our hospital. Plain abdominal X-ray followed by cystoscopy demonstrated a large stone (43 x 37 mm) in the bladder, and the patient underwent suprapubic cystotomy to remove the stone. The stone contained a surgical sponge, which was apparently left in situ at transvaginal hysterectomy two years previously. The sponge had most likely eroded the bladder wall and migrated into the cavity. We found a total of 17 cases reported in Japan of a surgical sponge migrating into the bladder. In particular, our case was associated with transvaginal surgery, while the other 16 cases involved transabdominal surgery.

  18. Comparison of Office Hysteroscopy, Transvaginal Ultrasonography and Endometrial Biopsy in Evaluation of Abnormal Uterine Bleeding

    PubMed Central

    Lapensee, L.; Toth, T.L.; Isaacson, K.B.

    1997-01-01

    Objective: A comparison between office hysteroscopy, transvaginal ultrasonography and endometrial biopsy was performed, in terms of detection of intrauterine lesions. A secondary objective was assessment of evaluatory approach in the management of abnormal uterine bleeding in an outpatient setting. Design: Prospective observational study. Material and Methods: A total of 54 women were evaluated for abnormal uterine bleeding. Assessment included performance of an endometrial biopsy, a transvaginal ultra-sound scan followed by office hysteroscopy. Results of hysteroscopy were taken as the gold standard. Sensitivity and specificity of the investigations were assessed. The bleeding pattern was classified as heavy regular, irregular, postmenopausal and heavy or unscheduled bleeding on hormone replacement therapy. Results: The incidence of focal intrauterine lesions in patients presenting with abnormal bleeding was 52% for all ages and 31% for the postmenopausal group. Seventy-five percent of the patients with Hb < 11 gm% and 67% with an enlarged uterus harbored a focal pathology. The incidence of lesions in patients with heavy regular bleeding was 74%. The sensitivity and specificity of transvaginal ultrasound when compared with results of hysteroscopy was 0.60 and 0.88 respectively. A normal endometrial biopsy had a negative predictive value of 51%. The sensitivity and specificity of endometrial biopsy were 0.04 and 0.83, respectively. Conclusion: Both transvaginal ultrasound and endometrial biopsy exhibited poor sensitivity for detection of focal intrauterine lesions. Considering the significantly high incidence of intrauterine lesions in patients presenting with abnormal bleeding, the most cost-effective approach appears to be proceeding with hysteroscopy early in assessment. PMID:9876659

  19. A new species of Melitaea from Israel, with notes on taxonomy, cytogenetics, phylogeography and interspecific hybridization in the Melitaea persea complex (Lepidoptera, Nymphalidae).

    PubMed

    Lukhtanov, Vladimir A

    2017-01-01

    Specimens with intermediate morphology are often considered to be the result of ongoing interspecific hybridization; however, this conclusion is difficult to prove without analysis of chromosomal and/or molecular markers. In the butterfly genus Melitaea, such an intermediacy can be detected in male genitalia, and is more or less regularly observed in localities where two closely related, presumably parental species are found in sympatry. Here I analyze a high altitude Melitaea population from Mt. Hermon in north Israel and show that its male genitalia are clearly differentiated from those found in phenotypically similar M. persea and M. didyma, but in some aspects intermediate between them. This hybrid-like population is unique because, although M. didyma is present on Mt. Hermon, the true, low-altitude M. persea has never been reported from Israel. Cytogenetic analysis revealed no apomorphic chromosomal characters to distinguish the Mt. Hermon population from other known taxa of the M. persea and M. didyma species groups. At the same time, DNA barcode-based phylogeographic study showed that this population is ancient. It was estimated to originate 1-1.6 million years ago in the Levantine refugium from a common ancestor with M. persea. Generally, the data obtained are incompatible with interpretation of the studied population as a taxon conspecific with M. persea or M. didyma, or a swarm of recent hybrids between M. persea and M. didyma, although the possibility of ancient homoploid hybrid speciation cannot be ruled out. I also argue that the name Melitaea montium assigned to butterflies from north Lebanon cannot be applied to the studied taxon from Mt. Hermon. Here I describe this morphologically and ecologically distinct entity as a new species Melitaea acentriasp. n., and compare it with other taxa of the M. persea complex.

  20. NOTE: Hybrid plan verification for intensity-modulated radiation therapy (IMRT) using the 2D ionization chamber array I'mRT MatriXX—a feasibility study

    NASA Astrophysics Data System (ADS)

    Dobler, Barbara; Streck, Natalia; Klein, Elisabeth; Loeschel, Rainer; Haertl, Petra; Koelbl, Oliver

    2010-01-01

    The 2D ionization chamber array I'mRT MatriXX (IBA, Schwarzenbruck, Germany) has been developed for absolute 2D dosimetry and verification of intensity-modulated radiation therapy (IMRT) for perpendicular beam incidence. The aim of this study is to evaluate the applicability of I'mRT MatriXX for oblique beam incidence and hybrid plan verification of IMRT with original gantry angles. For the assessment of angular dependence, open fields with gantry angles in steps of 10° were calculated on a CT scan of I'mRT MatriXX. For hybrid plan verification, 17 clinical IMRT plans and one rotational plan were used. Calculations were performed with pencil beam (PB), collapsed cone (CC) and Monte Carlo (MC) methods, which had been previously validated. Measurements were conducted on an Elekta SynergyS linear accelerator. To assess the potential and limitations of the system, gamma evaluation was performed with different dose tolerances and distances to agreement. Hybrid plan verification passed the gamma test with 4% dose tolerance and 3 mm distance to agreement in all cases, in 82-88% of the cases for tolerances of 3%/3 mm, and in 59-76% of the cases if 3%/2 mm were used. Separate evaluation of the low dose and high dose regions showed that I'mRT MatriXX can be used for hybrid plan verification of IMRT plans within 3% dose tolerance and 3 mm distance to agreement with a relaxed dose tolerance of 4% in the low dose region outside the multileaf collimator (MLC).

  1. A novel hybrid tobacco product that delivers a tobacco flavour note with vapour aerosol (Part 2): In vitro biological assessment and comparison with different tobacco-heating products.

    PubMed

    Breheny, Damien; Adamson, Jason; Azzopardi, David; Baxter, Andrew; Bishop, Emma; Carr, Tony; Crooks, Ian; Hewitt, Katherine; Jaunky, Tomasz; Larard, Sophie; Lowe, Frazer; Oke, Oluwatobiloba; Taylor, Mark; Santopietro, Simone; Thorne, David; Zainuddin, Benjamin; Gaça, Marianna; Liu, Chuan; Murphy, James; Proctor, Christopher

    2017-08-01

    This study assessed the toxicological and biological responses of aerosols from a novel hybrid tobacco product. Toxicological responses from the hybrid tobacco product were compared to those from a commercially available Tobacco Heating Product (c-THP), a prototype THP (p-THP) and a 3R4F reference cigarette, using in vitro test methods which were outlined as part of a framework to substantiate the risk reduction potential of novel tobacco and nicotine products. Exposure matrices used included total particulate matter (TPM), whole aerosol (WA), and aqueous aerosol extracts (AqE) obtained after machine-puffing the test products under the Health Canada Intense smoking regime. Levels of carbonyls and nicotine in these matrices were measured to understand the aerosol dosimetry of the products. The hybrid tobacco product tested negative across the in vitro assays including mutagenicity, genotoxicity, cytotoxicity, tumour promotion, oxidative stress and endothelial dysfunction. All the THPs tested demonstrated significantly reduced responses in these in vitro assays when compared to 3R4F. The findings suggest these products have the potential for reduced health risks. Further pre-clinical and clinical assessments are required to substantiate the risk reduction of these novel products at individual and population levels. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Transvaginal versus transabdominal sonography in patients suspected of having ectopic pregnancy.

    PubMed

    Gramith, F; Sirr, S; Hollerman, J; Hawks, L

    1991-01-01

    To determine the value of transvaginal sonography in the evaluation of women with suspected ectopic pregnancy, we retrospectively studied 47 pregnant patients in whom both conventional transabdominal sonography (TAS) and transvaginal sonography (TVS) had been performed. Each patient had been given a standard TAS examination with the bladder moderately distended. After voiding, a TVS examination was performed. TAS and TVS were compared for their ability to reveal specific sonographic findings, including the double decidual sac sign, yolk sac, embryonic pole, and embryonic heart activity. Results indicate that the important sonographic findings of early pregnancy are more likely to be seen transvaginally than transabdominally. In 23% of the patients, only TVS provided the findings for diagnosis of the location and status of the pregnancy. In another 22%, the information gathered through TVS allowed increased confidence in the diagnostic accuracy of the TAS findings by providing additional findings. Therefore, in 45% of the cases, TVS influenced clinical decision-making. In no case was TVS less informative than TAS. These results support the claim that TVS contributes to diagnostic accuracy in early pregnancy. TVS should usually be used in conjunction with, and not as a substitute for, TAS. TVS is best used when TAS is not conclusive, or when immediate confirmation of an intrauterine pregnancy is desired.

  3. Standing ovariectomy in mares using a transvaginal natural orifice transluminal endoscopic surgery (NOTES®) approach.

    PubMed

    Pader, Karine; Lescun, Timothy B; Freeman, Lynetta J

    2011-12-01

    To develop and assess the feasibility of standing transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES®) ovariectomy in the mare. Descriptive study. Mares (n=10). The technique was developed in 6 mares and then evaluated in a short-term study in 4 mares. Abdominal access was developed using controlled access vaginal cannula placement under endoscopic guidance. With viewing provided by a flexible endoscope, hemostasis, and transection of ovarian pedicles was performed using a customized bipolar vessel-sealing device. The ovaries were retrieved and the colpotomy was sutured. Surgical time, intra-, and postoperative complications were recorded. Necropsy was performed immediately after surgery in 6 mares and 15 days after surgery in 4 mares to assess short-term complications. After the instruments and techniques were developed, transvaginal NOTES® ovariectomy was successfully performed. Analgesia during the procedure was adequate in all cases. The visual field provided by the endoscope was acceptable. The customized 60 cm vessel-sealing device provided good hemostasis and a comfortable working length. Intraoperative complications included difficult viewing that prolonged operative time and inability to remove the second ovary in 1 mare. Postoperative recovery was excellent. Postmortem findings of 1 true positive microbial culture, elevated cell counts in abdominal fluid, and adhesion formation raise questions that must be addressed in future studies. Using specialized instruments, transvaginal NOTES® ovariectomy is technically feasible in mares. © Copyright 2011 by The American College of Veterinary Surgeons.

  4. Reinforcement of transvaginal repair using polypropylene mesh functionalized with basic fibroblast growth factor.

    PubMed

    Zhang, Dandan; Lin, Zhi Yuan William; Cheng, Ruoyu; Wu, Wei; Yu, Jia; Zhao, Xin; Chen, Xinliang; Cui, Wenguo

    2016-06-01

    Numerous modifications have been developed over the past two decades seeking to improve the transvaginal repair in the pelvic organ prolapse (POP) by using polypropylene (PP) mesh implants. The hydrophobicity of PP, however, presents a great hindrance for translating potential technologies into viable clinical applications. In this study, by manipulating self-polymerization and strong adhesive characteristics of dopamine, we developed a facile method to enhance the transvaginal repair by modifying PP meshes with polydopamine (PDA), which allowed easy grafting of basic fibroblast growth factor (bFGF) onto the surface of PP. Such surface modification of PP meshes with bFGF was found to efficiently promote bioactivity without changing the morphology or mechanical properties of the PP meshes. Additionally, bFGF-modified PP meshes significantly promoted cell viability and adhesion compared to the unmodified PP. Ultimately, after three months of implantation, the bFGF-modified PP meshes exhibited improved tissue repair with greater degree of organization of deposited collagen, increased tensile strength and reduced inflammatory response. Overall, the surface-modified PP meshes will be highly practical as templates for transvaginal repair in the POP treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Twin pregnancy experimental model for transvaginal ultrasound-guided twin reduction in mares

    PubMed Central

    Raggio, Ignacio; Lefebvre, Réjean C.; Poitras, Pierre; Vaillancourt, Denis; Goff, Alan K.

    2008-01-01

    Multiple pregnancies are still an important cause of noninfectious abortion, stillbirth, neonatal mortality, and significant delays in reproductive performance in mares. Despite new management techniques, reduction in multiple pregnancies is an ongoing preoccupation and challenge for the equine veterinarian. The aim of the present study was to establish a twin pregnancy experimental model in the mare to study the effectiveness of a transvaginal ultrasound-guided embryonic vesicle injection. Mares in heat were inseminated and then received an embryo at day 7 of the estrous cycle. At days 14 and 30, 53.5% (n = 23) and 23% (n = 10) of the mares, respectively, were carrying twins. Twin pregnancies were reduced at day 30 by transvaginal ultrasound-guided puncture of the embryonic vesicle (control, n = 5) or by transvaginal ultrasound-guided injection (TVUEVI) of 25 mg of amikacin into the embryonic vesicle (n = 5). The TVUEVI treatment had a 40% success rate and no significant variations in progesterone and prostaglandin metabolite were observed. Even though the technique does not seem very effective, the experimental model could be useful for clinical research in embryo reduction and early embryonic loss. PMID:19183731

  6. Comparison of transabdominal and transvaginal pelvic ultrasonography for ovarian follicle assessment in in vitro fertilisation.

    PubMed

    O'Shea, R T; Forbes, K L; Scopacasa, L; Jones, W R

    1988-01-01

    The emergence of transvaginal ultrasound-guided oocyte retrieval provided an opportunity to review and improve the traditional transabdominal ultrasonic approach for follicular tracking in in vitro fertilisation (IVF). This technique requires a full bladder, which may cause extreme discomfort. Hence, to provide both effective and comfortable monitoring, we instituted a study comparing transabdominal and transvaginal ultrasonography, with regard to patient preference and follicular number, size and dominance, in patients undergoing IVF and gamete intrafallopian transfer (GIFT). Commencing usually on day 9 of the treatment cycle, 45 patients were scanned on 55 occasions, initially abdominally (with a full bladder) and subsequently vaginally, using a transvaginal 7.5 MHz sector transducer. Follicular number was identical in 78% of cases, with the majority of the remaining patients showing an extra follicle on vaginal assessment. There were no significant differences in overall or dominant follicular diameters with either technique. Overall, 85% unashamedly preferred the vaginal approach. We believe that tracking follicular development in IVF treatment cycles is efficient and popular using the vaginal sector transducer and accordingly have ceased all assessments using the abdominal probe. Subsequently, 450 follicle scans have been performed with virtually the unanimous approval of our patients.

  7. Transvaginal Drainage of Pelvic Abscesses and Collections Using Transabdominal Ultrasound Guidance.

    PubMed

    Ching, Kevin C; Sumkin, Jules H

    2015-01-01

    Objectives. To evaluate clinical outcomes following transvaginal catheter placement using transabdominal ultrasound guidance for management of pelvic fluid collections. Methods. A retrospective review was performed for all patients who underwent transvaginal catheter drainage of pelvic fluid collections utilizing transabdominal ultrasound guidance between July 2008 and July 2013. 24 consecutive patients were identified and 24 catheters were placed. Results. The mean age of patients was 48.1 years (range = 27-76 y). 88% of collections were postoperative (n = 21), 8% were from pelvic inflammatory disease (n = 2), and 4% were idiopathic (n = 1). Of the 24 patients, 83% of patients (n = 20) had previously undergone a hysterectomy and 1 patient (4%) was pregnant at the time of drainage. The mean volume of initial drainage was 108 mL (range = 5 to 570). Catheters were left in place for an average of 4.3 days (range = 1-17 d). Microbial sampling was performed in all patients with 71% (n = 17) returning a positive culture. All collections were successfully managed percutaneously. There were no technical complications. Conclusions. Transvaginal catheter drainage of pelvic fluid collections using transabdominal ultrasound guidance is a safe and clinically effective procedure. Appropriate percutaneous management can avoid the need for surgery.

  8. Accuracy of pre operative real time dynamic transvaginal ultrasound sliding sign in prediction of pelvic adhesions in women with previous abdominopelvic surgery. A prospective multicenter double blinded study.

    PubMed

    Ayachi, Amira; Bouchahda, Rim; Derouich, Sadok; Mkaouer, Lassaad; Kehila, Mehdi; Abouda, Hassine; Channoufi, Badis; Bouyahia, Maha; Braham, Marouen; Zhioua, Fethi; Bouchahda, Haifa; Mourali, Mechaal

    2017-03-13

    To highlight the role of the transvaginal ultrasound sliding sign in predicting pelvic adhesions in women with a previous history of abdominopelvic surgery. Multicenter prospective, interventional, double blinded study. Patients were examined before the laparoscopy or laparotomy, in gynaecological position, with transvaginal ultrasound (TVU) probe to assess vesico uterine pouch, uterus, ovaries, pouch of Douglas by analysing the gliding between two structures. Ultrasounds findings, medical and surgical data were recorded. Accuracy of preoperative TVU sliding sign in diagnosis of pelvic adhesions for each compartment were calculated using sensitivity, specificity, PPV, NPV, LR+, LR- and ROC curves were analysed. During the study period, complete TVU sliding sign and laparoscopic or laparotomy data were available for 107 women. The mean age of our patients in this study was 43.96 (95% CI 41.56-46.35) (range 20 to 79 years). The mean parity was 1.97 (95% CI 1.66-2.29) (range 0 to 9). The mean number of previous abdominal surgeries was 1.33 (95% CI 1.20-1.45) (range 0 to 4). Adhesions were noted at 27/107 (25.23 %) patients with history of abdominopelvic surgery. In our study, the sliding sign technique had a total sensitivity of 96.3% and a total specificity of 92.6%. A significant relationship was noticed between adhesions in each compartment and the ultrasound pelvic sliding sign (p < 0.05). Detecting adhesions in the pelvis by a non-invasive and well tolerated technique like the sliding sign could help in the planning and counselling of the surgery for patients with previous abdominopelvic surgery. This article is protected by copyright. All rights reserved.

  9. Classroom Notes

    ERIC Educational Resources Information Center

    International Journal of Mathematical Education in Science and Technology, 2007

    2007-01-01

    In this issue's "Classroom Notes" section, the following papers are discussed: (1) "Constructing a line segment whose length is equal to the measure of a given angle" (W. Jacob and T. J. Osler); (2) "Generating functions for the powers of Fibonacci sequences" (D. Terrana and H. Chen); (3) "Evaluation of mean and variance integrals without…

  10. Biology Notes.

    ERIC Educational Resources Information Center

    School Science Review, 1984

    1984-01-01

    Presents information on the teaching of nutrition (including new information relating to many current O-level syllabi) and part 16 of a reading list for A- and S-level biology. Also includes a note on using earthworms as a source of material for teaching meiosis. (JN)

  11. Classroom Notes

    ERIC Educational Resources Information Center

    International Journal of Mathematical Education in Science and Technology, 2007

    2007-01-01

    In this issue's "Classroom Notes" section, the following papers are discussed: (1) "Constructing a line segment whose length is equal to the measure of a given angle" (W. Jacob and T. J. Osler); (2) "Generating functions for the powers of Fibonacci sequences" (D. Terrana and H. Chen); (3) "Evaluation of mean and variance integrals without…

  12. Biology Notes.

    ERIC Educational Resources Information Center

    School Science Review, 1984

    1984-01-01

    Presents information on the teaching of nutrition (including new information relating to many current O-level syllabi) and part 16 of a reading list for A- and S-level biology. Also includes a note on using earthworms as a source of material for teaching meiosis. (JN)

  13. Conference Notes.

    ERIC Educational Resources Information Center

    Davis, Pat

    1996-01-01

    Analyzes some of the comments offered by biology teachers concerning dissection in the classroom. Some teachers no longer do dissection, whereas others say that a number of students in every class want to dissect. Discusses problems noted in teachers' and other educators' attitudes as well as possible misinterpretations of students' attitudes by…

  14. Editor's note

    NASA Astrophysics Data System (ADS)

    Umapathy, Siva

    2017-01-01

    This is an editor's note related to the publication 'Biologically active and thermally stable polymeric Schiff base and its metal polychelates: Their synthesis and spectral aspects' by Raza Rasool and Sumaiya Hasnain, which appeared in Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy 148 (2015) 435-443.

  15. Editor's Notes.

    ERIC Educational Resources Information Center

    Smetana, Judith G.

    1994-01-01

    Introduces the articles in this journal issue, noting the burgeoning interest in the roots of parental beliefs, values, and goals. Highlights thematic continuities among the otherwise diverse research approaches presented, for example, synthesis of different theoretical perspectives of parent beliefs, or the context in which parental beliefs…

  16. Classroom Notes

    ERIC Educational Resources Information Center

    International Journal of Mathematical Education in Science and Technology, 2007

    2007-01-01

    In this issue's "Classroom Notes" section, the following papers are described: (1) "Sequences of Definite Integrals" by T. Dana-Picard; (2) "Structural Analysis of Pythagorean Monoids" by M.-Q Zhan and J. Tong; (3) "A Random Walk Phenomenon under an Interesting Stopping Rule" by S. Chakraborty; (4) "On Some Confidence Intervals for Estimating the…

  17. Apparatus Notes.

    ERIC Educational Resources Information Center

    Eaton, Bruce G., Ed.

    1980-01-01

    This collection of notes describes (1) an optoelectronic apparatus for classroom demonstrations of mechanical laws, (2) a more efficient method for demonstrated nuclear chain reactions using electrically energized "traps" and ping-pong balls, and (3) an inexpensive demonstration for qualitative analysis of temperature-dependent resistance. (CS)

  18. Note: Easy-to-maintain electron cyclotron resonance (ECR) plasma sputtering apparatus featuring hybrid waveguide and coaxial cables for microwave delivery

    SciTech Connect

    Akazawa, Housei

    2016-06-15

    The branched-waveguide electron cyclotron resonance plasma sputtering apparatus places quartz windows for transmitting microwaves into the plasma source not in the line of sight of the target. However, the quartz windows must be replaced after some time of operation. For maintenance, the loop waveguide branching from the T-junction must be dismounted and re-assembled accurately, which is a time-consuming job. We investigated substituting the waveguide branches with two sets of coaxial cables and waveguide/coaxial cable converters to simplify assembly as far as connection and disconnection go. The resulting hybrid system worked well for the purposes of plasma generation and film deposition.

  19. Note: Easy-to-maintain electron cyclotron resonance (ECR) plasma sputtering apparatus featuring hybrid waveguide and coaxial cables for microwave delivery

    NASA Astrophysics Data System (ADS)

    Akazawa, Housei

    2016-06-01

    The branched-waveguide electron cyclotron resonance plasma sputtering apparatus places quartz windows for transmitting microwaves into the plasma source not in the line of sight of the target. However, the quartz windows must be replaced after some time of operation. For maintenance, the loop waveguide branching from the T-junction must be dismounted and re-assembled accurately, which is a time-consuming job. We investigated substituting the waveguide branches with two sets of coaxial cables and waveguide/coaxial cable converters to simplify assembly as far as connection and disconnection go. The resulting hybrid system worked well for the purposes of plasma generation and film deposition.

  20. The use of a pedicle screw-cortical screw hybrid system for the surgical treatment of a patient with congenital multilevel spinal non-segmentation defect and spinal column deformity: a technical note.

    PubMed

    Ashayeri, Kimberly; Nasser, Rani; Nakhla, Jonathan; Yassari, Reza

    2016-11-01

    This technical note presents, to the authors' knowledge, the first reported case of a hybrid pedicle-cortical screw system for instrumented fusion in a patient with congenital vertebral column deformity. Cortical screws were navigated using stereotactic guidance to extend a prior non-segmented fusion mass, facilitating instrumentation in a circumstance with completely distorted anatomy. This technique provided a safe trajectory with excellent cortical purchase in an anatomically deformed spine. Cortical screw fixation may serve to be helpful in augmenting pedicle screw fixation and in circumstances in which the bone quality is suboptimal or the pedicles are compromised. Cortical screw fixation is a relatively new technology, but it may prove to be invaluable in providing an adjunct to pedicle screw constructs in anatomically distorted or osteoporotic spines.

  1. Application note :

    SciTech Connect

    Russo, Thomas V.

    2013-08-01

    The development of the XyceTM Parallel Electronic Simulator has focused entirely on the creation of a fast, scalable simulation tool, and has not included any schematic capture or data visualization tools. This application note will describe how to use the open source schematic capture tool gschem and its associated netlist creation tool gnetlist to create basic circuit designs for Xyce, and how to access advanced features of Xyce that are not directly supported by either gschem or gnetlist.

  2. Ultrasound-Guided Transvaginal Core Biopsy of Pelvic Masses: Feasibility, Safety, and Short-Term Follow-Up.

    PubMed

    Park, Jung Jae; Kim, Chan Kyo; Park, Byung Kwan

    2016-04-01

    The purpose of this study was to evaluate the diagnostic accuracy and safety of ultrasound (US)-guided transvaginal core biopsy of pelvic masses. Fifty-five pelvic masses in 55 consecutive women who underwent US-guided transvaginal core biopsy were enrolled in our study. All lesions were detected on CT or MRI before biopsy. The procedure was performed with local anesthesia using a transvaginal US probe equipped with a guide and an 18-gauge needle with an automatic biopsy gun. We evaluated the diagnostic accuracy and complication rate of the procedure. All acquired specimens were adequate for the histopathologic analysis. The overall diagnostic accuracy of US-guided transvaginal core biopsy was 93% (51/55). Of the 55 lesions, 46 (84%) were confirmed to be either benign or malignant tumors, and five (9%) were diagnosed as active or chronic inflammatory lesions. Four lesions (7%) were not histopathologically diagnosed after biopsy: two were confirmed as fibrothecoma and leiomyosarcoma after surgery, and the remaining two were clinically determined to be recurrent cancer. In terms of minor complications, vaginal bleeding occurred in 10 patients (18%), and gross hematuria occurred in two patients (4%). These complications resolved spontaneously in all patients without further workup or treatment. US-guided transvaginal core biopsy seems to be safe and reliable procedure for the histopathologic diagnosis of pelvic masses.

  3. Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases.

    PubMed

    Shalev, E; Yarom, I; Bustan, M; Weiner, E; Ben-Shlomo, I

    1998-01-01

    To evaluate the efficacy of transvaginal sonography and serum beta-hCG levels as diagnostic tools for deciding whether to perform operative laparoscopy in the treatment of presumed ectopic pregnancy (EP). A prospective protocol for the evaluation and treatment of women with presumed EP. Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Israel. Eight hundred forty women with presumed EP who were seen in our emergency department from January 1988 through December 1995. On the basis of specific sonographic signs and beta-hCG levels, we performed immediate operative laparoscopy in patients with demonstrable extrauterine fetal heart activity or >100 mL of fluid in the pelvic cavity. We followed up all other patients, using defined criteria for laparoscopic intervention. The accuracy of transvaginal sonography in predicting EP was evaluated as part of the described protocol. Overall, 380 patients were found to have EP. Of these, 331 were identified positively by transvaginal sonography and 49 were not. In 27 of 358 laparoscopies, no EP was found. The sensitivity of transvaginal sonography for the prediction of EP was 87% and the specificity was 94%. The positive and negative predictive values were 92.5% and 90%, respectively. In this protocol, which invariably captured the true location of the products of conception, using transvaginal sonography as the primary modality in the evaluation of patients with presumed EP resulted in the use of laparoscopy mainly as a treatment tool. This approach is both safe and economical.

  4. Teaching Notes

    NASA Astrophysics Data System (ADS)

    2001-07-01

    If you would like to contribute a teaching note for any of these sections please contact ped@iop.org Contents: LET'S INVESTIGATE: Bows and arrows STARTING OUT: A late start ON THE MAP: A South African school making a world of difference TECHNICAL TRIMMINGS: May the force be with you an easily constructed force sensor Modelling Ultrasound A-scanning with the Pico Technology ADC-200 Virtual Instrument PHYSICS ON A SHOESTRING: Sugar cube radioactivity models CURIOSITY: Euler's disk MY WAY: Why heavy things don't fall faster

  5. Editor's Note.

    PubMed

    Alberts, Bruce

    2011-05-27

    The Research Article "A bacterium that can grow by using arsenic instead of phosphorus" by F. Wolfe-Simon et al., published online 2 December 2010, was the subject of extensive discussion and criticism following its online publication. Science received a wide range of correspondence that raised specific concerns about the Research Article's methods and interpretations. Eight Technical Comments that represent the main concerns, as well as a Technical Response by Wolfe-Simon et al., are published online in Science Express at the addresses listed in this note. They have been peer-reviewed and revised according to Science's standard procedure.

  6. [Transvaginal cervico-isthmic cerclage using polypropylene tape: Surgical procedure and pregnancy outcome].

    PubMed

    Kdous, Moez; Ferchiou, Monia; Chaker, Anis; Zhioua, Feth

    2015-02-01

    To assess the efficacy of performing transvaginal cervicoisthmic cerclage (CIC) using synthetic tape in prevention of preterm labor in high-risk women. A retro and prospective analysis of 23 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of two or more losses in the second trimester and/or prior failure of Hervet or Mac Donald's cerclage. Cerclage was at 14 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. The median age of the patients in this series was 33.2 years (range 25-41 years). No intra-operative complication occurred. The median operating time was 36.9 minutes (±4.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Term birth rate was 57.5% (3% before CIC; p<0.0001). Pregnancy loss in the second trimester was 7.8% (66% before CIC; p<0.0001). Preterm birth rate was 23.1% (31% before CIC). Birth at less than 28 weeks occurred in only 1patients (3.7%) (10.7% before CIC). In one case, the tape has been removed later because of secondary displacement. Amniotic fluid infection occurred in 4 cases (5%). Living birth rate was 80.7% (21% before CIC) and no neonatal death occurred (13% before CIC). Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.

  7. Anatomical and Functional Outcomes of Prolift Transvaginal Mesh for Treatment of Pelvic Organ Prolapse.

    PubMed

    Song, Wan; Kim, Tae Heon; Chung, Jin Woo; Cho, Won Jin; Lee, Ha Na; Lee, Young Suk; Lee, Kyu-Sung

    2016-09-01

    To evaluate anatomical and functional outcomes of the Prolift Transvaginal Mesh for treatment of pelvic organ prolapse (POP) with regard to safety and satisfaction. We reviewed the medical records of 163 patients who underwent POP repair with Prolift Transvaginal Mesh between December 2005 and March 2012. An "optimal" anatomic outcome was defined as Pelvic Organ Prolapse Quantification System (POP-Q) stage 0, and a "satisfactory" anatomic outcome was defined as POP-Q stage 1. A total of 163 patients were included in this study, with a mean age (range) of 61.6 (35-83) years. An anterior mesh was used in 110 patients, and combined anterior and posterior mesh was used in 53 patients. The mean follow-up period after POP repair was 40.4 (12-63) months. Optimal anatomic outcomes for anterior, apical, and posterior prolapse were achieved in 55.9, 69.2, and 65.8% of cases, respectively. Optimal or satisfactory anatomic outcomes for anterior, apical, and posterior prolapse occurred in 76.7, 85.0, and 82.5% of cases, respectively. Mean values for points in the POP-Q, urinary distress inventory (UDI), and pelvic organ prolapsed distress inventory (POPDI) in the Pelvic Floor Distress Inventory (PFDI) were all significantly improved after the operation. The overall satisfaction rate for the operation was 84.7%. Five patients (3.1%) were diagnosed with vaginal erosion and treated with partial excision of the mesh without evidence of infection. Pelvic organ prolapse repair using Prolift Transvaginal Mesh is an effective and safe procedure without significant complications. © 2015 Wiley Publishing Asia Pty Ltd.

  8. Transvaginal ultrasound in the prediction of preterm delivery: singleton and twin gestations.

    PubMed

    Crane, J M; Van den Hof, M; Armson, B A; Liston, R

    1997-09-01

    To compare, in singleton and twin pregnancies, the effectiveness of transvaginal ultrasound versus digital examination in predicting preterm delivery in women with suspected preterm labor. Transvaginal ultrasound and pelvic examinations were performed on patients admitted with suspected preterm labor between 23 and 33 weeks' gestation. Ultrasound assessment of cervical length and the presence of funneling with fundal pressure were recorded for each patient, and the results were compared with dilatation and effacement as assessed by digital examination for the prediction of preterm delivery in the two groups (singletons and twins). One hundred sixty-two subjects were recruited (136 singletons and 26 twin pregnancies), with no significant demographic differences between the groups. Overall, 33% of the participants delivered preterm (27% of singletons, 62% of twins). Using receiver operating characteristics curves, the best cutoff points were 30 mm for endocervical length at ultrasound, 50% for effacement, and 1.5 cm for dilatation. Of these, the best predictor was endocervical length, which was a better predictor in singleton than in twin pregnancies. Of the potential predictors, including endocervical length, funneling, dilatation, and effacement, only endocervical length was an independent predictor of preterm delivery at less than 34 weeks' gestation for both singletons and twins by multiple logistic regression. When analyzed for delivery at less than 37 weeks' gestation, this relation held true for singletons but not twins. Endocervical length less than 30 mm had a sensitivity of 81% and 75%, specificity of 65% and 30%, positive predictive value of 46% and 63%, and negative predictive value of 90% and 43% for singleton and twin pregnancies, respectively, in predicting spontaneous birth at less than 37 weeks' gestation. Between 23 and 33 weeks' gestation, transvaginal ultrasound assessment of endocervical length is superior to funneling and digital examination in

  9. Transvaginal Small Bowel Evisceration in Known Case of Uterine Prolapse Due to Trauma

    PubMed Central

    Gheewala, Umesh; Shukla, Radha; Bhatt, Ravi; Srivastava, Shirish

    2015-01-01

    Spontaneous transvaginal bowel evisceration is a rare surgical emergency with only a few cases reported and particularly postmenopausal, posthysterectomy, multiparous elderly women are considered to be at higher risk for development of bowel evisceration. It is difficult to manage such a patient for any surgeon and poses significant challenges especially intraoperatively. Here, we report a case of vaginal vault rupture with small bowel evisceration through the vagina in a known case of uterine prolapse and highlight the risk factors, clinical presentation, and treatment options for this rare surgical emergency PMID:25738028

  10. Implications of the FDA statement on transvaginal placement of mesh: the aftermath.

    PubMed

    Koski, Michelle E; Rovner, Eric S

    2014-02-01

    The release of the U.S. Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh (TVM) for pelvic organ prolapse (POP) has resulted in changes in the pelvic reconstruction community. This monograph reviews the implications of the FDA statements over the last 18-24 months. Recent findings show that there have been significant developments in the areas of regulatory mandates, media and medico-legal activity, and statements from surgical societies. In summary, well-publicized communications from the FDA and major medical organizations are defining a change in the use of TVM for POP.

  11. Repeatability of Junctional Zone Measurements Using 3-Dimensional Transvaginal Sonography in Healthy Fertile Women.

    PubMed

    Rasmussen, Christina Kjaergaard; Glavind, Julie; Madsen, Lene Duch; Uldbjerg, Niels; Dueholm, Margit

    2016-07-01

    To describe the junctional zone and determine the intraobserver and interobserver repeatability of junctional zone measurements using 3-dimensional (3D) transvaginal sonography in healthy fertile women. We examined 82 consecutive women with 3D transvaginal sonography. The maximum and minimum junctional zone thickness was measured in all uterine walls. The difference between maximum and minimum thickness and average measurements (maximum thickness + minimum thickness/2) of the anterior, posterior, fundal, and lateral walls were calculated. Among the first 40 consecutive women, intraobserver and interobserver repeatability was evaluated according to the Bland-Altman method and expressed as a coefficient of repeatability. Using 3D transvaginal sonography, we visualized a thin and regular junctional zone in most women. The posterior uterine wall had the largest median maximum junctional zone thickness value of 5.2 (interquartile range, 3.8-6.5) mm. Ten women (12%) had maximum thickness values of 8.0 to 12.0 mm. The maximum thickness in each uterine wall had intraobserver and interobserver coefficients of repeatability of ±2.1 to ±3.4 and ±2.6 to ±3.9 mm, respectively, which were reduced by average measurements: ±1.9 and ±2.0 mm (anterior and posterior walls) and ±1.5 mm (fundal and lateral walls) for intraobserver and interobserver values. Correlations between measurements were poor in the narrow range of junctional zone thickness. The junctional zone has an indistinct outline on 3D transvaginal sonography, resulting in measurement errors within a broad range of ±2 to ±4 mm, which were only reduced to some extent by average measurements. The thickness of the junctional zone varied within a narrow range in this healthy fertile population, and reliability measurements of junctional zone thickness have to be evaluated in women with a wider range of thickness. The observer repeatability and reliability of junctional zone measurements need to be further evaluated

  12. Tecnical Note: Analysis of non-regulated vehicular emissions by extractive FTIR spectrometry: tests on a hybrid car in Mexico City

    NASA Astrophysics Data System (ADS)

    Reyes, F.; Grutter, M.; Jazcilevich, A.; González-Oropeza, R.

    2006-11-01

    A methodology to acquire valuable information on the chemical composition and evolution of vehicular emissions is presented. The analysis of the gases is performed by passing a constant flow of a sample gas from the tail-pipe into a 10 L multi-pass cell. The absorption spectra within the cell are obtained using an FTIR spectrometer at 0.5 cm-1 resolution along a 13.1 m optical path. Additionally, the total flow from the exhaust is continuously measured from a differential pressure sensor on a textit{Pitot} tube installed at the exit of the exhaust. This configuration aims to obtain a good speciation capability by coadding spectra during 30 s and reporting the emission (in g/km) of both criteria and non-regulated pollutants, such as CO2, CO, NO, SO2, NH3, HCHO and some NMHC, during predetermined driving cycles. The advantages and disadvantages of increasing the measurement frequency, as well as the effect of other parameters such as spectral resolution, cell volume and flow rate, are discussed. To test and evaluate the proposed technique, experiments were performed on a dynamometer running FTP-75 and typical driving cycles for the Mexico City Metropolitan Area (MCMA) on a Toyota Prius hybrid vehicle. This car is an example of recent marketed automotive technology dedicated to reduced emissions, increasing the need for sensitive detection techniques. This study shows the potential of the proposed technique to measure and report in real time the emissions of a large variety of pollutants, even from a super ultra-low emission vehicle (SULEV). The emissions of HC's, NOx, CO and CO2 obtained here were compared to experiments performed in other locations with the same model vehicle. The proposed technique provides a tool for future studies comparing in detail the emissions of vehicles using alternative fuels and emission control systems.

  13. Editors' note

    NASA Astrophysics Data System (ADS)

    Denker, Carsten; Feller, Alex; Schmidt, Wolfgang; von der Lühe, Oskar

    2012-11-01

    This topical issue of Astronomische Nachrichten/Astronomical Notes is a collection of reference articles covering the GREGOR solar telescope, its science capabilities, its subsystems, and its dedicated suite of instruments for high-resolution observations of the Sun. Because ground-based telescopes have life spans of several decades, it is only natural that they continuously reinvent themselves. Literally, the GREGOR telescope builds on the foundations of the venerable Gregory-Coudé Telescope (GCT) at Observatorio del Teide, Tenerife, Spain. Acknowledging the fact that new discoveries in observational solar physics are driven by larger apertures to collect more photons and to scrutinize the Sun in finer detail, the GCT was decommissioned and the building was made available to the GREGOR project.

  14. Randomized Clinical Trial of Virtual Reality Simulation Training for Transvaginal Gynecologic Ultrasound Skills.

    PubMed

    Chao, Coline; Chalouhi, Gihad E; Bouhanna, Philippe; Ville, Yves; Dommergues, Marc

    2015-09-01

    To compare the impact of virtual reality simulation training and theoretical teaching on the ability of inexperienced trainees to produce adequate virtual transvaginal ultrasound images. We conducted a randomized controlled trial with parallel groups. Participants included inexperienced residents starting a training program in Paris. The intervention consisted of 40 minutes of virtual reality simulation training using a haptic transvaginal simulator versus 40 minutes of conventional teaching including a conference with slides and videos and answers to the students' questions. The outcome was a 19-point image quality score calculated from a set of 4 images (sagittal and coronal views of the uterus and left and right ovaries) produced by trainees immediately after the intervention, using the same simulator on which a new virtual patient had been uploaded. Experts assessed the outcome on stored images, presented in a random order, 2 months after the trial was completed. They were blinded to group assignment. The hypothesis was an improved outcome in the intervention group. Randomization was 1 to 1. The mean score was significantly greater in the simulation group (n = 16; mean score, 12; SEM, 0.8) than the control group (n = 18; mean score, 9; SEM, 1.0; P= .0302). The quality of virtual vaginal images produced by inexperienced trainees was greater immediately after a single virtual reality simulation training session than after a single theoretical teaching session. © 2015 by the American Institute of Ultrasound in Medicine.

  15. A proposal to reduce the risk of transmission of human papilloma virus via transvaginal ultrasound.

    PubMed

    Combs, C Andrew; Fishman, Alan

    2016-07-01

    Three steps must be followed to prevent the transmission of infection via a contaminated transvaginal ultrasound probe: cleaning the probe after every use, high-level disinfection, and covering the probe with a single-use barrier during the examination. There may be critical flaws in at least 2 of these steps as they are currently practiced. First, 2 widely used disinfectants, glutaraldehyde and orthophthalaldehyde, have recently been found to be ineffective at neutralizing human papilloma virus type 16 and type 18. Second, commercial ultrasound probe covers have an unacceptable rate of leakage (8-81%) compared to condoms (0.9-2%). We recommend the use of a sonicated hydrogen peroxide disinfectant system rather than aldehyde-type disinfectants. We recommend that the probe be covered with a condom rather than a commercial probe cover during transvaginal ultrasound examination. Combined with probe cleaning, these 2 steps are estimated to result in an 800 million- to 250 billion-fold reduction in human papilloma virus viral load, which should translate to greatly enhanced patient safety. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Effect of transvaginal ultrasound on human chorionic villus cell apoptosis during pregnancy.

    PubMed

    Qu, X L; Wang, H T; Zou, J L; Cheng, L; Wang, F; Ma, L L; Li, J

    2015-12-29

    With the advancement of ultrasonic technology in recent years, sonography has become a common medical diagnostic tool, as it has elevated output sonic intensity and elongated exposure time. This study investigates the effect of ultrasound on human chorionic villus cell apoptosis during early pregnancy. Transvaginal ultrasound was performed for a total of 60 women who had undergone induced abortion at our hospital. They were randomly divided into the control, short ultrasound (10 min), and long ultrasound (20 min) groups (N = 20 each). Twenty-four hours after ultrasonic exposure, chorionic villus tissues were extracted during induced abortion, and were tested for cell apoptosis using flow cytometry. Bax and B cell lymphoma-2 (Bcl-2) protein levels were also quantified by immunohistochemistry. We found that the long ultrasound group had significantly higher cell apoptosis rates compared to the short ultrasound group, which in turn had higher rates compared to the control group (P < 0.05 in both cases). Bax protein levels were elevated in both the long and short ultrasound groups (P < 0.05). Bcl-2 proteins in two ultrasound groups, however, were downregulated as compared to those in the control group (P < 0.05). It is therefore possible that transvaginal sonography can potentiate the apoptosis of human chorionic villus cells by increasing the Bax/Bcl-2 protein ratio.

  17. Detection of congenital uterine malformation by using transvaginal three-dimensional ultrasound.

    PubMed

    Yu, Li-Li; Zhang, Xuan; Zhang, Ting; Chen, Han-Rong; Wang, Ze-Hua

    2014-10-01

    This study assessed the clinical application of transvaginal three-dimensional ultrasound (3D TVUS) in the diagnosis of congenital uterine malformation. A retrospective study was performed on 62 patients with congenital uterine malformation confirmed hysteroscopically and/or laparoscopically. The patients were subjected to transvaginal two-dimensional ultrasound (2D TVUS) and 3D TVUS. The accuracy rate was compared between the two methods. The accuracy rate of 3D TVUS was (98.38%, 61/62), higher than that of 2D TVUS (80.65%, 50/62). 3D TVUS coronal plane imaging could demonstrate the internal shape of the endometrial cavity and the external contour of the uterine fundus. It allowed accurate measurement on the coronary plane, and could three-dimensionally show the image of cervical tube, thereby providing information for the diagnosis of some complex uterine malformation. 3D TVUS imaging can obtain comprehensive information of the uterus malformation, and it is superior to 2D TVUS for the diagnosis of congenital uterine malformations, especially complex uterine anomaly.

  18. Editorial Note

    NASA Astrophysics Data System (ADS)

    van der Meer, F.; Ommen Kloeke, E.

    2015-07-01

    With this editorial note we would like to update you on the performance of the International Journal of Applied Earth Observation and Geoinformation (JAG) and inform you about changes that have been made to the composition of the editorial team. Our Journal publishes original papers that apply earth observation data for the management of natural resources and the environment. Environmental issues include biodiversity, land degradation, industrial pollution and natural hazards such as earthquakes, floods and landslides. As such the scope is broad and ranges from conceptual and more fundamental work on earth observation and geospatial sciences to the more problem-solving type of work. When I took over the role of Editor-in-Chief in 2012, I together with the Publisher set myself the mission to position JAG in the top-3 of the remote sensing and GIS journals. To do so we strived at attracting high quality and high impact papers to the journal and to reduce the review turnover time to make JAG a more attractive medium for publications. What has been achieved? Have we reached our ambitions? We can say that: The submissions have increased over the years with over 23% for the last 12 months. Naturally not all may lead to more papers, but at least a portion of the additional submissions should lead to a growth in journal content and quality.

  19. Assessment of Cesarean hysterotomy scar in non-pregnant women: reliability of transvaginal sonography with and without contrast enhancement.

    PubMed

    Baranov, A; Gunnarsson, G; Salvesen, K Å; Isberg, P-E; Vikhareva, O

    2016-04-01

    To determine intra- and interobserver reliability of evaluating the appearance and measurement of Cesarean hysterotomy scars using transvaginal ultrasound (TVS), with and without saline contrast sonohysterography (SCSH), in non-pregnant women. Fifty-six women with one previous Cesarean delivery were examined by TVS, with and without contrast enhancement, 6-9 months after the Cesarean delivery. Two observers, blinded to their own and each other's measurements, evaluated the appearance of the hysterotomy scar and measured the myometrial thickness adjacent to the scar or scar defect (MTS). If a scar defect was noted, the remaining myometrial thickness over the defect (RMT) was measured. A scar defect was defined as large if RMT was ≤ 2.2 mm on conventional TVS and ≤ 2.5 mm when SCSH was performed. Intra- and interobserver reliability of conventional TVS and SCSH were assessed. Intraobserver reliability was good, with intraclass correlation coefficients (ICCs) of ≥ 0.97 for measurements of MTS and RMT on conventional TVS and SCSH. Interobserver ICCs for measurements obtained on SCSH were 0.85 (95% CI, 0.76-0.91) for MTS and 0.96 (95% CI, 0.93-0.98) for RMT, compared with 0.82 (95% CI, 0.72-0.89) for MTS and 0.87 (95% CI, 0.68-0.95) for RMT measured on conventional TVS. The kappa coefficient for measurements obtained on SCSH was 0.92, compared with 0.85 for conventional TVS. Intermethod ICC was 0.86 (95% CI, 0.78-0.92) for measurement of MTS and 0.89 (95% CI, 0.78-0.95) for measurement of RMT, with a kappa coefficient of 0.57. Measurement of RMT using SCSH is a reliable method for assessing Cesarean hysterotomy scars in non-pregnant women and can be used in clinical practice. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  20. Visualization of ureters on standard gynecological transvaginal scan: a feasibility study.

    PubMed

    Pateman, K; Mavrelos, D; Hoo, W-L; Holland, T; Naftalin, J; Jurkovic, D

    2013-06-01

    To investigate the feasibility of identifying pelvic segments of normal ureters and measuring their size on standard transvaginal ultrasound examination. This was a prospective observational study from June to July 2012. All women in the study underwent a transvaginal ultrasound examination performed for various indications either by an expert or by an intermediate-level operator. A standardized assessment of the pelvic organs was performed, recording any congenital or acquired uterine pathology and ovarian abnormalities. Visualization of pelvic segments of both ureters was attempted in all cases. The success in finding the ureters, the time required to identify them and their dimensions at rest and while exhibiting peristalsis were all recorded. A total of 245 consecutive women were included in the study. In all women at least one ureter was successfully identified. Both ureters were seen in 227 women (92.7% (95% CI, 89.4-96.0%)). In 17 (6.9% (95% CI, 3.7-10.1%)) the left ureter was not seen and in one woman (0.4% (95% CI, 0.0-1.2%)) the right ureter could not be visualized (P < 0.001). There were no significant differences in the median time required to visualize the right and left ureters (9.0 (interquartile range (IQR), 6.0-14.0) s vs 8.0 (IQR, 6.0 -14.0) s, respectively; P = 0.9). The median diameter of the right ureter was 1.7 (IQR, 1.4-2.2) mm at rest and 2.9 (IQR, 2.4-3.6) mm during peristalsis. The median diameter of the left ureter was 1.9 (IQR, 1.6-2.3) mm at rest and 2.9 (IQR, 2.4-3.6) mm during peristalsis. Pelvic segments of normal ureters can be identified in most women on transvaginal ultrasound examination. Visualization of the ureters could be integrated into the routine pelvic ultrasound examination, particularly in women presenting with pelvic pain or in those with suspected pelvic endometriosis. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

  1. Mesh complications and failure rates after transvaginal mesh repair compared with abdominal or laparoscopic sacrocolpopexy and to native tissue repair in treating apical prolapse.

    PubMed

    Dandolu, Vani; Akiyama, Megumi; Allenback, Gayle; Pathak, Prathamesh

    2017-02-01

    Our objective was to quantitate the extent of complications and failure rate for apical prolapse repair with transvaginal mesh (TVM) use versus sacrocolpopexy over a minimum of 2 years of follow-up. Truven CCAE and Medicare Supplemental databases 2008-2013 were used for analysis. Patients with apical prolapse repair via transvaginal mesh (TVMR), abdominal sacrocolpopexy (ASCP), laparoscopic sacrocolpopexy (LSCP), or native tissue repair (NTR) and continuously enrolled for years were in the study cohort. Surgical failures were identified by reoperation for any prolapse or subsequent use of pessary. SAS® 9.3 was used for analysis. Mesh removal/revision was reported highest in TVMR (5.1 %), followed by LSCP (1.7 %) and ASCP (1.2 %). In those with concomitant sling, combined rates for mesh/sling revision were high, at 9.0 % in TVMR + sling, 5.6 % in ASCP + sling, and 4.5 % LSCP + sling. Sling-alone cases reported a 3.5 % revision rate. Pelvic pain (16.4-22.7 %) and dyspareunia (5.6-7.5 %) were high in all three approaches for apical prolapse repairs. Reoperation for apical prolapse was more common for TVMR (2.9 %) compared with NTR (2.3 %) [odds ratio (OR) 1.27; confidence interval (CI) 1.1-1.47; p 0.002]. Both ASCP and LSCP were superior to NTR (ASCP 1.5 %, OR 0.63, CI 0.46-0.86; p 0.003) and LSCP 1.8 % (OR 0.79, CI 0.62-1.01; p 0.07). Overall prolapse recurrence, as indicated by any compartment surgery for prolapse and/or pessary use, was also noted highest in TVMR (5.9 % OR 1.23, CI 1.11-1.36; p <0.0001). Laparoscopic sacrocolpopexies were slightly superior at 4.0 % overall recurrence (OR 0.83, CI 0.7-0.98); p 0.03). Failure of incontinence surgery was higher when the initial procedure combined prolapse and sling surgery (1.97 %) versus sling alone (1.6 %). Reoperation for apical prolapse is more common with TVMR than with sacrocolpopexies and NTR. Incontinence procedures are more likely to fail when performed along with prolapse repair than

  2. Acute pulmonary edema caused by takotsubo cardiomyopathy in a pregnant woman undergoing transvaginal cervical cerclage

    PubMed Central

    Lee, Jae-Young; Kwon, Hyun-Jung; Park, Sang-Wook; Lee, Yu-Mi

    2017-01-01

    Abstract Background: The physiological changes associated with pregnancy may predispose pregnant women to pulmonary edema. Other known causes of pulmonary edema during pregnancy include tocolytic drugs, preeclampsia, eclampsia, and peripartum cardiomyopathy. Methods: We describe a rare case of pulmonary edema caused by takotsubo cardiomyopathy in a pregnant woman at 14 weeks of gestation who was undergoing emergency transvaginal cervical cerclage. Results: Intraoperative chest radiography revealed severe pulmonary edema and echocardiography indicated moderate left ventricular dysfunction with akinesia of the mid to apical left ventricular wall segment, which is reflective of takotsubo cardiomyopathy. Conclusion: With early detection and appropriate management, the patient was stabilized in a relatively short period of time. Based on her clinical signs and symptoms, we suspect that the pulmonary edema was caused by takotsubo cardiomyopathy. PMID:28072695

  3. Transvaginal ultrasonography and hysteroscopy as predictors of endometrial polyps in postmenopause.

    PubMed

    de Godoy Borges, Pítia Cárita; Dias, Rogério; Bonassi Machado, Rogério; Borges, João Bosco Ramos; Spadoto Dias, Daniel

    2015-01-01

    The study compared ultrasound and ambulatorial hysteroscopy as diagnostic methods detecting endometrial polyps in postmenopause women. 281 women aged 41-82 years who underwent ambulatorial hysteroscopy were analyzed for presence of uterine bleeding and/or altered transvaginal ultrasound (endometrial thickness ≥5 mm). Ultrasonography detected endometrial polyps in 22.8% of patients and endometrial thickening in the other 59.8%. Hysteroscopy diagnosed endometrial polyps in 80.8%. Ultrasonography showed sensitivity of 88.7%, specificity of 25.4%, positive predictive value of 81.7%, negative predictive value of 37.5% and accuracy of 75.4% in diagnosing endometrial polyps. Hysteroscopy showed 96.4% sensitivity, 74.6% specificity, 93.4% positive predictive value, 84.6% negative predictive value and 91.8% accuracy. Hysteroscopy demonstrated more accuracy than ultrasonography, which is not sufficient for accurate diagnosis.

  4. High-throughput fiber-array transvaginal ultrasound/photoacoustic probe for ovarian cancer imaging

    NASA Astrophysics Data System (ADS)

    Salehi, Hassan S.; Kumavor, Patrick D.; Alqasemi, Umar; Li, Hai; Wang, Tianheng; Zhu, Quing

    2014-03-01

    A high-throughput ultrasound/photoacoustic probe for delivering high contrast and signal-to-noise ratio images was designed, constructed, and tested. The probe consists of a transvaginal ultrasound array integrated with four 1mm-core optical fibers and a sheath. The sheath encases transducer and is lined with highly reflecting aluminum for high intensity light output and uniformity while at the same time remaining below the maximum permissible exposure (MPE) recommended by the American National Standards Institute (ANSI). The probe design was optimized by simulating the light fluence distribution in Zemax. The performance of the probe was evaluated by experimental measurements of the fluence and real-time imaging of polyethylene-tubing filled with blood. These results suggest that our probe has great potential for in vivo imaging and characterization of ovarian cancer.

  5. Transvaginal single-incision mesh reconstruction for recurrent or advanced anterior vaginal wall prolapse.

    PubMed

    Marschke, J; Hengst, L; Schwertner-Tiepelmann, N; Beilecke, K; Tunn, R

    2015-05-01

    Single-incision transvaginal mesh for reconstruction of Level I and II prolapses in women with recurrent or advanced prolapse. We evaluated functional, anatomical, sonomorphological and quality-of-life outcome. Data were collected retrospectively for preoperative parameters and at follow-up visits. Anatomical cure was assessed with vaginal examination using the ICS-POP-Q system; introital-ultrasound scan for postvoidal residual and description of mesh characteristics was performed. We applied a visual analogue scale (VAS) and the German Pelvic Floor Questionnaire to assess quality-of-life. Seventy women with cystocele (III: 61.3%/IV: 16%), all post-hysterectomy and in majority (81.4%) after previous cystocele repair, were operated using a single-incision transvaginal technique. Overall anatomical success rate was 95.7% with significant improvement in quality-of-life (p < 0.0001). Mesh erosion occurred in 5.7%, one patient presented symptomatic vaginal vault prolapse. Postvoidal residual declined significantly (58 vs. 2.9%). Sonographic mesh length was 55.7% of implanted mesh with a wide range of mesh position, but no signs of mesh dislocation. There was no de novo dyspareunia reported, one case of preoperative existing dyspareunia worsened. No severe adverse event was observed. We hereby present a trial of a high-risk group of patients requiring reconstruction of anterior and apical vaginal wall in mostly recurrent prolapse situation. Our data support the hypothesis of improved anatomical and functional results and less mesh shrinkage caused by the single-incision technique with fixation in sacrospinous ligament in combination with modification in mesh quality compared to former multi-incision techniques.

  6. A 52-month follow-up on the transvaginal mesh surgery in vaginal cuff eversion.

    PubMed

    Lo, Tsia-Shu; Yusoff, Faridah Mohd; Kao, Chuan-Chi; Jaili, Sukanda; Uy Patrimonio, Ma Clarissa

    2017-06-01

    Transvaginal mesh anterior-posterior (TVM-AP) provides better cure rates in the surgical treatment of vaginal cuff eversion than anterior transvaginal mesh combined with sacrospinous ligament fixation (TVM-A). We determine the outcomes after TVM-A and TVM-AP surgeries in advanced vaginal cuff prolapse. The charts of 796 women who underwent pelvic organ prolapse (POP) surgery from July 2006 to January 2012 in Chang Gung Memorial Hospitals were reviewed. We included women who presented with advanced cuff eversion and treated with TVM surgery. Data were analysed after three years post-surgery. Descriptive statistics were used for demographic and perioperative data. The paired-samples t test was used for comparison of preoperative and postoperative continuous data. The outcomes measured were objective cure (POP-Q stage ≤ 1) and subjective cure (negative response to question 2 and 3 on POPDI-6). A total of 97 patients was analysed. 61 patients had TVM-A and 36 patients had TVM-AP insertion. Mean follow-up was 52 months. The objective cure rate for TVM-AP was significantly higher than TVM-A, 94.4% versus 80.3%. TVM-AP also showed a higher subjective cure rate (91.7%) though there was no significant difference from TVM-A (p = 0.260). The mesh extrusion rate was low at 3.1% with no major complications seen. In TVM-A the blood loss was lesser and the operation time was shorter. TVM-AP showed better objective cure rate than TVM-A at 52 months. However, TVM-A is less invasive in comparison with an acceptably good cure rates. Copyright © 2017. Published by Elsevier B.V.

  7. Three-dimensional transvaginal tomographic ultrasound imaging for cervical cancer staging.

    PubMed

    Han, Xue-Song; Ning, Chun-Ping; Sun, Li-Tao; Li, Xiao-Ying; Peng, Yan-Qing; Dang, Mei-Zheng

    2015-09-01

    The objective of this study was to investigate the feasibility of using 3-D transvaginal tomographic ultrasound imaging (TUI) to stage patients with cervical carcinoma. Eighty women with cervical cancer who underwent transvaginal TUI examinations were enrolled. In all patients, cancer was confirmed pre-operatively by pathologic examination. Staging on the basis of clinical features, ultrasonography and magnetic resonance imaging was performed according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Clinical, TUI and magnetic resonance imaging staging was compared with that based on histology. Depth of invasion into the stroma was measured by TUI in 52 cases and compared with pathologic results. An interclass correlation coefficient was used to analyze reproducibility. In total, all 80 patients underwent surgical treatment. The accuracy of pre-operative staging, compared with histologic findings, was 92.50% for TUI, 82.50% for magnetic resonance imaging and 78.75% for clinical examination. The mean depth of lesions as measured with TUI was 12.5 ± 6.2 mm (range: 3.5-40.0 mm), and that measured on histology was 10.5 ± 8.0 mm (range: 3.0-40.0 mm). The interclass correlation coefficient of the two methods was 0.933 (95% confidence interval: 0.887-0.961). Pre-operative TUI is promising as a method for pre-operative staging of cervical carcinomas. TUI can also reliably assess lesion depth. Copyright © 2015. Published by Elsevier Inc.

  8. Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies.

    PubMed

    Babacan, Ali; Gun, Ismet; Kizilaslan, Cem; Ozden, Okan; Muhcu, Murat; Mungen, Ercument; Atay, Vedat

    2014-01-01

    A thorough evaluation of the uterine cavity is frequently required in gynecology practice. The aim of this study was to compare the diagnostic values of transvaginal ultrasound examination and hysteroscopy in detecting uterine abnormalities in a group of patients within a range of menopausal status and symptomatology. This study included 285 patients admitted with complaints of abnormal uterine bleeding, postmenopausal bleeding, lower abdominal pain, abnormal vaginal discharge or for a routine gynecological examination. All patients had available transvaginal ultrasonography and hysteroscopy data for evaluation. A biopsy was obtained from all patients during the hysteroscopy session. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio were calculated for both methods and compared, considering the histopathological diagnosis as the gold standard. The mean age of the patients was 49.5±12.9 years (range, 24-89 y). Majority of the patients admitted for abnormal uterine bleeding (n=198, 69.4%). For the diagnosis of polyps of any size, hysteroscopy had better sensitivity (p<0.001), however, specificities did not differ (p=1.0). On the other hand, hysteroscopy did not have a sensitivity advantage over TVU in diagnosing polyps greater than 1 cm (p=0.077), although this time hysteroscopy had better specificity (p<0.001). Combined approach did not offer diagnostic advantage for any of the specific pathologies. Although TVU represents a practical approach for the initial evaluation of uterine pathologies, hysteroscopy seems to offer better diagnostic value for uterine pathologies in general, and uterine polyps in particular.

  9. Efficacy of transvaginal biofeedback and electrical stimulation in women with urinary urgency and frequency and associated pelvic floor muscle spasm.

    PubMed

    Bendaña, Emma E; Belarmino, James M; Dinh, Jenny H; Cook, Cynthia L; Murray, Brian P; Feustel, Paul J; De, Elise J B

    2009-01-01

    Women with urinary urgency and frequency may also have pelvic floor muscle spasm. Transvaginal biofeedback (TVBF) and electrical stimulation (EStim) is a treatment modality that has been used to treat vaginismus and chronic pelvic pain. In this study, TVBF/EStim was evaluated in women with pelvic floor muscle spasm associated with urinary symptoms. Fifty-two women underwent therapy with TVBF/EStim and reported a mean symptom improvement of 64.5%.

  10. Does the addition of saline infusion sonohysterography to transvaginal ultrasonography prevent unnecessary hysteroscopy in premenopausal women with abnormal uterine bleeding?

    PubMed

    Short, John; Sharp, Benjamin; Elliot, Nikki; McEwing, Rachael; McGeoch, Graham; Shand, Brett; Holland, Kieran

    2016-08-01

    This observational case series in 65 premenopausal women with abnormal uterine bleeding evaluated whether transvaginal ultrasound followed by saline infusion sonohysterography (SIS) prevented unnecessary hysteroscopy. Although SIS indicated that hysteroscopy was unnecessary in eight women, this benefit was offset by the invasive nature of the scan, the number of endometrial abnormalities falsely detected by SIS and the cost of the additional investigation. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  11. Transvaginal ultrasonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women.

    PubMed

    Park, Kyo Hoon

    2007-08-01

    The aim of this study was to evaluate the value of transvaginal sonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women. One hundred and sixty-one women scheduled for labor induction underwent transvaginal ultrasonography and digital cervical examinations. Logistic regression demonstrated that cervical length and gestational age at induction, but not the Bishop score, significantly and independently predicted failed labor induction. According to the receiver operating characteristic curves analysis, the best cut-off value of cervical length for predicting failed labor induction was 28 mm, with a sensitivity of 62% and a specificity of 60%. In terms of the likelihood of a cesarean delivery for failure to progress as the outcome variable, logistic regression indicated that maternal height and birth weight, but not cervical length or Bishop score, were significantly and independently associated with an increased risk of cesarean delivery for failure to progress. Transvaginal sonographic measurements of cervical length thus independently predicted failed labor induction in nulliparous women. However, the relatively poor predictive performance of this test undermines its clinical usefulness as a predictor of failed labor induction. Moreover, cervical length appears to have a poor predictive value for the likelihood of a cesarean delivery for failure to progress.

  12. Identification of benign and malignant endometrial cancer with transvaginal ultrasonography combined with elastography and tissue hardness analysis.

    PubMed

    Zhang, Y; Luo, L; Luo, Q

    2015-01-01

    This study was designed to explore tissue hardness and distinguish benign and malignant endometrial cancer with the use of transvaginal ultrasonography combined with elastography. Color Doppler ultrasonic diasonograph was used to carry out transvaginal ultrasonography and elastography. Once the nidus was observed, features of the 2D image were analyzed. Then features of elasticity of the uterine cavity in different states were analyzed by elastography, and strain rate ratio was measured. Finally, elasticity scoring (0~5 points) was made. Receiver operating characteristic (ROC) curve was drawn based on elasticity score and strain rate ratio. The area under the elasticity score curve and strain rate ratio curve was 0.761 and 0.852, respectively, and there was no statistically significant difference between them (c2= 4.663, P>0.05). Then 2.98 was confirmed as the diagnostic cut-off value of benign and malignant lesions, based on strain rate ratio. Ultrasonic elastography as an effective assistance for transvaginal ultrasonography provides more valuable information for confirmation of lesions and offers more accurate evidence for diagnosis of disease in the uterine cavity.

  13. Repeatability and reproducibility of measurements of the suburethral tape location obtained in pelvic floor ultrasound performed with a transvaginal probe.

    PubMed

    Dresler, Maria Magdalena; Kociszewski, Jacek; Wlaźlak, Edyta; Pędraszewski, Piotr; Trzeciak, Agnieszka; Surkont, Grzegorz

    2017-06-01

    Implants used to treat patients with urogynecological conditions are well visible in US examination. The position of the suburethral tape (sling) is determined in relation to the urethra or the pubic symphysis. The study was aimed at assessing the accuracy of measurements determining suburethral tape location obtained in pelvic US examination performed with a transvaginal probe. The analysis covered the results of sonographic measurements obtained according to a standardized technique in women referred for urogynecological diagnostics. Data from a total of 68 patients were used to analyse the repeatability and reproducibility of results obtained on the same day. The intraclass correlation coefficient for the repeatability and reproducibility of the sonographic measurements of suburethral tape location obtained with a transvaginal probe ranged from 0.6665 to 0.9911. The analysis of the measurements confirmed their consistency to be excellent or good. Excellent and good repeatability and reproducibility of the measurements of the suburethral tape location obtained in a pelvic ultrasound performed with a transvaginal probe confirm the test's validity and usefulness for clinical and academic purposes.

  14. Transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese endometrial cancer patients.

    PubMed

    Fanning, James; Hojat, Rod; Johnson, Jil; Fenton, Bradford

    2010-01-01

    The purpose of this report is to evaluate our experience with transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese women with endometrial cancer in whom obesity precluded LAVH/BSO and lymphadenectomy and vaginal obesity limited visualization and exposure. We performed a retrospective review and identified 6 consecutive cases. No cases were excluded. A laparoscopic 33-cm Plasma Kinctic (PK) cutting forceps with a 5-mm diameter was applied transvaginally to coagulate and cut the uterosacral and cardinal ligaments, uterine vasculature, and ovarian ligaments. The uterus was delivered vaginally. Staging lymphadenectomy was not performed. Median age was 51 years, median weight was 405 lbs, and median BMI was 66 kg/m². Five of 6 cases were successfully performed vaginally (83%). Median operative time was 1 hour 10 minutes, median blood loss was 500 mL, and pain was only discomforting. All patients were discharged the day after surgery. There were no complications. At median follow-up of 1 year, all patients were alive with no evidence of disease. It is our opinion that the transvaginal application of a laparoscopic bipolar cutting forceps can successfully assist vaginal hysterectomy in extremely obese endometrial cancer patients who cannot tolerate LAVH/BSO and lymphadenectomy and vaginal obesity limits visualization and exposure.

  15. Transvaginal Application of a Laparoscopic Bipolar Cutting Forceps to Assist Vaginal Hysterectomy in Extremely Obese Endometrial Cancer Patients

    PubMed Central

    Hojat, Rod; Johnson, Jil; Fenton, Bradford

    2010-01-01

    Introduction: The purpose of this report is to evaluate our experience with transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese women with endometrial cancer in whom obesity precluded LAVH/BSO and lymphadenectomy and vaginal obesity limited visualization and exposure. Materials and Methods: We performed a retrospective review and identified 6 consecutive cases. No cases were excluded. A laparoscopic 33-cm Plasma Kinctic (PK) cutting forceps with a 5-mm diameter was applied transvaginally to coagulate and cut the uterosacral and cardinal ligaments, uterine vasculature, and ovarian ligaments. The uterus was delivered vaginally. Staging lymphadenectomy was not performed. Results: Median age was 51 years, median weight was 405 lbs, and median BMI was 66 kg/m2. Five of 6 cases were successfully performed vaginally (83%). Median operative time was 1hour 10 minutes, median blood loss was 500 mL, and pain was only discomforting. All patients were discharged the day after surgery. There were no complications. At median follow-up of 1 year, all patients were alive with no evidence of disease. Conclusions: It is our opinion that the transvaginal application of a laparoscopic bipolar cutting forceps can successfully assist vaginal hysterectomy in extremely obese endometrial cancer patients who cannot tolerate LAVH/BSO and lymphadenectomy and vaginal obesity limits visualization and exposure. PMID:20932365

  16. Laparoscopic management or laparoscopy combined with transvaginal management of type II cesarean scar pregnancy.

    PubMed

    Wang, Huan-Ying; Zhang, Jun; Li, Yan-Na; Wei, Wei; Zhang, Da-Wei; Lu, Yu-Qiu; Zhang, Hao-Feng

    2013-01-01

    To evaluate the clinical effectiveness of laparoscopic management of cesarean scar pregnancy (CSP) by deep implantation. A pregnancy implanting within the scar from a previous cesarean delivery is a rare condition of ectopic pregnancy. There are two different types of CSPs. Type I is caused by implantation of the amniotic sac on the scar with progression toward either the cervicoisthmic space or the uterine cavity. Type II (CSP-II) is caused by deep implantation into a previous CS defect with infiltrating growth into the uterine myometrium and bulging from the uterine serosal surface, which may result in uterine rupture and severe bleeding during the first trimester of pregnancy. Thus, timely management with an early and accurate diagnosis of CSP-II is important. However, laparoscopic management in CSP-II has not yet been evaluated. Eleven patients with CSP-II underwent conservative laparoscopic surgery or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair to preserve the uterus from March 2008 to November 2011. Patients with CSP-II were diagnosed using color Doppler sonography, and the diagnosis was confirmed by laparoscopy. The operation time, the blood loss during surgery, the levels of β-human chorionic gonadotropin (β-hCG) before surgery, the time taken for serum β-hCG levels to return to <100 mIU/mL postoperatively, and the time for the uterine body to revert to its original state were retrospectively analyzed. All 11 operations were successfully performed using laparoscopy with preservation of the uterus. One patient underwent a dilation and curettage after laparoscopic bilateral uterine artery ligation. Eight patients were treated solely by laparoscopic bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair. The remaining two patients underwent laparoscopic bilateral uterine artery ligation and transvaginal resection of

  17. Laparoscopic Management or Laparoscopy Combined with Transvaginal Management of Type II Cesarean Scar Pregnancy

    PubMed Central

    Wang, Huan-Ying; Li, Yan-Na; Wei, Wei; Zhang, Da-Wei; Lu, Yu-Qiu; Zhang, Hao-Feng

    2013-01-01

    Objective: To evaluate the clinical effectiveness of laparoscopic management of cesarean scar pregnancy (CSP) by deep implantation. Background: A pregnancy implanting within the scar from a previous cesarean delivery is a rare condition of ectopic pregnancy. There are two different types of CSPs. Type I is caused by implantation of the amniotic sac on the scar with progression toward either the cervicoisthmic space or the uterine cavity. Type II (CSP-II) is caused by deep implantation into a previous CS defect with infiltrating growth into the uterine myometrium and bulging from the uterine serosal surface, which may result in uterine rupture and severe bleeding during the first trimester of pregnancy. Thus, timely management with an early and accurate diagnosis of CSP-II is important. However, laparoscopic management in CSP-II has not yet been evaluated. Methods: Eleven patients with CSP-II underwent conservative laparoscopic surgery or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair to preserve the uterus from March 2008 to November 2011. Patients with CSP-II were diagnosed using color Doppler sonography, and the diagnosis was confirmed by laparoscopy. The operation time, the blood loss during surgery, the levels of β-human chorionic gonadotropin (β-hCG) before surgery, the time taken for serum β-hCG levels to return to <100 mIU/mL postoperatively, and the time for the uterine body to revert to its original state were retrospectively analyzed. Results: All 11 operations were successfully performed using laparoscopy with preservation of the uterus. One patient underwent a dilation and curettage after laparoscopic bilateral uterine artery ligation. Eight patients were treated solely by laparoscopic bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair. The remaining two patients underwent laparoscopic bilateral uterine artery

  18. Comparison of two- and three-dimensional transvaginal ultrasound in the visualisation of intrauterine devices.

    PubMed

    Kerr, N K; Dunham, R; Wolstenhulme, S; Wilson, J

    2014-08-01

    The aims of the study were to evaluate whether three-dimensional transvaginal ultrasound (3D TV US) is superior to two-dimensional transvaginal ultrasound (2D TV US) at visualising intrauterine devices and determining their position. This prospective study included 52 participants with an intrauterine device fitted, who underwent 2D TV US and 3D TV US. 2D TV US and 3D-reconstructed coronal images were reviewed by two gynaecological radiologists to assess ease of visualisation and position of the intrauterine devices. Statistical analysis was performed using Wilcoxon signed-rank, McNemar and Chi-squared tests. The inter-observer agreement was measured using Cohen's Kappa. Intrauterine device visualisation scores were significantly higher with 2D TV US compared with 3D TV US (Radiologist 1 p = <0.001, Radiologist 2 p = 0.007). A significant number of T-arms appeared to perforate into the adjacent myometrium on the 3D-reconstructed coronal image, but were normal on the 2D images (Radiologist 1 p = <0.001, Radiologist 2 p = 0.008). Radiologist 1 found 19 perforated T-arms on 3D TV US compared with four on 2D TV US. Radiologist 2 found 13 perforated T-arms on 3D TV US compared with five on 2D TV US. Both radiologists agreed on the positions of the intrauterine devices substantially with 3D TV US (Kappa = 0.69) and moderately with 2D TV US (Kappa = 0.55). The 3D TV US did not visualise an intrauterine device better than 2D TV US. The 3D-reconstructed coronal image of the uterus can reliably display cases of T-arm perforation into the adjacent myometrium, which could be missed on 2D TV US images. The 3D TV US should be used in addition to 2D TV US in all cases where an intrauterine device is under evaluation.

  19. Transvaginal colour flow imaging: a possible new screening technique for ovarian cancer.

    PubMed Central

    Bourne, T.; Campbell, S.; Steer, C.; Whitehead, M. I.; Collins, W. P.

    1989-01-01

    OBJECTIVE--To assess whether changes in the intraovarian vasculature or blood flow impedance can be used to identify potentially malignant masses. DESIGN--Open, non-comparative prospective study. SETTING--Ovarian screening clinics at King's College Hospital and the Hallam Medical Centre. SUBJECTS--50 Women selected on the basis of their medical history and the result of a previous transvaginal ultrasound scan. Thirty women (10 premenopausal (scan taken on days 1 to 8 of the menstrual cycle) and 20 postmenopausal) had normal ovaries, and 20 had at least one ovary with an abnormal morphology or volume, or both. INTERVENTIONS--Women with a positive result on screening were referred for laparotomy. MAIN OUTCOME MEASURES--Presence or absence of coloured areas (neovascularisation) and the pulsatility index within each ovary. The pulsatility index is a measure of the impedance to blood flow, a low value indicating decreased impedance and a high value increased impedance to blood flow. RESULTS--Two women with a positive result on screening had hydrosalpinges, 10 a benign tumour or a tumour-like condition, and eight primary ovarian cancers. No areas of neovascularisation were seen in the 30 women with morphologically normal ovaries and the two patients with hydrosalpinges; the pulsatility index ranged from 3.1 to 9.4. Similarly, nine patients (10 affected ovaries) with a non-malignant mass had no signs of neovascularisation and the pulsatility index varied from 3.2 to 7.0. One patient with bilateral dermoid cysts containing nests of thyroid-like cells had vascular changes and pulsatility index values of 0.4 and 0.8. Seven patients (eight ovaries) with primary ovarian cancer (one stage IV, four stage II, and two stage Ia) showed clear evidence of neovascularisation and pulsatility index values were from 0.3 to 1.0. One patient with an intraepithelial serous cystadenocarcinoma in a small ovary (less than 5 ml volume) had no signs of any vascular change and the pulsatility

  20. Occurrence and characteristics of residual follicles formed after transvaginal ultrasound-guided follicle aspiration in cattle.

    PubMed

    Viana, J H M; Dorea, M D; Siqueira, L G B; Arashiro, E K N; Camargo, L S A; Fernandes, C A C; Palhão, M P

    2013-01-15

    Ultrasound-guided transvaginal follicle aspiration is used to recover cumulus-oocyte complexes (for IVF) and to synchronize follicular wave emergence (ablation of dominant follicle). Although aspirated follicles are generally supposed to undergo immediate atresia, there are indications that they may remain active. The objective was to evaluate the occurrence and characteristics of residual follicles (RF) after transvaginal follicle aspiration in cattle. Ovarian follicular wave emergence was synchronized in Holstein cows (N = 13) in the presence (groups 1 and 3) or absence (groups 2 and 4) of norgestomet implants. The largest follicle was aspirated at a diameter of 8 mm (groups 1 and 2) or 12 mm (groups 3 and 4). Ovarian follicles were visualized (transrectal ultrasonography) every 12 h after wave emergence. Follicular fluid samples were collected from the largest follicle and from the ensuing RF and concentrations of estradiol and progesterone were determined. After aspiration, 73.2% (52/71) of the follicles refilled with fluid, and a new antrum was detected 12 to 24 h later. Norgestomet did not affect (P > 0.05) RF occurrence or diameter, but in RF from group 4, concentrations of estradiol decreased (-530.7 ± 133.9 ng/mL; P < 0.01) whereas progesterone increased (+429.6 ± 171.7 ng/mL; P < 0.05) relative to preaspiration. In RF, there were three steroidogenesis patterns: (1) high estradiol concentration and high estradiol:progesterone ratio (estradiol-active RF); (2) low estradiol, but high progesterone concentrations (luteinized RF); and (3) low estradiol and low progesterone concentrations (inactive RF). Estradiol-active RF were more likely (P < 0.05) from follicles with high estradiol concentrations (regardless of diameter). In conclusion, fluid-filled structures (RF) with variable steroid production patterns are frequently formed after ultrasound-guided follicle aspiration. The occurrence and features of these RF depended on the diameter and status of these

  1. Comparison of two- and three-dimensional transvaginal ultrasound in the visualisation of intrauterine devices

    PubMed Central

    Dunham, R; Wolstenhulme, S; Wilson, J

    2014-01-01

    The aims of the study were to evaluate whether three-dimensional transvaginal ultrasound (3D TV US) is superior to two-dimensional transvaginal ultrasound (2D TV US) at visualising intrauterine devices and determining their position. This prospective study included 52 participants with an intrauterine device fitted, who underwent 2D TV US and 3D TV US. 2D TV US and 3D-reconstructed coronal images were reviewed by two gynaecological radiologists to assess ease of visualisation and position of the intrauterine devices. Statistical analysis was performed using Wilcoxon signed-rank, McNemar and Chi-squared tests. The inter-observer agreement was measured using Cohen’s Kappa. Intrauterine device visualisation scores were significantly higher with 2D TV US compared with 3D TV US (Radiologist 1 p = <0.001, Radiologist 2 p = 0.007). A significant number of T-arms appeared to perforate into the adjacent myometrium on the 3D-reconstructed coronal image, but were normal on the 2D images (Radiologist 1 p = <0.001, Radiologist 2 p = 0.008). Radiologist 1 found 19 perforated T-arms on 3D TV US compared with four on 2D TV US. Radiologist 2 found 13 perforated T-arms on 3D TV US compared with five on 2D TV US. Both radiologists agreed on the positions of the intrauterine devices substantially with 3D TV US (Kappa = 0.69) and moderately with 2D TV US (Kappa = 0.55). The 3D TV US did not visualise an intrauterine device better than 2D TV US. The 3D-reconstructed coronal image of the uterus can reliably display cases of T-arm perforation into the adjacent myometrium, which could be missed on 2D TV US images. The 3D TV US should be used in addition to 2D TV US in all cases where an intrauterine device is under evaluation. PMID:27433211

  2. Incidence of human papillomavirus contamination of transvaginal probes in Japan and possible contamination prevention strategy.

    PubMed

    Kuwata, Tomoyuki; Takahashi, Hironori; Koibuchi, Harumi; Ichizuka, Kiyotake; Natori, Michiya; Matsubara, Shigeki

    2016-10-01

    To clarify the present status of human papillomavirus (HPV) contamination of transvaginal probes in Japan and propose a preventive method. This study was performed at three institutes: a tertiary center, secondary hospital, and primary facility. To identify contamination rates, probes were disinfected and covered with probe covers and condoms; the cover was changed for each patient. The probes were tested for HPV, and those with HPV detected were analyzed to identify the type of HPV. Next, nurses put on new gloves before covering the probe for each patient, and the probes were similarly tested for HPV. A total of 120 probes were tested, and HPV was detected from a total of five probes, a contamination rate of 4.2 % (5/120). HPV was detected in all three institutes. Importantly, high-risk HPV, i.e., HPV-52, 56, and 59, was detected. After the "glove change strategy" was implemented, HPV was not detected on any of 150 probes tested at any of the three institutions. In Japan, the HPV contamination rate of vaginal probes in routine practice was 4.2 %. There was no HPV contamination of probes after changing the gloves for cover exchange for each patient. This strategy may prevent HPV probe contamination.

  3. Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound.

    PubMed

    Malvadkar, Sharad M; Malvadkar, Madhuri S; Domkundwar, Shilpa V; Mohd, Shariq

    2016-01-01

    Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge, this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.

  4. Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound

    PubMed Central

    Malvadkar, Sharad M.; Malvadkar, Madhuri S.; Domkundwar, Shilpa V.; Mohd, Shariq

    2016-01-01

    Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge, this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis. PMID:26989549

  5. Racial and ethnic disparities in universal cervical length screening with transvaginal ultrasound

    PubMed Central

    Haviland, Miriam J; Shainker, Scott A; Hacker, Michele R; Burris, Heather H

    2016-01-01

    Objective Determine if race or ethnicity is associated with missed or late transvaginal cervical length screening in a universal screening program. Methods Retrospective cohort study of nulliparous women with singleton gestations and a fetal anatomical ultrasound from 16-24 weeks' gestation from January, 2012 through November, 2013. We classified women into mutually exclusive racial and ethnic groups: non-Hispanic black (black), Hispanic, Asian, non-Hispanic white (white), and other or unknown race. We used log-binomial regression to calculate the risk ratio (RR) and 95% confidence interval (CI) of missed or late (≥ 20 weeks' gestation) screening vs. optimally-timed screening between the different racial and ethnic groups. Results Among the 2 967 women in our study population, 971 (32.7%) had either missed or late cervical length screening. Compared to white women, black (RR: 1.3; 95% CI:1.1-1.5) and Hispanic (RR:1.2; 95% CI:1.01-1.5) women were more likely to have missed or late screening. Among women screened, black (vs. white) women were more likely to be screened late (RR: 2.2; 95% CI: 1.6-3.1). Conclusions Black and Hispanic women may be more likely to have missed or late cervical length screenings. PMID:26987873

  6. Accuracy of transvaginal ultrasonography compared to endometrial biopsy for the etiological diagnosis of abnormal perimenopausal bleeding

    PubMed Central

    NICULA, RENATA; DICULESCU, DORU; LENCU, CODRUŢA CLAUDIA; CIORTEA, RĂZVAN; BUCURI, CARMEN ELENA; OLTEAN, IOANA ADRIANA; TRIF, IOANA ALEXANDRA; MIHU, DAN

    2017-01-01

    Background and aims Perimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management. Method The study included 103 patients aged between 41.5–55.11 years, divided into 3 age groups: 40–44 years (n=10), 45–49 years (n=54) and ≥50 years (n=39). Results Certain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes. Conclusions Transvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma. PMID:28246495

  7. Accuracy of transvaginal ultrasonography compared to endometrial biopsy for the etiological diagnosis of abnormal perimenopausal bleeding.

    PubMed

    Nicula, Renata; Diculescu, Doru; Lencu, Codruţa Claudia; Ciortea, Răzvan; Bucuri, Carmen Elena; Oltean, Ioana Adriana; Trif, Ioana Alexandra; Mihu, Dan

    2017-01-01

    Perimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management. The study included 103 patients aged between 41.5-55.11 years, divided into 3 age groups: 40-44 years (n=10), 45-49 years (n=54) and ≥50 years (n=39). Certain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes. Transvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma.

  8. Transvaginal Mesh and Transanal Resection to Treat Outlet Obstruction Constipation Caused by Rectocele

    PubMed Central

    Shi, Yang; Yu, Yongjun; Zhang, Xipeng; Li, Yuwei

    2017-01-01

    Background The aim of this study was to evaluate the curative effect of transvaginal mesh repair (TVMR) and stapled transanal rectal resection (STARR) in treating outlet obstruction constipation caused by rectocele. Material/Methods Patients who had outlet obstruction constipation caused by rectocele were retrospectively analyzed and 39 patients were enrolled the study. Patients were assigned to either the TVMR or STARR group. Postoperative factors such as complications, pain, recurrence rate, and operative time were compared between the 2 groups. Results Total effective rate was 100% in both groups. No long-term chronic pain occurred and discomfort rate of tenesmus was higher in the STARR group than in the TVMR group. Postoperative defecography showed that the rectocele depth was significantly reduced, and the prolapse of the rectal mucosa and the lower rectal capacity was also decreased. Four cases had mesh exposure in the TVMR group and 2 cases in the STARR group had anastomotic bleeding after the surgery. Conclusions For outlet obstruction constipation caused by rectocele, TVMR and STARR both obtained satisfactory results. Although TVMR is complex with longer operative time and hospitalization period, its long-term effect is better than that of STARR. PMID:28146137

  9. Analysis of endometrial thickness measured by transvaginal ultrasonography in obese patients

    PubMed Central

    Barboza, Isabela Corrêa; Depes, Daniella de Batista; Vianna, Ilzo; Patriarca, Marisa Teresinha; Arruda, Raquel Martins; Martins, João Alfredo; Lopes, Reginaldo Guedes Coelho

    2014-01-01

    ABSTRACT Objective To compare the endometrial echo values obtained by transvaginal ultrasonography with the body mass index of postmenopausal patients; to verify if there is higher prevalence of endometrial thickening in women with body mass index ≥30. Methods This is an analytical and cross-sectional study that evaluated 294 patients. Postmenopausal women were included, and those on hormone therapy were excluded. The variables evaluated were body mass index (considering obesity if >30), number of pregnancies, years since menopause, and age. These variables were correlated with endometrial echography. Results There was a statistically significant correlation between overweight and obese patients and increased endometrial thickness (p=0.0236). The correlation between age and endometrial echo was negative and statistically significant, that is, the older the woman, the lower the endometrial thickness (p=0.0478). Pregnancies and years since menopause showed no statistical significance in relation to endometrial echo, with p=0.0614 and p=0.115, respectively. Conclusion There was positive and significant correlation between body mass index ≥30 and endometrial thickeness. PMID:25003920

  10. Transvaginal strangulated small intestinal hernia after abdominal sacrocolpopexy: case report and literature review.

    PubMed

    Halwani, Y; Nicolau-Toulouse, V; Oakes, J; Leipsic, J; Geoffrion, R; Wiseman, S M

    2013-04-01

    To report a case of transvaginal small intestinal hernia following abdominal sacrocolpopexy and review this clinical presentation in the current literature. A review of our case and a literature review of vaginal evisceration were carried out. The patient underwent sacrocolpopexy and a Burch procedure. Six months later, a recurrent enterocele through a 1 cm defect in the vaginal vault was diagnosed. Several weeks later she presented with an incarcerated and strangulated loop of small intestine extending beyond the introitus. This required an urgent exploratory laparotomy, ileocecal resection, and vaginal vault closure. Postoperatively, she experienced gradual prolapse recurrence and is currently successfully managed with a pessary. Risk factors that include vaginal atrophy, chronic constipation, and previous pelvic surgery may have contributed to the evisceration, mesh erosion, and may have caused the breakdown in the vaginal vault mucosa ultimately responsible for the evisceration. In addition, placement of the sacrocolpopexy mesh without tension, and utilization of an interposition graft to reinforce the weakened vaginal vault tissue, are aspects of the surgical procedure that may influence outcomes. At the time of evisceration repair, the best approach to resuspend the vaginal vault, and prevent recurrent prolapse or evisceration, is currently unknown. Vaginal evisceration is a potential complication of abdominal sacrocolpopexy. Early recognition and treatment of this complication is critical, and prolapse recurrence may occur even after surgical repair.

  11. Transvaginal Sonography Versus Cystoscopy for Detecting Urinary Bladder Invasion in Early Stage Cervical Cancer

    PubMed Central

    Zutshi, Vijay; Garg, Anju; Batra, Swaraj

    2017-01-01

    Introduction Cervical cancer is a major cause of mortality from cancer among women. In it’s early stage pre operative staging with cystoscopy is a standard procedure for the detection of urinary bladder involvement. Aim The present study was conducted with the aim to compare the efficacy of Transvaginal Sonography (TVS) and cystoscopy in diagnosing bladder involvement in early stage cervical cancer patients by confirming it intraoperatively and further by histopathologic examination. Materials and Methods A prospective partially blinded study was conducted between March 2006 and September 2008 on 30 patients with early stage cervical cancer (Stage I and IIa) who were planned to undergo radical hysterectomy. Pre operatively, these patients underwent both TVS and cystoscopy to diagnose bladder involvement. Presence or absence of bladder involvement was then confirmed intra operatively and by histopathologic examination. Results In all the 30 patients studied, no bladder involvement was seen on cystoscopy where as TVS showed bladder involvement in three patients. Involvement of the bladder in these three patients was confirmed intra operatively and by histopathologic examination. Thus, in our study, TVS was 100% sensitive in detecting bladder involvement. Conclusion TVS is highly sensitive in diagnosing bladder involvement in early stage cervical cancer and could potentially detect cases missed with a cystoscopy.

  12. Robotic gastrectomy with transvaginal specimen extraction for female gastric cancer patients

    PubMed Central

    Zhang, Shu; Jiang, Zhi-Wei; Wang, Gang; Feng, Xiao-Bo; Liu, Jiang; Zhao, Jian; Li, Jie-Shou

    2015-01-01

    AIM: To describe the application of complete robotic gastrectomy with transvaginal specimen extraction (TVSE) for gastric cancer patients. METHODS: Between July and November 2014, eight female patients who were diagnosed with gastric adenocarcinoma underwent a TVSE following a full robot-sewn gastrectomy. According to the tumor location, the patients were allocated to two different groups; two patients received robotic total gastrectomy with TVSE and the other six received robotic distal gastrectomy with TVSE. RESULTS: Surgical procedures were successfully performed in all eight cases without conversion. The mean age was 55.3 (range, 42-69) years, and the mean body mass index was 23.2 (range, 21.6-26.0) kg/m2. The mean total operative time and blood loss were 224 (range, 200-298) min and 62.5 (range, 50-150) mL, respectively. The mean postoperative hospital stay was 3.6 (range, 3-5) d. The mean number of lymph nodes resected was 23.6 (range, 17-27). None was readmitted within 30 d of postoperation. During the follow-up, no stricture developed nor was any anastomotic leakage detected. CONCLUSION: It is possible to perform a TVSE following a full robot-sewn gastrectomy with standard D2 lymph node resection for female gastric cancer patients. PMID:26715817

  13. Transvaginal hydrolaparoscopy compared with laparoscopy for the evaluation of infertile women: a prospective comparative blind study.

    PubMed

    Darai, E; Dessolle, L; Lecuru, F; Soriano, D

    2000-11-01

    Standard diagnostic laparoscopy is considered the gold standard to investigate tubo-peritoneal infertility. It requires general anaesthesia and full operative facilities. Due to the risk of complications, laparoscopy is frequently postponed to the final stage of infertility evaluation or even after treatment trials have failed. Transvaginal hydrolaparoscopy (THL) is based on vaginal access using a needle puncture technique and saline for distention. THL can be performed on an outpatient basis under local anaesthesia. However, little data exist concerning the accuracy of THL in comparison with laparoscopy. We conducted a prospective comparative blind trial to assess the feasibility and accuracy of THL compared with diagnostic laparoscopy in infertile women. Sixty women were assigned to undergo THL immediately prior to laparoscopy. Different operators evaluated the findings of the two procedures. In order to evaluate the accuracy of THL, findings in terms of tubal pathology, endometriosis and adhesions were analysed. The success rate of accessing the pouch of Douglas was 90.2%. Complication rate was 1.6%. THL diagnosis was correlated with that of laparoscopy in 92.3% of cases. In cases of abnormal findings by THL, there were no normal laparoscopies. Our pilot study suggests that THL is a safe and reproducible method. Retroverted uterus should be considered as a relative contraindication to THL. When a complete evaluation by THL is available, it is a highly accurate technique in comparison with the laparoscopy.

  14. A strategy for reducing the mortality rate from vasa previa using transvaginal sonography with color Doppler.

    PubMed

    Oyelese, K O; Schwärzler, P; Coates, S; Sanusi, F A; Hamid, R; Campbell, S

    1998-12-01

    Vasa previa is a cause of sudden unanticipated fetal death, with a fetal mortality of 33-100%. Transvaginal sonography (TVS) and color Doppler may aid in making the diagnosis antenatally, allowing elective Cesarean delivery, thereby avoiding fetal death from exsanguination which would occur if the membranes were allowed to rupture in labor. Whilst it is not feasible to screen all pregnant women for vasa previa, antenatal examination with TVS and color Doppler of women at risk, specifically those with low-lying placentas, bi-lobed, multi-lobed and succenturiate-lobed placentas, multiple pregnancies and pregnancies resulting from in vitro fertilization may lead to antenatal diagnosis of the condition. We present the last three cases of vasa previa to have occurred in our institution, two of which were diagnosed antenatally using TVS and color Doppler. In all three cases, routine 20-week obstetric sonography revealed low-lying placentas; in only one of these did the placenta remain low at term. A low-lying placenta at 20 weeks may be a risk factor for vasa previa; we suggest that further studies be carried out to ascertain this. Judicious use of TVS and color Doppler in women considered at risk of vasa previa may help to reduce the mortality from this condition.

  15. Comparison of outcome and side effects between conventional and transvaginal laparoscopic cholecystectomy: a meta-analysis.

    PubMed

    Xu, Jian; Xu, Liang; Li, Lintao; Zha, Siluo; Hu, Zhiqian

    2014-10-01

    Transvaginal laparoscopic cholecystectomy (TVC) is becoming an attractive alternative to conventional laparoscopic cholecystectomy (CLC). We conducted a meta-analysis study to compare the outcome and side effects between TVC and CLC. Clinical studies on TVC with CLC as control were identified by searching PubMed and EMBASE (from 2007 to December 2013). Nine studies were identified for meta-analysis. Our results showed that TVC required much longer operative time [MD, 30.82; 95% confidence interval (CI), 13.00-48.65; P=0.0007] and had significantly lower pain score on postoperative day 1 as compared with CLC (MD, -1.77; 95% CI, -2.91 to -0.63; P=0.002). No statistical difference in days of hospital stay (MD, -1.60; 95% CI, -4.73 to 1.54; P=0.32) and number of complications was found between the 2 groups (risk ratio, 0.52; 95% CI, 0.25-1.10; P=0.09). Safety of TVC is similar as CLC. In conclusion, TVC patients have significantly less postoperative pain but need much longer operative time.

  16. Note-Making with T-Notes.

    ERIC Educational Resources Information Center

    Clark, Elvis G.; Davis, Archie D.

    The T-Note system is an easy way for students to take notes, is organized for effective review, and is adaptable because it provides a system for recording five types of information typically presented in the classroom. The student first divides a single loose-leaf notebook page vertically down the middle, and horizontally about one or two inches…

  17. Transvaginal cervical length scans to prevent prematurity in twins: a randomized controlled trial.

    PubMed

    Gordon, Michael C; McKenna, David S; Stewart, Theresa L; Howard, Bobby C; Foster, Kimberly F; Higby, Kenneth; Cypher, Rebecca L; Barth, William H

    2016-02-01

    Twin pregnancies are associated with an increased risk of perinatal morbidity and mortality primarily due to spontaneous preterm deliveries. The mean gestational age for delivery is 35.3 weeks and twins account for 23% of preterm births <32 weeks. A number of strategies have been proposed to prevent preterm deliveries: tocolytics, bed rest, hospitalization, home uterine activity monitoring, cerclage, and most recently, progesterone. Unfortunately, none have proven effective. Recent metaanalyses and reviews suggest that transvaginal cervical length (TVCL) ultrasound in the second trimester is a powerful predictor of preterm birth among asymptomatic women. Indeed, TVCL has the highest positive and negative predictive values for determining the risk of spontaneous preterm delivery in twin pregnancies. It follows that TVCL assessment may allow identification of a subset of twin pregnancies that re better candidates for interventions intended to prevent prematurity. We sought to determine whether use of TVCL prolongs gestation in twin pregnancies. This is a multicenter, randomized, controlled trial of 125 dichorionic or monochorionic/diamniotic twin pregnancies without prior preterm birth <28 weeks. The study group (n = 63) had TVCL and digital exams monthly from 16-28 weeks and were managed with a standard algorithm for activity restriction and cerclage. The control group (n = 62) had monthly digital cervical examinations but no routine TVCL ultrasound examinations. The primary outcome was gestational age at delivery. Secondary outcomes included percentage of deliveries <35 weeks, and maternal and neonatal outcomes. The mean gestational age at delivery was 35.7 weeks (95% confidence interval [CI], 35.2-36.2) among those managed with TVCL and 35.5 weeks (95% CI, 34.7-36.4) among the control patients. The Kaplan-Meier estimates of deliveries <38 weeks were not significantly different between groups. This was true whether we compared curves with a log-rank test (P = .67

  18. Writing a Condolence Note

    MedlinePlus

    ... Grief at Work Working Through Grief About Us Writing a Condolence Note By Helen Fitzgerald, CT Focusing ... to write an anniversary or birthday greeting. But writing a condolence note is something altogether different because, ...

  19. BASINS Technical Notes

    EPA Pesticide Factsheets

    EPA has developed several technical notes that provide in depth information on a specific function in BASINS. Technical notes can be used to answer questions users may have, or to provide additional information on the application of features in BASINS.

  20. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic.

    PubMed

    Naftalin, J; Hoo, W; Pateman, K; Mavrelos, D; Holland, T; Jurkovic, D

    2012-12-01

    What is the prevalence of adenomyosis in a population of women attending a general gynaecological clinic? Adenomyosis was present in 206 of 985 [20.9%; 95% confidence interval (CI): 18.5-23.6%] women included in the study. Previous studies of occurrence of adenomyosis have been limited to women who underwent hysterectomy, which is likely to overestimate its prevalence compared with the general population of women. There are no large prospective studies on the prevalence of adenomyosis, either in the general population of women or in a general gynaecology clinic setting. This was a prospective observational study set in the general gynaecology clinic of a university teaching hospital between January 2009 and January 2010. There were 985 consecutive women who attended the clinic and underwent structured clinical and transvaginal ultrasound examination in accordance with the study protocol. Morphological features of adenomyosis were systematically recorded with the ultrasound scan to determine its prevalence and factors which may affect its occurrence. Adenomyosis was present in 206/985 [20.9% (95% CI: 18.5-23.6%)] women included in the study. Multivariate analysis showed that the prevalence of adenomyosis was significantly associated with women's age, gravidity and pelvic endometriosis (P< 0.001). In women who subsequently underwent hysterectomy, there was a good level of agreement between the ultrasound and histological diagnosis of adenomyosis [κ = 0.62 (P = 0.001), 95% CI (0.324, 0.912)]. Our estimate of prevalence of adenomyosis is likely to be higher than in the general population as we studied symptomatic women attending a gynaecology clinic. Better estimates of the prevalence of adenomyosis can improve our understanding of the burden of the disease, help to identify women at high risk of developing the condition and facilitate the development of preventative strategies and effective treatment. The authors have no competing interests to declare. The study was

  1. Total pelvic floor reconstruction versus transvaginal hysterectomy for pelvic organ prolapse: a retrospective cohort.

    PubMed

    Shi, R X; Sun, H T

    2014-01-01

    To evaluate the surgical outcomes following total pelvic floor reconstruction (TPFR) and transvaginal hysterectomy (TVH). This was a retrospective cohort study of all patients who underwent TPFR or TVH repair for pelvic organ prolapse (POP) between January 2005 and January 2011. A total of 251 consecutive women were evaluated prior to, and at two, six, and 12 months after surgery. Anatomy, symptoms, and quality of life were measured using the Pelvic Organ Prolapse Quantification system (POP-Q) and pelvic floor distress inventory (PFDI). The surgical outcomes were compared between groups using Student's t-test and ANCOVA tests (p < 0.05). Of the 251 patients, 129 had a total pelvic floor reconstruction (TPFR group), and concomitant modified transobturator inside-out tension-free urethral suspension (TVT-O) was used in pelvic floor dysfunction patients with stress urinary incontinence. The patients that underwent vaginal hysterectomy surgery (TVH group) were 122. At two, six, and 12 months, respectively, 12.40% (TPFR group) and 18.85% (TVH group) of the patients were lost to follow-up. There were no significant differences between TPFR group and TVH group for all preoperative variables (p > 0.05). The TPFR patients had significantly lower operation time, blood loss, anus exhaust time, remaining catheter time, and the length of stay in hospital (p < 0.05). Postoperatively, the recurrence rate in TVH group was higher than that ofTPFR group after surgery at six and 12 months (p < 0.05). The PFDI scorewas significantly different between the groups. The short-term clinical results suggest that the two surgeries are safe and effective in treating female POP. The patients' quality life was improved, but TPFR technique was more conspicuous for treating POP.

  2. Persistence of Microbial Contamination on Transvaginal Ultrasound Probes despite Low-Level Disinfection Procedure

    PubMed Central

    M'Zali, Fatima; Bounizra, Carole; Leroy, Sandrine; Mekki, Yahia; Quentin-Noury, Claudine; Kann, Michael

    2014-01-01

    Aim of the Study In many countries, Low Level Disinfection (LLD) of covered transvaginal ultrasound probes is recommended between patients' examinations. The aim of this study was to evaluate the antimicrobial efficacy of LLD under routine conditions on a range of microorganisms. Materials and Methods Samples were taken over a six month period in a private French Radiology Center. 300 specimens derived from endovaginal ultrasound probes were analyzed after disinfection of the probe with wipes impregnated with a quaternary ammonium compound and chlorhexidine. Human papillomavirus (HPV) was sought in the first set of s100 samples, Chlamydia trachomatis and mycoplasmas were searched in the second set of 100 samples, bacteria and fungi in the third 100 set samples. HPV, C. trachomatis and mycoplasmas were detected by PCR amplification. PCR positive samples were subjected to a nuclease treatment before an additional PCR assay to assess the likely viable microorganisms. Bacteria and fungi were investigated by conventional methods. Results A substantial persistence of microorganisms was observed on the disinfected probes: HPV DNA was found on 13% of the samples and 7% in nuclease-resistant form. C. trachomatis DNA was detected on 20% of the probes by primary PCR but only 2% after nuclease treatment, while mycoplasma DNA was amplified in 8% and 4%, respectively. Commensal and/or environmental bacterial flora was present on 86% of the probes, occasionally in mixed culture, and at various levels (10->3000 CFU/probe); Staphylococcus aureus was cultured from 4% of the probes (10-560 CFU/probe). No fungi were isolated. Conclusion Our findings raise concerns about the efficacy of impregnated towels as a sole mean for disinfection of ultrasound probes. Although the ultrasound probes are used with disposable covers, our results highlight the potential risk of cross contamination between patients during ultrasound examination and emphasize the need for reviewing the disinfection

  3. The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions.

    PubMed

    Cogendez, Ebru; Eken, Meryem Kurek; Bakal, Nuray; Gun, Ismet; Kaygusuz, Ecmel Isik; Karateke, Ates

    2015-10-01

    The purpose of this prospective study was to assess the role of power Doppler imaging in the differential diagnosis of benign intrauterine focal lesions such as endometrial polyps and submucous myomas using the characteristics of power Doppler flow mapping. A total of 480 premenopausal patients with abnormal uterine bleeding were evaluated by transvaginal ultrasonography (TVS) searching for intrauterine pathology. Sixty-four patients with a suspicious focal endometrial lesion received saline infusion sonography (SIS) after TVS. Fifty-eight patients with focal endometrial lesions underwent power Doppler ultrasound (PDUS). Three different vascular flow patterns were defined: Single vessel pattern, multiple vessel pattern, and circular flow pattern. Finally, hysteroscopic resection was performed in all cases, and Doppler flow characteristics were then compared with the final histopathological findings. Histopathological results were as follows: endometrial polyp: 40 (69 %), submucous myoma: 18 (31 %). Of the cases with endometrial polyps, 80 % demonstrated a single vessel pattern, 7.5 % a multiple vessel pattern, and 0 % a circular pattern. Vascularization was not observed in 12.5 % of patients with polyps. Of the cases with submucousal myomas, 72.2 % demonstrated a circular flow pattern, 27.8 % a multiple vessel pattern, and none of them showed a single vessel pattern. The sensitivity, specificity, and positive and negative predictive values of the single vessel pattern in diagnosing endometrial polyps were 80, 100, 100, and 69.2 %, respectively; and for the circular pattern in diagnosing submucous myoma, these were 72.2, 100, 100, and 88.9 %, respectively. Power Doppler blood flow mapping is a useful, practical, and noninvasive diagnostic method for the differential diagnosis of benign intrauterine focal lesions. Especially in cases of recurrent abnormal uterine bleeding, recurrent abortion, and infertility, PDUS can be preferred as a first-line diagnostic method.

  4. Measurement of cervical biometry using transvaginal ultrasonography in predicting preterm labor.

    PubMed

    Tanvir; Ghose, Seetesh; Samal, Sunita; Armugam, Sedhilcoumari; Parida, Pallavee

    2014-07-01

    Preterm delivery is associated with high perinatal mortality and morbidity. Although detection of fetal fibronectin in cervical can predict preterm labor, but it is not available in lower source setting area. So, cervical length measurement by ultrasound can be used as an alternative to fetal fibronectin for predicting preterm labor. To find out the effectiveness of assessment of cervical length by endovaginal ultrasonography in predicting preterm delivery. The study was conducted in the infertility clinic of Mahatma Gandhi Medical College and Research Institute, Pondicherry from January 2010 to July 2011. A total of 130 women with singleton gestation were studied with transvaginal ultrasonography (TVS) to assess the cervical changes (cervical length, dilation of internal os, presence of funneling) between 22 weeks and 24 weeks of gestation. The gestational age at delivery in women with cervical length with ≥25 mm were compared with those of <25 mm. Statistical analysis was done using Chi-square test. The P value is <0.001 which is statistically significant. The mean cervical length in the study population was 33.16 mm. 16 women had cervical length <25 mm at mid trimesters can out of which 13 (40.62%) went for spontaneous preterm delivery. The relative risk of preterm delivery increased as the length of the cervix decreased. The P value is <0.001 which is statistically significant. A significant difference was found between multigravida at risk of preterm being 62.5% compared to primigravida which was 37.5%. The risk of spontaneous preterm delivery is increased in women who are found to have a short cervix by TVS during pregnancy and it is a sensitive, simple and cost effective method of assessing risk of preterm delivery.

  5. Measurement of cervical biometry using transvaginal ultrasonography in predicting preterm labor

    PubMed Central

    Tanvir; Ghose, Seetesh; Samal, Sunita; Armugam, Sedhilcoumari; Parida, Pallavee

    2014-01-01

    Context: Preterm delivery is associated with high perinatal mortality and morbidity. Although detection of fetal fibronectin in cervical can predict preterm labor, but it is not available in lower source setting area. So, cervical length measurement by ultrasound can be used as an alternative to fetal fibronectin for predicting preterm labor. Aims: To find out the effectiveness of assessment of cervical length by endovaginal ultrasonography in predicting preterm delivery. Settings and Design: The study was conducted in the infertility clinic of Mahatma Gandhi Medical College and Research Institute, Pondicherry from January 2010 to July 2011. Materials and Methods: A total of 130 women with singleton gestation were studied with transvaginal ultrasonography (TVS) to assess the cervical changes (cervical length, dilation of internal os, presence of funneling) between 22 weeks and 24 weeks of gestation. The gestational age at delivery in women with cervical length with ≥25 mm were compared with those of <25 mm. Statistical Analysis Used: Statistical analysis was done using Chi-square test. The P value is <0.001 which is statistically significant. Results: The mean cervical length in the study population was 33.16 mm. 16 women had cervical length <25 mm at mid trimesters can out of which 13 (40.62%) went for spontaneous preterm delivery. The relative risk of preterm delivery increased as the length of the cervix decreased. The P value is <0.001 which is statistically significant. A significant difference was found between multigravida at risk of preterm being 62.5% compared to primigravida which was 37.5%. Conclusions: The risk of spontaneous preterm delivery is increased in women who are found to have a short cervix by TVS during pregnancy and it is a sensitive, simple and cost effective method of assessing risk of preterm delivery. PMID:25097417

  6. Cervical length measured by transvaginal ultrasonography versus Bishop score to predict successful labour induction in term pregnancies

    PubMed Central

    Groeneveld, Y.J.B.; Bohnen, A.M.; Van Heusden, A.M.

    2010-01-01

    Objectives: To compare the value of transvaginal ultrasonographic measurement of the cervical length versus the Bishop score, prior to induction of labour, in predicting the mode of delivery within four days. Materials and Methods: This longitudinal study included 110 women (at term, singleton, vertex presentation) in whom induction of labour was performed at 37-42 weeks of gestation. Cervical length on transvaginal ultrasound and the Bishop score were assessed prior to induction according to standard protocol. Medical records were reviewed for relevant demographic and clinical data. Primary outcome criterion was successful vaginal delivery within 96 h. Univariate analyses and receiver operating characteristic (ROC) curves were used to examine differences between variables possibly predicting outcome. Results: Of the 110 women 66 were nulliparous and 44 multiparous. Vaginal delivery within 96 h was successful in 48 (73%) nulliparous and in 40 (91%) multiparous women ( i.e. in 80% of the total population). The overall rate of caesarean delivery was 17%. There was a significant difference between nulliparous and multiparous women in age, cervical length (mean in mm in nulliparous women: 29.31, range: 5.00-56.00; in multiparous women: 37.04, range: 12.00-56.00), Bishop score and successful induction, but no significant difference between these subgroups in neonatal outcomes. Only the Bishop score in nulliparous women showed a significant relationship between this variable and predicting successful labour induction (area under the ROC curve 0.679; standard error 0.73; p < 0.05; 95% CI: 0.536-0.823). The best cut-off value for the Bishop score was 3, with a sensitivity of 56.3% and a specificity of 72.2%. Conclusion: In this study group significant independent prediction of vaginal delivery within 96 h is provided by the Bishop score but only in nulliparous women. Transvaginal ultrasonographic measurement of cervical length is not a significant independent predictor

  7. Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding.

    PubMed

    Ozer, Alev; Ozer, Serdar; Kanat-Pektas, Mine

    2016-05-01

    The present study aims to determine how transvaginal ultrasonography and histopathological examination findings are correlated in a cohort of premenopausal and postmenopausal Turkish women with abnormal uterine bleeding. This is a retrospective review of 350 Turkish women who underwent transvaginal ultrasonography and suction curettage as a result of abnormal uterine bleeding. Sonographic appearance of the endometrium was normal in 244 patients (69.7%), while homogeneous thickening was detected in 47 patients (13.4%) and cystic thickening in 21 patients (6.0%). A sonographic diagnosis of endometrial polyp was made in 38 patients (10.9%). Histopathological analysis of endometrial samplings revealed proliferative endometrium (36%), secretory endometrium (24.6%), decidualization (10.9%), endometrial polyp (8.3%), endometritis (6.8%), endometrial hyperplasia (4.6%), irregular shedding (3.7%), atrophic endometrium (3.1%), endometrial cancer (1.1%) and placental retention (0.9%). The sonographic and histopathological findings correlated significantly (χ(2) = 122 768, P = 0.001; r = 0.215, P = 0.001). Approximately 51% of the women with homogeneous endometrial thickening had proliferative endometrium. Only 44.7% of the women with ultrasonographically visualized endometrial polyps had histopathologically diagnosed endometrial polyps. Nearly 57% of the women with cystic endometrial thickening had proliferative endometrium. If there is no facility for hysteroscopy or hysteroscopy-guided endometrial biopsy for women with abnormal uterine bleeding, transvaginal ultrasonography findings can be efficiently used to make a preliminary diagnosis and, thus, notify the pathologists. © 2016 Japan Society of Obstetrics and Gynecology.

  8. [Preterm labor: Reproducibility of detection test of PAMG-1 before and after digital examination, and transvaginal ultrasound cervical length].

    PubMed

    Werlen, S; Raia, T; Di Bartolomeo, A; Chauleur, C

    2015-10-01

    With current diagnostic resources, it is impossible to predict if a patient consulting in the obstetrics emergencies with symptoms of preterm labor, preterm delivery or not. A novel test for the detection of time to spontaneous preterm delivery was developed and would predict imminent delivery in 7 or 14 days from the time of testing. The diagnostic performances of detection test of PAMG-1 have been validated before digital examination. However digital examination is usually made in first line. The objective of this study was to assess the reproducibility of these diagnostic performances after digital examination and transvaginal ultrasound cervical length. A prospective and observational study was conducted in a level 3 maternity (University Hospital of Saint-Etienne), from June 2013 to January 2014. Patients consulted in the obstetrics emergencies for threatened preterm birth between 24-34 weeks were enrolled with written and signed consent. Reproducibility of this test was assessed after digital examination, transvaginal ultrasound cervical length and a long time after all investigations. Forty-one patients were included in our study. Average gestational age was 29 weeks, digital examination was changed in 36 patients, whereas cervical length was less than 26mm for only 17 patients. In our study, 100% of tests results remain negative or positive after digital examination and 95,1% after transvaginal ultrasound. Our results confirmed this excellent specificity (97.5% [IC 95%; 86.8-99.9]) and negative predictive value (97.5% [IC 95%; 86.8-99.9]). This work allowed to demonstrate the reproducibility of detection test of PAMG-1 after a digital examination. An initial management with detection test of PAMG-1 could allow reducing the rate of unnecessary hospitalization. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate.

    PubMed

    Son, Moeun; Grobman, William A; Ayala, Nina K; Miller, Emily S

    2016-03-01

    Mid-trimester transvaginal cervical length assessment can identify women who are at risk of preterm birth and afford opportunities for preterm birth prevention. However, the incidence of a short cervix is low, and some physicians have questioned whether a universal screening program among women without a previous preterm birth would be beneficial. The purpose of this study was to examine whether the introduction of a universal transvaginal cervical length screening program is associated with a reduction in the preterm birth rate. This is a cohort study of women with singleton gestations and without any previous preterm births who underwent an obstetric sonogram at 18-24 weeks of gestation and who had their delivery at a single tertiary institution from January 2007 to January 2014. In July 2011, a program was implemented in which all pregnant women who had a sonogram at 18-24 weeks of gestation were to receive a transvaginal cervical length measurement. The preterm birth rates were compared before and after the implementation of the universal cervical length screening program. Multivariable analysis was used to identify whether the universal cervical length screening program was associated independently with the frequency of preterm birth. The Breslow-Day test for homogeneity was used to assess whether any interaction existed in the association based on parity. Of 64,207 eligible women, 46,598 underwent their mid-trimester sonogram before the universal cervical length screening program, and 17,609 underwent a sonogram after implementation of the program. Of the 17,590 women (99.9%) who agreed to cervical length measurement, 157 (0.89%) had a measurement of ≤25 mm. The introduction of the cervical length program was associated with a significant decrease in the frequency of preterm birth at <37 weeks of gestation (6.7% vs 6.0%; adjusted odds ratio, 0.82 [95% confidence interval, 0.76-0.88]), <34 weeks of gestation (1.9% vs 1.7%; adjusted odds ratio, 0.74 [95

  10. Transumbilical flexible endoscopic cholecystectomy in humans: first feasibility study using a hybrid technique.

    PubMed

    Palanivelu, C; Rajan, P S; Rangarajan, M; Parthasarathi, R; Senthilnathan, P; Praveenraj, P

    2008-05-01

    Natural-orifice transluminal endoscopic surgery (NOTES) procedures have been tested using numerous approaches, mainly in animals. In humans, only cholecystectomy has been assessed, using a combined transvaginal and transumbilical approach. We present another variant of a hybrid technique for cholecystectomy, namely the combination of a flexible transumbilical double-channel endoscope and a 3-mm rigid transcutaneous trocar placed in the left hypochondrium for liver retraction. The procedure was attempted in 10 well-selected young patients (M : F = 4 : 6, mean age 29.5 years). Instruments used through the two working channels of the endoscope were either a grasping forceps or snare for grasping and pulling and a hot-biopsy forceps for cold and hot preparation and dissection. Endoclips were used for cystic duct and artery closure. Postoperative analgesia consisted of one intravenous dose of analgesic, followed by oral administration for one further day. Follow-up visits were scheduled at 7 days, 30 days, 90 days, and 6 months. In 4 of the 10 cases the operation had to be converted to conventional laparoscopic cholecystectomy due to difficulty in dissection (in 2 cases) or uncontrollable hemorrhage (2 cases). The mean operating time was 148 minutes. Of the 6 cases in which the procedure was finished by the new approach, cystic artery bleeding occurred in 1 and was successfully clipped. One further patient had a postoperative cystic duct leak with a bilioma, successfully treated by endoscopic retrograde cholangiopancreatography with stenting. Five of the six patients reported themselves as satisfied at 3- or 6-month follow-up. So far, our endoscope-based transumbilical cholecystectomy technique has not yielded satisfactory results in humans. Further instrument and accessory improvements may increase both success rate and acceptance. Scarless surgery without the inherent risks of a transluminal approach may then become feasible.

  11. [Which initial tests should be performed to evaluate meno-metrorrhagias? A comparison of hysterography, transvaginal sonohysterography and hysteroscopy].

    PubMed

    Descargues, G; Lemercier, E; David, C; Genevois, A; Lemoine, J P; Marpeau, L

    2001-02-01

    Evaluate the feasibility and the value of hysterography, sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding. Method. Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause. All patients underwent an hysterography and transvaginal sonohysterography, in random order, followed by an hysteroscopy with histological sample. The results were compared with the histo-pathological examination that was used for reference diagnosis. Statistical study of sensitivity, specificity and Positive and Negative Predictive Value (PPV-NPV) of each investigation; rate of agreement by the coefficient of Kappa. The hysterography offers a PPV of 83% and a NPV of 100%. The interpretation errors were associated with the simple mucous hypertrophy interpreted as "hyperplasy". The limits correspond to a contrast agent allergy. The sonohysterography had a VPP of 89% and a VPN of 100%. The false positive is due to the difficulties of distinguishing the clots from the polyps. The limits correspond to the difficulties of cervix catheterization (13%). As regards the hysteroscopy, the VPP was 81.5% and the VPN of 75%. The interpretation mistakes were associated with mucous hypertrophy and the hyperplasy. The most useful examination for abnormal uterine bleeding, in the first instance, is transvaginal sonography with saline instillation. A complement by Doppler study would probably make it possible to limit the false positives.

  12. Post-operative ovarian adhesion formation after ovarian drilling: a randomized study comparing conventional laparoscopy and transvaginal hydrolaparoscopy.

    PubMed

    Giampaolino, Pierluigi; Morra, Ilaria; Tommaselli, Giovanni Antonio; Di Carlo, Costantino; Nappi, Carmine; Bifulco, Giuseppe

    2016-10-01

    To compare conventional laparoscopic ovarian drilling (LOD) with transvaginal hydrolaparoscopy (THL) ovarian drilling in terms of ovarian adhesion formation, evaluated using office THL during follow-up in CC-resistant anovulatory patients affected by PCOS. Prospective randomized study on 246 CC-resistant women with PCOS. The patients enrolled were divided into two groups, 123 were scheduled to undergo LOD and 123 to undergo THL ovarian drilling. Six months after the procedure all patients were offered office transvaginal hydrolaparoscopy (THL) follow-up, under local anesthesia to evaluate adhesion formation. Duration of the procedure was significantly shorter in the THL group in comparison with LOD group (p < 0.0001). No intra- or post-operative complication was observed in any of the patients in both groups. Post-operative THL follow-up after 6 months showed that 15 (15.5 %) patients in the THL group and 73 (70.2 %) in the LOD group showed the presence of ovarian adhesion. This difference was highly significant with a p value <0.0001 and a relative risk of 0.22 [95 % IC 0.133-0.350]. This study seems to indicate that THL ovarian drilling may reduce the risk of ovarian adhesion formation and could be used as a safe and effective option to reduce ovarian adhesion formation in patients undergoing ovarian drilling.

  13. Transvaginal cervical length measurement at 22- to 26-week pregnancy in prediction of preterm births in twin pregnancies.

    PubMed

    El-Gharib, Mohamed Nabih; Albehoty, Sherin Barakat

    2017-03-01

    To investigate the predictive role of transvaginal ultrasonographic measurement of cervical length (CL) at 22-26 weeks of gestation in determining preterm deliveries in twin pregnancies. The study included 150 twin pregnancies. CL was measured by transvaginal ultrasonography at 22-26 weeks. Signs of preterm labor, ruptured membranes, vaginal bleeding, patients with systemic disease, and cervical incompetencies were excluded. The patients had monthly digital cervical examinations but no routine TVCL ultrasound examinations. The primary outcome was spontaneous preterm birth at before 37 weeks of gestation. Ninety-two percent of twin pregnancies delivered by cesarean section and 16% babies had a neonatal intensive care unit requisitioned. Ninety-two patients were delivered in smaller than 37 gestational weeks and the mean CL measurement (CLM) was <37.64 ± 6.23 mm. According to the ROC curve analysis, CLM was found to be a discriminating parameter in patients. The area under the curve, cutoff values, sensitivity, and specificity were 0.794, 34.95, and 70-80%; respectively (p = 0.029). In women with twin pregnancy, the risk of preterm birth can be evaluated using the ultrasonographic measurement of CL at 22-26 weeks of gestation.

  14. Collection of oocytes through transvaginal ovum pick-up for in vitro embryo production in Nanyang Yellow cattle.

    PubMed

    Li, F; Chen, X; Pi, W; Liu, C; Shi, Z

    2007-12-01

    The objectives of this study were to use ultrasound-guided transvaginal follicular aspiration to develop a technique for preservation of Nanyang Yellow cattle germ plasm. In Nanyang Yellow heifers, aspiration twice per week yielded a higher mean numbers of aspirated follicles, recovered oocytes and viable oocytes per session than once-weekly aspiration. Intriguingly, twice-weekly aspiration from Holstein heifers yielded a higher mean numbers of aspirated follicles, recovered oocytes and viable oocytes per session than in Nanyang Yellow heifers. Moreover, the oocyte recovery rate was significantly higher in Holstein heifers than in Nanyang Yellow heifers. Importantly, similar rates of embryos undergoing cleavage division were observed in Nanyang Yellow and Holstein, as was the number of viable day 8 blastocysts. These observations demonstrate that twice-weekly aspiration harvested the similar proportions of viable oocytes from Nanyang Yellow and Holstein follicles, and that twice-weekly aspiration yields a higher number of viable oocytes than once-weekly aspiration in Nanyang Yellow heifers. The results also suggest that the combination of ultrasound-guided transvaginal follicular aspiration and in vitro production is an effective and practical strategy for establishment of a germ plasm preservation programme for Nanyang Yellow cattle.

  15. Prevalence in a volunteer population of pelvic cancer detected with transvaginal ultrasound and color flow Doppler.

    PubMed

    Schulman, H; Conway, C; Zalud, I; Farmakides, G; Haley, J; Cassata, M

    1994-09-01

    Our objective was to find the prevalence of non-symptomatic endometrial and ovarian neoplasms in a volunteer population of women, aged 40 and over. We offered a free volunteer screening program to asymptomatic women for a study using transvaginal ultrasound and color flow Doppler for the detection of pelvic cancer. In the first 2 years, 2117 women were examined, 51.3% post-menopausal. An ovarian cyst was defined as having a maximum diameter of more than 2.4 cm. Color flow was used to identify blood vessels feeding pelvic organs and adnexal enlargements. An abnormal Doppler flow velocity for the ovary was defined as a resistance index of less than 0.41. Ovarian cysts of less than 5 cm with normal Doppler indices were followed up in 6 months to 1 year. An adnexal morphology score was created to quantify the usefulness of this parameter, particularly in postmenopausal women. Indications for surgery were pre-defined as a persistent ovarian cyst of more than 5 cm, a persistent suspicious Doppler and a total endometrial thickness of greater than 0.59 cm in postmenopausal women not taking hormones.A total of 202 women (9.5%) had ovarian cysts. Fourteen women were operated upon because of size criteria, one because of family history and three for persistent abnormal flow. By Doppler study, 15 cysts were predicted to be benign and histology was confirmatory. There were two false positives and one true positive, a stage Ib ovarian cancer. There were no false negatives, although a stage I endometrioid cancer of the ovary was detected 8 months after a negative scan. In those cases in which follow-up data were available, 56% of the cysts regressed in premenopausal women. In postmenopausal women, 28% regressed. Twenty of 1086 postmenopausal women had endometrial biopsies. Three had endometrial cancer, two stage I and one stage IIA. Five had atypical or adenomatous hyperplasia, and seven had benign polyps. So many women have small asymptomatic cysts of the ovary that a major

  16. Transvaginal 3D Image-Guided High Intensity Focused Ultrasound Array

    NASA Astrophysics Data System (ADS)

    Held, Robert; Nguyen, Thuc Nghi; Vaezy, Shahram

    2005-03-01

    The goal of this project is to develop a transvaginal image-guided High Intensity Focused Ultrasound (HIFU) device using piezocomposite HIFU array technology, and commercially-available ultrasound imaging. Potential applications include treatment of uterine fibroids and abnormal uterine bleeding. The HIFU transducer was an annular phased array, with a focal length range of 30-60 mm, an elliptically-shaped aperture of 35×60 mm, and an operating frequency of 3 MHz. A pillow-shaped bag with water circulation will be used for coupling the HIFU energy into the tissue. An intra-cavity imaging probe (C9-5, Philips) was integrated with the HIFU array such that the focal axis of the HIFU transducer was within the image plane. The entire device will be covered by a gel-filled condom when inserted in the vaginal cavity. To control it, software packages were developed in the LabView programming environment. An imaging algorithm processed the ultrasound image to remove noise patterns due to the HIFU signal. The device will be equipped with a three-dimensional tracking system, using a six-degrees-of-freedom articulating arm. Necrotic lesions were produced in a tissue-mimicking phantom and a turkey breast sample for all focal lengths. Various HIFU doses allow various necrotic lesion shapes, including thin ellipsoidal, spherical, wide cylindrical, and teardrop-shaped. Software control of the device allows multiple foci to be activated sequentially for desired lesion patterns. Ultrasound imaging synchronization can be achieved using hardware signals obtained from the imaging system, or software signals determined empirically for various imaging probes. The image-guided HIFU device will provide a valuable tool in visualization of uterine fibroid tumors for the purposes of planning and subsequent HIFU treatment of the tumor, all in a 3D environment. The control system allows for various lesions of different shapes to be optimally positioned in the tumor to cover the entire tumor

  17. The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy.

    PubMed

    Panebianco, Nova L; Shofer, Frances; Fields, J Matthew; Anderson, Kenton; Mangili, Alessandro; Matsuura, Asako C; Dean, Anthony J

    2015-06-01

    For patients with early intrauterine pregnancy (IUP), the sonographic signs of the gestation may be below the resolution of transabdominal ultrasound (TAU); however, it may be identified by transvaginal ultrasound (TVU). We sought to determine how often TVU performed in the emergency department (ED) reveals a viable IUP after a nondiagnostic ED TAU and the impact of ED TVU on patient length of stay (LOS). This was a retrospective cohort study of women presenting to our ED with complications of early pregnancy from January 1, 2007 to February 28, 2009 in a single urban adult ED. Abstractors recorded clinical and imaging data in a database. Patient imaging modality and results were recorded and compared with respect to ultrasound (US) findings and LOS. Of 2429 subjects identified, 795 required TVU as part of their care. Emergency department TVU was performed in 528 patients, and 267 went to radiology (RAD). Emergency department TVU identified a viable IUP in 261 patients (49.6%). Patients having initial ED US had shorter LOS than patients with initial RAD US (median 4.0 vs 6.0 hours; P < .001). Emergency department LOS was shorter for women who had ED TVU performed compared with those sent for RAD TVU regardless of the findings of the US (median 4.9 vs 6.7 hours; P < .001). There was no increased LOS for patients who needed further RAD US after an indeterminate ED TVU (7.0 vs 7.1 hours; P = .43). There was no difference in LOS for those who had a viable IUP confirmed on ED TAU vs ED (median 3.1 vs 3.2 hours, respectively; P < .32). When an ED TVU was performed, a viable IUP was detected 49.6% of the time. Emergency department LOS was significantly shorter for women who received ED TVU after indeterminate ED TAU compared with those sent to RAD for TVU, with more marked time savings among those with live IUP diagnosed on ED TVU. For patients who do not receive a definitive diagnosis of IUP on ED TVU, this approach does not result in increased LOS. Copyright © 2015

  18. Magnetic resonance enema vs rectal water-contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis.

    PubMed

    Leone Roberti Maggiore, U; Biscaldi, E; Vellone, V G; Venturini, P L; Ferrero, S

    2017-04-01

    To compare the accuracy of magnetic resonance enema (MR-e) and rectal water-contrast transvaginal sonography (RWC-TVS) in the diagnosis of rectosigmoid endometriosis. This prospective study included 286 patients of reproductive age with clinical suspicion of rectosigmoid endometriosis. Patients underwent MR-e and RWC-TVS before laparoscopic excision of endometriotic lesions. The findings of MR-e and RWC-TVS were compared with surgical and histological results. Of the 286 patients included in the study, 151 (52.8%) had rectosigmoid endometriosis. MR-e and RWC-TVS had similar accuracy in the diagnosis of rectosigmoid endometriosis (P = 0.063). In the diagnosis of rectosigmoid endometriosis with MR-e, the sensitivity was 95.4% (95% CI, 90.7-99.1%), specificity was 97.8% (95% CI, 93.6-99.5%), positive predictive value (PPV) was 98.0% (95% CI, 94.1-99.6%), negative predictive value (NPV) was 95.0% (95% CI, 89.9-97.9%), positive likelihood ratio (LR+) was 42.91 (95% CI, 14.01-131.46) and negative likelihood ratio (LR-) was 0.05 (95% CI, 0.02-0.10). For diagnosis with RWC-TVS, sensitivity was 92.7% (95% CI, 87.3-96.3%), specificity was 97.0% (95% CI, 92.6-99.2%), PPV was 97.2% (95% CI, 93.0-99.2%), NPV was 92.3% (95% CI, 86.6-96.1%), LR+ was 31.29 (95% CI, 11.90-82.25) and LR- was 0.08 (95% CI, 0.04-0.13). MR-e and RWC-TVS underestimated the size of the endometriotic nodules; for both imaging techniques the underestimation was greater for nodules with a diameter ≥ 30 mm. There was no significant difference in the mean intensity of pain experienced by the patients during the two examinations. RWC-TVS should be the first-line investigation in patients with clinical suspicion of rectosigmoid endometriosis and physicians should be trained in performing this examination. Considering that MR-e is more expensive than RWC-TVS, it should be used only when the findings of RWC-TVS are unclear. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016

  19. Adherence to criteria for transvaginal ultrasound imaging and measurement of cervical length.

    PubMed

    Iams, Jay D; Grobman, William A; Lozitska, Albina; Spong, Catherine Y; Saade, George; Mercer, Brian M; Tita, Alan T; Rouse, Dwight J; Sorokin, Yoram; Wapner, Ronald J; Leveno, Kenneth J; Blackwell, Sean C; Esplin, M Sean; Tolosa, Jorge E; Thorp, John M; Caritis, Steve N; Van Dorsten, Peter J

    2013-10-01

    Adherence to published criteria for transvaginal imaging and measurement of cervical length is uncertain. We sought to assess adherence by evaluating images submitted to certify research sonographers for participation in a clinical trial. We reviewed qualifying test results of sonographers seeking certification to image and measure cervical length in a clinical trial. Participating sonographers were required to access training materials and submit 15 images, 3 each from 5 pregnant women not enrolled in the trial. One of 2 sonologists reviewed all qualifying images. We recorded the proportion of images that did not meet standard criteria (excess compression, landmarks not seen, improper image size, or full maternal bladder) and the proportion in which the cervical length was measured incorrectly. Failure for a given patient was defined as >1 unacceptable image, or >2 acceptable images with incorrect caliper placement or erroneous choice of the "shortest best" cervical length. Certification required satisfactory images and cervical length measurement from ≥4 patients. A total of 327 sonographers submitted 4905 images. A total of 271 sonographers (83%) were certified on the first, 41 (13%) on the second, and 2 (0.6%) on the third submission. Thirteen never achieved certification. Of 314 who passed, 196 submitted 15 acceptable images that were appropriately measured for all 5 women. There were 1277 deficient images: 493 were acceptable but incorrectly measured images from sonographers who passed certification because mismeasurement occurred no more than twice. Of 784 deficient images submitted by sonographers who failed the certification, 471 were rejected because of improper measurement (caliper placement and/or failure to identify the shortest best image), and 313 because of failure to obtain a satisfactory image (excessive compression, required landmarks not visible, incorrect image size, brief examination, and/or full maternal bladder). Although 83% of

  20. Comparison of transvaginal color Doppler imaging and color Doppler energy for assessment of intraovarian blood flow.

    PubMed

    Tailor, A; Jurkovic, D; Bourne, T H; Natucci, M; Collins, W P; Campbell, S

    1998-04-01

    To investigate any systematic differences in the analysis of blood flow velocity waveforms derived by color Doppler imaging and color Doppler energy examination of corpora lutea and adnexal tumors, to test whether the accuracy for diagnosing ovarian malignancy differs between end points derived by color Doppler imaging and color Doppler energy, and to compare the reproducibility of flow velocity waveform analysis obtained by both methods. Fifty-six asymptomatic women with presumed corpora lutea and 67 women with known adnexal masses were included in the study. They all were examined using transvaginal sonography with color Doppler imaging and color Doppler energy. Pulsed Doppler sonography was used to obtain flow velocity waveforms to determine the pulsatility index (PI), resistance index (RI), peak systolic velocity, and time-averaged maximum velocity. The tumors were classified retrospectively according to histologic criteria. There were 52 women with benign, three with borderline, and 12 with malignant ovarian tumors. Repeated-measures analysis of variance revealed no systematic differences in the values of all four measurements performed under color Doppler imaging and color Doppler energy for all cases of corpora lutea and adnexal tumors (PI: P=.153, RI: P=.197, peak systolic velocity: P=.355, time-averaged maximum velocity: P=.159). All cases of borderline and malignant tumors had detectable pulsatile blood flow with color Doppler imaging and color Doppler energy. Forty-two (80.8%) of the benign tumors had flow detectable with color Doppler imaging, compared with 40 (76.9%) with color Doppler energy (P=.480). Analysis of receiver operating characteristic curves showed a marginal but nonsignificant improvement in diagnostic performance with color Doppler energy compared with color Doppler imaging for all four measurements (PI: P=.182, RI: P=.178, peak systolic velocity: P=.254, time-averaged maximum velocity: P=.238). The intraclass correlation coefficients

  1. Comparison of the POP-Q examination, transvaginal ultrasound, and direct anatomic measurement of cervical length.

    PubMed

    Dancz, Christina E; Werth, Lisa; Sun, Vanessa; Lee, Sandy; Walker, Daphne; Özel, Begüm

    2014-04-01

    Our objective was to determine the relationship between the Pelvic Organ Prolapse Quantification (POP-Q) examination for determining cervical length (CL) and CL at hysterectomy. Secondary objectives were to define cervical elongation using both measures in a urogynecologic population, determine the relationship between POP-Q estimate and CL on ultrasound (US) and examine the interobserver reliability of each mode of measurement. This was a prospective cohort study of women scheduled for hysterectomy at the Los Angeles County + University of Southern California (LAC + USC) medical center. CLs were measured by POP-Q and at the time of hysterectomy. Transvaginal US CLs were determined when available. Exam CL (eCL) was compared with anatomic (aCL) and US (uCL) CL. Repeat measures of eCL, uCL, and aCL were all compared for interobserver reliability. The study enrolled 151 women. Median eCL was 3.0 cm (0.5-9.0) (n = 149); average uCL was 2.3 cm ± 0.7 (n = 108), average aCL 2.8 cm ± 1.1 (n = 87); eCL correlated fairly with aCL (r = 0.3, p = 0.005, n = 88) but poorly with uCL (r = -0.13, p = 0.18, n = 105); uCL correlated poorly with aCL (r = 0.19, p = 0.14, n = 64). Interobserver reliability for eCL and aCL were good to excellent (eCL α=0.881; aCL α=0.889) but for uCL adequate (α=0.699). The 97.5 percentile cutoff for aCL was 5.0 cm and for eCL 8.0 cm. The POP-Q examination estimate of CL correlates fairly with aCL at the time of hysterectomy; uCL does not appear to correlate with aCL or eCL. Cervical elongation may be defined as an anatomic length of 5.0 cm or a POP-Q estimate of 8.0 cm.

  2. A note on notes: note taking and containment.

    PubMed

    Levine, Howard B

    2007-07-01

    In extreme situations of massive projective identification, both the analyst and the patient may come to share a fantasy or belief that his or her own psychic reality will be annihilated if the psychic reality of the other is accepted or adopted (Britton 1998). In the example of' Dr. M and his patient, the paradoxical dilemma around note taking had highly specific transference meanings; it was not simply an instance of the generalized human response of distracted attention that Freud (1912) had spoken of, nor was it the destabilization of analytic functioning that I tried to describe in my work with Mr. L. Whether such meanings will always exist in these situations remains a matter to be determined by further clinical experience. In reopening a dialogue about note taking during sessions, I have attempted to move the discussion away from categorical injunctions about what analysis should or should not do, and instead to foster a more nuanced, dynamic, and pair-specific consideration of the analyst's functioning in the immediate context of the analytic relationship. There is, of course, a wide variety of listening styles among analysts, and each analyst's mental functioning may be affected differently by each patient whom the analyst sees. I have raised many questions in the hopes of stimulating an expanded discussion that will allow us to share our experiences and perhaps reach additional conclusions. Further consideration may lead us to decide whether note taking may have very different meanings for other analysts and analyst-patient pairs, and whether it may serve useful functions in addition to the one that I have described.

  3. Sticky-Note Murals

    ERIC Educational Resources Information Center

    Sands, Ian

    2011-01-01

    In this article, the author describes a sticky-note mural project that originated from his desire to incorporate contemporary materials into his assignments as well as to inspire collaboration between students. The process takes much more than sticking sticky notes to the wall. It takes critical thinking skills and teamwork to design and complete…

  4. Sticky-Note Murals

    ERIC Educational Resources Information Center

    Sands, Ian

    2011-01-01

    In this article, the author describes a sticky-note mural project that originated from his desire to incorporate contemporary materials into his assignments as well as to inspire collaboration between students. The process takes much more than sticking sticky notes to the wall. It takes critical thinking skills and teamwork to design and complete…

  5. Computer simulations of thermal tissue remodeling during transvaginal and transurethral laser treatment of female stress urinary incontinence.

    PubMed

    Hardy, Luke A; Chang, Chun-Hung; Myers, Erinn M; Kennelly, Michael J; Fried, Nathaniel M

    2017-02-01

    A non-surgical method is being developed for treating female stress urinary incontinence by laser thermal remodeling of subsurface tissues with applied surface tissue cooling. Computer simulations of light transport, heat transfer, and thermal damage in tissue were performed, comparing transvaginal and transurethral approaches. Monte Carlo (MC) simulations provided spatial distributions of absorbed photons in the tissue layers (vaginal wall, endopelvic fascia, and urethral wall). Optical properties (n,μa ,μs ,g) were assigned to each tissue at λ = 1064 nm. A 5-mm-diameter laser beam and incident power of 5 W for 15 seconds was used, based on previous experiments. MC output was converted into absorbed energy, serving as input for finite element heat transfer simulations of tissue temperatures over time. Convective heat transfer was simulated with contact probe cooling temperature set at 0°C. Variables used for thermal simulations (κ,c,ρ) were assigned to each tissue layer. MATLAB code was used for Arrhenius integral thermal damage calculations. A temperature matrix was constructed from ANSYS output, and finite sum was incorporated to approximate Arrhenius integral calculations. Tissue damage properties (Ea ,A) were used to compute Arrhenius sums. For the transvaginal approach, 37% of energy was absorbed in the endopelvic fascia target layer with 0.8% deposited beyond it. Peak temperature was 71°C, the treatment zone was 0.8-mm-diameter, and 2.4 mm of the 2.7-mm-thick vaginal wall was preserved. For transurethral approach, 18% energy was absorbed in endopelvic fascia with 0.3% deposited beyond the layer. Peak temperature was 80°C, treatment zone was 2.0-mm-diameter, and 0.6 mm of 2.4-mm-thick urethral wall was preserved. Computer simulations suggest that transvaginal approach is more feasible than transurethral approach. Lasers Surg. Med. 49:198-205, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. Cervical Length Measured by Transvaginal Ultrasonography and Cervicovaginal Infection as Predictor of Preterm Birth Risk

    PubMed Central

    Banicevic, Arnela Ceric; Popovic, Miroslav; Ceric, Amela

    2014-01-01

    Introduction: The study shows possibilities of transvaginal sonographic measurement of the cervix in prediction of premature birth risk. Goals: The aim of the study was to follow up the cervical length in the pregnant from 16th to 37th week, as well as to do a microbiological analysis of the vaginal and cervical flora and to identify relation between the cervical shortening and microbiological flora as well as with a premature birth. Material and methods: The investigation was conducted as a prospective study on two groups of female patients in Clinical Centre of Banja Luka. In the high risk group we had 8% of patients with cervical length bellow than 15mm, 30% of patients with cervical length from 15 to 25m and 62% of patients with cervical length bigger than 25mm. In the low risk group we had no patients with cervical length bellow 15mm, 95% of patients had cervical length bigger than 25mm and 5% of patients had cervical length from 15 do 25mm. Results: The regression coefficient of the cervical length in the high risk group was 0.44mm, while in the low risk group it was 0.26mm. In the high risk group 67.56% patients had a positive cervical smear finding, while in the low risk group it was 4%. A high premature birth (defined as birth before 36.6 weeks) incidence of 50% was presented in patients with cervical length bellow 15mm. In the group of patients with cervical length up to 25mm the premature risk incidence was 10.52±0.05. In the high risk group of patients with a positive cervical smear finding, regarding the cervical length the percentage was as follows; in the subgroup of 15mm length 88,89±11,87, in subgroup from 15 to 25mm was 62,07±11,43 and in the subgroup bigger than 25mm, 60.06±8.05. Conclusion: By the analysis of the first and second goal of our study we can conclude that ultrasound assessment of cervical length is simple and feasible in the 16th week of pregnancy in both groups, with high and low risk. The length of the cervix in this period is

  7. Acute pulmonary edema caused by takotsubo cardiomyopathy in a pregnant woman undergoing transvaginal cervical cerclage: A case report.

    PubMed

    Lee, Jae-Young; Kwon, Hyun-Jung; Park, Sang-Wook; Lee, Yu-Mi

    2017-01-01

    The physiological changes associated with pregnancy may predispose pregnant women to pulmonary edema. Other known causes of pulmonary edema during pregnancy include tocolytic drugs, preeclampsia, eclampsia, and peripartum cardiomyopathy. We describe a rare case of pulmonary edema caused by takotsubo cardiomyopathy in a pregnant woman at 14 weeks of gestation who was undergoing emergency transvaginal cervical cerclage. Intraoperative chest radiography revealed severe pulmonary edema and echocardiography indicated moderate left ventricular dysfunction with akinesia of the mid to apical left ventricular wall segment, which is reflective of takotsubo cardiomyopathy. With early detection and appropriate management, the patient was stabilized in a relatively short period of time. Based on her clinical signs and symptoms, we suspect that the pulmonary edema was caused by takotsubo cardiomyopathy.

  8. LUVOIR Tech Notes

    NASA Technical Reports Server (NTRS)

    Bolcar, Matthew R.; Shaklan, Stuart; Roberge, Aki; Rioux, Norman; Feinberg, Lee; Werner, Michael; Rauscher, Bernard; Mandell, Avi; France, Kevin; Schiminovich, David

    2016-01-01

    We present nine "tech notes" prepared by the Large UV/Optical/Infrared (LUVOIR) Science and Technology Definition Team (STDT), Study Office, and Technology Working Group. These tech notes are intended to highlight technical challenges that represent boundaries in the trade space for developing the LUVOIR architecture that may impact the science objectives being developed by the STDT. These tech notes are intended to be high-level discussions of the technical challenges and will serve as starting points for more in-depth analysis as the LUVOIR study progresses.

  9. Disinfection of transvaginal ultrasound probes in a clinical setting: comparative performance of automated and manual reprocessing methods.

    PubMed

    Buescher, D L; Möllers, M; Falkenberg, M K; Amler, S; Kipp, F; Burdach, J; Klockenbusch, W; Schmitz, R

    2016-05-01

    Transvaginal and intracavitary ultrasound probes are a possible source of cross-contamination with microorganisms and thus a risk to patients' health. Therefore appropriate methods for reprocessing are needed. This study was designed to compare the standard disinfection method for transvaginal ultrasound probes in Germany with an automated disinfection method in a clinical setting. This was a prospective randomized controlled clinical study of two groups. In each group, 120 microbial samples were collected from ultrasound transducers before and after disinfection with either an automated method (Trophon EPR®) or a manual method (Mikrozid Sensitive® wipes). Samples were then analyzed for microbial growth and isolates were identified to species level. Automated disinfection had a statistically significantly higher success rate of 91.4% (106/116) compared with 78.8% (89/113) for manual disinfection (P = 0.009). The risk of contamination was increased by 2.9-fold when disinfection was performed manually (odds ratio, 2.9 (95% CI, 1.3-6.3)). Before disinfection, bacterial contamination was observed on 98.8% of probes. Microbial analysis revealed 36 different species of bacteria, including skin and environmental bacteria as well as pathogenic bacteria such as Staphylococcus aureus, enterobacteriaceae and Pseudomonas spp. Considering the high number of contaminated probes and bacterial species found, disinfection of the ultrasound probe's body and handle should be performed after each use to decrease the risk of cross-contamination. This study favored automated disinfection owing to its significantly higher efficacy compared with a manual method. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  10. Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department.

    PubMed

    Adhikari, Srikar; Blaivas, Michael; Lyon, Matthew

    2008-05-01

    Tubo-ovarian Abscess (TOA) is a complication of pelvic inflammatory disease (PID) requiring admission, i.v. antibiotics and, possibly, aspiration or surgery. The purpose of this study was to describe the role of emergency department (ED) bedside transvaginal ultrasonography (US) in the diagnosis of TOA. This was a retrospective review of non-pregnant ED patients presenting with pelvic pain who were diagnosed with TOA using bedside transvaginal US. ED US examinations were performed by emergency medicine residents and ultrasound-credentialed attending physicians within 1 h after clinical assessment. ED US logs were reviewed for the diagnosis of TOA. Medical records were reviewed for risk factors, medical and sexual history, physical examination findings, laboratory results, additional diagnostic testing, hospital course, and a discharge diagnosis of TOA by the admitting gynecology service. A total of 20 patients with TOA were identified over a 3-year period. Ages ranged from 14 to 45 years (mean 27 years). Seven (35%) patients reported a prior history of PID or sexually transmitted disease, and 1 (5%) was febrile. All had lower abdominal tenderness and 9 (45%) had cervical motion or adnexal tenderness. The sonographic abnormalities included 14 (70%) with a complex adnexal mass, 5 (25%) with echogenic fluid in the cul-de-sac, and 3 (15%) patients with pyosalpinx. The discharge diagnosis was TOA by the admitting gynecology service for all patients. Our study illustrates the limitations of clinical criteria in diagnosing TOA and supports the use of bedside US when evaluating patients with pelvic pain and symptoms that do not meet classic Centers for Disease Control and Prevention criteria for PID.

  11. Notes on Linguistics, 1998.

    ERIC Educational Resources Information Center

    Notes on Linguistics, 1998

    1998-01-01

    The four issues of the journal of language research and linguistic theory include these articles: "Notes on Determiners in Chamicuro" (Steve Parker); Lingualinks Field Manual Development" (Larry Hayashi); "Comments from an International Linguistics Consultant: Thumbnail Sketch" (Austin Hale); "Carlalinks…

  12. Novel method of laparoendoscopic single-site and natural orifice specimen extraction for live donor nephrectomy: single-port laparoscopic donor nephrectomy and transvaginal graft extraction

    PubMed Central

    Jeong, Won Jun; Choi, Byung Jo; Hwang, Jeong Kye; Yuk, Seung Mo; Song, Min Jong

    2016-01-01

    Laparoscopic live donor nephrectomy (DN) has been established as a useful alternative to the traditional open methods of procuring kidneys. To maximize the advantages of the laparoendoscopic single-site (LESS) method, we applied natural orifice specimen extraction to LESS-DN. A 46-year-old woman with no previous abdominal surgery history volunteered to donate her left kidney to her husband and underwent single-port laparoscopic DN with transvaginal extraction. The procedure was completed without intraoperative complications. The kidney functioned well immediately after transplantation, and the donor and recipient were respectively discharged 2 days and 2 weeks postoperatively. Single-port laparoscopic DN and transvaginal graft extraction is feasible and safe. PMID:26878020

  13. Robotics Technical Note 102.

    DTIC Science & Technology

    1981-06-01

    IAfl-AIBZ 4U2 AIR FORCE BUSINESS RESEARCH MANAGEMENT CENTER WRIGHT-ETC F/6 13/8 I ROBOTICS TECHNIICAL NOTE 102.(U) JUN Al B M BLABIERSALL UNCLASSIFE...CATALOG uME 1T4.T7- Subtitle S. TYPE OF REPOR & PERIOO COVERED Technical Note 102 Robotics 𔄁 FInal r ---- 6. PERFORMING O1G. REPORT NUMBER C 7. A tNORa B...Identify by block number) Robotics Manufacturing Industrial Robots Robot Technology SRobotics Application BQ~.STRACT (Continue on revere* side It

  14. Notes on Piezoelectricity

    SciTech Connect

    Redondo, Antonio

    2016-02-03

    These notes provide a pedagogical discussion of the physics of piezoelectricity. The exposition starts with a brief analysis of the classical (continuum) theory of piezoelectric phenomena in solids. The main subject of the notes is, however, a quantum mechanical analysis. We first derive the Frohlich Hamiltonian as part of the description of the electron-phonon interaction. The results of this analysis are then employed to derive the equations of piezoelectricity. A couple of examples with the zinc blende and and wurtzite structures are presented at the end

  15. Laparoscopic colon and rectal resections with intracorporeal anastomosis and trans-vaginal specimen extraction for colorectal cancer. A case series and systematic literature review.

    PubMed

    Stipa, Francesco; Burza, Antonio; Curinga, Rosanna; Santini, Ettore; Delle Site, Pietro; Avantifiori, Riccardo; Picchio, Marcello

    2015-07-01

    Intracorporeal anastomosis associated to trans-vaginal specimen extraction decreases the extent of colon mobilisation and the number and size of abdominal incisions, improving the benefits of minimally invasive surgery in female patients. The aim of this study was to evaluate the safety and effectiveness of this procedure for colorectal cancer. Between 2009 and 2013, 13 female patients underwent laparoscopic colon and rectal resection for colorectal cancer with intracorporeal anastomosis and trans-vaginal specimen extraction: 2 right colectomies, 1 transverse colon resection, 4 left colectomies and 6 anterior resections were performed. A MEDLINE search of publications on the presented procedure for colon neoplasms was carried out. There were no intraoperative complications and no conversions. Postoperative visual analogue scale (VAS) score in the pelvis, abdomen and shoulder was moderate. In the postoperative period, we observed two colorectal anastomotic strictures, successfully treated with pneumatic endoscopic dilation. Median length of the specimen was 18.5 cm, with a median tumour size of 5.5 cm in diameter. Median number of retrieved lymph nodes was 12. All circumferential resection margins were negative. During a mean follow-up of 31 months (range, 6-62), there was neither evidence of recurrent disease nor disorders related to the genitourinary system. The aesthetic outcome was considered satisfactory in all patients. Nine studies were identified in the systematic review. Our case series, according to the results of the literature, showed that intracorporeal anastomosis associated to trans-vaginal specimen extraction is feasible and safe in selected female patients.

  16. Transvaginal early fistula debridement and repair plus continuous vacuum aspiration via anal tube for rectovaginal fistula following rectal cancer surgery: report of four cases.

    PubMed

    Luo, Guo-De; Cao, Yong-Kuan; Wang, Yong-Hua; Zhang, Guo-Hu; Wang, Pei-Hong; Gong, Jia-Qing

    2014-01-01

    To investigate the feasibility and superiority of transvaginal early fistula debridement and repair plus continuous vacuum aspiration via anal tube for rectovaginal fistula following rectal cancer surgery. The clinical data of four cases of rectovaginal fistula following rectal cancer surgery were retrospectively analyzed in our center. After adequate preoperative preparation, the patients underwent transvaginal fistula debridement and repair plus continuous vacuum aspiration via anal tube under continuous epidural anesthesia. After surgery and before discharge, anti-infection and nutritional support was administered for 2 d, and fluid diet and anal tube vacuum aspiration continued for 7 d. All the four cases healed. Three of them healed after one operation, and the other patient had obvious shrinkage of the fistular orifice after the first operation and underwent the same operation for a second time before complete healing. The duration of postoperative follow-up was 2, 7, 8 and 9 months respectively. No recurrence or abnormal sex life was reported. Early transvaginal fistula debridement and repair plus continuous vacuum aspiration via anal tube are feasible for rectovaginal fistula following rectal cancer surgery. This operation has many advantages, such as minimal invasiveness, short durations of operation, short treatment cycles, and easy acceptance by the patient. In addition, it does not necessitate colostomy for feces shunt and a secondary colostomy and reduction.

  17. Reference values for the cervical length measurement in the second trimester of pregnancy using the transvaginal ultrasound in a large Brazilian population.

    PubMed

    Peixoto, Alberto Borges; da Cunha Caldas, Taciana Mara Rodrigues; Alamy, Ana Helena Bittencourt; Martins, Wellington P; Bruns, Rafael Frederico; Araujo Júnior, Edward

    2016-07-01

    To establish reference values for the cervical length (CL) measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large Brazilian population. A retrospective cross-sectional study was performed with 996 singleton pregnancies. The CL measurement (mm) using the transvaginal ultrasound was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. The median±standard deviation and ranges for the CL measurement (mm) was 37.0±10.7 (range, 8 to 51). CL measurement did not modify significantly with gestational age. The observed percentiles for the CL measurement (mm) considering all number case were the following: 5th, 28 mm; 50th, 37 mm; and 95th, 45 mm. Reference values for the CL measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large heterogeneous Brazilian population were established.

  18. Predictive role of transvaginal ultrasonographic measurement of cervical length at 34 weeks for late pre-term and late-term deliveries in nulliparous women.

    PubMed

    Kokanali, Mahmut Kuntay; Çelik, Hatice; Kokanali, Demet; Taşçi, Yasemin

    2016-01-01

    To investigate the predictive role of transvaginal ultrasonographic measurement of cervical length (CL) at 34 weeks of gestation in determining late-preterm and late-term deliveries in nulliparous women. CL was measured by transvaginal ultrasonography at 34 weeks in 318 women (singleton, nulliparous, low-risk and vertex presentation). All women were followed-up till birth and delivered at hospital. Deliveries were classifed according to gestational week as late-preterm (34(0/7) to 36(6/7) weeks), term (37(0/7) to 40(6/7) weeks) and late-term (41(0/7) to 41(6/7) weeks). There was a significant correlation between CL at 34 weeks and gestational week at delivery (r = 0.614, p < 0.001). Receiver-operating characteristic curve analysis showed that CL measurement below 25.5 mm predicted late-preterm delivery with a sensitivity of 80.0%, specificity of 93.9%, positive predictive value (PPV) of 52.6% and negative predictive value (NPV) of 98.2%; while CL above 42.5 mm had 70.4% sensitivity, 93.5% specificity, 50.0% PPV and 97.1% NPV in prediction of late-term delivery. Measurement of CL with transvaginal ultrasonography at 34 weeks of gestation can be of beneficial in predicting the risk of late-preterm and late-term deliveries in nulliparous women.

  19. The transvaginal probe as a uterine manipulator: a new technique to simplify transabdominal chorionic villus sampling in cases with difficult access to the trophoblast.

    PubMed

    Bertucci, E; Pati, M; Cani, C; Volpe, A; Mazza, V

    2011-09-01

    To evaluate the efficacy of using the transvaginal probe to manipulate the uterus and change the position of the trophoblast, and to simplify access to the chorionic villus under difficult conditions. One thousand five hundred and thirty-nine procedures were performed in our centre in 1524 pregnant women from September 2006 to September 2009. In 90 of these, a difficult access to the trophoblast was observed and uterine manipulation under continuous ultrasound guidance with a double needle technique, was applied to obtain the sample. Of these, 86 samples were taken from singleton pregnancies and 4 from two bichorionic twin pregnancies One thousand five hundred and thirty-nine transabdominal chorionic villus sampling (TA-CVS) procedures were conducted on 1524 pregnant women. As many as 1449 were performed without manipulation with the transvaginal probe and in 90 cases the manipulation was carried out. In 89 cases, access to the trophoblast was difficult and the uterus was manipulated, which enabled an adequate TA-CVS to be performed with a single aspiration. In one case, TA-CVS was not performed due to significant pelvic pain in a patient with a fixed, retroflexed uterus and a previous history of endometriosis. Uterine manipulation with the transvaginal probe may be a useful solution in cases where TA-CVS is limited by difficult access to the trophoblast. Copyright © 2011 John Wiley & Sons, Ltd.

  20. Programmable Logic Application Notes

    NASA Technical Reports Server (NTRS)

    Katz, Richard

    2000-01-01

    This column will be provided each quarter as a source for reliability, radiation results, NASA capabilities, and other information on programmable logic devices and related applications. This quarter will start a series of notes concentrating on analysis techniques with this issues section discussing worst-case analysis requirements.

  1. NCTM Student Math Notes.

    ERIC Educational Resources Information Center

    Maletsky, Evan, Ed.; Yunker, Lee E., Ed.

    1986-01-01

    Five sets of activities for students are included in this document. Each is designed for use in junior high and secondary school mathematics instruction. The first Note concerns mathematics on postage stamps. Historical procedures and mathematicians, metric conversion, geometric ideas, and formulas are among the topics considered. Successful…

  2. Notes on Literacy, 1997.

    ERIC Educational Resources Information Center

    Notes on Literacy, 1997

    1997-01-01

    The 1997 volume of "Notes on Literacy," numbers 1-4, includes the following articles: "Community Based Literacy, Burkina Faso"; "The Acquisition of a Second Writing System"; "Appropriate Methodology and Social Context"; "Literacy Megacourse Offered"; "Fitting in with Local Assumptions about…

  3. Notes on Linguistics, 1990.

    ERIC Educational Resources Information Center

    Notes on Linguistics, 1990

    1990-01-01

    This document consists of the four issues of "Notes on Linguistics" published during 1990. Articles in the four issues include: "The Indians Do Say Ugh-Ugh" (Howard W. Law); "Constraints of Relevance, A Key to Particle Typology" (Regina Blass); "Whatever Happened to Me? (An Objective Case Study)" (Aretta…

  4. Notes and Discussion

    ERIC Educational Resources Information Center

    American Journal of Physics, 1978

    1978-01-01

    Includes eleven short notes, comments and responses to comments on a variety of topics such as uncertainty in a least-squares fit, display of diffraction patterns, the dark night sky paradox, error in the dynamics of deformable bodies and relative velocities and the runner. (GA)

  5. Student Math Notes.

    ERIC Educational Resources Information Center

    Maletsky, Evan, Ed.

    1985-01-01

    Five sets of activities for students are included in this document. Each is designed for use in junior high and secondary school mathematics instruction. The first "Note" concerns magic squares in which the numbers in every row, column, and diagonal add up to the same sum. An etching by Albrecht Durer is presented, with four questions followed by…

  6. Sawtooth Functions. Classroom Notes

    ERIC Educational Resources Information Center

    Hirst, Keith

    2004-01-01

    Using MAPLE enables students to consider many examples which would be very tedious to work out by hand. This applies to graph plotting as well as to algebraic manipulation. The challenge is to use these observations to develop the students' understanding of mathematical concepts. In this note an interesting relationship arising from inverse…

  7. Programmable Logic Application Notes

    NASA Technical Reports Server (NTRS)

    Katz, Richard; Day, John H. (Technical Monitor)

    2001-01-01

    This report will be provided each quarter as a source for reliability, radiation results, NASA capabilities, and other information on programmable logic devices and related applications. This quarter will continue a series of notes concentrating on analysis techniques with this issue's section discussing the use of Root-Sum-Square calculations for digital delays.

  8. Notes on Linguistics, 1991.

    ERIC Educational Resources Information Center

    Loos, Eugene, Ed.

    1991-01-01

    This document consists of the four issues of "Notes on Linguistics" published during 1991. Articles in the four issues include: "Linguistics without Books: A Diary Entry" (John Verhaar); "Writing for Scholarly Publications" (Howard Law); "Will Kofi Understand the White Woman's Dictionary?" (Gillian Hansford); "Tips About 'WORD'" (Bryan Harmelink);…

  9. Notes on Linguistics, 1999.

    ERIC Educational Resources Information Center

    Payne, David, Ed.

    1999-01-01

    The 1999 issues of "Notes on Linguistics," published quarterly, include the following articles, review articles, reviews, book notices, and reports: "A New Program for Doing Morphology: Hermit Crab"; "Lingualinks CD-ROM: Field Guide to Recording Language Data"; "'Unruly' Phonology: An Introduction to Optimality Theory"; "Borrowing vs. Code…

  10. Notes and Discussion

    ERIC Educational Resources Information Center

    American Journal of Physics, 1978

    1978-01-01

    Includes eleven short notes, comments and responses to comments on a variety of topics such as uncertainty in a least-squares fit, display of diffraction patterns, the dark night sky paradox, error in the dynamics of deformable bodies and relative velocities and the runner. (GA)

  11. Repeated ultrasound-guided transvaginal oocyte retrieval from cyclic Murrah buffaloes (Bubalus bubalis): oocyte recovery and quality.

    PubMed

    Gupta, V; Manik, R S; Chauhan, M S; Singla, S K; Akshey, Y S; Palta, P

    2006-01-01

    The present study was undertaken to explore the potential of the Murrah breed of buffaloes as donors of oocytes and to find out the recovery rate and oocyte quality in cyclic Murrah buffaloes subjected to oocyte recovery once a week. Murrah buffaloes (n = 5) were synchronized for estrus by a single prostaglandin injection schedule. The animals were subjected to transvaginal oocyte retrieval (TVOR) once weekly for 6 weeks, starting from Day 7 of the oestrous cycle (Day 0 = day of oestrus). TVOR was performed using an ultrasound machine with a 5 MHz transvaginal transducer, single lumen 19-gauge, 60 cm long needle and a constant vacuum pressure of 50 mmHg. The number and size of follicles in each ovary was determined before puncture. The follicles were characterized on the basis of their diameter as small (3-5 mm), medium (6-9 mm) and large (> or = 10 mm). The oocytes recovered were classified as grade A, cumulus-oocytes complexes (COCs) with > or = 5 layers of cumulus cells; grade B, those with two to four layers; grade C, partially denuded oocytes; and grade D, completely denuded oocytes. The mean (+/- S.E.M) number of small, medium and large follicles, and the number of total follicles observed per animal per session, which was 2.2 +/- 0.3, 0.6 +/- 0.2, 0.9 +/- 0.1 and 3.7 +/- 0.3, respectively, did not differ between animals or between puncture sessions. Small follicles constituted a major proportion (59%) of the total observed follicles. A mean (+/- S.E.M) number of 3.0 +/- 0.3 follicles were punctured and 2.0 +/- 0.3 oocytes recovered per animal per session, with a recovery rate of 68%. Out of the total 61 oocytes recovered, 36 (59%) were of grades A + B whereas 25 (41%) were of grades C + D. In conclusion, this study describes the potential of cyclic Murrah buffaloes as donors of oocytes collected by repeated TVOR once a week, without any adverse effects on follicular growth and oocyte recovery. It also describes an efficient system for carrying out TVOR in

  12. Predictive accuracy of changes in transvaginal sonographic cervical length over time for preterm birth: a systematic review and metaanalysis.

    PubMed

    Conde-Agudelo, Agustin; Romero, Roberto

    2015-12-01

    To determine the accuracy of changes in transvaginal sonographic cervical length over time in predicting preterm birth in women with singleton and twin gestations. PubMed, Embase, Cinahl, Lilacs, and Medion (all from inception to June 30, 2015), bibliographies, Google scholar, and conference proceedings. Cohort or cross-sectional studies reporting on the predictive accuracy for preterm birth of changes in cervical length over time. Two reviewers independently selected studies, assessed the risk of bias, and extracted the data. Summary receiver-operating characteristic curves, pooled sensitivities and specificities, and summary likelihood ratios were generated. Fourteen studies met the inclusion criteria, of which 7 provided data on singleton gestations (3374 women) and 8 on twin gestations (1024 women). Among women with singleton gestations, the shortening of cervical length over time had a low predictive accuracy for preterm birth at <37 and <35 weeks of gestation with pooled sensitivities and specificities, and summary positive and negative likelihood ratios ranging from 49% to 74%, 44% to 85%, 1.3 to 4.1, and 0.3 to 0.7, respectively. In women with twin gestations, the shortening of cervical length over time had a low to moderate predictive accuracy for preterm birth at <34, <32, <30, and <28 weeks of gestation with pooled sensitivities and specificities, and summary positive and negative likelihood ratios ranging from 47% to 73%, 84% to 89%, 3.8 to 5.3, and 0.3 to 0.6, respectively. There were no statistically significant differences between the predictive accuracies for preterm birth of cervical length shortening over time and the single initial and/or final cervical length measurement in 8 of 11 studies that provided data for making these comparisons. In the largest and highest-quality study, a single measurement of cervical length obtained at 24 or 28 weeks of gestation was significantly more predictive of preterm birth than any decrease in cervical length

  13. Open-access transvaginal sonography in women of reproductive age with abnormal vaginal bleeding: a descriptive study in general practice.

    PubMed

    de Vries, Corlien J H; Wieringa-de Waard, Margreet; Bindels, Patrick J E; Ankum, Willem M

    2011-06-01

    Diagnostic ultrasonography is used by GPs in approximately 10% of patients of reproductive age with abnormal vaginal bleeding. Transvaginal sonography is recommended as a first-line diagnostic instrument for assessing uterine pathology. To assess if findings resulting from open-access sonography were in agreement with the GPs' working hypotheses and if these findings contributed to GPs' management. Prospective observational cohort study of GPs working in the health district of the Academic Medical Center, Amsterdam and their patients consulting with abnormal vaginal bleeding. Data on patients' history, GPs' primary working hypotheses, and intended management were recorded. After sonography, GPs recorded their actual management. A total of 122 patients were included by 18 GPs from June 2003 to December 2004. Data from 89 patients were available for analysis. The GPs' working hypotheses implied 'no structural pathology' in 65/89 patients, and 'fibroids' in 24/89 patients. Sonographic findings were confirmed in 50/65 patients where 'no structural pathology', and in 14/24 of those where 'fibroids' were expected. Initially, GPs had intended to refer nine patients to a gynaecologist. Actual management after sonographic assessment was watchful waiting or drug therapy in 57/89 patients. Eighty-nine per cent of these patients had normal sonographic findings. The actual referral rate rose to 27/89 patients. In 17 referred patients, sonographic findings were suggestive of intracavitary abnormalities. Open-access sonography contributed to more accurate diagnoses and improved GPs' management of women with abnormal vaginal bleeding.

  14. Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture

    PubMed Central

    de Oliveira, Gilvandro Lins; Serralheiro, Fernando Cesar; Fonseca, Fernando Luiz Affonso; Ribeiro, Onésimo Duarte; Adami, Fernando; Christofolini, Denise Maria; Bianco, Bianca; Barbosa, Caio Parente

    2016-01-01

    ABSTRACT Objective: To compare the anesthetic techniques using propofol and fentanyl versus midazolam and remifentanil associated with a paracervical block with lidocaine in performing ultrasound-guided transvaginal oocyte aspiration. Methods: A randomized double-blind clinical trial (#RBR-8kqqxh) performed in 61 women submitted to assisted reproductive treatment. The patients were divided into two groups: anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group, n=32), in comparison with anesthetic induction using 0.075mg/kg of midazolam associated with 0.25mcg/kg/min of remifentanil, and paracervical block with 3mL of 2% lidocaine (MRPB Group, n=29). Main outcome measures: human reproduction outcomes, modified Aldrete-Kroulik index, hemodynamic parameters, and salivary cortisol. Results: The results revealed a higher number of embryos formed in the FP Group (p50=2 versus 1; p=0.025), gestation rate two times higher in the FP Group (44.4% versus 22.2%; p=0.127), less time to reach AK=10 in the MRPB Group (p50=10 versus 2; p<0.001), and lower mean of hemodynamic parameters in the MRPB Group (p<0.05). Conclusion: Anesthesia with fentanyl and propofol as well as with midazolam, remifentanil, and paracervical block offered satisfactory anesthetic conditions when performing assisted reproduction procedures, providing comfort for the patient and physician. PMID:27759816

  15. Transvaginal ovarian trauma, poor responders and improvement of success rates in IVF: anecdotal data and a hypothesis.

    PubMed

    Siristatidis, Charalampos; Vogiatzi, Paraskevi; Bettocchi, Stefano; Basios, George; Mastorakos, George; Vrachnis, Nikos

    2014-08-01

    In this report, we propose an intervention capable of improving IVF outcomes in subfertile women with poor ovarian response. This intervention derives from anecdotal data and observations in our daily practice, but most importantly from trials on experimental models and subfertile women with Polycystic Ovarian Syndrome (PCOS). Our hypothesis suggests that transvaginal induction of trauma to the ovary in the cycle preceding IVF should benefit poor ovarian responders and their lowered pregnancy rates by increasing - at least - the number of retrieved oocytes during oocyte retrieval. Up-to-the minute data show that, via this means, there is a unique response of the ovarian surface epithelium and stroma to the induced trauma. The potential pathways of this beneficial response involve an improvement of the raised gonadotrophins to act either through the mechanical reduction of the size of the ovary or through alterations of the hormonal profile by lowering LH, inhibin and local androgen concentrations through hypothalamic-pituitary axis feedbacks, the induction of increased blood flow to the ovaries, a differentiated local immune reaction and a non-elucidated as yet role of reactive oxygen species. In this report, we also describe the technique and the associated possible negative points while we try to point out the needed research steps to ensure its efficiency before it enters daily clinical practice.

  16. Transvaginal 3-d power Doppler ultrasound evaluation of the fetal brain at 10-13 weeks' gestation.

    PubMed

    Hata, Toshiyuki; Tanaka, Hirokazu; Noguchi, Junko

    2012-03-01

    The objective of this study was to measure the fetal brain volume (FBV) and vascularization and blood flow using transvaginal 3-D power Doppler (3DPD) ultrasound late in the first trimester of pregnancy. 3DPD ultrasound examinations with the VOCAL imaging analysis program were performed on 36 normal fetuses from 10-13 weeks' gestation. FBV and 3DPD indices related to the fetal brain vascularization (vascularization index [VI], flow index [FI] and vascularization flow index [VFI]) were calculated in each fetus. Intra- and interclass correlation coefficients and intra- and interobserver agreements of measurements were assessed. FBV was curvilinearly correlated well with the gestational age (R2 = 0.861, p < 0.0001). All 3-D power Doppler indices (VI, FI and VFI) showed no change at 10-13 weeks' gestation. FBV and all 3-D power Doppler indices (VI, FI and VFI) showed a correlation > 0.82, with good intra- and interobserver agreement. Our findings suggest that 3-D ultrasound is a superior means of evaluating the FBV in utero, and that 3-D power Doppler ultrasound histogram analysis may provide new information on the assessment of fetal brain perfusion.

  17. Transvaginal follicle aspiration in Thai swamp buffalo heifers using different vacuum pressures after FSH pretreatment (Bubalus bubalis).

    PubMed

    Techakumphu, Mongkol; Promdireg, Akachart; Phutikanit, Nawapen; Nachiengmai, Anchalee; Thongjan, Sak

    2004-08-01

    The objective of the experiment was to study oocyte recovery by transvaginal, ultrasound-guided, follicle aspiration, from Thai swamp buffalo using different vacuum pressures. Six adult buffalo heifers, aged 2.5-3.0 yrs were treated with a total dose of 280 mg FSH, given twice a day in a divided doses over a three day period (60/60 mg, 50/50 mg, 30/30 mg) at d7 after progesterone implant. Three vacuum pressures were used; 100 (n=12), 80 (n=12) and 60 mmHg (n=12) and all of the pressures were performed in each animal. The animals were treated repeatedly and collection took place using 2 sets of each pressure every 2 months, giving a total of 36 collections from each animal. The oocyte recovery rates from each pressure were 81.2% (69/85) 79.1% (53/67) and 90.3% (93/103) for 100, 80 and 60 mmHg respectively. The number of oocytes collected per donor were 5.33 +/- 3.27, 4.42 +/- 2.71 and 7.75 +/- 4.31 respectively. The quality of the oocytes did not improved with the lower vacuum pressure. In conclusion, the application of FSH pretreatment improves the yield of oocytes from Thai, swamp buffalo heifers after gonadotropin treatment when using the vacuum pressures between 60-100 mmHg.

  18. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals.

    PubMed

    Ludwig, A K; Glawatz, M; Griesinger, G; Diedrich, K; Ludwig, M

    2006-12-01

    Although transvaginal ultrasound-guided oocyte retrievals (OR) are performed routinely worldwide, there is very little systematic data about its complications. We performed a prospective cohort study following the perioperative and post-operative complications of over 1058 ORs. Additionally, we assessed the pain experienced during the OR. A total of 1166 OR were performed during the study period, of which 1058 (90.7%) ORs were included prospectively. Incomplete data meant that the remaining 9.3% were excluded. No complications were caused by sedation or general anaesthesia. Vaginal bleeding was observed in 2.8% of procedures, without any cases of intra-abdominal bleeding. An injury of pelvic structures (a ureteral lesion) occurred in one case. No case of pelvic infection, but one case of unexplained fever, was observed. A severe ovarian hyperstimulation syndrome (OHSS) occurred in 2.7% of cases. Although most patients tolerated the OR well, 3% of patients experienced severe to very severe pain after the OR and 2% of patients were still suffering from severe pain 2 days after the procedure. The pain level increased with the number of oocytes retrieved. About 0.7% of patients required hospitalization for pain treatment. Patients can be reassured that overall OR is a safe procedure. However, patients have to be counselled about the minor risks of the OR. The literature on complications is reviewed in the article.

  19. Severe haematoperitoneum caused by ovarian bleeding after transvaginal oocyte retrieval: a retrospective analysis and systematic literature review.

    PubMed

    Nouri, Kazem; Walch, Katharina; Promberger, Regina; Kurz, Christine; Tempfer, Clemens B; Ott, Johannes

    2014-12-01

    A case series of haematoperitoneum caused by ovarian bleeding after transvaginal oocyte retrieval (TVOR) is presented and all published cases summarized. In a retrospective case series, four patients with ovarian bleeding after TVOR were included. In addition, a pooled analysis of all published cases (n = 32) who underwent surgical intervention for severe haematoperitoneum caused by ovarian bleeding after TVOR was carried out. Main outcome measures were incidence, risk factors, course and intraoperative findings. In the pooled analysis, the incidence was 0.08%. The first sign of haematoperitoneum was evident in 33.3% within the first postoperative hour, and, cumulatively, in 93.3% within 24 h. The median time between TVOR and surgical intervention was 10 h. In four patients, the ovary could not be preserved, which was associated with a longer time interval between TVOR and the onset of symptoms (median 18 h versus 2.5 h; P = 0.004) as well as between TVOR and surgical intervention (median 21.5 h versus 8.5 h; 0.004). In conclusion, severe haematoperitoneum occurs in 0.08% after TVOR. Late-onset bleeding is common. A longer time interval between TVOR and surgical intervention might put a patient at risk of ovariectomy.

  20. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis.

    PubMed

    Bazot, Marc; Lafont, Clarisse; Rouzier, Roman; Roseau, Gilles; Thomassin-Naggara, Isabelle; Daraï, Emile

    2009-12-01

    To compare the value of physical examination, transvaginal sonography (TVS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) for the assessment of different locations of deep infiltrating endometriosis (DIE). Retrospective longitudinal study. Tertiary university gynecology unit. Ninety-two consecutive patients with clinical evidence of pelvic endometriosis. Physical examination, TVS, RES, and MRI, performed preoperatively. Descriptive statistics, calculation of likelihood ratios (LR(+) and LR(-)) of physical examination, TVS, RES, and MRI for DIE in specific locations confirmed by surgery/histology. The sensitivity and LR(+) and LR(-) values of physical examination, TVS, RES, and MRI were, respectively, 73.5%, 3.3, and 0.34, 78.3%, 2.34, and 0.32, 48.2%, 0.86, and 1.16, and 84.4%, 7.59, and 0.18 for uterosacral ligament endometriosis; 50%, 3.88, and 0.57, 46.7%, 9.64, and 0.56, 6.7%, -, and 0.93, and 80%, 5.51, and 0.23 for vaginal endometriosis; and 46%, 1.67, and 0.75, 93.6%, -, and 0.06, 88.9%, 12.89, and 0.12, and 87.3%, 12.66, and 0.14 for intestinal endometriosis. The MRI performs similarly to TVS and RES for the diagnosis of intestinal endometriosis but has higher sensitivity and likelihood ratios for uterosacral ligament and vaginal endometriosis.

  1. 4. Panama Mount. Note concrete ring and metal rail. Note ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. Panama Mount. Note concrete ring and metal rail. Note cliff erosion under foundation at left center. Looking 297° W. - Fort Funston, Panama Mounts for 155mm Guns, Skyline Boulevard & Great Highway, San Francisco, San Francisco County, CA

  2. Note-Taking: Different Notes for Different Research Stages.

    ERIC Educational Resources Information Center

    Callison, Daniel

    2003-01-01

    Explains the need to teach students different strategies for taking notes for research, especially at the exploration and collecting information stages, based on Carol Kuhlthau's research process. Discusses format changes; using index cards; notes for live presentations or media presentations versus notes for printed sources; and forming focus…

  3. Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture.

    PubMed

    Oliveira, Gilvandro Lins de; Serralheiro, Fernando Cesar; Fonseca, Fernando Luiz Affonso; Ribeiro, Onésimo Duarte; Adami, Fernando; Christofolini, Denise Maria; Bianco, Bianca; Barbosa, Caio Parente

    2016-01-01

    To compare the anesthetic techniques using propofol and fentanyl versus midazolam and remifentanil associated with a paracervical block with lidocaine in performing ultrasound-guided transvaginal oocyte aspiration. A randomized double-blind clinical trial (#RBR-8kqqxh) performed in 61 women submitted to assisted reproductive treatment. The patients were divided into two groups: anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group, n=32), in comparison with anesthetic induction using 0.075mg/kg of midazolam associated with 0.25mcg/kg/min of remifentanil, and paracervical block with 3mL of 2% lidocaine (MRPB Group, n=29). Main outcome measures: human reproduction outcomes, modified Aldrete-Kroulik index, hemodynamic parameters, and salivary cortisol. The results revealed a higher number of embryos formed in the FP Group (p50=2 versus 1; p=0.025), gestation rate two times higher in the FP Group (44.4% versus 22.2%; p=0.127), less time to reach AK=10 in the MRPB Group (p50=10 versus 2; p<0.001), and lower mean of hemodynamic parameters in the MRPB Group (p<0.05). Anesthesia with fentanyl and propofol as well as with midazolam, remifentanil, and paracervical block offered satisfactory anesthetic conditions when performing assisted reproduction procedures, providing comfort for the patient and physician. Comparar as técnicas anestésicas utilizando propofol e fentanil contra midazolam e remifentanil associados a um bloqueio paracervical com lidocaína na aspiração de oócitos transvaginal guiada por ultrassom. Ensaio clínico randomizado duplocego (#RBR-8kqqxh) realizado em 61 mulheres submetidas ao tratamento de reprodução assistida. As pacientes foram divididas em dois grupos: um grupo foi submetido à indução da anestesia com 1mcg/kg de fentanil associada com 1,5mg/kg de propofol (Grupo FP, n=32), em comparação com ao grupo submetido à indução da anestesia utilizando 0,075mg/kg de midazolam associada com 0,25mcg

  4. 360-degree 3D transvaginal ultrasound system for high-dose-rate interstitial gynaecological brachytherapy needle guidance

    NASA Astrophysics Data System (ADS)

    Rodgers, Jessica R.; Surry, Kathleen; D'Souza, David; Leung, Eric; Fenster, Aaron

    2017-03-01

    Treatment for gynaecological cancers often includes brachytherapy; in particular, in high-dose-rate (HDR) interstitial brachytherapy, hollow needles are inserted into the tumour and surrounding area through a template in order to deliver the radiation dose. Currently, there is no standard modality for visualizing needles intra-operatively, despite the need for precise needle placement in order to deliver the optimal dose and avoid nearby organs, including the bladder and rectum. While three-dimensional (3D) transrectal ultrasound (TRUS) imaging has been proposed for 3D intra-operative needle guidance, anterior needles tend to be obscured by shadowing created by the template's vaginal cylinder. We have developed a 360-degree 3D transvaginal ultrasound (TVUS) system that uses a conventional two-dimensional side-fire TRUS probe rotated inside a hollow vaginal cylinder made from a sonolucent plastic (TPX). The system was validated using grid and sphere phantoms in order to test the geometric accuracy of the distance and volumetric measurements in the reconstructed image. To test the potential for visualizing needles, an agar phantom mimicking the geometry of the female pelvis was used. Needles were inserted into the phantom and then imaged using the 3D TVUS system. The needle trajectories and tip positions in the 3D TVUS scan were compared to their expected values and the needle tracks visualized in magnetic resonance images. Based on this initial study, 360-degree 3D TVUS imaging through a sonolucent vaginal cylinder is a feasible technique for intra-operatively visualizing needles during HDR interstitial gynaecological brachytherapy.

  5. Transvaginal ultrasound cervical length for prediction of spontaneous labour at term: a systematic review and meta-analysis.

    PubMed

    Saccone, G; Simonetti, B; Berghella, V

    2016-01-01

    The possibility to predict the delivery date is a question frequently raised by pregnant women. However, a clinician has currently little to predict when a woman at term will deliver. To evaluate the predictive accuracy of transvaginal ultrasound (TVU) cervical length (CL) for spontaneous onset of labour in singleton gestation enrolled at term by a meta-analysis. We performed a literature search in electronic databases. We included only studies assessing the accuracy of TVU CL in prediction of spontaneous onset of labour in singleton gestations with vertex presentation who were enrolled at term. The primary outcome was the accuracy of CL for prediction of spontaneous labour within 7 days. Pooled sensitivities and specificities were calculated. Five studies including 735 singleton gestations were included. For the prediction of spontaneous labour within 7 days for CL <30 mm the pooled sensitivity was 64% and pooled specificity was 60%. The higher the CL, the better the sensitivity; the lower the CL, the better the specificity. A woman with a singleton gestation at term and a TVU CL of 30 mm has a <50% chance of delivering within 7 days, while one with a TVU CL of 10 mm has an over 85% chance of delivery within 7 days. TVU CL at term has moderate value in predicting the onset of spontaneous labour. A woman with a TVU CL of 10 mm or less has a high chance of delivering within a week. Cervical length at term has moderate value in predicting the onset of spontaneous labour. © 2015 Royal College of Obstetricians and Gynaecologists.

  6. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis.

    PubMed

    Guerriero, S; Ajossa, S; Orozco, R; Perniciano, M; Jurado, M; Melis, G B; Alcazar, J L

    2016-03-01

    To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of rectosigmoid endometriosis in patients with clinical suspicion of deep infiltrating endometriosis (DIE), comparing enhanced (E-TVS) and non-enhanced approaches. An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. The eligibility criterion was use of TVS for preoperative detection of rectosigmoid endometriosis in women with clinical suspicion of DIE, using surgical data as the reference standard. Study quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Our extended search identified a total of 801 citations, among which 19 studies (n = 2639) were considered eligible and included in the meta-analysis. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting DIE in the rectosigmoid were 91% (95%CI, 85-94%), 97% (95%CI, 95-98%), 33.0 (95%CI, 18.6-58.6) and 0.10 (95%CI, 0.06-0.16), respectively. Significant heterogeneity was found for sensitivity (I(2) , 90.8%; Cochran Q, 195.2; P < 0.001) and specificity (I(2) , 76.8%; Cochran Q, 77.7; P < 0.001). We did not find statistical differences between non-enhanced TVS and E-TVS (P = 0.304). Overall diagnostic performance of TVS for DIE of the rectosigmoid is good. However, further studies with improved quality in design are needed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  7. The prevalence of incidental simple ovarian cysts >or= 3 cm detected by transvaginal sonography in early pregnancy.

    PubMed

    Glanc, Phyllis; Brofman, Nicole; Salem, Shia; Kornecki, Anat; Abrams, Jason; Farine, Dan

    2007-06-01

    To determine the prevalence of simple ovarian cysts of >or= 3 cm diameter detected by transvaginal sonography (TVS) in a population of asymptomatic women in early pregnancy. We conducted a retrospective review of 10,830 consecutive women presenting prior to 14 weeks' gestational age (GA) for early dating TVS. The records of all women with simple cysts >or= 3 cm in diameter were included. The study population was divided into five groups by GA: >or= 6 weeks; 6.1-8 weeks; 8.1-10 weeks; 10.1-12 weeks; and 12.1-14 weeks. A simple cyst >or= 3 cm in diameter was present in 4.9% of women at >or= 6 weeks' gestation, in 5.1% between 6.1 and 8 weeks, in 5.3% between 8.1 and 10 weeks, in 3.2% between 10.1. and 12 weeks, and in 1.5% between 12 and 14 weeks. Overall, a simple cyst >or= 3 cm was present in 516 women (4.8%). Prior to 10 weeks, 5.1% had simple cysts >or= 3 cm, dropping to 2.7% after 10 weeks, a statistically significant decrease (P<0.0001). Between 10.1 weeks and 12 weeks, the prevalence dropped to 3.2%, and then to 1.5% in the 12.1-14 week group. This investigation provides reference data on the prevalence of detecting simple ovarian cysts >or= 3 cm by TVS in an asymptomatic early pregnancy population. A progressive decline in the frequency of detecting simple ovarian cysts >or= 3 cm begins after 10 weeks' gestational age.

  8. Computed tomographic colonography vs rectal water- contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis: a pilot study.

    PubMed

    Ferrero, S; Biscaldi, E; Vellone, V G; Venturini, P L; Leone Roberti Maggiore, U

    2017-04-01

    To compare the performance of computed tomographic colonography (CTC) and rectal water-contrast transvaginal sonography (RWC-TVS) in the diagnosis of rectosigmoid endometriosis, and compare precision in estimating the length of the rectosigmoid nodules and the distance between the nodules and the anal verge. This prospective study included 70 patients of reproductive age with clinical suspicion of rectosigmoid endometriosis. Patients underwent RWC-TVS and CTC before laparoscopic excision of endometriotic nodules. The findings of RWC-TVS and CTC were compared with surgical and histological results. Of the 70 patients included in the study, 40 (57.1%) had rectosigmoid endometriosis. CTC and RWC-TVS had similar accuracy in the diagnosis of rectosigmoid endometriosis (P = 0.508) and similar precision in estimating the length of the endometriotic nodules (P = 0.077). CTC was more precise than RWC-TVS in estimating the distance between the rectosigmoid nodule and the anal verge (P < 0.001). The intensity of pain experienced during CTC was higher than that perceived during RWC-TVS (P < 0.001); however, intestinal distension for CTC was well-tolerated in all patients without significant adverse effects. RWC-TVS and CTC have similar accuracy in the diagnosis of rectosigmoid endometriosis and similar precision in estimating the size of the nodules; however, CTC is more precise than RWC-TVS in estimating the distance between the nodules and the anal verge, yet patients tolerate RWC-TVS better than CTC. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  9. Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women

    PubMed Central

    Zhu, Huili; Fu, Jing; Lei, Haike; Song, Yong; Shen, Licong; Huang, Wei

    2016-01-01

    The aims of the present study were to evaluate the effectiveness of transvaginal sonography (TVS) in the detection of endometrial polyps (EPs), and to assess the pregnancy outcome in infertile women following hysteroscopic polypectomy. A total of 145 women diagnosed with primary or secondary infertility and intrauterine disorders by TVS and hysterosalpingography (HSG) were included in the current study. All subjects were divided into three groups based on hysteroscopic findings, including the EP, intrauterine adhesion and normal groups. EPs were removed for biopsy and intrauterine adhesions were treated. Pregnancy rates between groups were compared. In total, 34 EPs were detected by TVS, while 45 subjects were later confirmed with EP by hysteroscopy. The sensitivity, specificity, positive predictive value and negative predictive value of TVS in the detection of EPs were 67, 96, 88.23 and 86.49%, respectively. Of the included patients, 120 subjects were followed up, including 40 patients diagnosed with EPs, 42 with intrauterine adhesions and 38 with normal cavities. The results indicated no statistically significant differences in the age, type and duration of infertility, least function (LF) score and classification of the extent of tubal disease with the distal fimbrial obstruction between the three groups. In addition, pregnancy rate and spontaneous abortion rate in the EP group following hysteroscopic polypectomy were 45 and 5.6%, respectively. No significant difference was observed in the fertility rate following surgery. In conclusion, TVS features high sensitivity, specificity and certain unique sonographic characteristics in diagnosing EPs, and may be used as a preliminary diagnostic procedure to select patients for hysteroscopy. Furthermore, hysteroscopic polypectomy is an important approach for the treatment of infertile patients with EPs and appears to help increase the pregnancy rate of previously infertile women. PMID:27446343

  10. The reliability of transabdominal cervical length measurement in a low-risk obstetric population: Comparison with transvaginal measurement.

    PubMed

    Peng, Cheng-Ran; Chen, Chie-Pein; Wang, Kuo-Gon; Wang, Liang-Kai; Chen, Chen-Yu; Chen, Yi-Yung

    2015-04-01

    To determine the correlation between transabdominal (TA) and transvaginal (TV) cervical length measurement in a low-risk obstetric population in Taiwan. Women with a singleton pregnancy between 20 weeks and 24 weeks of gestation underwent postvoid TA and TV cervical length measurements. Differences between the measurements obtained using the two methods were evaluated. Two hundred and five women agreed to participate in the study. Paired TA and TV measurements were obtained in 174 women. The mean TA cervical length was 36.0 ± 4.9 mm and the mean TV cervical length was 37.6 ± 5.4 mm. The mean TA cervical length was shorter than the mean TV cervical length by 1.6 mm. The 5(th) percentile of TA and TV cervical length was 29 mm and 29.1 mm, respectively. The discrepancies between the two methods were not significantly correlated with maternal body mass index (BMI). All women with TV cervical length <25 mm had a corresponding TA cervical length <29 mm. The TA cervical length could be obtained in the majority of the low-risk pregnant women in the present study, and the TA cervical length was closely correlated with the TV cervical length. The use of TA ultrasound could be an effective initial tool for cervical length screening in low-risk pregnant women. TA cervical length <29 mm (5(th) percentile) could be used as a cut-off value for further TV ultrasound. Copyright © 2015. Published by Elsevier B.V.

  11. [Evaluation of transvaginal ultrasonography-color Doppler energy imaging in surveillance of gynecologic malignant tumors after operation].

    PubMed

    Pei, Xiao-Qing; Xie, Yan-Jun; Zeng, Hui; Chen, Xiao-Yue; Wang, Yue; Liu, Fu-Yuan

    2004-02-01

    Transvaginal ultrasonography (TVS) and color Doppler energy imaging (CDE) have been already applied in ultrasonography diagnosis extensively, but articles about the methods in surveillance of gynecologic malignant tumors after operation are few. The objective of this study was to evaluate TVS-CDE in surveillance of gynecologic malignant tumors after operation. Fifty-four cases of gynecologic malignant tumors after operation, which were doubted as recurrent malignant tumors in clinic, were scanned with transabdominal ultrasonography (TAS), TVS, and TVS-CDE. The results were compared with that of pathology. Then their sensitivity, specificity,and accuracy were calculated, and the accuracy was compared by Chi-square test. Forty-three cases were diagnosed as malignant tumors by TAS; Forty-six cases were diagnosed as malignant tumors by TVS,and the positions, sizes, characteristics of the recurrent malignant tumors could be depicted visually. Forty-seven cases were diagnosed as malignant tumors by TVS-CDE; Not only the blood flow characteristics of masses,but also more diagnostic information than TVS were provided. The sensitivity was 81.3%, 91.7%, and 95.9%, respectively; the specificity was 33.3%,66.7%, and 83.3%, respectively; the accuracy was 75.9%, 88.9%, and 94.4%, respectively. Obviously, the accuracy of both TVS and TVS-CDE was higher than that of TAS(P< 0.05), but the accuracy of TVS and TVS-CDE was similar (P >0.05). TVS-CDE is helpful in the diagnosis of gynecologic malignant masses. It will be more effective in surveillance of recurrent gynecologic malignant tumors if it combined with CDE.

  12. Comparison of uterine and tubal pathology identified by transvaginal sonography, hysterosalpingography, and hysteroscopy in female patients with infertility.

    PubMed

    Phillips, Catherine H; Benson, Carol B; Ginsburg, Elizabeth S; Frates, Mary C

    2015-01-01

    The causes of female infertility are multifactorial and necessitate comprehensive evaluation including physical examination, hormonal testing, and imaging. Given the associated psychological and financial stress that imaging can cause, infertility patients benefit from a structured and streamlined evaluation. The goal of such a work up is to evaluate the uterus, endometrium, and fallopian tubes for anomalies or abnormalities potentially preventing normal conception. To date, the standard method for assessing these structures typically involves some combination of transvaginal sonography (TVS), hysterosalpingography (HSG), and hysteroscopy (HSC). The goal of this review is to compare the diagnostic accuracy of TVS, HSG, and HSC for diagnosing abnormalities in infertility patients to determine if all studies are necessary for pre-treatment evaluation. We identified infertility patients prior to initiation of assisted reproductive technology who had baseline TVS, HSG, and HSC within 180 days of each other. From medical record review, we compared frequencies of each finding between modalities. Of the 1274 patients who received a baseline TVS over 2 years, 327 had TVS and HSG within 180 days and 55 patients had TVS, HSG and HSC. Of the 327, TVS detected fibroids more often than HSG (74 vs. 5, p < .0001), and adenomyosis more often than HSG (7 vs. 2, p = .02). HSG detected tubal obstruction more often than TVS (56 vs. 8, p = .002). Four (1.2 %) patients had endometrial polyps on both HSG and TVS. In the 55 patients with HSG, TVS, and HSC, HSC identified endometrial polyps more often than TVS (10 vs. 1, p = .0001) and HSG (10 vs. 2, p = .0007). TVS detected more fibroids than HSC (17 vs. 5, p < .0001). Tubal obstruction was identified more often by HSG than HSC (19 vs. 5, p < .0001). TVS is superior for evaluation of myometrial pathology. HSG is superior for evaluation of tubal pathologies. Endometrial pathologies are best identified with

  13. AB289. SPR-16 A preliminary evaluation of vaginal alignment following a transvaginal procedure using MatriStem™ pelvic floor matrix in the rhesus macaque

    PubMed Central

    Easley, Deanna C.; Barone, William R.; Moalli, Pamela A.; Abramowitch, Steven D.

    2016-01-01

    Objective Implantation of biological or synthetic mesh is the most common method of surgical intervention for pelvic organ prolapse, however, complications ensuing from these surgical repairs occur in 15.5% of cases. MatristemTM (ACell, Inc., USA) Pelvic Floor Matrix is a urinary bladder matrix (UBM) device indicated for transvaginal repair. This device is remodeled and replaced by host tissue following implantation, which raises the concern that the process may result in a loss of support to the vagina. Thus, the goal of this study was to quantify measurable changes in vaginal alignment via magnetic resonance imaging (MRI) before (pre) and after (10 days and 3 months) a transvaginal procedure with this device in a rhesus macaque model. Methods Two rhesus macaques underwent a transvaginal procedure in accordance with the IACUC at the University of Pittsburgh (protocol #13081928). Level 1 & 2 support to the vagina was transected to simulate compromised support. Two sheets of 6-ply MatriStemTM were implanted to support the anterior and posterior vagina. Vaginal alignment was derived from MRIs taken pre, 10 days, and 3 months after surgery. The border of the vagina was manually traced, and used to calculate the centroid of each tracing. These centroids represent the path of the vagina through the pelvis. Further, a 3D coordinate system was mapped to the pelvis, and lines fit to the proximal and distal vagina were used to measure the angle of each line with respect to a cephalic oriented axis in the mid-sagittal plane, which is referred to as the angle of elevation. Results At 10 days, the angle of elevation became more acute by 8.6% and 17%, respectively. These changes reflect expectations of a tensioned transvaginal fixation of the vagina. At 3 months post-surgery, angles of elevation approached pre surgery conditions, indicating that MatriStemTM was providing a comparable level of support to native tissue, even following remodeling. Conclusions This preliminary

  14. What's In a Note: Construction of a Suicide Note Corpus.

    PubMed

    Pestian, John P; Matykiewicz, Pawel; Linn-Gust, Michelle

    2012-01-01

    This paper reports on the results of an initiative to create and annotate a corpus of suicide notes that can be used for machine learning. Ultimately, the corpus included 1,278 notes that were written by someone who died by suicide. Each note was reviewed by at least three annotators who mapped words or sentences to a schema of emotions. This corpus has already been used for extensive scientific research.

  15. Do postmenopausal women with thickened endometrium on trans-vaginal ultrasound in the absence of vaginal bleeding need hysteroscopic assessment? A Pilot Study.

    PubMed

    Laiyemo, R; Dudill, W; Jones, S E; Browne, H

    2016-01-01

    We aimed to determine the incidence of endometrial cancer in a cohort of postmenopausal women with thickened endometrium but no bleeding referred for hysteroscopy and determine the risk estimate of cancer using a cut-off of > 11 mm. This retrospective study of asymptomatic postmenopausal women with thickened endometrium on trans-vaginal scan referred for hysteroscopy was performed using data from 2008 to 2010. In total 63 women were identified. 2 cases of endometrial cancer were identified with an incidence of 3.17%. 22 cases had endometrial thickness (ET) > 11 mm of which 2 were malignant giving a risk estimate for endometrial cancer of 9.1%. 61 women had benign pathology, 40.98% had atrophic endometrium and 59.02% had benign polyp. In conclusion, the incidence of endometrial cancer in postmenopausal women with thickened endometrium on transvaginal scan without vaginal bleeding is low and ET of 11 mm or more seems realistic to use as a cut-off for referral for hysteroscopy.

  16. Efficacy of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vaginal vault suspension.

    PubMed

    Park, Amy J; Ridgeway, Beri; Gustilo-Ashby, A Marcus; Paraiso, Marie Fidela R; Walters, Mark D; Barber, Matthew D

    2008-10-01

    The aim of this paper is to describe the efficacy and safety of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vault prolapse and determine how well the pre-operative pelvic examination predicted successful peritoneal entry. A retrospective review of patients undergoing post-hysterectomy trans-vaginal apical suspensions using a standardized technique of peritoneal entry was employed in this study. A subset of patients underwent a standardized pre-operative evaluation to predict what organ was behind the vaginal cuff and posterior cul-de-sac. Peritoneal entry was attempted in 280 patients, and successfully achieved in 223(80%). One cystotomy and one proctotomy (0.3%) occurred during attempted entry. Of those who underwent the standardized pre-operative evaluation, peritoneal entry was successful 86% of the time when small bowel was predicted to lie behind the vaginal cuff or posterior cul-de-sac. Peritoneal entry can be safely achieved in the majority of post-hysterectomy prolapse patients. Pre-operative examination assists in predicting successful peritoneal entry.

  17. The tension-free transvaginal tape procedure in the treatment of female urinary stress incontinence: a French prospective multicentre study.

    PubMed

    Soulié, M; Cuvillier, X; Benaïssa, A; Mouly, P; Larroque, J M; Bernstein, J; Soulié, R; Tollon, C; Brucher, P; Vazzoler, N; Seguin, P; Pontonnier, F; Plante, P

    2001-06-01

    To evaluate in a prospective multicentre study (five centres) the preliminary results regarding efficacy and morbidity of the new tension-free transvaginal tape (TVT) technique in the treatment of urinary stress incontinence (USI) in women. From November 1996 to May 1999, 52 women of mean age 64 (range 37--91) years underwent the TVT procedure to treat isolated grade 2 or 3 USI (44 cases) or grade 1 or 2 USI associated with uterine or rectal prolapse surgery (8 cases). Twenty-nine patients (55.8%) presented recurrent USI (1--4 previous procedures). Clinical data showed urethrovesical junction hypermobility in 35 cases (67.3%), isolated intrinsic sphincter deficiency (ISD) in 17 cases (32.6%) and pelvic organ prolapse in 8 cases. Urodynamics confirmed ISD in 27 cases (51.9%) with a mean urethral closure pressure of 18.5 (range 7--25) cm H(2)O. All data were collected by surgeons on a questionnaire. The surgical procedure was performed under spinal cord anaesthesia in 82.7% of patients (local anaesthesia 11.5%) with a mean operation time of 30 (range 20--60) min for TVT implantation. Six bladder injuries (11.5%) were identified and the needle was repositioned. Mean hospital stay was 2.5 (range 1-7) days in the group who underwent TVT alone. Mean follow-up of continence was 15.2 (range 6--36) months: 83% of patients were dry and 17% were improved. Nine patients (17.3%) required self-catheterization for 2--10 days postoperatively. No recurrence of USI, defect healing or tape rejection were reported. TVT is a new technique for the surgical treatment of USI which is useful for recurrent cases. The advantages are simplicity, low morbidity, reproducibility and reduced operative time. These early results indicate the technique is effective in correcting incontinence and is locally well tolerated. But these are preliminary data and the long-term outcome on USI and the urethra is needed.

  18. Association between three-dimensional transvaginal sonographic markers and outcome of pregnancy of unknown location: a pilot study.

    PubMed

    Reid, S; Nadim, B; Bignardi, T; Lu, C; Martins, W P; Condous, G

    2016-11-01

    To assess the accuracy of three-dimensional (3D) transvaginal sonographic (TVS) parameters in predicting the evolution of a pregnancy of unknown location (PUL). This was a prospective observational study performed at the early pregnancy unit of a university hospital from September 2008 to June 2012. Women with a positive pregnancy test without any signs of intra- or extrauterine pregnancy at their first TVS examination were considered eligible and a 3D dataset containing the entire uterus was acquired. An experienced observer analyzed all 3D datasets for assessment of the following parameters: endometrial thickness, volume, mean gray-scale index and asymmetry. Women were followed until they were classified as having: (i) non-visualized pregnancy loss (NVPL); (ii) intrauterine pregnancy (IUP); or (iii) ectopic pregnancy or persistent PUL. We compared the values of the TVS parameters across the three groups. We also assessed the area under the receiver-operating characteristics curve of the 3D-TVS parameters in comparison to that for serum β-human chorionic gonadotropin (β-hCG) ratio (48 h/baseline) to predict PUL outcome. We then evaluated whether combining the 3D-TVS parameters with serum β-hCG ratio improved the predictive accuracy for PUL outcome by performing a logistic regression analysis. During the study period 4939 consecutive pregnant women presented at the unit for their initial TVS examination and 325 (7%) were classified as having a PUL, of whom 161 women were enrolled and had a 3D scan of the uterus. However, 19 were excluded because of incomplete follow-up. Data from 142 women with PUL were therefore included in the analysis and the outcomes of these women were: NVPL in 98 (69%), IUP in 27 (19%) and ectopic pregnancy + persistent PUL in 14 + 3 = 17 (12%). Endometrial thickness, endometrial volume and the proportion of women with asymmetric endometrial shape differed significantly between the outcome groups. Endometrial thickness and volume could be

  19. Collection of oocytes through transvaginal ultrasound-guided aspiration of follicles in an Indian breed of cattle.

    PubMed

    Manik, R S; Singla, S K; Palta, P

    2003-04-15

    The present study was undertaken in Karan Fries, an Indian breed of cattle to (1) determine the number of follicles available for puncture and (2) explore the potential of this breed as a donor of developmentally competent oocytes. Ovum pick-up (OPU) was performed using an ultrasound machine with a transvaginal convex transducer (5 MHz) with a needle guide, single lumen 19-gauge 60 cm long needle and a vacuum pressure of 90 mmHg. The number and size of follicles in each ovary was determined before puncture. The follicles were characterized on the basis of their diameter as small (3-5 mm), medium (6-9 mm) and large (>/=10 mm). The oocytes recovered were classified by quality. They were matured in vitro, irrespective of their grade, in 50 microl droplets of the in vitro maturation (IVM) medium (TCM-199+10% fetal bovine serum(FBS)+5 microg/ml follicle stimulating hormone (folltropin)+1 microg/ml estradiol-17beta+0.2 mM sodium pyruvate), covered with paraffin oil, in 35 mm petridish for 24 h in a CO(2) incubator (5% CO(2) in air) at 38.5 degrees C. The cleavage rate was recorded at day 2 post-insemination after subjecting the oocytes to in vitro fertilization (IVF). The differences in follicular populations of all size categories among individual donors were not significant. A total of 92 oocytes were recovered by aspiration of 157 follicles, with an overall recovery rate of 59% (range 35-79%). Of these, 32% were of grades A and B and the rest of grades C and D. The mean numbers of total follicles and the oocytes recovered per session did not differ significantly among individual donors. Out of the 73 oocytes subjected to IVM and IVF, 24 reached 2-4 cell stage at day 2 post-fertilization, with a cleavage rate of 33%. The total number of oocytes recovered was correlated with the number of small (R=0.54, P<0.01) but not with the number of medium and large follicles. This study demonstrates the use of OPU as a means of obtaining developmentally competent oocytes from an

  20. [The use of transvaginal ultrasound following voluntary interruption of pregnancy to reduce complications due to incomplete curettage].

    PubMed

    Caserta, L; Labriola, D; Torella, M; Di Caterina, B

    2008-02-01

    The aim of the study was to assess by what percentage the use of transvaginal ultrasound (TV, curettage) following voluntary interruption of pregnancy (IVG) reduces the incidence of haemorrhagic events resulting from incomplete drainage of the cavity during the first trimester of gestation. The present is a randomized prospective study involving 720 women who in the period between January 2005 and January 2007 underwent drainage of the cavity during the first trimester of gestation. The study group involved 360 women who were submitted to TV ultrasound using the Toshiba JustVision 400 system at the end of the surgical procedure. The control group also numbered 360 women; they, by contrast, did not undergo ultrasound examination at the end of surgery. In the study group, in those cases in which the ultrasound examination carried out with a TV probe highlighted an endometrial rima of thickness 8 mm, recurettage was carried out. Patients then underwent further gynecological and ultrasound control examination, 5-8 days after the surgical procedure. The index of complications overall was 3.2%. Retained products of conception were encountered in 2 women in the study group (0.5%) and in 13 women from the control group (3.6%, P<0.05). Vaginal bleeding requiring hospitalization was observed in 2 women in the study group (0,5%) against 6 in the control group (1.6%, P=0.2). Cases of endometritis were diagnosed in only one woman in the study group (0.3%) against 5 in the control group (1.4%) and uterine perforation occurred in only one woman in the control group versus no case in the study group. There were no cases of retained products of conception in women presenting endometrial thickness <8 mm, a dimension obtained with the aid of ultrasound at the end of the surgical procedure. The use of ultrasound examination, carried out with the aid of a TV probe immediately following uterine drainage during the first trimester of pregnancy, may considerably reduce the incidence both

  1. Uterine Leiomyomas: Safety and Efficacy of US-guided Suprapubic Transvaginal Radiofrequency Ablation at 1-year Follow-up.

    PubMed

    Wu, Xiang-Jun; Guo, Qing; Cao, Bing-Sheng; Tan, Li-Xia; Zhang, Hong-Yu; Cai, Yu-Ru; Gao, Bu-Lang

    2016-06-01

    Purpose To assess the safety and efficacy of ultrasonography (US)-guided suprapubic transvaginal (ST) radiofrequency ablation (RFA) in the treatment of symptomatic uterine leiomyomas at 1-year follow-up. Materials and Methods The institutional review board approved this prospective study, and all patients provided informed consent. ST RFA was performed as an outpatient procedure 3 days after menstruation in 51 women (age range, 32-52 years; mean age, 42.2 years) with 62 leiomyomas. The leiomyomas were assessed with conventional and contrast material-enhanced US before and after ST RFA for leiomyoma size, location, and blood flow. All patients were evaluated for postoperative complications, including abdominal pain, injury to surrounding tissues and organs, vaginal bleeding, increased vaginal discharge, fever, dyspnea, and menorrhagia, after ST RFA and at follow-up visits. The leiomyoma volumes, improvement in leiomyoma-related symptoms, effect on quality of life (QOL), and patient satisfaction were assessed and compared before and after ST RFA and at follow-up visits by using statistical analyses. Results Sixty-two leiomyomas were successfully treated with ST RFA until 90% of the leiomyoma was echogenic. At 1-month follow-up, 46 (74%) leiomyomas had no contrast enhancement, five (8%) had peripheral enhancement, eight (13%) had focal enhancement, and three (5%) had scattered enhancement at contrast-enhanced US. At 6-month follow-up, the number of leiomyomas that had no enhancement, peripheral enhancement, focal enhancement, or scattered enhancement was 43 (69%), seven (11%), nine (15%), and three (5%), respectively. The leiomyoma volumes were significantly (P < .05) reduced at 1-, 3-, 6-, and 12-month follow-up (from 33.0 cm(3) ± 25.1 [standard deviation] before treatment to 6.8 cm(3) ± 7.7 at 12-month follow-up). The mean percentage volume reduction at 1-, 3-, 6-, and 12-month follow-up was 28%, 57%, 63%, and 78%, respectively. The scores for symptoms and QOL

  2. Online Class Size, Note Reading, Note Writing and Collaborative Discourse

    ERIC Educational Resources Information Center

    Qiu, Mingzhu; Hewitt, Jim; Brett, Clare

    2012-01-01

    Researchers have long recognized class size as affecting students' performance in face-to-face contexts. However, few studies have examined the effects of class size on exact reading and writing loads in online graduate-level courses. This mixed-methods study examined relationships among class size, note reading, note writing, and collaborative…

  3. Online Class Size, Note Reading, Note Writing and Collaborative Discourse

    ERIC Educational Resources Information Center

    Qiu, Mingzhu; Hewitt, Jim; Brett, Clare

    2012-01-01

    Researchers have long recognized class size as affecting students' performance in face-to-face contexts. However, few studies have examined the effects of class size on exact reading and writing loads in online graduate-level courses. This mixed-methods study examined relationships among class size, note reading, note writing, and collaborative…

  4. Hybrid Vehicles

    DTIC Science & Technology

    2008-12-08

    hybrid electric vehicles typically contain potentially hazardous levels of electrical voltage or current. It is important to protect the operators...60740. ITOP 2-2-607(1)41 is used for tracked vehicles. 13 TOP 2-1-003 08 December 2008 Hybrid electric vehicles often employ much more

  5. Research Notes and Information References

    SciTech Connect

    Hartley, III, Dean S.

    1994-12-01

    The RNS (Research Notes System) is a set of programs and databases designed to aid the research worker in gathering, maintaining, and using notes taken from the literature. The sources for the notes can be books, journal articles, reports, private conversations, conference papers, audiovisuals, etc. The system ties the databases together in a relational structure, thus eliminating data redundancy while providing full access to all the information. The programs provide the means for access and data entry in a way that reduces the key-entry burden for the user. Each note has several data fields. Included are the text of the note, the subject classification (for retrieval), and the reference identification data. These data are divided into four databases: Document data - title, author, publisher, etc., fields to identify the article within the document; Note data - text and page of the note; Sublect data - subject categories to ensure uniform spelling for searches. Additionally, there are subsidiary files used by the system, including database index and temporary work files. The system provides multiple access routes to the notes, both structurally (access method) and topically (through cross-indexing). Output may be directed to a printer or saved as a file for input to word processing software.

  6. 49 CFR Appendix - Editorial Note:

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 1 2013-10-01 2013-10-01 false Editorial Note: Transportation Office of the Secretary of Transportation ORGANIZATION AND DELEGATION OF POWERS AND DUTIES Operating Administrations.... Editorial Note: For Federal Register citations affecting appendix A to part 1, see the List of CFR Sections...

  7. Stellarator hybrids

    SciTech Connect

    Furth, H.P.; Ludescher, C.

    1984-08-01

    The present paper briefly reviews the subject of tokamak-stellarator and pinch-stellarator hybrids, and points to two interesting new possibilities: compact-torus-stellarators and mirror-stellarators.

  8. Comparison of scar thickness measurements using trans-vaginal sonography and MRI in cases of pregnancy with previous caesarean section. Do they correlate with actual scar thickness?

    PubMed

    Singh, N; Tripathi, R; Mala, Y M; Dixit, R; Tyagi, S; Batra, A

    2013-11-01

    The aim of this study was to evaluate scar thickness in cases of pregnancy with previous caesarean section, by trans-vaginal sonography (TVS) and magnetic resonance imaging (MRI), and to correlate precision of radiologically-measured scar thickness with actual measurement of scar thickness. A total of 35 pregnant patients with previous caesarean section planned for elective caesarean section, were evaluated prospectively. Their scar thickness was measured by TVS and MRI on the day of elective repeat caesarean section. These measurements were correlated with each other and with scar thickness measured during elective repeat caesarean section by using a caliper. The correlation coefficients between scar thickness measured by TVS and MRI with peroperative evaluation with a caliper, were +0.72 and +0.59, respectively. The study concluded that as MRI is a costlier modality and TVS has better correlation coefficient with actual scar thickness, TVS can be considered to be the better modality for antenatal scar thickness measurement.

  9. [Problem-oriented nursing notes].

    PubMed

    Plante, A

    1989-09-01

    These notes use the nursing process to communicate effectively the work done with the patient. The author describes with the help of examples this professional work system, which is simple yet revealing of the nurse's capacity for analysis.

  10. Constitutive heterochromatin in chromosomes of duck hybrids and goose hybrids.

    PubMed

    Wójcik, E; Smalec, E

    2017-01-01

    Constitutive heterochromatin is a highly condensed fraction of chromatin in chromosomes. It is characterized by a high degree of polymorphism. Heterochromatin is located in the centromeric, telomeric, and interstitial parts of chromosomes. We used the CBG ( C: banding using B: arium hydroxide by G: iemsa) staining technique to identify heterochromatin in chromosomes. Analysis of karyotypes of F1 hybrids resulting from intergeneric hybridization of ducks (A. platyrhynchos × C. moschata) and interspecific crosses of geese (A. anser × A. cygnoides) were used to compare the karyotypes of 2 species of duck and 2 species of geese, as well as to compare the hybrids with the parent species. The localization of C-bands and their size were determined. In the duck hybrid, greater amounts of heterochromatin were noted in the homologous chromosomes from the duck A. platyrhynchos than in the chromosomes from the duck C. moschata. In the goose hybrid more heterochromatin was observed in the homologous chromosomes from the goose A. cygnoides than in the chromosomes from the goose A. anser. Comparison of chromosomes from the duck hybrid with chromosomes of the ducks A. platyrhynchos and C. moschata revealed nearly twice as much constitutive heterochromatin in the chromosomes of the hybrid. When chromosomes from the goose hybrid were compared with those of the geese A. anser and A. cygnoides, differences in the average content of heterochromatin were observed on only a few chromosomes. © 2016 Poultry Science Association Inc.

  11. The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care: A Multicenter Single-blind Randomized Trial.

    PubMed

    Tolsgaard, Martin G; Ringsted, Charlotte; Rosthøj, Susanne; Nørgaard, Lone; Møller, Lars; Freiesleben, Nina La Cour; Dyre, Liv; Tabor, Ann

    2017-03-01

    To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. Simulation-based ultrasound training may be an effective adjunct to clinical training, but no studies have examined its effects on quality and efficiency of care. Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training only (control group, n = 26).The primary outcome was patient-reported discomfort during transvaginal ultrasound examinations performed by study participants. Secondary outcomes included patient-reported perceived safety and confidence in ultrasound provider. Finally, the need for trainee supervision or repeated patient examinations was recorded. In total, 1150 patient ratings were collected. The intervention was associated with a reduction of patient discomfort by 18.5% [95% confidence interval (CI), 10.7-25.5; P < 0.001), and with a 7.9% (95% CI, 0.5-14.7; P = 0.04) increase in perceived safety. The intervention group participants received 11.1% (95% CI, 2.5-18.9) higher scores on patients' confidence compared with control group participants (P = 0.01). When the number of days of clinical training was doubled, the odds for trainee supervision or repeated patient examination was reduced by 45.3% (95% CI, 33.5-55.1) and 19.8% (95% CI, 4.1-32.9) in the intervention and control group, respectively (P = 0.005). Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.

  12. Influence of transvaginal ultrasound-guided follicular punctures in the mare on heart rate, respiratory rate, facial expression changes, and salivary cortisol as pain scoring.

    PubMed

    Diego, Rodrigo; Douet, Cécile; Reigner, Fabrice; Blard, Thierry; Cognié, Juliette; Deleuze, Stefan; Goudet, Ghylène

    2016-10-15

    Transvaginal ultrasound-guided follicular punctures are widely used in the mare for diagnosis, research, and commercial applications. The objective of our study was to determine their influence on pain, stress, and well-being in the mare, by evaluating heart rate, breath rate, facial expression changes, and salivary cortisol before, during, and after puncture. For this experiment, 21 pony mares were used. Transvaginal ultrasound-guided aspirations were performed on 11 mares. After injections for sedation, analgesia, and antispasmodia, the follicles from both ovaries were aspirated with a needle introduced through the vagina wall into the ovary. In the control group, 10 mares underwent similar treatments and injections, but no follicular aspiration. Along the session, heart rate and breath rate were evaluated by a trained veterinarian, ears position, eyelid closure, and contraction of facial muscles were evaluated, and salivary samples were taken for evaluation of cortisol concentration. A significant relaxation was observed after sedative injection in the punctured and control mares, according to ear position, eyelid closure, and contraction of facial muscles, but no difference between punctured and control animals was recorded. No significant modification of salivary cortisol concentration during puncture and no difference between punctured and control mares at any time were observed. No significant modification of the breath rate was observed along the procedure for the punctured and the control mares. Heart rate increased significantly but transiently when the needle was introduced in the ovary and was significantly higher at that time for the punctured mares than that for control mares. None of the other investigated parameters were affected at that time, suggesting discomfort is minimal and transient. Improving analgesia, e.g., through a multimodal approach, during that possibly more sensitive step could be recommended. The evaluation of facial expression

  13. 7 CFR 1786.154 - Qualified Notes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 12 2011-01-01 2011-01-01 false Qualified Notes. 1786.154 Section 1786.154... Discounted Prepayments on RUS Electric Loans § 1786.154 Qualified Notes. An eligible borrower may prepay Qualified Notes under this subpart at the discounted present value. A Qualified Note is a note evidencing an...

  14. 12 CFR 161.33 - Note account.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Note account. 161.33 Section 161.33 Banks and... SAVINGS ASSOCIATIONS § 161.33 Note account. The term note account means a note, subject to the right of immediate call, evidencing funds held by depositories electing the note option under applicable United...

  15. 12 CFR 390.300 - Note account.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Note account. 390.300 Section 390.300 Banks and... Associations § 390.300 Note account. The term note account means a note, subject to the right of immediate call, evidencing funds held by depositories electing the note option under applicable United States Treasury...

  16. 7 CFR 1786.154 - Qualified Notes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Qualified Notes. 1786.154 Section 1786.154... Discounted Prepayments on RUS Electric Loans § 1786.154 Qualified Notes. An eligible borrower may prepay Qualified Notes under this subpart at the discounted present value. A Qualified Note is a note evidencing an...

  17. 7 CFR 1786.154 - Qualified Notes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Qualified Notes. 1786.154 Section 1786.154 Agriculture... Prepayments on RUS Electric Loans § 1786.154 Qualified Notes. An eligible borrower may prepay Qualified Notes under this subpart at the discounted present value. A Qualified Note is a note evidencing an RUS...

  18. 12 CFR 561.33 - Note account.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 6 2014-01-01 2012-01-01 true Note account. 561.33 Section 561.33 Banks and... SAVINGS ASSOCIATIONS § 561.33 Note account. The term note account means a note, subject to the right of immediate call, evidencing funds held by depositories electing the note option under applicable United...

  19. 12 CFR 161.33 - Note account.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Note account. 161.33 Section 161.33 Banks and... SAVINGS ASSOCIATIONS § 161.33 Note account. The term note account means a note, subject to the right of immediate call, evidencing funds held by depositories electing the note option under applicable United...

  20. 12 CFR 561.33 - Note account.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Note account. 561.33 Section 561.33 Banks and... SAVINGS ASSOCIATIONS § 561.33 Note account. The term note account means a note, subject to the right of immediate call, evidencing funds held by depositories electing the note option under applicable United...

  1. 12 CFR 561.33 - Note account.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 6 2013-01-01 2012-01-01 true Note account. 561.33 Section 561.33 Banks and... SAVINGS ASSOCIATIONS § 561.33 Note account. The term note account means a note, subject to the right of immediate call, evidencing funds held by depositories electing the note option under applicable United...

  2. 12 CFR 561.33 - Note account.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Note account. 561.33 Section 561.33 Banks and... SAVINGS ASSOCIATIONS § 561.33 Note account. The term note account means a note, subject to the right of immediate call, evidencing funds held by depositories electing the note option under applicable United...

  3. Usefulness of a Flexible Port for Natural Orifice Transluminal Endoscopic Surgery by the Transrectal and Transvaginal Routes

    PubMed Central

    Ohdaira, Takeshi; Ikeda, Keiichi; Tajiri, Hisao; Yasuda, Yoshikazu; Hashizume, Makoto

    2010-01-01

    We developed a flexible port for NOTES which allows the use of conventional forceps for laparoscope-assisted surgery without change. The port is not affected by the location of the through hole in the gastrointestinal tract or vagina which elicits a problem in conventional NOTES, and its length can be adjusted during surgery by cutting the port itself. The port is made of polymer resin with a low friction coefficient. Furthermore, the port walls have a square wave structure which contributes to (1) the prevention of devices, for example, endoscope, from getting stuck at the time of insertion and retrieval, (2) the prevention of port slippage in the surgical opening for port insertion, (3) the prevention of unexpected port removal, (4) the prevention of port bore deformation, and (5) the improvement of port flexibility in the longitudinal direction. We validated the insertion and retrieval capacities of commercially available forceps for laparoscope-assisted surgery and power devices. Furthermore, we used the flexible port to conduct cholecystectomy and partial gastrectomy. We could confirm that the selection of the flexible port diameter according to the device type allowed the smooth insertion and retrieval of the device and that the port produced no air leakage. We affirmed that it is possible to conduct surgery by the cross or parallel method similarly to single port surgery. We considered that the flexible port has a potential of becoming a revolutionary port in NOTES. PMID:20508827

  4. Some Notes on a Functional Equation. Classroom Notes

    ERIC Educational Resources Information Center

    Ren, Zhong-Pu; Wu, Zhi-Qin; Zhou, Qi-Fa; Guo, Bai-Ni; Qi, Feng

    2004-01-01

    In this short note, a mathematical proposition on a functional equation for f(xy)=xf(y) + yf(x)for x,y [does not equal] 0, which is encountered in calculus, is generalized step by step. These steps involve continuity, differentiability, a functional equation, an ordinary differential linear equation of the first order, and relationships between…

  5. Notes.

    ERIC Educational Resources Information Center

    Physics Teacher, 1979

    1979-01-01

    Some topics included are: the relative merits of a programmable calculator and a microcomputer; the advantages of acquiring a sound-level meter for the laboratory; how to locate a virtual image in a plane mirror; center of gravity of a student; and how to demonstrate interference of light using two cords.

  6. Notes.

    ERIC Educational Resources Information Center

    Physics Teacher, 1979

    1979-01-01

    Some topics included are: the relative merits of a programmable calculator and a microcomputer; the advantages of acquiring a sound-level meter for the laboratory; how to locate a virtual image in a plane mirror; center of gravity of a student; and how to demonstrate interference of light using two cords.

  7. A brief note regarding randomization.

    PubMed

    Senn, Stephen

    2013-01-01

    This note argues, contrary to claims in this journal, that the possible existence of indefinitely many causal factors does not invalidate randomization. The effect of such factors has to be bounded by outcome, and since inference is based on a ratio of between-treatment-group to within-treatment-group variation, randomization remains valid.

  8. EndNote at Lehigh.

    ERIC Educational Resources Information Center

    Siegler, Sharon; Simboli, Brian

    2002-01-01

    Describes the experiences of librarians at Lehigh University in implementing campus-wide use of EndNote, a citation management software package that allows users to create a searchable library of downloaded or manually entered references for any type of publication to be able to insert citations and format footnotes or endnotes within a…

  9. Applied Fluid Mechanics. Lecture Notes.

    ERIC Educational Resources Information Center

    Gregg, Newton D.

    This set of lecture notes is used as a supplemental text for the teaching of fluid dynamics, as one component of a thermodynamics course for engineering technologists. The major text for the course covered basic fluids concepts such as pressure, mass flow, and specific weight. The objective of this document was to present additional fluids…

  10. Lunar nomenclature: A dissenting note

    USGS Publications Warehouse

    Arthur, D.W.G.

    1976-01-01

    This note reviews the nature of the traditional (Ma??dler) lunar nomenclature and the recent developments based on the use of more than 2000 named provinces. It appears that the new nomenclature is less efficient than the old in many cases and may lead to an impossible publication situation. The unnecessary break with the past is especially critized. ?? 1976.

  11. Notes on the Montessori Adolescent.

    ERIC Educational Resources Information Center

    Stephenson, Margaret E.

    2000-01-01

    Maintains that Montessori education of adolescents (Erdkinder) should prepare them to exercise a self-disciplined will and judgment. Notes the importance of preparing children through Cosmic Education and through community service. Maintains that the logical focus of study for the third plane is the cosmic plan and the adolescent's place in it.…

  12. A Note on Hamiltonian Graphs

    ERIC Educational Resources Information Center

    Skurnick, Ronald; Davi, Charles; Skurnick, Mia

    2005-01-01

    Since 1952, several well-known graph theorists have proven numerous results regarding Hamiltonian graphs. In fact, many elementary graph theory textbooks contain the theorems of Ore, Bondy and Chvatal, Chvatal and Erdos, Posa, and Dirac, to name a few. In this note, the authors state and prove some propositions of their own concerning Hamiltonian…

  13. Applied Fluid Mechanics. Lecture Notes.

    ERIC Educational Resources Information Center

    Gregg, Newton D.

    This set of lecture notes is used as a supplemental text for the teaching of fluid dynamics, as one component of a thermodynamics course for engineering technologists. The major text for the course covered basic fluids concepts such as pressure, mass flow, and specific weight. The objective of this document was to present additional fluids…

  14. Possibilities of lasers within NOTES.

    PubMed

    Stepp, Herbert; Sroka, Ronald

    2010-10-01

    Lasers possess unique properties that render them versatile light sources particularly for NOTES. Depending on the laser light sources used, diagnostic as well as therapeutic purposes can be achieved. The diagnostic potential offered by innovative concepts such as new types of ultra-thin endoscopes and optical probes supports the physician with optical information of ultra-high resolution, tissue discrimination and manifold types of fluorescence detection. In addition, the potential 3-D capability promises enhanced recognition of tissue type and pathological status. These diagnostic techniques might enable or at least contribute to accurate and safe procedures within the spatial restrictions inherent with NOTES. The therapeutic potential ranges from induction of phototoxic effects over tissue welding, coagulation and tissue cutting to stone fragmentation. As proven in many therapeutic laser endoscopic treatment concepts, laser surgery is potentially bloodless and transmits the energy without mechanical forces. Specialized NOTES endoscopes will likely incorporate suitable probes for improving diagnostic procedures, laser fibres with advantageous light delivery possibility or innovative laser beam manipulation systems. NOTES training centres may support the propagation of the complex handling and the safety aspects for clinical use to the benefit of the patient.

  15. EndNote at Lehigh.

    ERIC Educational Resources Information Center

    Siegler, Sharon; Simboli, Brian

    2002-01-01

    Describes the experiences of librarians at Lehigh University in implementing campus-wide use of EndNote, a citation management software package that allows users to create a searchable library of downloaded or manually entered references for any type of publication to be able to insert citations and format footnotes or endnotes within a…

  16. A Note on Hamiltonian Graphs

    ERIC Educational Resources Information Center

    Skurnick, Ronald; Davi, Charles; Skurnick, Mia

    2005-01-01

    Since 1952, several well-known graph theorists have proven numerous results regarding Hamiltonian graphs. In fact, many elementary graph theory textbooks contain the theorems of Ore, Bondy and Chvatal, Chvatal and Erdos, Posa, and Dirac, to name a few. In this note, the authors state and prove some propositions of their own concerning Hamiltonian…

  17. Lecture Notes on Multigrid Methods

    SciTech Connect

    Vassilevski, P S

    2010-06-28

    The Lecture Notes are primarily based on a sequence of lectures given by the author while been a Fulbright scholar at 'St. Kliment Ohridski' University of Sofia, Sofia, Bulgaria during the winter semester of 2009-2010 academic year. The notes are somewhat expanded version of the actual one semester class he taught there. The material covered is slightly modified and adapted version of similar topics covered in the author's monograph 'Multilevel Block-Factorization Preconditioners' published in 2008 by Springer. The author tried to keep the notes as self-contained as possible. That is why the lecture notes begin with some basic introductory matrix-vector linear algebra, numerical PDEs (finite element) facts emphasizing the relations between functions in finite dimensional spaces and their coefficient vectors and respective norms. Then, some additional facts on the implementation of finite elements based on relation tables using the popular compressed sparse row (CSR) format are given. Also, typical condition number estimates of stiffness and mass matrices, the global matrix assembly from local element matrices are given as well. Finally, some basic introductory facts about stationary iterative methods, such as Gauss-Seidel and its symmetrized version are presented. The introductory material ends up with the smoothing property of the classical iterative methods and the main definition of two-grid iterative methods. From here on, the second part of the notes begins which deals with the various aspects of the principal TG and the numerous versions of the MG cycles. At the end, in part III, we briefly introduce algebraic versions of MG referred to as AMG, focusing on classes of AMG specialized for finite element matrices.

  18. Hybrid Arrays for Chemical Sensing

    NASA Astrophysics Data System (ADS)

    Kramer, Kirsten E.; Rose-Pehrsson, Susan L.; Johnson, Kevin J.; Minor, Christian P.

    In recent years, multisensory approaches to environment monitoring for chemical detection as well as other forms of situational awareness have become increasingly popular. A hybrid sensor is a multimodal system that incorporates several sensing elements and thus produces data that are multivariate in nature and may be significantly increased in complexity compared to data provided by single-sensor systems. Though a hybrid sensor is itself an array, hybrid sensors are often organized into more complex sensing systems through an assortment of network topologies. Part of the reason for the shift to hybrid sensors is due to advancements in sensor technology and computational power available for processing larger amounts of data. There is also ample evidence to support the claim that a multivariate analytical approach is generally superior to univariate measurements because it provides additional redundant and complementary information (Hall, D. L.; Linas, J., Eds., Handbook of Multisensor Data Fusion, CRC, Boca Raton, FL, 2001). However, the benefits of a multisensory approach are not automatically achieved. Interpretation of data from hybrid arrays of sensors requires the analyst to develop an application-specific methodology to optimally fuse the disparate sources of data generated by the hybrid array into useful information characterizing the sample or environment being observed. Consequently, multivariate data analysis techniques such as those employed in the field of chemometrics have become more important in analyzing sensor array data. Depending on the nature of the acquired data, a number of chemometric algorithms may prove useful in the analysis and interpretation of data from hybrid sensor arrays. It is important to note, however, that the challenges posed by the analysis of hybrid sensor array data are not unique to the field of chemical sensing. Applications in electrical and process engineering, remote sensing, medicine, and of course, artificial

  19. 34 CFR 674.31 - Promissory note.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 3 2012-07-01 2012-07-01 false Promissory note. 674.31 Section 674.31 Education..., DEPARTMENT OF EDUCATION FEDERAL PERKINS LOAN PROGRAM Terms of Loans § 674.31 Promissory note. (a) Promissory note. (1) An institution may use only the promissory note that the Secretary provides. The institution...

  20. 32 CFR 806b.5 - Personal notes.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Personal notes. 806b.5 Section 806b.5 National... Overview of the Privacy Act Program § 806b.5 Personal notes. The Privacy Act does not apply to personal notes on individuals used as memory aids. Personal notes may become Privacy Act records if they are...

  1. 32 CFR 806b.5 - Personal notes.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Personal notes. 806b.5 Section 806b.5 National... Overview of the Privacy Act Program § 806b.5 Personal notes. The Privacy Act does not apply to personal notes on individuals used as memory aids. Personal notes may become Privacy Act records if they are...

  2. 32 CFR 806b.5 - Personal notes.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Personal notes. 806b.5 Section 806b.5 National... Overview of the Privacy Act Program § 806b.5 Personal notes. The Privacy Act does not apply to personal notes on individuals used as memory aids. Personal notes may become Privacy Act records if they are...

  3. 7 CFR 1786.206 - Refinancing note.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Refinancing note. 1786.206 Section 1786.206... Refinancing note. (a) RUS will issue a replacement guaranty for refinancing notes delivered to FFB to replace and substitute for existing FFB notes in connection with any refinancing by FFB pursuant to section...

  4. 32 CFR 806b.5 - Personal notes.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Personal notes. 806b.5 Section 806b.5 National... Overview of the Privacy Act Program § 806b.5 Personal notes. The Privacy Act does not apply to personal notes on individuals used as memory aids. Personal notes may become Privacy Act records if they are...

  5. 7 CFR 1786.206 - Refinancing note.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Refinancing note. 1786.206 Section 1786.206... Refinancing note. (a) RUS will issue a replacement guaranty for refinancing notes delivered to FFB to replace and substitute for existing FFB notes in connection with any refinancing by FFB pursuant to section...

  6. 7 CFR 1786.206 - Refinancing note.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 12 2011-01-01 2011-01-01 false Refinancing note. 1786.206 Section 1786.206... Refinancing note. (a) RUS will issue a replacement guaranty for refinancing notes delivered to FFB to replace and substitute for existing FFB notes in connection with any refinancing by FFB pursuant to section...

  7. Notes for Serials Cataloging. Second Edition.

    ERIC Educational Resources Information Center

    Geer, Beverley, Ed.; Caraway, Beatrice L., Ed.

    Notes are indispensable to serials cataloging. Researchers, reference librarians, and catalogers regularly use notes on catalog records and, as the audience for these notes has expanded from the local library community to the global Internet community, the need for notes to be cogent, clear, and useful is greater than ever. This book is a…

  8. The Disability Impact and Associated Cost per Disability in Women Who Underwent Surgical Revision of Transvaginal Mesh Kits for Prolapse Repair.

    PubMed

    Javadian, Pouya; Shobeiri, S Abbas

    2017-09-13

    The aim of this study was to investigate disability impact in patients and cost to the families of patients who have had complications of transvaginal prolapse mesh kits and underwent surgical revision. Patients who developed complications of transvaginal mesh kits for prolapse and who had undergone vaginal prolapse mesh surgical revision/removal in 2009 to 2014 at a single institution were identified by Current Procedural Terminology codes. The group was invited to complete a phone survey pertaining to the initial vaginal mesh used for prolapse surgery utilizing Sheehan Disability Scale (scale 0-10) and Years of life Lived with Disability (YLDs) questionnaires. The data collected were used to estimate the disability and cost analysis. We used our data to estimate the economic and quality-of-life impact of vaginal mesh complications on patients in the United States RESULTS: Sixty-two patients (62/198 [31.2%]) were consented to participate and completed the questionnaires by phone. Extremely disabled patients were 18 (29%) of 62 of whole cases, and 5 (8%) of 62 reported that they had no disability after vaginal mesh surgery. The median for overall disability score after vaginal mesh procedure was 8 (which reflects marked disability on a scale of 0-10). The majority of patients missed a median of 12 months of their school or work because of their mesh complications. Thirty-seven (59.6%) of 62 did not improve after mesh removal. Twenty-one (33.9%) of 62 stated that their family income dropped because of productivity loss related to mesh complications. The mean time between vaginal mesh surgery and mesh removal procedure was 4.7 years. Sheehan Disability Scale scores are significantly correlated with YLDs outcomes. Patients' overall disability score showed a significant correlation with YLDs scores (P < 0.0001). Vaginal mesh for prolapse reduction complications had a sustained disability impact that continued despite mesh removal. Likewise, the complications were

  9. Factorial comparison of two transvaginal surgical approaches and of perioperative behavioral therapy for women with apical vaginal prolapse: The OPTIMAL Randomized Trial

    PubMed Central

    Barber, Matthew D.; Brubaker, Linda; Burgio, Kathryn L.; Richter, Holly E.; Nygaard, Ingrid; Weidner, Alison C.; Menefee, Shawn A.; Lukacz, Emily S.; Norton, Peggy; Schaffer, Joseph; Nguyen, John N.; Borello-France, Diane; Goode, Patricia S.; Jakus-Waldman, Sharon; Spino, Cathie; Klein Warren, Lauren; Gantz, Marie G.; Meikle, Susan F.

    2014-01-01

    IMPORTANCE Over 300,000 surgeries are performed annually in the United States for pelvic organ prolapse. Sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are commonly performed transvaginal surgeries to correct apical prolapse. Little is known about their comparative efficacy and safety, and it is unknown whether perioperative behavioral therapy with pelvic floor muscle training (BPMT) improves outcomes of prolapse surgery. OBJECTIVE To compare outcomes between 1) SSLF and ULS and 2) perioperative BPMT and usual perioperative care in women undergoing surgery for vaginal prolapse and stress urinary incontinence. DESIGN, SETTING AND PARTICIPANTS Multi-center, 2×2 factorial randomized trial of 374 women undergoing surgery to treat both apical vaginal prolapse and stress urinary incontinence was conducted between 2008 and 2013 at 9 U.S. medical centers. Two-year follow-up rate was 84.5%. INTERVENTIONS Surgical intervention: Transvaginal surgery including mid-urethral sling with randomization to SSLF (n = 186) or ULS (n=188); Behavioral intervention: Randomization to perioperative BPMT (n = 186) or usual care (n=188). MAIN OUTCOME MEASURES The primary outcome for the surgical intervention (surgical success) was defined as: 1) no apical descent greater than one-third into vaginal canal or anterior or posterior vaginal wall beyond the hymen (anatomic success); 2) no bothersome vaginal bulge symptoms and 3) no retreatment for prolapse at 2 years. For the behavioral intervention, primary outcome at 6 months was urinary symptom scores (Urinary Distress Inventory; range 0–300, higher scores worse), and primary outcomes at 2 years were prolapse symptom scores (Pelvic Organ Prolapse Distress Inventory; range 0–300, higher scores worse) and anatomic success. RESULTS At 2 years, surgical group was not significantly associated with surgical success rates [ULS 59.2% (93/154) vs. SSLF 60.5% (92/152), OR 0.9 (95% CI 0.6, 1.5)] or serious adverse

  10. Cervical assessment at 22 and 27 weeks for the prediction of spontaneous birth before 34 weeks in twin pregnancies: is transvaginal sonography more accurate than digital examination?

    PubMed

    Vayssière, C; Favre, R; Audibert, F; Chauvet, M P; Gaucherand, P; Tardif, D; Grangé, G; Novoa, A; Descamps, P; Perdu, M; Andrini, E; Janse-Marec, J; Maillard, F; Nisand, I

    2005-12-01

    This study compared the accuracy of ultrasound cervical assessment (cervical length and cervical index) and digital examination (Bishop score and cervical score) in the prediction of spontaneous birth before 34 weeks in twin pregnancies. In a prospective multicenter study, digital examination and transvaginal sonography were performed consecutively in twin pregnancies attending for routine sonography at either 22 weeks (175 women) or 27 weeks (153 women). The digital examination took place first, and the Bishop score and cervical score (cervical length minus cervical dilatation) were calculated. Ultrasound measurements were then made of cervical length and funnel length to yield the cervical index (1 + funnel length/cervical length). The association between each variable and delivery before 34 weeks was tested by the Mann-Whitney U-test. The receiver-operating characteristics (ROC) curves of the ultrasound and digital indicators were determined for both gestational age periods, and the areas under the ROC curves compared. The best cut-off values for each indicator were used to determine predictive values for delivery before 34 weeks. The median gestational age at delivery among the women included in the 22-week examination period was 36.0 (range, 21-40) weeks; 10.9% (19) gave birth spontaneously before 34 weeks. The median cervical length was 40 (range, 6-65) mm. All four parameters were predictors of delivery before 34 weeks. The areas under the ROC curves for cervical index, cervical length, Bishop score and cervical score did not differ significantly. The median gestational age at delivery among the women in the 27-week examination period was 36.0 (range, 27-40) weeks; 9.2% (14) gave birth spontaneously before 34 weeks. The median cervical length was 35 (range, 1-57) mm. All parameters except the Bishop score were predictors of delivery before 34 weeks. The likelihood ratio of the positive and negative tests for cervical length < or = 25 mm was 5.4 (range, 3

  11. Kindergarten Quantum Mechanics: Lecture Notes

    SciTech Connect

    Coecke, Bob

    2006-01-04

    These lecture notes survey some joint work with Samson Abramsky as it was presented by me at several conferences in the summer of 2005. It concerns 'doing quantum mechanics using only pictures of lines, squares, triangles and diamonds'. This picture calculus can be seen as a very substantial extension of Dirac's notation, and has a purely algebraic counterpart in terms of so-called Strongly Compact Closed Categories (introduced by Abramsky and I which subsumes my Logic of Entanglement. For a survey on the 'what', the 'why' and the 'hows' I refer to a previous set of lecture notes. In a last section we provide some pointers to the body of technical literature on the subject.

  12. A Note on Disappearing Veterans

    PubMed Central

    Teachman, Jay

    2014-01-01

    In this research note, the rapid decline of the veteran population in the United States from 1980 to 2010 is outlined. The decline in the veteran population has been accompanied by an increasing concentration of veterans in smaller, more rural counties, often surrounding military bases. The result is that there has been a consistent increase in the residential segregation of veterans from the nonveteran population. PMID:25580041

  13. A note on "Kepler's equation".

    NASA Astrophysics Data System (ADS)

    Dutka, J.

    1997-07-01

    This note briefly points out the formal similarity between Kepler's equation and equations developed in Hindu and Islamic astronomy for describing the lunar parallax. Specifically, an iterative method for calculating the lunar parallax has been developed by the astronomer Habash al-Hasib al-Marwazi (about 850 A.D., Turkestan), which is surprisingly similar to the iterative method for solving Kepler's equation invented by Leonhard Euler (1707 - 1783).

  14. Recognizing Exponential Growth. Classroom Notes

    ERIC Educational Resources Information Center

    Dobbs, David E.

    2004-01-01

    Two heuristic and three rigorous arguments are given for the fact that functions of the form Ce[kx], with C an arbitrary constant, are the only solutions of the equation dy/dx=ky where k is constant. Various of the proofs in this self-contained note could find classroom use in a first-year calculus course, an introductory course on differential…

  15. Recognizing Exponential Growth. Classroom Notes

    ERIC Educational Resources Information Center

    Dobbs, David E.

    2004-01-01

    Two heuristic and three rigorous arguments are given for the fact that functions of the form Ce[kx], with C an arbitrary constant, are the only solutions of the equation dy/dx=ky where k is constant. Various of the proofs in this self-contained note could find classroom use in a first-year calculus course, an introductory course on differential…

  16. 4th Stage Transvaginal omental herniation during VBAC complicated by shoulder dystocia: a unique presentation of uterine rupture

    PubMed Central

    2013-01-01

    Background Uterine rupture is a common complication in women attempting their first virginal birth after caesarean section (VBAC) but the risk diminishes with subsequent VBACs. It occurs in rates of 0.5-9% and is influenced by various factors. Case presentation A unique case of uterine rupture in a Kenyan woman of African descent during a repeat VBAC complicated by shoulder dystocia was discovered during the 4th stage of labour when omentum was noted protruding through the vagina. She had delivered 4 years earlier by caesarean section. Conclusion It is not common to experience uterine rupture among women attempting repeat VBAC. When it occurs, it may not always follow the known pattern intra-partum and is often associated with poor foetal outcome. PMID:23521920

  17. LESS and NOTES instrumentation: future.

    PubMed

    Morgan, Monica; Olweny, Ephrem O; Cadeddu, Jeffrey A

    2014-01-01

    Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) are novel techniques with potential to minimize the morbidity of surgery. Challenging ergonomics, instrument clashing, and the lack of true triangluation still remain great concerns. New technological developments in instrument design have been created to enhance clinical applicability of these techniques. Further technological advancements including the incorporation of novel robotic surgical platforms (R-LESS) exploit the ergonomic benefits in an attempt to further advance LESS surgery. Promising devices include magnetic anchoring and guidance systems that have the potential to allow external manoeuvring of intracorporeal instruments while facilitating triangulation and reducing clashing. As well, the benefit of miniature in-vivo robots that can be placed endoscopically intra-abdominally and controlled wirelessly will allow internal manipulation of tissue from internal repositionable platforms. It remains to be seen whether LESS or NOTES will prove their clinical benefit over standard laparoscopic or robotic procedures. In this chapter, we review the current LESS and NOTES technology, and focus on new innovations and research in the field.

  18. Impact of transvaginal hydrolaparoscopy ovarian drilling on ovarian stromal blood flow and ovarian volume in clomiphene citrate-resistant PCOS patients: a case-control study.

    PubMed

    Giampaolino, Pierluigi; Morra, Ilaria; De Rosa, Nicoletta; Cagnacci, Angelo; Pellicano, Massimiliano; Di Carlo, Costantino; Nappi, Carmine; Bifulco, Giuseppe

    2017-09-01

    Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in gynecology. In PCOS patients vascularization parameters are altered. Transvaginal hydrolaparoscopy (THL) is a mini-invasive approach for ovarian drilling in PCOS patients. In this study, we assessed the effect of ovarian drilling using THL on ovarian volume (OV) and vascularization index (VI) using 3D power Doppler ultrasonography in CC-resistant PCOS patients. A case-control study on 123 CC-resistant PCOS women who underwent THL ovarian drilling was performed. Patients underwent 3D ultrasound and power Doppler to measure VI, flow index (FI), vascularization flow index (VFI) and to evaluate OV before and after the procedure, at six months, and on the early follicular phase of the menstrual cycle. After THL ovarian drilling, OV and power Doppler flow indices were significantly reduced compared to pre-operative values (OV: 7.85 versus 11.72 cm(3), p < 0.01; VI: 2.50 versus 4.81, p < 0.01; VFI: 1.10 versus 2.16, p < 0.01; FI: 32.05 versus 35.37, p < 0.01). In conclusion, THL ovarian drilling seems to reduce OV and 3D power Doppler indices, and could therefore be a viable alternative to LOD in PCOS patients resistant to medical therapy.

  19. Intrapartum sonography for fetal head asynclitism and transverse position: sonographic signs and comparison of diagnostic performance between transvaginal and digital examination.

    PubMed

    Malvasi, Antonio; Stark, Michael; Ghi, Tullio; Farine, Dan; Guido, Marcello; Tinelli, Andrea

    2012-05-01

    The primary goal of this study was to determine the ultrasonographic signs of asynclitic and transverse head positioning. In addition, we compared the performance of intrapartum ultrasound to vaginal digital examination. 150 women were evaluated by 2D transabdominal and translabial ultrasound (US) to detect the asynclitic and deep transverse positions. Transvaginal sterile digital examinations were performed immediately after each intrapartum US assessments, the examinations were repeated at intervals of 45-90 minutes. Examiners were blinded to each other's findings (clinical or sonographic). Data were reviewed and analyzed by an independent reviewer. The efficacy of digital examination was significantly lower than US evaluation for the detection of either transverse position or asynclitism. The most frequent transverse position was the left one, while the most frequent asynclitism was the anterior one. Digital pelvic examination for detection of fetal head transverse position during labor is inferior to US, especially in the deep transverse positioning, where caput succedaneum occurs and reduces the diagnostic accuracy of vaginal digital examination. The US examination leads to early detection of persistent transverse position allowing for earlier timing and optimal technique for the operative vaginal delivery. We describe two signs for diagnosing asynclitism. The "squint sign" and the "sunset of thalamus and cerebellum signs" are two simple US signs allowing detection of anterior and posterior asynclitism.

  20. Improving the Accuracy of Diagnosing Placenta Previa on Transvaginal Ultrasound by Distinguishing between the Uterine Isthmus and Cervix: A Prospective Multicenter Observational Study.

    PubMed

    Hasegawa, Junichi; Kawabata, Ikuno; Takeda, Yoshiharu; Aoki, Hiroaki; Fukami, Takehiko; Tajima, Atsushi; Miyakoshi, Kei; Otsuki, Katsufumi; Shinozuka, Norio; Matsuda, Yoshio; Iwashita, Mitsutoshi; Okai, Takashi; Nakai, Akihito

    2017-01-01

    To clarify whether distinguishing between the uterine isthmus and cervix can improve the accuracy of diagnosing placenta previa at term. A multicenter prospective observational study was conducted among pregnant women with suspected placenta previa at 20-24 weeks' gestation. Subjects were divided into the open isthmus group and closed isthmus group. The accuracy of diagnosing placenta previa at term was compared between the 2 groups. We screened 9,341 patients, and 53 (0.6%) met the inclusion criteria. Nineteen cases with an open isthmus and 34 with a closed isthmus were followed. The accuracy for diagnosing placenta previa or a low-lying placenta at term was 94.7% in the open isthmus group and 26.5% in the closed isthmus group (p < 0.001). Elective or emergency Cesarean section was required in 100% of cases in the open isthmus group and 20.6% in the closed isthmus group (p < 0.001). A high prediction rate of placenta previa was obtained by using transvaginal ultrasound at 20-24 weeks' gestation after the isthmus opened by carefully distinguishing between the cervix and isthmus. © 2016 S. Karger AG, Basel.

  1. The effects of twisting and type of aspiration needle on the efficiency of transvaginal ultrasound-guided ovum pick-up in cattle.

    PubMed

    Sasamoto, Yoshihiko; Sakaguchi, Minoru; Katagiri, Seiji; Yamada, Yutaka; Takahashi, Yoshiyuki

    2003-10-01

    The effects of twisting and type (single- or double-lumen) of aspiration needle on the efficiency of transvaginal ultrasound-guided ovum pick-up (US-guided OPU) were investigated in cattle. The first study using slaughterhouse ovaries revealed that twisting of the needle during follicle aspiration improved the oocyte recovery rate without deleterious effects on the attachment of cumulus layers. Vacuum pressure affected the oocyte recovery and cumulus attachment, regardless of the needle type. The needle type did not affect the oocyte recovery or cumulus attachment with an optimized vacuum pressure. In the second study, US-guided OPU was performed in live cows using two types of needles with a vacuum pressure of 75 mmHg. The needle type did not affect the oocyte recovery or cumulus attachment of the recovered oocytes. The results revealed that twisting of the needle is effective in follicle aspiration, and suggested that a single-lumen needle is as useful as a double-lumen needle for US-guided OPU in cattle.

  2. Measurement of endometrial thickness by transvaginal ultrasonography to predict pathological response to medroxyprogesterone acetate in patients with grade 1 endometrioid adenocarcinoma.

    PubMed

    Sato, Masakazu; Arimoto, Takahide; Kawana, Kei; Miyamoto, Yuichiro; Ikeda, Yuji; Tomio, Kensuke; Tanikawa, Michihiro; Sone, Kenbun; Mori-Uchino, Mayuyo; Tsuruga, Tetsushi; Nagasaka, Kazunori; Adachi, Katsuyuki; Matsumoto, Yoko; Oda, Katsutoshi; Osuga, Yutaka; Fujii, Tomoyuki

    2016-04-01

    The aim of the present study was to evaluate whether measuring endometrial thickness during fertility-sparing treatment with medroxyprogesterone acetate (MPA) can be a predictive marker for effectiveness in women with endometrioid adenocarcinoma, grade 1 (EmCa, G1). A total of 32 patients with stage IA EmCa, G1 underwent treatment with MPA. Patients were <40 years of age and preferred fertility-sparing treatment. MPA (600 mg/day) with low-dose aspirin was administered orally for 26 weeks. Pathological evaluation was performed by total curettage at weeks 8 and 16 and by fractional curettage at week 26. Patients underwent curative surgery in case of disease progression. Endometrial thickness was measured by transvaginal ultrasonography at weeks 8 and 16. Patients who showed non-complete response (non-CR) had thicker endometrium than that of CR patients at weeks 8 and 16. Receiver operating characteristic analysis revealed cut-off values of 8.3 and 4.7 mm endometrial thickness at weeks 8 and 16, respectively, for non-CR. Endometrial thickness >5 mm at week 16 was an independent factor for prediction of non-CR. Measurement of endometrial thickness during MPA treatment may be useful as a predictive marker for pathological response to MPA in patients with EmCa, G1.

  3. Revising Lecture Notes: How Revision, Pauses, and Partners Affect Note Taking and Achievement

    ERIC Educational Resources Information Center

    Luo, Linlin; Kiewra, Kenneth A.; Samuelson, Lydia

    2016-01-01

    Note taking has been categorized as a two-stage process: the recording of notes and the review of notes. We contend that note taking might best involve a three-stage process where the missing stage is revision. This study investigated the benefits of revising lecture notes and addressed two questions: First, is revision more effective than…

  4. Hybrid Gear

    NASA Technical Reports Server (NTRS)

    Handschuh, Robert F. (Inventor); Roberts, Gary D. (Inventor)

    2016-01-01

    A hybrid gear consisting of metallic outer rim with gear teeth and metallic hub in combination with a composite lay up between the shaft interface (hub) and gear tooth rim is described. The composite lay-up lightens the gear member while having similar torque carrying capability and it attenuates the impact loading driven noise/vibration that is typical in gear systems. The gear has the same operational capability with respect to shaft speed, torque, and temperature as an all-metallic gear as used in aerospace gear design.

  5. Lecture notes for criticality safety

    SciTech Connect

    Fullwood, R.

    1992-03-01

    These lecture notes for criticality safety are prepared for the training of Department of Energy supervisory, project management, and administrative staff. Technical training and basic mathematics are assumed. The notes are designed for a two-day course, taught by two lecturers. Video tapes may be used at the options of the instructors. The notes provide all the materials that are necessary but outside reading will assist in the fullest understanding. The course begins with a nuclear physics overview. The reader is led from the macroscopic world into the microscopic world of atoms and the elementary particles that constitute atoms. The particles, their masses and sizes and properties associated with radioactive decay and fission are introduced along with Einstein's mass-energy equivalence. Radioactive decay, nuclear reactions, radiation penetration, shielding and health-effects are discussed to understand protection in case of a criticality accident. Fission, the fission products, particles and energy released are presented to appreciate the dangers of criticality. Nuclear cross sections are introduced to understand the effectiveness of slow neutrons to produce fission. Chain reactors are presented as an economy; effective use of the neutrons from fission leads to more fission resulting in a power reactor or a criticality excursion. The six-factor formula is presented for managing the neutron budget. This leads to concepts of material and geometric buckling which are used in simple calculations to assure safety from criticality. Experimental measurements and computer code calculations of criticality are discussed. To emphasize the reality, historical criticality accidents are presented in a table with major ones discussed to provide lessons-learned. Finally, standards, NRC guides and regulations, and DOE orders relating to criticality protection are presented.

  6. Lecture notes for criticality safety

    SciTech Connect

    Fullwood, R.

    1992-03-01

    These lecture notes for criticality safety are prepared for the training of Department of Energy supervisory, project management, and administrative staff. Technical training and basic mathematics are assumed. The notes are designed for a two-day course, taught by two lecturers. Video tapes may be used at the options of the instructors. The notes provide all the materials that are necessary but outside reading will assist in the fullest understanding. The course begins with a nuclear physics overview. The reader is led from the macroscopic world into the microscopic world of atoms and the elementary particles that constitute atoms. The particles, their masses and sizes and properties associated with radioactive decay and fission are introduced along with Einstein`s mass-energy equivalence. Radioactive decay, nuclear reactions, radiation penetration, shielding and health-effects are discussed to understand protection in case of a criticality accident. Fission, the fission products, particles and energy released are presented to appreciate the dangers of criticality. Nuclear cross sections are introduced to understand the effectiveness of slow neutrons to produce fission. Chain reactors are presented as an economy; effective use of the neutrons from fission leads to more fission resulting in a power reactor or a criticality excursion. The six-factor formula is presented for managing the neutron budget. This leads to concepts of material and geometric buckling which are used in simple calculations to assure safety from criticality. Experimental measurements and computer code calculations of criticality are discussed. To emphasize the reality, historical criticality accidents are presented in a table with major ones discussed to provide lessons-learned. Finally, standards, NRC guides and regulations, and DOE orders relating to criticality protection are presented.

  7. Hybrid Simulator

    SciTech Connect

    Trujillo, David J.; Sridharan, Srikesh; Weinstock, Irvin

    2005-10-15

    HybSim (short for Hybrid Simulator) is a flexible, easy to use screening tool that allows the user to quanti the technical and economic benefits of installing a village hybrid generating system and simulates systems with any combination of —Diesel generator sets —Photovoltaic arrays -Wind Turbines and -Battery energy storage systems Most village systems (or small population sites such as villages, remote military bases, small communities, independent or isolated buildings or centers) depend on diesel generation systems for their source of energy. HybSim allows the user to determine other "sources" of energy that can greatly reduce the dollar to kilo-watt hour ratio. Supported by the DOE, Energy Storage Program, HybSim was initially developed to help analyze the benefits of energy storage systems in Alaskan villages. Soon after its development, other sources of energy were added providing the user with a greater range of analysis opportunities and providing the village with potentially added savings. In addition to village systems, HybSim has generated interest for use from military institutions in energy provisions and USAID for international village analysis.

  8. Note on new KLT relations

    NASA Astrophysics Data System (ADS)

    Feng, Bo; He, Song; Huang, Rijun; Jia, Yin

    2010-10-01

    In this short note, we present two results about KLT relations discussed in recent several papers. Our first result is the re-derivation of Mason-Skinner MHV amplitude by applying the S n-3 permutation symmetric KLT relations directly to MHV amplitude. Our second result is the equivalence proof of the newly discovered S n-2 permutation symmetric KLT relations and the well-known S n-3 permutation symmetric KLT relations. Although both formulas have been shown to be correct by BCFW recursion relations, our result is the first direct check using the regularized definition of the new formula.

  9. Do the U.S. Dioecious and Monoecious biotypes of Hydrilla verticillata L.F. Royle hybridize?

    USDA-ARS?s Scientific Manuscript database

    This technical note reports the results of two studies to address the question of whether the two hydrilla biotypes present in the U.S. can hybridize. These include whether hybridization can occur under controlled conditions and in field populations where the two hybrids coexist in close proximity ...

  10. Strength of adhesive-bonded hybrid structures

    NASA Technical Reports Server (NTRS)

    Kirschke, L.; Prinz, R.; Schnell, H.

    1979-01-01

    Structures prepared from materials with different thermal and mechanical properties by means of fiber-strengthened binders can fail in a number of ways. The present lecture is focused on failures through debonding at the metal or at the fiber-reinforced plastic. A method for calculating the stress distribution in adhesive layers as a function of the load is outlined, and its usefulness in providing insight into the behavior of bonds in hybrid structures is noted. Means of eliminating the unfavorable effects of temperature, humidity, creep and relaxation on the bonds in the manufacture of hybrid structures are examined, along with test methods developed for such structures.

  11. Planet-B: Technical notes and drawings

    NASA Technical Reports Server (NTRS)

    Carignan, George R.

    1996-01-01

    The design of the transformer designated as T101 (061-0351) in the Filament/Bias module (061-0119) in the Planet-B NMS instrument was verified because of the differences from the GCMS and INMS instrument designs. A breadboard of a representation of the Hybrid 2301065, Bias Drive A driving a 2N3700 NPN transistor, with dual 75V secondaries, with loads, was used to test the circuit. The initial transformer design that was wound with bifilar secondaries was too unstable to test. The second 1408 transformer with a split bobbin and the feedback winding below the primary was also found to be unstable. (It was nearly impossible to keep the circuit from squeeging). The third transformer tested has the feedback on the outside of the resonant winding. The primary goal of the design was to have as tight a magnetic coupling as possible to the resonant winding, and as loose a coupling as possible to the primary. Further, the circuit AC ground is connected to the winding at the feedback end of the secondary winding. This transformer proved to be very stable - it is virtually impossible to make this design squeg. An emitter resistor (Rl29A) was added to this circuit, as referenced to the GCMS design, to protect Q102 from thermal runaway in the event of a turn on with a non- resonate circuit or load short. This was verified to protect Q102 for at least 30 seconds in the event of a short. Approximately 1% of the 4lmW input power is lost in this protection resistor under normal operation. The circuit was verified to operate normally when a radiated Q102 (2N3700), (low Beta) transistor was substituted for the normal 2N3700. It should be noted that the monitored drive voltage went to approximately 2.7V with this low gain transistor.

  12. 19 CFR 152.100 - Interpretative notes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 2 2013-04-01 2013-04-01 false Interpretative notes. 152.100 Section 152.100 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE... Interpretative notes. The interpretative notes set forth in this subpart have been derived from information...

  13. 48 CFR 836.579 - Special notes.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Special notes. 836.579... OF CONTRACTING CONSTRUCTION AND ARCHITECT-ENGINEER CONTRACTS Contract Clauses 836.579 Special notes. The contracting officer shall insert the clause at 852.236-91, Special notes, in solicitations and...

  14. 19 CFR 152.100 - Interpretative notes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 2 2011-04-01 2011-04-01 false Interpretative notes. 152.100 Section 152.100 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE... Interpretative notes. The interpretative notes set forth in this subpart have been derived from information...

  15. 7 CFR 1735.93 - Notes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Notes. 1735.93 Section 1735.93 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... Acquisitions and Mergers § 1735.93 Notes. Substitute notes may be required in the case of an acquisition or...

  16. 38 CFR 21.4504 - Promissory note.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Promissory note. 21.4504...) VOCATIONAL REHABILITATION AND EDUCATION Education Loans § 21.4504 Promissory note. (a) General. The agreement... shall be in the form of a promissory note which shall include: (1) The full amount of the loan. (2...

  17. 19 CFR 152.100 - Interpretative notes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 2 2012-04-01 2012-04-01 false Interpretative notes. 152.100 Section 152.100 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE... Interpretative notes. The interpretative notes set forth in this subpart have been derived from information...

  18. 48 CFR 836.579 - Special notes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Special notes. 836.579... OF CONTRACTING CONSTRUCTION AND ARCHITECT-ENGINEER CONTRACTS Contract Clauses 836.579 Special notes. The contracting officer shall insert the clause at 852.236-91, Special notes, in solicitations and...

  19. Promoting Knowledge Transfer with Electronic Note Taking

    ERIC Educational Resources Information Center

    Katayama, Andrew D.; Shambaugh, R. Neal; Doctor, Tasneem

    2005-01-01

    We investigated the differences between (a) copying and pasting text versus typed note-taking methods of constructing study notes simultaneously with (b) vertically scaffolded versus horizontally scaffold notes on knowledge transfer. Forty-seven undergraduate educational psychology students participated. Materials included 2 electronic…

  20. 32 CFR 806b.5 - Personal notes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Personal notes. 806b.5 Section 806b.5 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE ADMINISTRATION PRIVACY ACT PROGRAM... notes on individuals used as memory aids. Personal notes may become Privacy Act records if they...

  1. What Predicts Skill in Lecture Note Taking?

    ERIC Educational Resources Information Center

    Peverly, Stephen T.; Ramaswamy, Vivek; Brown, Cindy; Sumowski, James; Alidoost, Moona; Garner, Joanna

    2007-01-01

    Despite the importance of good lecture notes to test performance, very little is known about the cognitive processes that underlie effective lecture note taking. The primary purpose of the 2 studies reported (a pilot study and Study 1) was to investigate 3 processes hypothesized to be significantly related to quality of notes: transcription…

  2. Hybridized tetraquarks

    DOE PAGES

    Esposito, Angelo; Pilloni, Alessadro; Polosa, A. D.

    2016-05-12

    In this study, we propose a new interpretation of the neutral and charged X,Z exotic hadron resonances. Hybridized-tetraquarks are neither purely compact tetraquark states nor bound or loosely bound molecules. The latter would require a negative or zero binding energy whose counterpart in h-tetraquarks is a positive quantity. The formation mechanism of this new class of hadrons is inspired by that of Feshbach metastable states in atomic physics. The recent claim of an exotic resonance in the B0s π± channel by the D0 collaboration and the negative result presented subsequently by the LHCb collaboration are understood in this scheme, togethermore » with a considerable portion of available data on X, Z particles. Considerations on a state with the same quantum numbers as the X(5568) are also made.« less

  3. Manual rupture versus transvaginal ultrasound-guided aspiration of allanto-amniotic fluid in multiple pregnancies: a clinical approach to embryo reduction in dairy cattle.

    PubMed

    Andreu-Vázquez, Cristina; Garcia-Ispierto, Irina; López-Gatius, Fernando

    2012-01-01

    To avoid the problems associated with twinning in dairy cattle, one of the embryos may be eliminated. This study compares the effect on pregnancy maintenance of two embryo reduction techniques, manual rupture (MR) and transvaginal ultrasound-guided aspiration (TUGA) of allanto-amniotic fluid, in Holstein-Friesian cows with multiple pregnancies. In the first experiment, 61 lactating cows bearing unilateral twins (n=27), bilateral twins (n=30) or triplets/quadruplets (n=4) were subjected to MR (n=45) or TUGA using a 17-G neddle (n=16) on day 28-34 of gestation. In 21 and 10 cows undergoing MR and TUGA embryo reduction, respectively, pregnancy loss occurred before day 90 (46.7 vs. 62.5%, P= 0.28). Through binary logistic regression, the type of pregnancy was identified as the only variable significantly affecting pregnancy maintenance (P=0.03). Based on the odds ratio, the risk of pregnancy loss was 4.1 times higher for unilateral twins than for bilateral twins (70.4 vs. 36.7%, respectively, P=0.01). No effect was detected on pregnancy maintenance of the technique used (P=0.17) or of the interaction technique by type of pregnancy (P=0.22). In the second experiment, a 22-G needle was used to perform TUGA on 22 lactating cows. The pregnancy loss rates were 44.4% (4/9), 18.2% (2/11) and 50% (1/2) for cows bearing unilateral twins, bilateral twins and triplets, respectively. The total pregnancy loss rate following TUGA using the 22-G needle tended to be lower than that using the 17-G needle (31.8 vs. 62.5%; P=0.06). Our results suggest that TUGA using a 22-G needle could be the method of choice to perform embryo reduction in cows carrying multiple pregnancies.

  4. The Diagnostic Value of Transvaginal Sonograph (TVS), Color Doppler, and Serum Tumor Marker CA125, CEA, and AFP in Ovarian Cancer.

    PubMed

    Zhang, Fang; Zhang, Zhou-Long

    2015-06-01

    The purpose of this study is to investigate the diagnostic value of transvaginal sonograph (TVS), color Doppler, and serum tumor marker CA125, CEA, and AFP in ovarian cancer. From June, 2011 to May, 2013, 102 cases with adnexal mass were recruited in this study (32 cases of malignant ovarian cancer and 70 cases of benign ovarian tumor according to pathological diagnosis). TVS, color Doppler, and serum tumor markers were used for tumor diagnosis. The sensitivity, specifity, positive prediction, negative prediction, and Youden's index were analyzed. Of the 102 patients, 32 were diagnosed with malignant ovarian cancer and 70 were diagnosed with benign ovarian tumor according to pathological diagnosis. Based on TVS results, 37 cases were malignant while 65 cases were benign. Based on color Doppler results, 34 cases were malignant while 68 cases were benign. Based on TVS and color Doppler results, 35 cases were malignant while 65 were benign. Based on CA125 test results, 34 cases were malignant while 68 cases were benign. Based on CEA test results, 8 cases were malignant and 94 cases were benign. Bases on AFP test results, 9 cases were malignant while 93 cases were benign. Based on the results of combination tumor marker test, 38 cases were malignant while 64 cases were benign. The combination of TVS, color Doppler, and tumor marker test showed optimal diagnostic value with a sensitivity of 90.63 %, specificity of 97.14 %, positive prediction of 93.94 %, negative prediction of 98.55 %, and Youden's index of 94.02 %. The combination of TVS, color Doppler, and tumor marker test is of great diagnostic value, which should be widely used in clinical practice.

  5. Kepler Data Release 4 Notes

    NASA Technical Reports Server (NTRS)

    Van Cleve, Jeffrey (Editor); Jenkins, Jon; Caldwell, Doug; Allen, Christopher L.; Batalha, Natalie; Bryson, Stephen T.; Chandrasekaran, Hema; Clarke, Bruce D.; Cote, Miles T.; Dotson, Jessie L.; Gilliland, Ron; Girouard, Forrest; Haas, Michael R.; Hall, Jennifer; Ibrahim, Khadeejah; Klaus, Todd; Kolodziejczak, Jeff; Li, Jie; McCauliff, Sean D.; Middour, Christopher K.; Pletcher, David L.; Quintana, Elisa V.; Tenenbaum, Peter G.; Twicken, Joe; Uddin, Akm Kamal

    2010-01-01

    The Data Analysis Working Group have released long and short cadence materials, including FFIs and Dropped Targets for the Public. The Kepler Science Office considers Data Release 4 to provide "browse quality" data. These notes have been prepared to give Kepler users of the Multimission Archive at STScl (MAST) a summary of how the data were collected and prepared, and how well the data processing pipeline is functioning on flight data. They will be updated for each release of data to the public archive and placed on MAST along with other Kepler documentation, at http://archive.stsci.edu/kepler/documents.html. Data release 3 is meant to give users the opportunity to examine the data for possibly interesting science and to involve the users in improving the pipeline for future data releases. To perform the latter service, users are encouraged to notice and document artifacts, either in the raw or processed data, and report them to the Science Office.

  6. Systems Engineering of Electric and Hybrid Vehicles

    NASA Technical Reports Server (NTRS)

    Kurtz, D. W.; Levin, R. R.

    1986-01-01

    Technical paper notes systems engineering principles applied to development of electric and hybrid vehicles such that system performance requirements support overall program goal of reduced petroleum consumption. Paper discusses iterative design approach dictated by systems analyses. In addition to obvious peformance parameters of range, acceleration rate, and energy consumption, systems engineering also considers such major factors as cost, safety, reliability, comfort, necessary supporting infrastructure, and availability of materials.

  7. Systems Engineering of Electric and Hybrid Vehicles

    NASA Technical Reports Server (NTRS)

    Kurtz, D. W.; Levin, R. R.

    1986-01-01

    Technical paper notes systems engineering principles applied to development of electric and hybrid vehicles such that system performance requirements support overall program goal of reduced petroleum consumption. Paper discusses iterative design approach dictated by systems analyses. In addition to obvious peformance parameters of range, acceleration rate, and energy consumption, systems engineering also considers such major factors as cost, safety, reliability, comfort, necessary supporting infrastructure, and availability of materials.

  8. Hybrid mimics and hybrid vigor in Arabidopsis

    PubMed Central

    Wang, Li; Greaves, Ian K.; Groszmann, Michael; Wu, Li Min; Dennis, Elizabeth S.; Peacock, W. James

    2015-01-01

    F1 hybrids can outperform their parents in yield and vegetative biomass, features of hybrid vigor that form the basis of the hybrid seed industry. The yield advantage of the F1 is lost in the F2 and subsequent generations. In Arabidopsis, from F2 plants that have a F1-like phenotype, we have by recurrent selection produced pure breeding F5/F6 lines, hybrid mimics, in which the characteristics of the F1 hybrid are stabilized. These hybrid mimic lines, like the F1 hybrid, have larger leaves than the parent plant, and the leaves have increased photosynthetic cell numbers, and in some lines, increased size of cells, suggesting an increased supply of photosynthate. A comparison of the differentially expressed genes in the F1 hybrid with those of eight hybrid mimic lines identified metabolic pathways altered in both; these pathways include down-regulation of defense response pathways and altered abiotic response pathways. F6 hybrid mimic lines are mostly homozygous at each locus in the genome and yet retain the large F1-like phenotype. Many alleles in the F6 plants, when they are homozygous, have expression levels different to the level in the parent. We consider this altered expression to be a consequence of transregulation of genes from one parent by genes from the other parent. Transregulation could also arise from epigenetic modifications in the F1. The pure breeding hybrid mimics have been valuable in probing the mechanisms of hybrid vigor and may also prove to be useful hybrid vigor equivalents in agriculture. PMID:26283378

  9. Hybrid mimics and hybrid vigor in Arabidopsis.

    PubMed

    Wang, Li; Greaves, Ian K; Groszmann, Michael; Wu, Li Min; Dennis, Elizabeth S; Peacock, W James

    2015-09-01

    F1 hybrids can outperform their parents in yield and vegetative biomass, features of hybrid vigor that form the basis of the hybrid seed industry. The yield advantage of the F1 is lost in the F2 and subsequent generations. In Arabidopsis, from F2 plants that have a F1-like phenotype, we have by recurrent selection produced pure breeding F5/F6 lines, hybrid mimics, in which the characteristics of the F1 hybrid are stabilized. These hybrid mimic lines, like the F1 hybrid, have larger leaves than the parent plant, and the leaves have increased photosynthetic cell numbers, and in some lines, increased size of cells, suggesting an increased supply of photosynthate. A comparison of the differentially expressed genes in the F1 hybrid with those of eight hybrid mimic lines identified metabolic pathways altered in both; these pathways include down-regulation of defense response pathways and altered abiotic response pathways. F6 hybrid mimic lines are mostly homozygous at each locus in the genome and yet retain the large F1-like phenotype. Many alleles in the F6 plants, when they are homozygous, have expression levels different to the level in the parent. We consider this altered expression to be a consequence of transregulation of genes from one parent by genes from the other parent. Transregulation could also arise from epigenetic modifications in the F1. The pure breeding hybrid mimics have been valuable in probing the mechanisms of hybrid vigor and may also prove to be useful hybrid vigor equivalents in agriculture.

  10. A collection of Schottky-scan notes

    SciTech Connect

    Sabersky, A.P.

    1980-10-01

    This paper is a republication of ISR-RF notes and performance reports on work done in 1974-1975. The original notes have been edited, corrected and, in most cases, shortened. Discussed in this note are the following topics: noise, errors and the Schottky scan; speeding up the Schottky scan; Schottky markers and fast Schottky scans; and some engineering aspects of the fast Schottky scan.

  11. New NOTES Clinical Training and Program Development.

    PubMed

    Saxena, Payal; Khashab, Mouen A

    2016-04-01

    Natural orifice translumenal endoscopic surgery (NOTES) is an intense area of research, and is arguably the most significant endoscopic innovation of this decade. Training for new NOTES is a relatively long, encompassing advanced endoscopy training, mastery of endoscopic dexterity within the narrow submucosal or "third space" with an in-depth understanding of the tissue planes. Proficiency with new closure and hemostatic devices is also essential. Few institutions worldwide can provide all the cognitive and technical elements essential to train new NOTES trainees. Trainees may need to spend time across several institutions to ensure safe and effective practice of new NOTES.

  12. Station Program Note Pull Automation

    NASA Technical Reports Server (NTRS)

    Delgado, Ivan

    2016-01-01

    Upon commencement of my internship, I was in charge of maintaining the CoFR (Certificate of Flight Readiness) Tool. The tool acquires data from existing Excel workbooks on NASA's and Boeing's databases to create a new spreadsheet listing out all the potential safety concerns for upcoming flights and software transitions. Since the application was written in Visual Basic, I had to learn a new programming language and prepare to handle any malfunctions within the program. Shortly afterwards, I was given the assignment to automate the Station Program Note (SPN) Pull process. I developed an application, in Python, that generated a GUI (Graphical User Interface) that will be used by the International Space Station Safety & Mission Assurance team here at Johnson Space Center. The application will allow its users to download online files with the click of a button, import SPN's based on three different pulls, instantly manipulate and filter spreadsheets, and compare the three sources to determine which active SPN's (Station Program Notes) must be reviewed for any upcoming flights, missions, and/or software transitions. Initially, to perform the NASA SPN pull (one of three), I had created the program to allow the user to login to a secure webpage that stores data, input specific parameters, and retrieve the desired SPN's based on their inputs. However, to avoid any conflicts with sustainment, I altered it so that the user may login and download the NASA file independently. After the user has downloaded the file with the click of a button, I defined the program to check for any outdated or pre-existing files, for successful downloads, to acquire the spreadsheet, convert it from a text file to a comma separated file and finally into an Excel spreadsheet to be filtered and later scrutinized for specific SPN numbers. Once this file has been automatically manipulated to provide only the SPN numbers that are desired, they are stored in a global variable, shown on the GUI, and

  13. Kepler Data Release 3 Notes

    NASA Technical Reports Server (NTRS)

    Cleve, Jeffrey E.

    2010-01-01

    This describes the collection of data and the processing done on it so when researchers around the world get the Kepler data sets (which are a set of pixels from the telescope of a particular target (star, galaxy or whatever) over a 3 month period) they can adjust their algorithms fro things that were done (like subtracting all of one particular wavelength for example). This is used to calibrate their own algorithms so that they know what it is they are starting with. It is posted so that whoever is accessing the publicly available data (not all of it is made public) can understand it .. (most of the Kepler data is under restriction for 1 - 4 years and is not available, but the handbook is for everyone (public and restricted) The Data Analysis Working Group have released long and short cadence materials, including FFls and Dropped Targets for the Public. The Kepler Science Office considers Data Release 3 to provide "browse quality" data. These notes have been prepared to give Kepler users of the Multimission Archive at STScl (MAST) a summary of how the data were collected and prepared, and how well the data processing pipeline is functioning on flight data. They will be updated for each release of data to the public archive and placed on MAST along with other Kepler documentation, at http:// archive.stsci.edu/kepler/documents.html .Data release 3 is meant to give users the opportunity to examine the data for possibly interesting science and to involve the users in improving the pipeline for future data releases. To perform the latter service, users are encouraged to notice and document artifacts, either in the raw or processed data, and report them to the Science Office.

  14. Agreement of two-dimensional and three-dimensional transvaginal ultrasound with magnetic resonance imaging in assessment of parametrial infiltration in cervical cancer.

    PubMed

    Chiappa, V; Di Legge, A; Valentini, A L; Gui, B; Miccò, M; Ludovisi, M; Giansiracusa, C; Testa, A C; Valentin, L

    2015-04-01

    To compare two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound with magnetic resonance imaging (MRI) as the gold standard in assessment of parametrial infiltration of cervical cancer and to determine if all parts of the cervix are equally assessable with ultrasound. Patients with macroscopically evident and histologically confirmed cervical cancer were staged using International Federation of Gynecology and Obstetrics (FIGO) criteria and underwent MRI and 2D and 3D ultrasound examination before treatment. When assessing parametrial infiltration with 3D ultrasound and MRI, the cervix was (virtually) divided into three cylinders (cranial, middle and caudal) of equal size and each cylinder was then divided into six sectors in a clockwise manner following a consensus between radiologists and ultrasound examiners. The presence and the extent of parametrial invasion were recorded for each sector. Results of 2D ultrasound, 3D ultrasound and MRI were compared and reported in terms of percentage agreement and kappa value. A total of 29 consecutive patients were included in the study. The percentage agreement between 2D ultrasound and MRI in assessing parametrial infiltration (yes or no) was 76% (kappa, 0.459) and that between 3D ultrasound and MRI was 79% (kappa, 0.508). The results of 2D ultrasound showed the following agreement with those of MRI: 90% for the ventral parametrium (kappa, 0.720), 72% for the right lateral parametrium (kappa, 0.494), 69% for the left lateral parametrium (kappa, 0.412) and 58.5% for the dorsal parametrium (kappa, 0.017). The results of 3D ultrasound showed the following agreement with those of MRI: 62.5% for the ventral parametrium (kappa, 0.176), 81% for the right lateral parametrium (kappa, 0.595), 70% for the left lateral parametrium (kappa, 0.326) and 52% for the dorsal parametrium (kappa, 0.132). The best agreement between 3D ultrasound and MRI was for the middle cervical cylinder (76%; kappa, 0.438) and the poorest

  15. Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: interobserver reproducibility among ultrasound experts and gynecologists.

    PubMed

    Eriksson, L S E; Lindqvist, P G; Flöter Rådestad, A; Dueholm, M; Fischerova, D; Franchi, D; Jokubkiene, L; Leone, F P; Savelli, L; Sladkevicius, P; Testa, A C; Van den Bosch, T; Ameye, L; Epstein, E

    2015-04-01

    To assess interobserver reproducibility among ultrasound experts and gynecologists in the prediction by transvaginal ultrasound of deep myometrial and cervical stromal invasion in women with endometrial cancer. Sonographic videoclips of the uterine corpus and cervix of 53 women with endometrial cancer, examined preoperatively by the same ultrasound expert, were integrated into a digitalized survey. Nine ultrasound experts and nine gynecologists evaluated presence or absence of deep myometrial and cervical stromal invasion. Histopathology from hysterectomy specimens was used as the gold standard. Compared with gynecologists, ultrasound experts showed higher sensitivity, specificity and agreement with histopathology in the assessment of cervical stromal invasion (42% (95% CI, 31-53%) vs 57% (95% CI, 45-68%), P < 0.01; 83% (95% CI, 78-86%) vs 87% (95% CI, 83-90%), P = 0.02; and kappa, 0.45 (95% CI, 0.40-0.49) vs 0.58 (95% CI, 0.53-0.62), P < 0.001, respectively) but not of deep myometrial invasion (73% (95% CI, 66-79%) vs 73% (95% CI, 66-79%), P = 1.0; 70% (95% CI, 65-75%) vs 69% (95% CI, 63-74%), P = 0.68; and kappa, 0.48 (95% CI, 0.44-0.53) vs 0.52 (95% CI, 0.48-0.57), P = 0.11, respectively). Though interobserver reproducibility (in the context of test proportions 'good' and 'very good', according to kappa) regarding deep myometrial invasion did not differ between the groups (experts, 34% vs gynecologists, 22%, P = 0.13), ultrasound experts assessed cervical stromal invasion with significantly greater interobserver reproducibility than did gynecologists (53% vs 14%, P < 0.001). Preoperative ultrasound assessment of deep myometrial and cervical stromal invasion in endometrial cancer is best performed by ultrasound experts, as, compared with gynecologists, they showed a greater degree of agreement with histopathology and greater interobserver reproducibility in the assessment of cervical stromal invasion. Copyright © 2014 ISUOG

  16. Efficacy of transvaginal ultrasound-guided twin reduction in the mare by embryonic or fetal stabbing compared with yolk sac or allantoic fluid aspiration.

    PubMed

    Journée, S L; de Ruijter-Villani, M; Hendriks, W K; Stout, T A E

    2013-09-01

    Transvaginal ultrasound-guided pregnancy reduction (TUGR) is a procedure described for the management of twins post-fixation in the horse. Success rates are often disappointing but are reported to be more favorable for bilaterally situated twins and when intervention takes place before day 35 of gestation. This study aimed to determine whether stabbing the embryo/fetus rather than aspirating conceptus fluids improved the likelihood of success, measured as the birth of a normal live singleton foal. Data from 103 TUGR interventions were analyzed by logistic regression analysis; method of treatment, relative conceptus location (i.e., uni- vs. bilateral), and stage of gestation were included as interdependent factors that potentially influence the outcome. Overall, 34/103 (33%) TUGR interventions resulted in a single live foal. There was no significant difference (P = 0.14) in the outcome between TUGR based on fetal stabbing (12/28: 42.9%) versus fluid aspiration (22/75: 29.3%). There was also no significant influence (P = 0.11) of the conceptuses being located unilaterally (19/65: 29.2%) versus bilaterally (15/38: 39.5%). However, TUGR was numerically more successful (P = 0.05) when performed ≤ Day 35 of gestation (21/53: 39.6%), as opposed to > Day 35 (13/50: 26%). Day 45 may represent an even more critical time point because only 2 out of 15 TUGRs (13.3%) performed beyond this day resulted in the birth of a live foal, compared with 11/35 (31.4%) performed between Days 36 and 45. Although the numbers are low, this suggests that TUGR is not the method of choice for reducing > Day 45 twins. Four pregnancy losses were recorded 1 to 7 months post-TUGR (4/38: 10.5%), and although it is tempting to attribute the losses to TUGR, this rate of late gestation pregnancy loss is normal. We conclude that TUGR by fetal stabbing does not offer significant advantages over fluid aspiration. However, TUGR should be performed before Day 35 of gestation and is considered primarily a

  17. Trocar-guided trans-vaginal mesh surgery for pelvic organ prolapse: effects on urinary continence and anatomical and functional outcomes. A prospective observational study.

    PubMed

    Natale, F; Costantini, E; La Penna, C; Illiano, E; Balsamo, R; Carbone, A; Cervigni, M

    2017-03-01

    Primary objective of this study was to assess the effects of trocar-guided transvaginal mesh surgery (TVM) on cure and prevention rates for incontinence, without concomitant surgery for Stress Urinary Incontinence (SUI). Our secondary objectives were anatomical outcomes, relief of symptoms and effect on quality of life (QoL). This prospective observational study evaluated women who underwent TVM for symptomatic stage >2 Pelvic Organ Prolapse (POP). SUI was evaluated objectively using the cough stress test with prolapse reduced. SUI and urge urinary incontinence (UUI) were subjectively evaluated using ICIQ-SF. Anatomical cure was defined as stage <2 at POP-Q. McNemar chi-square test; paired t-test; Mann-Whitney test. Seventy-two patients reached final evaluation (mean follow-up 72 months). In the 40 pre-op continent patients, 34 (85%) remained continent postoperatively and 6 (15%) showed de novo SUI. Only 1 patient chose to undergo subsequent TVT. The number needed to treat was 6 to prevent 1 women developing de novo objective SUI and 39 to prevent 1 woman having to undergo SUI surgery. In the 32 pre-op incontinent patients, 18 (56.3%) became continent postoperatively. Only 1 patient chose to undergo subsequent TVT. UUI was present in 44 patients pre-operatively and 15 (20.8%) post-operatively (1 de novo). Forty-four patients (61.1%) were continent post-operatively for SUI and UUI. We observed a significant improvement in storage, voiding, post-micturition and prolapse-related symptoms. The anatomical cure rate was 87.5% for the anterior compartment and 90.3%.for the apical segment. The apical recurrence was 8.3% in the patients previously hysterectomised, 18.8% in the patients with uterus preservation and 0% in the patients with concomitant hysterectomy. QoL scores improved in all domains except sleep and personal relationships. We observed mesh exposure in 10 patients (13.9%), in 5 of whom it was associated with a concomitant hysterectomy CONCLUSIONS: TVM showed

  18. Invasion of the hybrids.

    PubMed

    Hegarty, M J

    2012-10-01

    Human activity and climate change are increasingly driving species, which were once separate together, leading to the potential for gene flow. Hybridization between diverged species brings together two genomes which have evolved to meet different adaptive requirements. The unique combination of these traits in a hybrid may be beneficial or maladaptive, but either way it results in increased phenotypic variation. A percentage of hybrid individuals may, therefore, find themselves able to exploit environmental niches which their progenitors cannot, leading to invasive hybrid swarms becoming established in new habitats. Previous research into hybrids, most famously that of Loren Rieseberg and co-workers (Rieseberg et al. 1999, 2003) in sunflowers, demonstrated that hybridization can give rise to transgressive segregation of adaptive traits, wherein the combination of favourable alleles from both parents in hybrids can enable them to outperform either. However, the question still remains as to how much of the competitive ability of hybrids is a direct result of admixture and how much is the result of selection after the fact. In this issue of Molecular Ecology, (Czypionka et al. 2012) describe their study of transcriptional changes resulting from hybridization in a fish hybrid termed invasive sculpins (Cottus). Using gene expression microarray assays, they compare gene expression in both wild and lab-reared invasive hybrids to the progenitor species and experimentally produced F(2) hybrids. They demonstrate that whilst hybridization alone does result in higher variance in gene expression (some of which is transgressive), many of the transgressive changes distinguishing the invasives appear to have come about subsequent to the initial natural hybridization event. They speculate that initial success of the hybrids in their new habitat is facilitated by hybridization, but that optimization of the invasive phenotype and removal of maladaptive traits rapidly reduces the

  19. The Great Case-Teaching-Notes Debate

    ERIC Educational Resources Information Center

    Lundberg, Craig C.; Winn, Joan

    2005-01-01

    Teaching notes, sometimes called an instructor's manual, are routinely required to accompany written teaching cases that are submitted to case journals and case writing conferences. Although the content and organization of these notes have become fairly standardized, the literature on the case method contains relatively little discussion…

  20. Suicide Notes in Hong Kong in 2000

    ERIC Educational Resources Information Center

    Wong, Paul W. C.; Yeung, April W. M.; Chan, Wincy S. C.; Yip, Paul S. F.; Tang, Arthur K. H.

    2009-01-01

    Suicide notes have been regarded as one of the most informative data sources to understand the reasons why people commit suicide. However, there is a paucity of suicide note studies, leaving researchers with an assumption that this phenomenon remains static over time. This study examines this assumption by comparing the characteristics of…

  1. Idea Bank: Duct Tape Note Twister

    ERIC Educational Resources Information Center

    McHenry, Molly

    2008-01-01

    In this article, the author relates how she observed a middle school math teacher deliver a miserable class. She realized that she did the same thing to her music students. To engage her students, she developed "Note Twister," a music reading game using duct tape to form musical notes and the basic premise behind the game,…

  2. Note on Conditional Compilation in Standard ML

    DTIC Science & Technology

    1993-06-01

    eOmputer-Science No-te on Coridhitiom Cominliati"I~n Standard ML1 Nicholas Haines Edoardo Biagioni Robert Hiarper mom Brian G. Mimnes June 1993 CMU...CS-93. 11 TIC ELECTE f 00..7733 %goo~~OO Note on Conditioual Compilation in Standard ML Nicholas Haines Edoardo Biagioni Robert Harper Brian G. Milnes

  3. 34 CFR 674.31 - Promissory note.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 3 2011-07-01 2011-07-01 false Promissory note. 674.31 Section 674.31 Education..., DEPARTMENT OF EDUCATION FEDERAL PERKINS LOAN PROGRAM Terms of Loans § 674.31 Promissory note. (a) Promissory... monthly repayment amount if the institution chooses the option under § 674.33(b). (b) Provisions of...

  4. Suicide Notes in Hong Kong in 2000

    ERIC Educational Resources Information Center

    Wong, Paul W. C.; Yeung, April W. M.; Chan, Wincy S. C.; Yip, Paul S. F.; Tang, Arthur K. H.

    2009-01-01

    Suicide notes have been regarded as one of the most informative data sources to understand the reasons why people commit suicide. However, there is a paucity of suicide note studies, leaving researchers with an assumption that this phenomenon remains static over time. This study examines this assumption by comparing the characteristics of…

  5. The Great Case-Teaching-Notes Debate

    ERIC Educational Resources Information Center

    Lundberg, Craig C.; Winn, Joan

    2005-01-01

    Teaching notes, sometimes called an instructor's manual, are routinely required to accompany written teaching cases that are submitted to case journals and case writing conferences. Although the content and organization of these notes have become fairly standardized, the literature on the case method contains relatively little discussion…

  6. 34 CFR 674.31 - Promissory note.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 3 2014-07-01 2014-07-01 false Promissory note. 674.31 Section 674.31 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION FEDERAL PERKINS LOAN PROGRAM Terms of Loans § 674.31 Promissory note. (a)...

  7. 34 CFR 674.31 - Promissory note.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 3 2013-07-01 2013-07-01 false Promissory note. 674.31 Section 674.31 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION FEDERAL PERKINS LOAN PROGRAM Terms of Loans § 674.31 Promissory note. (a)...

  8. Skin suicide note written in mehndi (henna).

    PubMed

    Behera, Chittaranjan; Swain, Rajanikanta; Bhardwaj, Daya Nand; Millo, Tabin

    2016-03-01

    Suicide messages on the skin are rare. Until now, in all reported cases, the writing tool used by the victims has been a pen. We report a suicide case by hanging in which the victim had written a note on her palm in mehndi, or henna, at a wedding ceremony three days before the fatal act. The note was discovered at autopsy.

  9. Model Disciplinary Policies. Research Note. Volume 0902

    ERIC Educational Resources Information Center

    Blazer, Christie

    2009-01-01

    This Research Note is in response to a request from the Office of Alternative Education to review and report on "model disciplinary policies" as used in school districts around the nation. The primary source of information used to prepare this Research Note came from a professional group identified by Alternative Education. The Advancement…

  10. From hybrid swarms to swarms of hybrids

    USDA-ARS?s Scientific Manuscript database

    The introgression of modern humans (Homo sapiens) with Neanderthals 40,000 YBP after a half-million years of separation, may have led to the best example of a hybrid swarm on earth. Modern trade and transportation in support of the human hybrids has continued to introduce additional species, genotyp...

  11. Hybrid rocket propulsion

    NASA Technical Reports Server (NTRS)

    Holzman, Allen L.

    1993-01-01

    Topics addressed are: (1) comparison of the theoretical impulses; (2) comparison of the density-specific impulses; (3) general propulsion system features comparison; (4) hybrid systems, booster applications; and (5) hybrid systems, upper stage propulsion applications.

  12. Hydraulic Hybrid Vehicles

    EPA Pesticide Factsheets

    EPA and the United Parcel Service (UPS) have developed a hydraulic hybrid delivery vehicle to explore and demonstrate the environmental benefits of the hydraulic hybrid for urban pick-up and delivery fleets.

  13. Mysore study: A study of suicide notes

    PubMed Central

    Namratha, P.; Kishor, M.; Sathyanarayana Rao, T. S.; Raman, Rajesh

    2015-01-01

    Background: Suicide is one of the leading causes of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in the world. In 2013, 134,799 people committed suicide in India according to the statistics released by the National Crime Records Bureau. Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of the world are sparse. Objective: The aim was to study the themes in suicide notes that might be useful in prevention strategies. Materials and Methods: A descriptive study of all suicide notes of those individuals who committed suicide between 2010 and 2013 available with Police Department, Mysore district was obtained and analyzed. Results: A total of 22 suicide note were available. A majority of suicide note was in age group of 16–40 years (86%) and most were men (59%). All suicide notes were handwritten, the majority (70%) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology/shame/guilt (80%), love for those left behind (55%) and instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% mentioned that they are committing suicide to prove their innocence. 32% mentioned a last wish. Conclusion: The majority of suicidal note contained “guilt” which is a strong indicator of possible depression in deceased. Creating awareness about suicide among public and ensuring access to professionals trained in suicide prevention is need of the hour in this part of the world. PMID:26816426

  14. Mesoscale hybrid calibration artifact

    DOEpatents

    Tran, Hy D.; Claudet, Andre A.; Oliver, Andrew D.

    2010-09-07

    A mesoscale calibration artifact, also called a hybrid artifact, suitable for hybrid dimensional measurement and the method for make the artifact. The hybrid artifact has structural characteristics that make it suitable for dimensional measurement in both vision-based systems and touch-probe-based systems. The hybrid artifact employs the intersection of bulk-micromachined planes to fabricate edges that are sharp to the nanometer level and intersecting planes with crystal-lattice-defined angles.

  15. Effects of Guided Notes versus Completed Notes during Lectures on College Students' Quiz Performance

    ERIC Educational Resources Information Center

    Neef, Nancy A.; McCord, Brandon E.; Ferreri, Summer J.

    2006-01-01

    We compared the effects of guided lecture notes versus completed lecture notes on pre- to postlecture improvements in quiz performance across two sections of a college course. The results of a counterbalanced multielement design did not reveal consistent differences between the two note formats on students' mean quiz scores. However, fewer errors…

  16. Hybrid armature projectile

    DOEpatents

    Hawke, Ronald S.; Asay, James R.; Hall, Clint A.; Konrad, Carl H.; Sauve, Gerald L.; Shahinpoor, Mohsen; Susoeff, Allan R.

    1993-01-01

    A projectile for a railgun that uses a hybrid armature and provides a seed block around part of the outer surface of the projectile to seed the hybrid plasma brush. In addition, the hybrid armature is continuously vaporized to replenish plasma in a plasma armature to provide a tandem armature and provides a unique ridge and groove to reduce plasama blowby.

  17. Hybrid quantum information processing

    SciTech Connect

    Furusawa, Akira

    2014-12-04

    I will briefly explain the definition and advantage of hybrid quantum information processing, which is hybridization of qubit and continuous-variable technologies. The final goal would be realization of universal gate sets both for qubit and continuous-variable quantum information processing with the hybrid technologies. For that purpose, qubit teleportation with a continuousvariable teleporter is one of the most important ingredients.

  18. Realizing the Hybrid Library.

    ERIC Educational Resources Information Center

    Pinfield, Stephen; Eaton, Jonathan; Edwards, Catherine; Russell, Rosemary; Wissenburg, Astrid; Wynne, Peter

    1998-01-01

    Outlines five projects currently funded by the United Kingdom's Electronic Libraries Program (eLib): HyLiFe (Hybrid Library of the Future), MALIBU (MAnaging the hybrid Library for the Benefit of Users), HeadLine (Hybrid Electronic Access and Delivery in the Library Networked Environment), ATHENS (authentication scheme), and BUILDER (Birmingham…

  19. Homoploid hybrid expectations

    USDA-ARS?s Scientific Manuscript database

    Homoploid hybrid speciation occurs when a stable, fertile, and reproductively isolated lineage results from hybridization between two distinct species without a change in ploidy level. Reproductive isolation between a homoploid hybrid species and its parents is generally attained via chromosomal re...

  20. Hybrid armature projectile

    DOEpatents

    Hawke, R.S.; Asay, J.R.; Hall, C.A.; Konrad, C.H.; Sauve, G.L.; Shahinpoor, M.; Susoeff, A.R.

    1993-03-02

    A projectile for a railgun that uses a hybrid armature and provides a seed block around part of the outer surface of the projectile to seed the hybrid plasma brush. In addition, the hybrid armature is continuously vaporized to replenish plasma in a plasma armature to provide a tandem armature and provides a unique ridge and groove to reduce plasma blowby.

  1. Intraply Hybrid Composite Design

    NASA Technical Reports Server (NTRS)

    Chamis, C. C.; Sinclair, J. H.

    1986-01-01

    Several theoretical approaches combined in program. Intraply hybrid composites investigated theoretically and experimentally at Lewis Research Center. Theories developed during investigations and corroborated by attendant experiments used to develop computer program identified as INHYD (Intraply Hybrid Composite Design). INHYD includes several composites micromechanics theories, intraply hybrid composite theories, and integrated hygrothermomechanical theory. Equations from theories used by program as appropriate for user's specific applications.

  2. Hybrid rocket instability

    NASA Technical Reports Server (NTRS)

    Greiner, B.; Frederick, R. A., Jr.

    1993-01-01

    The paper provides a brief review of theoretical and experimental studies concerned with hybrid rocket instability. The instabilities discussed include atomization and mixing instabilities, chuffing instabilities, pressure coupled combustion instabilities, and vortex shedding. It is emphasized that the future use of hybrid motor systems as viable design alternatives will depend on a better understanding of hybrid instability.

  3. Bank note recognition for the vision impaired.

    PubMed

    Hinwood, A; Preston, P; Suaning, G J; Lovell, N H

    2006-06-01

    Blind Australians find great difficulty in recognising bank notes. Each note has the same feel, with no Braille markings, irregular edges or other tangible features. In Australia, there is only one device available that can assist blind people recognise their notes. Internationally, there are devices available; however they are expensive, complex and have not been developed to cater for Australian currency. This paper discusses a new device, the MoneyTalker that takes advantage of the largely different colours and patterns on each Australian bank note and recognises the notes electronically, using the reflection and transmission properties of light. Different coloured lights are transmitted through the inserted note and the corresponding sensors detect distinct ranges of values depending on the colour of the note. Various classification algorithms were studied and the final algorithm was chosen based on accuracy and speed of recognition. The MoneyTalker has shown an accuracy of more than 99%. A blind subject has tested the device and believes that it is usable, compact and affordable. Based on the devices that are available currently in Australia, the MoneyTalker is an effective alternative in terms of accuracy and usability.

  4. The hydrogen hybrid option

    SciTech Connect

    Smith, J.R.

    1993-10-15

    The energy efficiency of various piston engine options for series hybrid automobiles are compared with conventional, battery powered electric, and proton exchange membrane (PEM) fuel cell hybrid automobiles. Gasoline, compressed natural gas (CNG), and hydrogen are considered for these hybrids. The engine and fuel comparisons are done on a basis of equal vehicle weight, drag, and rolling resistance. The relative emissions of these various fueled vehicle options are also presented. It is concluded that a highly optimized, hydrogen fueled, piston engine, series electric hybrid automobile will have efficiency comparable to a similar fuel cell hybrid automobile and will have fewer total emissions than the battery powered vehicle, even without a catalyst.

  5. EndNote 7.0.

    PubMed

    Eapen, Bell Raj

    2006-01-01

    EndNote is a useful software for online literature search and efficient bibliography management. It helps to format the bibliography according to the citation style of each journal. EndNote stores references in a library file, which can be shared with others. It can connect to online resources like PubMed and retrieve search results as per the search criteria. It can also effortlessly integrate with popular word processors like MS Word. The Indian Journal of Dermatology, Venereology and Leprology website has a provision to import references to EndNote.

  6. A study of actions in operative notes.

    PubMed

    Wang, Yan; Pakhomov, Serguei; Burkart, Nora E; Ryan, James O; Melton, Genevieve B

    2012-01-01

    Operative notes contain rich information about techniques, instruments, and materials used in procedures. To assist development of effective information extraction (IE) techniques for operative notes, we investigated the sublanguage used to describe actions within the operative report 'procedure description' section. Deep parsing results of 362,310 operative notes with an expanded Stanford parser using the SPECIALIST Lexicon resulted in 200 verbs (92% coverage) including 147 action verbs. Nominal action predicates for each action verb were gathered from WordNet, SPECIALIST Lexicon, New Oxford American Dictionary and Stedman's Medical Dictionary. Coverage gaps were seen in existing lexical, domain, and semantic resources (Unified Medical Language System (UMLS) Metathesaurus, SPECIALIST Lexicon, WordNet and FrameNet). Our findings demonstrate the need to construct surgical domain-specific semantic resources for IE from operative notes.

  7. 17 CFR 256.231 - Notes payable.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 7. Current and Accrued Liabilities § 256.231 Notes payable. This account shall include... companies. ...

  8. 17 CFR 256.231 - Notes payable.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 7. Current and Accrued Liabilities § 256.231 Notes payable. This account shall include... companies. ...

  9. 25 CFR 169.7 - Field notes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... filed separately on tracing linen in such form that they may be folded readily for filing. Where field notes are placed on separate tracing linen, it will be necessary to place on the maps only a...

  10. 25 CFR 169.7 - Field notes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... filed separately on tracing linen in such form that they may be folded readily for filing. Where field notes are placed on separate tracing linen, it will be necessary to place on the maps only a...

  11. 25 CFR 169.7 - Field notes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... filed separately on tracing linen in such form that they may be folded readily for filing. Where field notes are placed on separate tracing linen, it will be necessary to place on the maps only a...

  12. 25 CFR 169.7 - Field notes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... filed separately on tracing linen in such form that they may be folded readily for filing. Where field notes are placed on separate tracing linen, it will be necessary to place on the maps only a...

  13. 25 CFR 169.7 - Field notes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... filed separately on tracing linen in such form that they may be folded readily for filing. Where field notes are placed on separate tracing linen, it will be necessary to place on the maps only a...

  14. Notes from the beginning of time

    PubMed Central

    Sidman, Murray

    2002-01-01

    Some remembrances of things past, and their possible relevance to things now. These remembrances include notes about informality, research as a social process, student training and evaluation, research grants, thesis and dissertation proposals, and interdisciplinary collaboration. PMID:22478373

  15. CMSC-130 Introductory Computer Science, Lecture Notes

    DTIC Science & Technology

    1993-07-01

    The CMSC 130 Introductory Computer Science lecture notes are used in the classroom for teaching CMSC 130, an introductory computer science course...using the Ada programming language. Computer science , Language concepts, Ada language, Software concepts.

  16. 31 CFR Appendixes to Chapter V - Note

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CONTROL, DEPARTMENT OF THE TREASURY Ch. V, Nt. Appendixes to Chapter V—Note Notes: The alphabetical lists... “formerly known as”; “n.k.a.” means “now known as”; “DOB” means “date of birth”; “DWT” means “deadweight”; “GRT” means “Gross Registered Tonnage”; “POB” means “place of birth”. 5. U.S. financial...

  17. Time to rethink: an evidence-based response from pelvic surgeons to the FDA Safety Communication: "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse".

    PubMed

    Murphy, Miles; Holzberg, Adam; van Raalte, Heather; Kohli, Neeraj; Goldman, Howard B; Lucente, Vincent

    2012-01-01

    In July of 2011 the U.S. Food and Drug Administration (FDA) released a safety communication entitled "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse." The stated purpose of this communication is to inform health care providers and patients that serious complications with placement of this mesh are not rare and that it is not clear that these repairs are more effective than nonmesh repair. The comments regarding efficacy are based on a systematic review of the scientific literature from 1996-2011 conducted by the FDA. Our review of the literature during this time yields some different conclusions regarding the safety and efficacy of mesh use in prolapse repair. It may be useful to consider this information prior to making recommendations regarding mesh use in prolapse surgery according to the recent UPDATE.

  18. Engraved Suicide Notes: The Last Note Written on Body by Metallic Object.

    PubMed

    Tumram, Nilesh Keshav; Ambade, Vipul Namdeorao

    2016-01-01

    "Suicide notes" are the notes, where the victim has documented the intention to terminate one's own life. The victim generally writes them on a paper, notebook, wall, or mirror by means of pen or marker. However, suicide notes written on one's own body are very rare, and suicide note engraved by some metallic objects over body has not yet reported. We present two cases where the victim had used some metallic objects to write a message on the body. These may be termed "engraved suicide notes." We believe these to be the first reported cases where a metallic object was used for engraving the last notes on the body before committing suicide. © 2015 American Academy of Forensic Sciences.

  19. Life testing of a nine-couple hybrid thermoelectric panel

    NASA Technical Reports Server (NTRS)

    Bifano, W. J.

    1973-01-01

    Life test data are presented for a nine couple thermoelectric panel of hybrid couples tested at an average hot junction temperature of 840 C (1113 K). In the hybrid couple, a hollow cylinder of p-type Si-Ge is used to encapsulate a segmented PbTe/Si-Ge n-leg. The output power and internal resistance of the panel as well as the resistances of the individual hybrid couples are presented as functions of test time covering a period of more than 4200 hours. Test results indicated improved stability relative to hybrid couples tested at higher temperatures. Thermal cycling of the panel resulted in an order of magnitude increase in room temperature resistance. However, very little change in resistance at operating temperatures was noted following the thermal cycles.

  20. What’s In a Note: Construction of a Suicide Note Corpus

    PubMed Central

    Pestian, John P.; Matykiewicz, Pawel; Linn-Gust, Michelle

    2012-01-01

    This paper reports on the results of an initiative to create and annotate a corpus of suicide notes that can be used for machine learning. Ultimately, the corpus included 1,278 notes that were written by someone who died by suicide. Each note was reviewed by at least three annotators who mapped words or sentences to a schema of emotions. This corpus has already been used for extensive scientific research. PMID:23170067

  1. Entanglement in Quantum-Classical Hybrid

    NASA Technical Reports Server (NTRS)

    Zak, Michail

    2011-01-01

    It is noted that the phenomenon of entanglement is not a prerogative of quantum systems, but also occurs in other, non-classical systems such as quantum-classical hybrids, and covers the concept of entanglement as a special type of global constraint imposed upon a broad class of dynamical systems. Application of hybrid systems for physics of life, as well as for quantum-inspired computing, has been outlined. In representing the Schroedinger equation in the Madelung form, there is feedback from the Liouville equation to the Hamilton-Jacobi equation in the form of the quantum potential. Preserving the same topology, the innovators replaced the quantum potential with other types of feedback, and investigated the property of these hybrid systems. A function of probability density has been introduced. Non-locality associated with a global geometrical constraint that leads to an entanglement effect was demonstrated. Despite such a quantum like characteristic, the hybrid can be of classical scale and all the measurements can be performed classically. This new emergence of entanglement sheds light on the concept of non-locality in physics.

  2. Hybrid radiator cooling system

    DOEpatents

    France, David M.; Smith, David S.; Yu, Wenhua; Routbort, Jules L.

    2016-03-15

    A method and hybrid radiator-cooling apparatus for implementing enhanced radiator-cooling are provided. The hybrid radiator-cooling apparatus includes an air-side finned surface for air cooling; an elongated vertically extending surface extending outwardly from the air-side finned surface on a downstream air-side of the hybrid radiator; and a water supply for selectively providing evaporative cooling with water flow by gravity on the elongated vertically extending surface.

  3. Military Hybrid Vehicle Survey

    DTIC Science & Technology

    2011-08-03

    Some examples include:  Allison Hybrid EP System™ - Transit buses two-mode parallel hybrid with continuously variable transmission (CVT)  Azure... Transit Buses , Proceeding of the Vehicular Technology Conference, Vol. 5, pp 3310-3315, October 2003. [3] E. Rosenthal, U.S. Military Orders Less...applications such as delivery trucks and transit busses. One of the biggest justifications for hybrids is their fuel efficiency. However, the U.S

  4. Managing hybrid marketing systems.

    PubMed

    Moriarty, R T; Moran, U

    1990-01-01

    As competition increases and costs become critical, companies that once went to market only one way are adding new channels and using new methods - creating hybrid marketing systems. These hybrid marketing systems hold the promise of greater coverage and reduced costs. But they are also hard to manage; they inevitably raise questions of conflict and control: conflict because marketing units compete for customers; control because new indirect channels are less subject to management authority. Hard as they are to manage, however, hybrid marketing systems promise to become the dominant design, replacing the "purebred" channel strategy in all kinds of businesses. The trick to managing the hybrid is to analyze tasks and channels within and across a marketing system. A map - the hybrid grid - can help managers make sense of their hybrid system. What the chart reveals is that channels are not the basic building blocks of a marketing system; marketing tasks are. The hybrid grid forces managers to consider various combinations of channels and tasks that will optimize both cost and coverage. Managing conflict is also an important element of a successful hybrid system. Managers should first acknowledge the inevitability of conflict. Then they should move to bound it by creating guidelines that spell out which customers to serve through which methods. Finally, a marketing and sales productivity (MSP) system, consisting of a central marketing database, can act as the central nervous system of a hybrid marketing system, helping managers create customized channels and service for specific customer segments.

  5. From hybrid swarms to swarms of hybrids

    USGS Publications Warehouse

    Stohlgren, Thomas J.; Szalanski, Allen L; Gaskin, John F.; Young, Nicholas E.; West, Amanda; Jarnevich, Catherine S.; Tripodi, Amber

    2014-01-01

    Science has shown that the introgression or hybridization of modern humans (Homo sapiens) with Neanderthals up to 40,000 YBP may have led to the swarm of modern humans on earth. However, there is little doubt that modern trade and transportation in support of the humans has continued to introduce additional species, genotypes, and hybrids to every country on the globe. We assessed the utility of species distributions modeling of genotypes to assess the risk of current and future invaders. We evaluated 93 locations of the genus Tamarix for which genetic data were available. Maxent models of habitat suitability showed that the hybrid, T. ramosissima x T. chinensis, was slightly greater than the parent taxa (AUCs > 0.83). General linear models of Africanized honey bees, a hybrid cross of Tanzanian Apis mellifera scutellata and a variety of European honey bee including A. m. ligustica, showed that the Africanized bees (AUC = 0.81) may be displacing European honey bees (AUC > 0.76) over large areas of the southwestern U.S. More important, Maxent modeling of sub-populations (A1 and A26 mitotypes based on mDNA) could be accurately modeled (AUC > 0.9), and they responded differently to environmental drivers. This suggests that rapid evolutionary change may be underway in the Africanized bees, allowing the bees to spread into new areas and extending their total range. Protecting native species and ecosystems may benefit from risk maps of harmful invasive species, hybrids, and genotypes.

  6. Clinical Note Creation, Binning, and Artificial Intelligence.

    PubMed

    Deliberato, Rodrigo Octávio; Celi, Leo Anthony; Stone, David J

    2017-08-03

    The creation of medical notes in software applications poses an intrinsic problem in workflow as the technology inherently intervenes in the processes of collecting and assembling information, as well as the production of a data-driven note that meets both individual and healthcare system requirements. In addition, the note writing applications in currently available electronic health records (EHRs) do not function to support decision making to any substantial degree. We suggest that artificial intelligence (AI) could be utilized to facilitate the workflows of the data collection and assembly processes, as well as to support the development of personalized, yet data-driven assessments and plans. ©Rodrigo Octávio Deliberato, Leo Anthony Celi, David J Stone. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 03.08.2017.

  7. Notes on the history of caffeine use.

    PubMed

    Fredholm, Bertil B

    2011-01-01

    As behooves something so deeply entrenched in culture, the historical origins of the use of methylxanthines are unknown and dressed in myth. This is true for coffee as well as tea, and for both it is interesting to note that their common use is really very recent. For coffee we know that its use became more widespread in the fifteenth and sixteenth centuries, and in Europe this occurred in the eighteenth and nineteenth centuries. The use of tea became more common during the Ming Dynasty in China and during the eighteenth century in Britain. Coffee was mostly an upper-class drink in Arabia, and remained a relative luxury in Europe until quite recently. The use of other methylxanthine-containing beverages, such as maté, is even less well known. It is interesting to note that before these drinks were commonly used on a daily basis they were used for medicinal purposes, indicating that their pharmacological actions had long been noted.

  8. Application Note: Power Grid Modeling With Xyce.

    SciTech Connect

    Sholander, Peter E.

    2015-06-01

    This application note describes how to model steady-state power flows and transient events in electric power grids with the SPICE-compatible Xyce TM Parallel Electronic Simulator developed at Sandia National Labs. This application notes provides a brief tutorial on the basic devices (branches, bus shunts, transformers and generators) found in power grids. The focus is on the features supported and assumptions made by the Xyce models for power grid elements. It then provides a detailed explanation, including working Xyce netlists, for simulating some simple power grid examples such as the IEEE 14-bus test case.

  9. TAP Implementation Notes Version 1.0

    NASA Astrophysics Data System (ADS)

    Demleitner, Markus; Harrison, Paul; Taylor, Mark; Demleitner, Markus

    2013-12-01

    This IVOA Note discusses several clarifications to the TAP protocol stack, i.e., to the ADQL dialect, the UWS job system, the VOSI metadata interfaces, and TAP itself. It also proposes a number of enhancements that might be incorporated in the next versions of the respective standards. The authors hope that the proposed text changes and additions can mature while in the relatively fluid note state to achieve a rapid and easy standards process later on. Further contributions to this text are most welcome.

  10. Xyce parallel electronic simulator release notes.

    SciTech Connect

    Keiter, Eric R; Hoekstra, Robert John; Mei, Ting; Russo, Thomas V.; Schiek, Richard Louis; Thornquist, Heidi K.; Rankin, Eric Lamont; Coffey, Todd S; Pawlowski, Roger P; Santarelli, Keith R.

    2010-05-01

    The Xyce Parallel Electronic Simulator has been written to support, in a rigorous manner, the simulation needs of the Sandia National Laboratories electrical designers. Specific requirements include, among others, the ability to solve extremely large circuit problems by supporting large-scale parallel computing platforms, improved numerical performance and object-oriented code design and implementation. The Xyce release notes describe: Hardware and software requirements New features and enhancements Any defects fixed since the last release Current known defects and defect workarounds For up-to-date information not available at the time these notes were produced, please visit the Xyce web page at http://www.cs.sandia.gov/xyce.

  11. A Note About HARP's State Trimming Method

    NASA Technical Reports Server (NTRS)

    Butler, Ricky W.; Hayhurst, Kelly J.; Johnson, Sally C.

    1998-01-01

    This short note provides some additional insight into how the HARP program works. In some cases, it is possible for HARP to tdm away too many states and obtain an optimistic result. The HARP Version 7.0 manual warns the user that 'Unlike the ALL model, the SAME model can automatically drop failure modes for certain system models. The user is cautioned to insure that no important failure modes are dropped; otherwise, a non-conservative result can be given.' This note provides an example of where this occurs and a pointer to further documentation that gives a means of bounding the error associated with trimming these states.

  12. A Comparison of Suicide Note Writers with Suicides Who Did Not Leave Notes

    ERIC Educational Resources Information Center

    Callanan, Valerie J.; Davis, Mark S.

    2009-01-01

    There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic…

  13. A Comparison of Suicide Note Writers with Suicides Who Did Not Leave Notes

    ERIC Educational Resources Information Center

    Callanan, Valerie J.; Davis, Mark S.

    2009-01-01

    There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic…

  14. Benefits of an Electronic Consultation-Liaison Note System: Better Notes Faster

    ERIC Educational Resources Information Center

    Sola, Christopher L.; Bostwick, J. Michael; Sampson, Shirlene

    2007-01-01

    Objective: The authors determined the efficiency of electronic documentation in consultation-liaison psychiatry. METHOD: An electronic note system was customized for a psychiatric consultation note. Specific attention given to common diagnoses permitted rapid documentation. Results: Residents learned the system quickly. The standardized nature of…

  15. Online Notes: Differential Effects of Studying Complete or Partial Graphically Organized Notes

    ERIC Educational Resources Information Center

    Katayama, Andrew D.; Crooks, Steven M.

    2003-01-01

    The authors investigated in this study the effects of two electronic notes conditions (complete vs. partial) and two testing conditions (immediate vs. delayed) on three types of tests (fact, structure, and application). A 2 x 2 factorial multivariate analysis of variance (MANOVA) yielded no significant main effects for notes conditions on the fact…

  16. The New Information Hybrid.

    ERIC Educational Resources Information Center

    Levitan, Karen B.

    1981-01-01

    Discusses the creation and existence of "hybrid" organizations, i.e., nonprofit companies sponsored by the government to provide extensive research and development services. Possibilities for hybrids are brought about by government intervention in the information marketplace to produce social benefits. (SW)

  17. Epigenetic Changes in Hybrids.

    PubMed

    Greaves, Ian K; Gonzalez-Bayon, Rebeca; Wang, Li; Zhu, Anyu; Liu, Pei-Chuan; Groszmann, Michael; Peacock, W James; Dennis, Elizabeth S

    2015-08-01

    Genome-wide approaches to the study of hybrid vigor have identified epigenetic changes in the hybrid nucleus in Arabidopsis (Arabidopsis thaliana), maize (Zea mays), and rice (Oryza sativa). DNA methylation associated with 24-nucleotide small interfering RNAs exhibits transallelic effects in hybrids of Arabidopsis and other species. Some of the transmethylation changes are inherited and some affect gene expression. Hybrids have larger leaves than those of the parents and have increases in cell size and number. The increased leaf size results in a greater photosynthetic capacity, which may support the increased vegetative and reproductive yields of the F1 hybrids. Genes and metabolic pathways that have altered expression relative to the parents include loci involved in responses to hormones and to biotic and abiotic stress. Whereas epigenetically induced changes in gene expression may contribute to hybrid vigor, the link between the transcriptional changes and the hybrid phenotype is not confirmed. Recurrent selection of high yielding F1 lines from the F2/F3 of a number of crops has fixed heterosis yields in pure breeding lines. These hybrid-like lines may have valuable applications in crop systems. © 2015 American Society of Plant Biologists. All Rights Reserved.

  18. Hybrid rocket performance

    NASA Technical Reports Server (NTRS)

    Frederick, Robert A., Jr.

    1992-01-01

    A hybrid rocket is a system consisting of a solid fuel grain and a gaseous or liquid oxidizer. Figure 1 shows three popular hybrid propulsion cycles that are under current consideration. NASA MSFC has teamed with industry to test two hybrid propulsion systems that will allow scaling to motors of potential interest for Titan and Atlas systems, as well as encompassing the range of interest for SEI lunar ascent stages and National Launch System Cargo Transfer Vehicle (NLS CTV) and NLS deorbit systems. Hybrid systems also offer advantages as moderate-cost, environmentally acceptable propulsion system. The objective of this work was to recommend a performance prediction methodology for hybrid rocket motors. The scope included completion of: a literature review, a general methodology, and a simplified performance model.

  19. Hybrid propulsion technology program

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Technology was identified which will enable application of hybrid propulsion to manned and unmanned space launch vehicles. Two design concepts are proposed. The first is a hybrid propulsion system using the classical method of regression (classical hybrid) resulting from the flow of oxidizer across a fuel grain surface. The second system uses a self-sustaining gas generator (gas generator hybrid) to produce a fuel rich exhaust that was mixed with oxidizer in a separate combustor. Both systems offer cost and reliability improvement over the existing solid rocket booster and proposed liquid boosters. The designs were evaluated using life cycle cost and reliability. The program consisted of: (1) identification and evaluation of candidate oxidizers and fuels; (2) preliminary evaluation of booster design concepts; (3) preparation of a detailed point design including life cycle costs and reliability analyses; (4) identification of those hybrid specific technologies needing improvement; and (5) preperation of a technology acquisition plan and large scale demonstration plan.

  20. Hybrid baryons in QCD

    SciTech Connect

    Dudek, Jozef J.; Edwards, Robert G.

    2012-03-21

    In this study, we present the first comprehensive study of hybrid baryons using lattice QCD methods. Using a large basis of composite QCD interpolating fields we extract an extensive spectrum of baryon states and isolate those of hybrid character using their relatively large overlap onto operators which sample gluonic excitations. We consider the spectrum of Nucleon and Delta states at several quark masses finding a set of positive parity hybrid baryons with quantum numbers $N_{1/2^+},\\,N_{1/2^+},\\,N_{3/2^+},\\, N_{3/2^+},\\,N_{5/2^+},\\,$ and $\\Delta_{1/2^+},\\, \\Delta_{3/2^+}$ at an energy scale above the first band of `conventional' excited positive parity baryons. This pattern of states is compatible with a color octet gluonic excitation having $J^{P}=1^{+}$ as previously reported in the hybrid meson sector and with a comparable energy scale for the excitation, suggesting a common bound-state construction for hybrid mesons and baryons.

  1. Hybrid reactors. [Fuel cycle

    SciTech Connect

    Moir, R.W.

    1980-09-09

    The rationale for hybrid fusion-fission reactors is the production of fissile fuel for fission reactors. A new class of reactor, the fission-suppressed hybrid promises unusually good safety features as well as the ability to support 25 light-water reactors of the same nuclear power rating, or even more high-conversion-ratio reactors such as the heavy-water type. One 4000-MW nuclear hybrid can produce 7200 kg of /sup 233/U per year. To obtain good economics, injector efficiency times plasma gain (eta/sub i/Q) should be greater than 2, the wall load should be greater than 1 MW.m/sup -2/, and the hybrid should cost less than 6 times the cost of a light-water reactor. Introduction rates for the fission-suppressed hybrid are usually rapid.

  2. The impact of note taking style and note availability at retrieval on mock jurors' recall and recognition of trial information.

    PubMed

    Thorley, Craig; Baxter, Rebecca E; Lorek, Joanna

    2016-01-01

    Jurors forget critical trial information and what they do recall can be inaccurate. Jurors' recall of trial information can be enhanced by permitting them to take notes during a trial onto blank sheets of paper (henceforth called freestyle note taking). A recent innovation is the trial-ordered-notebook (TON) for jurors, which is a notebook containing headings outlining the trial proceedings and which has space beneath each heading for notes. In a direct comparison, TON note takers recalled more trial information than freestyle note takers. This study investigated whether or not note taking improves recall as a result of enhanced encoding or as a result of note access at retrieval. To assess this, mock jurors watched and freely recalled a trial video with one-fifth taking no notes, two-fifths taking freestyle notes and two-fifths using TONs. During retrieval, half of the freestyle and TON note takers could access their notes. Note taking enhanced recall, with the freestyle note takers and TON note takers without note access performing equally as well. Note taking therefore enhances encoding. Recall was greatest for the TON note takers with note access, suggesting a retrieval enhancement unique to this condition. The theoretical and applied implications of these findings are discussed.

  3. MIL-STD-1553 Interface Application Notes,

    DTIC Science & Technology

    This paper describes Monolithic and Hybrid circuits used for interfacing to a MIL- STD -1553 Multiplex Data Bus. The focus in on how to implement smart...will complete the picture of the implementation of MIL- STD -1553 A or B. The MCE (Smith) LSI Chip Set for MIL- STD -1553B RTU and BC configurations will

  4. The hybrid BCI.

    PubMed

    Pfurtscheller, Gert; Allison, Brendan Z; Brunner, Clemens; Bauernfeind, Gunther; Solis-Escalante, Teodoro; Scherer, Reinhold; Zander, Thorsten O; Mueller-Putz, Gernot; Neuper, Christa; Birbaumer, Niels

    2010-01-01

    Nowadays, everybody knows what a hybrid car is. A hybrid car normally has two engines to enhance energy efficiency and reduce CO2 output. Similarly, a hybrid brain-computer interface (BCI) is composed of two BCIs, or at least one BCI and another system. A hybrid BCI, like any BCI, must fulfill the following four criteria: (i) the device must rely on signals recorded directly from the brain; (ii) there must be at least one recordable brain signal that the user can intentionally modulate to effect goal-directed behaviour; (iii) real time processing; and (iv) the user must obtain feedback. This paper introduces hybrid BCIs that have already been published or are in development. We also introduce concepts for future work. We describe BCIs that classify two EEG patterns: one is the event-related (de)synchronisation (ERD, ERS) of sensorimotor rhythms, and the other is the steady-state visual evoked potential (SSVEP). Hybrid BCIs can either process their inputs simultaneously, or operate two systems sequentially, where the first system can act as a "brain switch". For example, we describe a hybrid BCI that simultaneously combines ERD and SSVEP BCIs. We also describe a sequential hybrid BCI, in which subjects could use a brain switch to control an SSVEP-based hand orthosis. Subjects who used this hybrid BCI exhibited about half the false positives encountered while using the SSVEP BCI alone. A brain switch can also rely on hemodynamic changes measured through near-infrared spectroscopy (NIRS). Hybrid BCIs can also use one brain signal and a different type of input. This additional input can be an electrophysiological signal such as the heart rate, or a signal from an external device such as an eye tracking system.

  5. 17 CFR 256.141 - Notes receivable.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 3. Current and Accrued Assets § 256.141 Notes receivable. This account shall include... other than associate companies. The account shall be so maintained as to show separately amounts due...

  6. 17 CFR 256.141 - Notes receivable.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 3. Current and Accrued Assets § 256.141 Notes receivable. This account shall include... other than associate companies. The account shall be so maintained as to show separately amounts due...

  7. Practice Notes: Strategies in Health Education

    ERIC Educational Resources Information Center

    Health Education & Behavior, 2007

    2007-01-01

    The Practice Notes section is intended to keep readers informed about health education practice around the country. It is an attempt to spread the word about exemplary strategies, initiatives, and programs and share successes in overcoming obstacles or challenges. Periodically, articles presenting perspectives on practice-related issues are also…

  8. 19 CFR 152.100 - Interpretative notes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Interpretative notes. 152.100 Section 152.100 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE... by Congress along with the Trade Agreements Act of 1979 (Pub. L. 96-39), and will have the force and...

  9. 38 CFR 21.4504 - Promissory note.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) VOCATIONAL REHABILITATION AND EDUCATION Education Loans § 21.4504 Promissory note. (a) General. The agreement... insured by the Secretary of Education, Department of Education, under part B of Title IV of the Higher Education Act of 1965. The rate shall be determined as of the date the agreement is executed and shall be a...

  10. 34 CFR 674.31 - Promissory note.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... promissory note must state that the unpaid principal, interest, collection costs, and either penalty or late charges on the loan are canceled upon the death or permanent and total disability of the borrower. (4... time without penalty; (ii) The institution shall use amounts repaid during the academic year in...

  11. Shooting Gallery Notes. Working Paper #22. Preliminary.

    ERIC Educational Resources Information Center

    Bourgois, Philippe

    This paper contains ethnographic participant-observation field notes taken on a one-night visit to a "shooting gallery" in East Harlem (New York City) along with background information and commentary. East Harlem, also referred to as "El Barrio" or Spanish Harlem, is a 200-square block neighborhood on the upper East Side of…

  12. Forest Nursery Notes, Volume 30, Issue 1

    Treesearch

    R. Kasten Dumroese; Tom D. Landis

    2010-01-01

    Forest Nursery Notes (FNN) is a nursery news and literature service that is distributed free of charge to over 1,200 cooperators in the United States, Canada, and other foreign countries. This issue's topics include: fertigation, holdover nursery stock, late-season fertilization, and bird damage.

  13. Practice Notes: Strategies in Health Education

    ERIC Educational Resources Information Center

    Health Education & Behavior, 2007

    2007-01-01

    This article is included in the Practice Notes section of this journal, which is intended to keep readers informed about health education practice around the country. It is an attempt to spread the word about exemplary strategies, initiatives, and programs and share successes in overcoming obstacles or challenges. In this article, two programs are…

  14. The NIRCam Optical Telescope Simulator (NOTES)

    NASA Technical Reports Server (NTRS)

    Kubalak, David; Hakun, Claef; Greeley, Bradford; Eichorn, William; Leviton, Douglas; Guishard, Corina; Gong, Qian; Warner, Thomas; Bugby, David; Robinson, Frederick; Lansing, Peter; Garza, Mario; Kirk, Jeffrey

    2007-01-01

    The Near Infra-Red Camera (NIRCam), the 0.6-5.0 micron imager and wavefront sensing instrument for the James Webb Space Telescope (JWST), will be used on orbit both as a science instrument, and to tune the alignment of the telescope. The NIRCam Optical Telescope Element Simulator (NOTES) will be used during ground testing to provide an external stimulus to verify wavefront error, imaging characteristics, and wavefront sensing performance of this crucial instrument. NOTES is being designed and built by NASA Goddard Space Flight Center with the help of Swales Aerospace and Orbital Sciences Corporation. It is a single-point imaging system that uses an elliptical mirror to form an U20 image of a point source. The point source will be fed via optical fibers from outside the vacuum chamber. A tip/tilt mirror is used to change the chief ray angle of the beam as it passes through the aperture stop and thus steer the image over NIRCam's field of view without moving the pupil or introducing field aberrations. Interchangeable aperture stop elements allow us to simulate perfect JWST wavefronts for wavefront error testing, or introduce transmissive phase plates to simulate a misaligned JWST segmented mirror for wavefront sensing verification. NOTES will be maintained at an operating temperature of 80K during testing using thermal switches, allowing it to operate within the same test chamber as the NIRCam instrument. We discuss NOTES' current design status and on-going development activities.

  15. New Wrinkles on Retirement: Program Notes.

    ERIC Educational Resources Information Center

    Wray, Robert P.; Thorson, James A.

    The program notes were prepared to accompany the television series "New Wrinkles on Retirement." The eight units in the series are: facing inflation, which covers the decreasing value of the dollar, transportation costs, medical expenses, cutting expenses, family budgeting, investments, and places to live; vigor regained, which covers exercise and…

  16. Note Taking in Multi-Media Settings

    ERIC Educational Resources Information Center

    Black, Kelly; Yao, Guangming

    2014-01-01

    We provide a preliminary exploration into the use of note taking when combined with video examples. Student volunteers were divided into three groups and asked to perform two problems. The first problem was explored in a classroom setting and the other problem was a novel problem. The students were asked to complete the two questions. Furthermore,…

  17. Practice Notes: Strategies in Health Education

    ERIC Educational Resources Information Center

    Health Education & Behavior, 2007

    2007-01-01

    The Practice Notes section is intended to keep readers informed about health education practice around the country. It is an attempt to spread the word about exemplary strategies, initiatives, and programs and share successes in overcoming obstacles or challenges. Periodically, articles presenting perspectives on practice-related issues are also…

  18. Introducing Literary Arabic, Volume II: Grammatical Notes.

    ERIC Educational Resources Information Center

    Hanna, Sami A.; Greis, Naguib

    This volume, designed as a companion to "Introducing Literary Arabic" provides basic grammatical explanations essential in first-year courses. Each of the 15 units, with the exception of the first, contains related grammatical notes, paradigms, and illustrations. The grammatical rules are intended to make explicit general underlying structures.…

  19. Notes & Reflections. Issue 7, Fall 2004

    ERIC Educational Resources Information Center

    Fitzpatrick, Michele, Ed.

    2004-01-01

    "Notes & Reflections" offers practical information--ideas, strategies, tools, and resources--about topics of special interest to professional developers who are working to improve school performance. Today, professional development services to schools are provided by variety of people: teacher leaders; principals; and district, regional, and state…

  20. A Taste of Sunrise: A Director's Notes.

    ERIC Educational Resources Information Center

    Hovasse, Nancy

    2001-01-01

    Describes a director's experience working with "A Taste of Sunrise," a play depicting the deaf culture. Stresses how important it is to educate the cast and provide them an opportunity to learn sign language. Notes that American Sign Language is complex and beautiful and deserves to be carefully studied and respectfully acknowledged by the hearing…

  1. Microcounseling Skill Discrimination Scale: A Methodological Note

    ERIC Educational Resources Information Center

    Stokes, Joseph; Romer, Daniel

    1977-01-01

    Absolute ratings on the Microcounseling Skill Discrimination Scale (MSDS) confound the individual's use of the rating scale and actual ability to discriminate effective and ineffective counselor behaviors. This note suggests methods of scoring the MSDS that will eliminate variability attributable to response language and improve the validity of…

  2. Science Notes: Dilution of a Weak Acid

    ERIC Educational Resources Information Center

    Talbot, Christopher; Wai, Chooi Khee

    2014-01-01

    This "Science note" arose out of practical work involving the dilution of ethanoic acid, the measurement of the pH of the diluted solutions and calculation of the acid dissociation constant, K[subscript a], for each diluted solution. The students expected the calculated values of K[subscript a] to be constant but they found that the…

  3. Building Simple Hidden Markov Models. Classroom Notes

    ERIC Educational Resources Information Center

    Ching, Wai-Ki; Ng, Michael K.

    2004-01-01

    Hidden Markov models (HMMs) are widely used in bioinformatics, speech recognition and many other areas. This note presents HMMs via the framework of classical Markov chain models. A simple example is given to illustrate the model. An estimation method for the transition probabilities of the hidden states is also discussed.

  4. Practice Notes: Strategies in Health Education

    ERIC Educational Resources Information Center

    Health Education & Behavior, 2007

    2007-01-01

    This article is included in the Practice Notes section of this journal, which is intended to keep readers informed about health education practice around the country. It is an attempt to spread the word about exemplary strategies, initiatives, and programs and share successes in overcoming obstacles or challenges. In this article, two programs are…

  5. College Success Course, Fall 1988. Research Note.

    ERIC Educational Resources Information Center

    Reis, Elizabeth

    In spring 1988, Moraine Valley Community College (MVCC), in Palos Hills, Illinois, implemented "College Success," a course to increase student academic performance and improve college retention. Students in the course learned a variety of techniques to help them succeed in college, including note-taking skills, time management, memory…

  6. Notes on the RHIC Injection Kicker

    SciTech Connect

    Forsyth, E. B.

    1995-03-01

    The basic design of the RHIC injection kicker has been completed. However a good deal more must be done before the system is operational in RHIC. The purpose of this note is to discuss the outstanding issues and offer guidance on solutions.

  7. A note on the Goodman Jack

    USGS Publications Warehouse

    Swolfs, H.S.; Kibler, J.D.

    1982-01-01

    A Note on the Goodman Jack: Reconnaissance experiments, performed to evaluate the practical utility of the hard-rock variety of the Goodman Jack, reveal that the Hustrulid-T* correction adequately reconciles the discrepancy between the measured and true deformation modulus of the rock mass in the range of 30 to 50 gigapascals. ?? 1982 Springer-Verlag.

  8. Science Notes: Dilution of a Weak Acid

    ERIC Educational Resources Information Center

    Talbot, Christopher; Wai, Chooi Khee

    2014-01-01

    This "Science note" arose out of practical work involving the dilution of ethanoic acid, the measurement of the pH of the diluted solutions and calculation of the acid dissociation constant, K[subscript a], for each diluted solution. The students expected the calculated values of K[subscript a] to be constant but they found that the…

  9. European Science Notes. Volume 41, Number 9.

    DTIC Science & Technology

    1987-09-01

    management system and of the following: Secretaria de la Revista the inference engine. de Psicologia Social , Facultad de Psico- Application of Knowledge-Based...Notes NATO Advanced Research Workshop on Social and Environmental Psychology .................... William D. Crano 519 Applied Artificial Intelligence...An International Journal ................................. William D. Crano 520 New Spanish Journal of Social Psychology ................. William D

  10. A Note on Morley's Triangle Theorem

    ERIC Educational Resources Information Center

    Mueller, Nancy; Tikoo, Mohan; Wang, Haohao

    2012-01-01

    In this note, we offer a proof of a variant of Morley's triangle theorem, when the exterior angles of a triangle are trisected. We also offer a generalization of Morley's theorem when angles of an "n"-gon are "n"-sected. (Contains 9 figures.)

  11. A note on Morley's triangle theorem

    NASA Astrophysics Data System (ADS)

    Mueller, Nancy; Tikoo, Mohan; Wang, Haohao

    2012-06-01

    In this note, we offer a proof of a variant of Morley's triangle theorem, when the exterior angles of a triangle are trisected. We also offer a generalization of Morley's theorem when angles of an n-gon are n-sected.

  12. Practice Notes: Strategies in Health Education

    ERIC Educational Resources Information Center

    Health Education & Behavior, 2009

    2009-01-01

    The "Practice Notes" section is intended to keep readers informed about health education practice around the country. It is an attempt to spread the word about exemplary strategies, initiatives, and programs and share successes in overcoming obstacles or challenges. This article features two new programs on health education: (1) Project FIESTA;…

  13. Practice Notes: Strategies in Health Education

    ERIC Educational Resources Information Center

    Health Education & Behavior, 2009

    2009-01-01

    The "Practice Notes" section is intended to keep readers informed about health education practice around the country. It is an attempt to spread the word about exemplary strategies, initiatives, and programs and share successes in overcoming obstacles or challenges. This article features two new programs on health education: (1) Project FIESTA;…

  14. Note Taking in Multi-Media Settings

    ERIC Educational Resources Information Center

    Black, Kelly; Yao, Guangming

    2014-01-01

    We provide a preliminary exploration into the use of note taking when combined with video examples. Student volunteers were divided into three groups and asked to perform two problems. The first problem was explored in a classroom setting and the other problem was a novel problem. The students were asked to complete the two questions. Furthermore,…

  15. A Taste of Sunrise: A Director's Notes.

    ERIC Educational Resources Information Center

    Hovasse, Nancy

    2001-01-01

    Describes a director's experience working with "A Taste of Sunrise," a play depicting the deaf culture. Stresses how important it is to educate the cast and provide them an opportunity to learn sign language. Notes that American Sign Language is complex and beautiful and deserves to be carefully studied and respectfully acknowledged by the hearing…

  16. A Note on Evaluating Supplemental Instruction

    ERIC Educational Resources Information Center

    Paloyo, Alfredo R.

    2015-01-01

    Selection bias pervades the evaluation of supplemental instruction (SI) in non-experimental settings. This brief note provides a formal framework to understand this issue. The objective is to contribute to the accumulation of credible evidence on the impact of SI.

  17. 7 CFR 1735.41 - Notes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 11 2013-01-01 2013-01-01 false Notes. 1735.41 Section 1735.41 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GENERAL POLICIES, TYPES OF LOANS, LOAN REQUIREMENTS-TELECOMMUNICATIONS PROGRAM Terms of Loans §...

  18. 7 CFR 1735.41 - Notes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 11 2014-01-01 2014-01-01 false Notes. 1735.41 Section 1735.41 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GENERAL POLICIES, TYPES OF LOANS, LOAN REQUIREMENTS-TELECOMMUNICATIONS PROGRAM Terms of Loans §...

  19. 7 CFR 1735.41 - Notes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 11 2011-01-01 2011-01-01 false Notes. 1735.41 Section 1735.41 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GENERAL POLICIES, TYPES OF LOANS, LOAN REQUIREMENTS-TELECOMMUNICATIONS PROGRAM Terms of Loans §...

  20. 7 CFR 1735.41 - Notes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 11 2012-01-01 2012-01-01 false Notes. 1735.41 Section 1735.41 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GENERAL POLICIES, TYPES OF LOANS, LOAN REQUIREMENTS-TELECOMMUNICATIONS PROGRAM Terms of Loans §...

  1. 7 CFR 1735.41 - Notes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Notes. 1735.41 Section 1735.41 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GENERAL POLICIES, TYPES OF LOANS, LOAN REQUIREMENTS-TELECOMMUNICATIONS PROGRAM Terms of Loans §...

  2. A Note on Morley's Triangle Theorem

    ERIC Educational Resources Information Center

    Mueller, Nancy; Tikoo, Mohan; Wang, Haohao

    2012-01-01

    In this note, we offer a proof of a variant of Morley's triangle theorem, when the exterior angles of a triangle are trisected. We also offer a generalization of Morley's theorem when angles of an "n"-gon are "n"-sected. (Contains 9 figures.)

  3. A Note on the Heterogeneous Choice Model

    ERIC Educational Resources Information Center

    Rohwer, Goetz

    2015-01-01

    The heterogeneous choice model (HCM) has been proposed as an extension of the standard logit and probit models, which allows taking into account different error variances of explanatory variables. In this note, I show that in an important special case, this model is just another way to specify an interaction effect.

  4. A framework to guide the conservation of species hybrids based on ethical and ecological considerations.

    PubMed

    Jackiw, Raeya N; Mandil, Ghada; Hager, Heather A

    2015-08-01

    Species hybrids have long been undervalued in conservation and are often perceived as a threat to pure species. Recently, the conservation value of hybrids, especially those of natural origin, has gained recognition; however, hybrid conservation remains controversial. We reviewed hybrid management policies, including laws, regulations, and management protocols, from a variety of organizations, primarily in Canada and the United States. We found that many policies are based on limited ethical and ecological considerations and provide little opportunity for hybrid conservation. In most policies, hybrids are either unrepresented or considered a threat to conservation goals. This is problematic because our review of the hybrid conservation literature identified many ethical and ecological considerations relevant to determining the conservation value of a hybrid, all of which are management-context specific. We also noted a lack of discussion of the ethical considerations regarding hybrid conservation. Based on these findings, we created a policy framework outlining situations in which hybrids could be eligible for conservation in Canada and the United States. The framework comprises a decision tree that helps users determine whether a hybrid should be eligible for conservation based on multiple ecological and ethical considerations. The framework may be applied to any hybrid and is flexible in that it accommodates context-specific management by allowing different options if a hybrid is a threat to or could benefit conservation goals. The framework can inform policy makers and conservationists in decision-making processes regarding hybrid conservation by providing a systematic set of decision criteria and guidance on additional criteria to be considered in cases of uncertainty, and it fills a policy gap that limits current hybrid management.

  5. 42 CFR 57.308 - Nursing student loan promissory note.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Nursing student loan promissory note. 57.308... Nursing Student Loans § 57.308 Nursing student loan promissory note. (a) Promissory note form. Each nursing student loan must be evidenced by a properly executed promissory note in a form approved by the...

  6. 42 CFR 57.308 - Nursing student loan promissory note.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Nursing student loan promissory note. 57.308... Nursing Student Loans § 57.308 Nursing student loan promissory note. (a) Promissory note form. Each nursing student loan must be evidenced by a properly executed promissory note in a form approved by the...

  7. 42 CFR 57.308 - Nursing student loan promissory note.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Nursing student loan promissory note. 57.308... Nursing Student Loans § 57.308 Nursing student loan promissory note. (a) Promissory note form. Each nursing student loan must be evidenced by a properly executed promissory note in a form approved by the...

  8. 42 CFR 57.308 - Nursing student loan promissory note.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Nursing student loan promissory note. 57.308... Nursing Student Loans § 57.308 Nursing student loan promissory note. (a) Promissory note form. Each nursing student loan must be evidenced by a properly executed promissory note in a form approved by the...

  9. 42 CFR 57.308 - Nursing student loan promissory note.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Nursing student loan promissory note. 57.308... Nursing Student Loans § 57.308 Nursing student loan promissory note. (a) Promissory note form. Each nursing student loan must be evidenced by a properly executed promissory note in a form approved by the...

  10. Thinking Strategically to Record Notes in Content Classes

    ERIC Educational Resources Information Center

    Boyle, Joseph R.

    2011-01-01

    Although teachers today use a variety of teaching methods in content-area classrooms, lecture learning and note-taking still comprise a considerable portion of time in these classes. Unfortunately, most students are poor note-takers, typically recording only about one quarter of lecture notes. Strategic note-taking was developed to assist students…

  11. 31 CFR 342.2 - Description of notes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Description of notes. 342.2 Section..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS NOTES § 342.2 Description of notes. (a) General. Savings notes were issued only in registered form and are nontransferable...

  12. 12 CFR 615.5105 - Consolidated Systemwide notes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Consolidated Systemwide notes. 615.5105 Section..., LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Issuance of Bonds, Notes, Debentures and Similar Obligations § 615.5105 Consolidated Systemwide notes. Consolidated Systemwide notes authorized under § 615...

  13. 31 CFR 342.2 - Description of notes.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Description of notes. 342.2 Section..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS NOTES § 342.2 Description of notes. (a) General. Savings notes were issued only in registered form and are nontransferable...

  14. 12 CFR 615.5105 - Consolidated Systemwide notes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Consolidated Systemwide notes. 615.5105 Section..., LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Issuance of Bonds, Notes, Debentures and Similar Obligations § 615.5105 Consolidated Systemwide notes. Consolidated Systemwide notes authorized under § 615...

  15. 31 CFR 342.2 - Description of notes.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Description of notes. 342.2 Section..., DEPARTMENT OF THE TREASURY BUREAU OF THE FISCAL SERVICE OFFERING OF UNITED STATES SAVINGS NOTES § 342.2 Description of notes. (a) General. Savings notes were issued only in registered form and are nontransferable...

  16. 7 CFR 1956.97 - Disposition of promissory notes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 14 2012-01-01 2012-01-01 false Disposition of promissory notes. 1956.97 Section 1956...-Family Housing § 1956.97 Disposition of promissory notes. (a) Notes evidencing debts settled by completed... the debtor or to the debtor's legal representative. The original and copies of notes will be stamped...

  17. 31 CFR 342.2 - Description of notes.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Description of notes. 342.2 Section..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS NOTES § 342.2 Description of notes. (a) General. Savings notes were issued only in registered form and are nontransferable...

  18. 7 CFR 1956.97 - Disposition of promissory notes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 14 2011-01-01 2011-01-01 false Disposition of promissory notes. 1956.97 Section 1956...-Family Housing § 1956.97 Disposition of promissory notes. (a) Notes evidencing debts settled by completed... the debtor or to the debtor's legal representative. The original and copies of notes will be stamped...

  19. 24 CFR 201.12 - Requirements for the note.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Requirements for the note. 201.12... TITLE I PROPERTY IMPROVEMENT AND MANUFACTURED HOME LOANS Loan and Note Provisions § 201.12 Requirements for the note. The note shall bear the genuine signature of each borrower and of any co-maker or co...

  20. 7 CFR 1779.96 - Termination of Loan Note Guarantee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Termination of Loan Note Guarantee. 1779.96 Section... Termination of Loan Note Guarantee. The Loan Note Guarantee under this part will terminate automatically: (a... the Agency, provided that the lender holds all of the guaranteed portion and the original Loan Note...

  1. 7 CFR 1956.97 - Disposition of promissory notes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 14 2014-01-01 2014-01-01 false Disposition of promissory notes. 1956.97 Section 1956...-Family Housing § 1956.97 Disposition of promissory notes. (a) Notes evidencing debts settled by completed... the debtor or to the debtor's legal representative. The original and copies of notes will be stamped...

  2. 31 CFR 342.2 - Description of notes.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Description of notes. 342.2 Section..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS NOTES § 342.2 Description of notes. (a) General. Savings notes were issued only in registered form and are nontransferable...

  3. 7 CFR 1779.96 - Termination of Loan Note Guarantee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Termination of Loan Note Guarantee. 1779.96 Section... Termination of Loan Note Guarantee. The Loan Note Guarantee under this part will terminate automatically: (a... the Agency, provided that the lender holds all of the guaranteed portion and the original Loan Note...

  4. 7 CFR 1779.96 - Termination of Loan Note Guarantee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 12 2011-01-01 2011-01-01 false Termination of Loan Note Guarantee. 1779.96 Section... Termination of Loan Note Guarantee. The Loan Note Guarantee under this part will terminate automatically: (a... the Agency, provided that the lender holds all of the guaranteed portion and the original Loan Note...

  5. 12 CFR 615.5105 - Consolidated Systemwide notes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Consolidated Systemwide notes. 615.5105 Section..., LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Issuance of Bonds, Notes, Debentures and Similar Obligations § 615.5105 Consolidated Systemwide notes. Consolidated Systemwide notes authorized under § 615...

  6. DigiMemo: Facilitating the Note Taking Process

    ERIC Educational Resources Information Center

    Kurt, Serhat

    2009-01-01

    Everyone takes notes daily for various reasons. Note taking is very popular in school settings and generally recognized as an effective learning strategy. Further, note taking is a complex process because it requires understanding, selection of information and writing. Some new technological tools may facilitate the note taking process. Among such…

  7. Hybrid vigour in dogs?

    PubMed

    Nicholas, Frank W; Arnott, Elizabeth R; McGreevy, Paul D

    2016-08-01

    Evidence from other species justifies the hypotheses that useful hybrid vigour occurs in dogs and that it can be exploited for improved health, welfare and fitness for purpose. Unfortunately, most of the relevant published canine studies do not provide estimates of actual hybrid vigour because of inadequate specification of the parentage of mixed-bred dogs. To our knowledge, only three published studies have shed any light on actual hybrid vigour in dogs. There are two reports of actual hybrid vigour between Labrador and Golden retrievers, the first ranging from +2.5% to -6.0% for components of a standardised applied-stimulus behavioural test, and the second being at least +12.4% for chance of graduating as a guide dog. The third study provides a minimum estimate of negative actual hybrid vigour: crossbreds between Labrador retrievers and poodles had a higher prevalence of multifocal retinal dysplasia than the average prevalence in their purebred parent breeds. The lack of estimates of actual hybrid vigour can be overcome by including the exact nature of the cross (e.g. F1, F2 or backcross) and their purebred parental breeds in the specification of mixed-bred dogs. Even if only F1 crossbreds can be categorised, this change would enable researchers to conduct substantial investigations to determine whether hybrid vigour has any utility for dog breeding. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Hybrid Bloch brane

    NASA Astrophysics Data System (ADS)

    Bazeia, D.; Lima, Elisama E. M.; Losano, L.

    2017-02-01

    This work reports on models described by two real scalar fields coupled with gravity in the five-dimensional spacetime, with a warped geometry involving one infinite extra dimension. Through a mechanism that smoothly changes a thick brane into a hybrid brane, one investigates the appearance of hybrid branes hosting internal structure, characterized by the splitting on the energy density and the volcano potential, induced by the parameter which controls interactions between the two scalar fields. In particular, we investigate distinct symmetric and asymmetric hybrid brane scenarios.

  9. Hybrid electric vehicles TOPTEC

    SciTech Connect

    1994-06-21

    This one-day TOPTEC session began with an overview of hybrid electric vehicle technology. Updates were given on alternative types of energy storage, APU control for low emissions, simulation programs, and industry and government activities. The keynote speech was about battery technology, a key element to the success of hybrids. The TOPEC concluded with a panel discussion on the mission of hybrid electric vehicles, with a perspective from industry and government experts from United States and Canada on their view of the role of this technology.

  10. Hybrid Vibrio vulnificus

    PubMed Central

    Cohen, Daniel I.; Harding, Rosalind M.; Falush, Daniel; Crook, Derrick W.; Peto, Tim; Maiden, Martin C.

    2005-01-01

    The recent emergence of the human-pathogenic Vibrio vulnificus in Israel was investigated by using multilocus genotype data and modern molecular evolutionary analysis tools. We show that this pathogen is a hybrid organism that evolved by the hybridization of the genomes from 2 distinct and independent populations. These findings provide clear evidence of how hybridization between 2 existing and nonpathogenic forms has apparently led to the emergence of an epidemic infectious disease caused by this pathogenic variant. This novel observation shows yet another way in which epidemic organisms arise. PMID:15705319

  11. Hybrid matrix fiber composites

    DOEpatents

    Deteresa, Steven J.; Lyon, Richard E.; Groves, Scott E.

    2003-07-15

    Hybrid matrix fiber composites having enhanced compressive performance as well as enhanced stiffness, toughness and durability suitable for compression-critical applications. The methods for producing the fiber composites using matrix hybridization. The hybrid matrix fiber composites include two chemically or physically bonded matrix materials, whereas the first matrix materials are used to impregnate multi-filament fibers formed into ribbons and the second matrix material is placed around and between the fiber ribbons that are impregnated with the first matrix material and both matrix materials are cured and solidified.

  12. Artificial mismatch hybridization

    DOEpatents

    Guo, Zhen; Smith, Lloyd M.

    1998-01-01

    An improved nucleic acid hybridization process is provided which employs a modified oligonucleotide and improves the ability to discriminate a control nucleic acid target from a variant nucleic acid target containing a sequence variation. The modified probe contains at least one artificial mismatch relative to the control nucleic acid target in addition to any mismatch(es) arising from the sequence variation. The invention has direct and advantageous application to numerous existing hybridization methods, including, applications that employ, for example, the Polymerase Chain Reaction, allele-specific nucleic acid sequencing methods, and diagnostic hybridization methods.

  13. Molecular Design of Low-Density Multifunctional Hybrid Materials

    DTIC Science & Technology

    2016-01-01

    THE ABOVE ORGANIZATION . 1. REPORT DATE (DD-MM-YYYY) 29-01-2016 2. REPORT TYPE Final Report 3. DATES COVERED (From - To) April 1, 2012 - Oct. 31... ORGANIZATION NAME(S) AND ADDRESS(ES) Stanford University Department of Materials Science and Engineering 8. PERFORMING ORGANIZATION REPORT NUMBER...AVAILABILITY STATEMENT No distribution limitation. 13. SUPPLEMENTARY NOTES 14. ABSTRACT Low-density hybrid materials, which contain organic and

  14. Hybrid LES of Detonations in Reacting Multi-Phase Mixtures

    DTIC Science & Technology

    2009-02-28

    SUPPLEMENTARY NOTES 14. ABSTRACT A Large -Eddy Simulation (LES) methodology adapted to the resolution of high Reynolds number turbulent flows in...SUBJECT TERMS Large Eddy Simulation, hybrid shock capturing, compressible turbulence, shock-shear interactions 16. SECURITY CLASSIFICATION OF: a... Large scale structures for the reference JICF 125 5.13 Contours of temperature gradients magnitude and of Mach number field for the reference

  15. Chaotic mixer improves microarray hybridization.

    PubMed

    McQuain, Mark K; Seale, Kevin; Peek, Joel; Fisher, Timothy S; Levy, Shawn; Stremler, Mark A; Haselton, Frederick R

    2004-02-15

    Hybridization is an important aspect of microarray experimental design which influences array signal levels and the repeatability of data within an array and across different arrays. Current methods typically require 24h and use target inefficiently. In these studies, we compare hybridization signals obtained in conventional static hybridization, which depends on diffusional target delivery, with signals obtained in a dynamic hybridization chamber, which employs a fluid mixer based on chaotic advection theory to deliver targets across a conventional glass slide array. Microarrays were printed with a pattern of 102 identical probe spots containing a 65-mer oligonucleotide capture probe. Hybridization of a 725-bp fluorescently labeled target was used to measure average target hybridization levels, local signal-to-noise ratios, and array hybridization uniformity. Dynamic hybridization for 1h with 1 or 10ng of target DNA increased hybridization signal intensities approximately threefold over a 24-h static hybridization. Similarly, a 10- or 60-min dynamic hybridization of 10ng of target DNA increased hybridization signal intensities fourfold over a 24h static hybridization. In time course studies, static hybridization reached a maximum within 8 to 12h using either 1 or 10ng of target. In time course studies using the dynamic hybridization chamber, hybridization using 1ng of target increased to a maximum at 4h and that using 10ng of target did not vary over the time points tested. In comparison to static hybridization, dynamic hybridization reduced the signal-to-noise ratios threefold and reduced spot-to-spot variation twofold. Therefore, we conclude that dynamic hybridization based on a chaotic mixer design improves both the speed of hybridization and the maximum level of hybridization while increasing signal-to-noise ratios and reducing spot-to-spot variation.

  16. Providing Introductory Psychology Students Access to Online Lecture Notes: The Relationship of Note Use to Performance and Class Attendance

    ERIC Educational Resources Information Center

    Grabe, Mark; Christopherson, Kimberly; Douglas, Jason

    2005-01-01

    The relationships among the frequency of access to online lecture notes, examination performance, and class attendance were investigated. Data on use of online notes were gathered from the log maintained by the server and from student responses to a questionnaire. Students who made any attempt to access online notes viewed notes associated with…

  17. 31 CFR 100.18 - Counterfeit notes to be marked; “redemption” of notes wrongfully so marked.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Counterfeit notes to be marked; âredemptionâ of notes wrongfully so marked. 100.18 Section 100.18 Money and Finance: Treasury Regulations... notes to be marked; “redemption” of notes wrongfully so marked. The Act of June 30, 1876 (19 Stat. 4; 31...

  18. Note: Stability control of intermediate frequencies of a three laser far-infrared polarimeter-interferometer system.

    PubMed

    Yu, Jiang-Tao; Li, He-Ping; Nie, Qiu-Yue; Zou, Zhi-Yong; Liu, Hai-Qing; Bao, Cheng-Yu; Jie, Yin-Xian; Li, Zhan-Xian

    2016-12-01

    Stability of the intermediate frequency (IF) in the far-infrared polarimeter-interferometer diagnostic system is critically important for the long pulse discharge experiments on the EAST tokamak. In this note, a real-time remote/local IF stability control system is described. The measured plasma parameters, including the Faraday rotation angle, electron density, lower hybrid wave, and plasma current, are obtained with the aid of this newly developed IF stability control system.

  19. Note: Stability control of intermediate frequencies of a three laser far-infrared polarimeter-interferometer system

    NASA Astrophysics Data System (ADS)

    Yu, Jiang-Tao; Li, He-Ping; Nie, Qiu-Yue; Zou, Zhi-Yong; Liu, Hai-Qing; Bao, Cheng-Yu; Jie, Yin-Xian; Li, Zhan-Xian

    2016-12-01

    Stability of the intermediate frequency (IF) in the far-infrared polarimeter-interferometer diagnostic system is critically important for the long pulse discharge experiments on the EAST tokamak. In this note, a real-time remote/local IF stability control system is described. The measured plasma parameters, including the Faraday rotation angle, electron density, lower hybrid wave, and plasma current, are obtained with the aid of this newly developed IF stability control system.

  20. 15 CFR Notes Applicable to State... - Notes applicable to State of Understanding related to Medical Equipment:

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the practice of medicine (does not include medical research). (2) Commodities or software are... Understanding related to Medical Equipment: applicable Notes applicable to State of Understanding related to Medical Equipment: Commerce and Foreign Trade Regulations Relating to Commerce and Foreign...