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Sample records for par implants permanents

  1. [Permanent pacemaker implantation. Indications and results].

    PubMed

    Gutiérrez, A; Iturralde, P; Gutiérrez Fuster, E; Martínez Ríos, N; Martínez Ríos, M A; Romero, L; Hernández, D; González Hermosillo, J A

    1990-01-01

    Clinical, laboratory and electrocardiographic data from 608 patients with permanent pacemakers implanted over a period of 8 years, were evaluated retrospectively. The number of implants was greater in males (56.5%) and in patients over 60 years of age (77.5%). Atherosclerosis was the most common disease found in this group (50%). Syncope occurred in 96.2% of the cases; and complete AV block was the most common electrocardiographic alteration (50.5%). Electrode displacement occurred in 32 patients (5.2%) and was the most commonly found early complication. Among the late complications, 10.3% of the patients had infections in the area of the generator. The total mortality was 7.7% due to the heart disease rather than pacemaker-related complication.

  2. Effects of magnetic resonance imaging on implantable permanent magnets.

    PubMed

    Schneider, M L; Walker, G B; Dormer, K J

    1995-09-01

    Implantable permanent magnets are increasingly used in devices for otolaryngologic applications. It is likely that at least some of the patients with implanted magnets will be in need of magnetic resonance imaging (MRI). The effect of an MRI scan on the magnetic properties of implanted permanent magnets has not been previously demonstrated. Some of the basic concepts and descriptive terminology used in industry regarding permanent magnets are reviewed. Experiments presented show that the MRI scan is capable of demagnetizing permanent magnets. A case history is also presented that demonstrates demagnetizing of an implanted Audiant magnet by an MRI scan.

  3. Permanent Breast Seed Implant Dosimetry Quality Assurance

    SciTech Connect

    Keller, Brian M.; Ravi, Ananth; Sankreacha, Raxa; Pignol, Jean-Philippe

    2012-05-01

    Purpose: A permanent breast seed implant is a novel method of accelerated partial breast irradiation for women with early-stage breast cancer. This article presents pre- and post-implant dosimetric data, relates these data to clinical outcomes, and makes recommendations for those interested in starting a program. Methods and Materials: A total of 95 consecutive patients were accrued into one of three clinical trials after breast-conserving surgery: a Phase I/II trial (67 patients with infiltrating ductal carcinoma); a Phase II registry trial (25 patients with infiltrating ductal carcinoma); or a multi-center Phase II trial for patients with ductal carcinoma in situ (3 patients). Contouring of the planning target volume (PTV) was done on a Pinnacle workstation and dosimetry calculations, including dose-volume histograms, were done using a Variseed planning computer. Results: The mean pre-implant PTV coverage for the V{sub 90}, V{sub 100}, V{sub 150}, and V{sub 200} were as follows: 98.8% {+-} 1.2% (range, 94.5-100%); 97.3% {+-} 2.1% (range, 90.3-99.9%), 68.8% {+-} 14.3% (range, 32.7-91.5%); and 27.8% {+-} 8.6% (range, 15.1-62.3%). The effect of seed motion was characterized by post-implant dosimetry performed immediately after the implantation (same day) and at 2 months after the implantation. The mean V{sub 100} changed from 85.6% to 88.4% (p = 0.004) and the mean V{sub 200} changed from 36.2% to 48.3% (p < 0.001). Skin toxicity was associated with maximum skin dose (p = 0.014). Conclusions: Preplanning dosimetry should aim for a V{sub 90} of approximately 100%, a V{sub 100} between 95% and 100%, and a V{sub 200} between 20% and 30%, as these numbers are associated with no local recurrences to date and good patient tolerance. In general, the target volume coverage improved over the duration of the seed therapy. The maximum skin dose, defined as the average dose over the hottest 1 Multiplication-Sign 1-cm{sup 2} surface area, should be limited to 90% of the

  4. Femoral approach: an exceptional alternative for permanent pacemaker implantation.

    PubMed

    Tereno Valente, Bruno; Conceição, José M; Nogueira da Silva, Manuel; M Oliveira, Mário; S Cunha, Pedro; Lousinha, Ana; Galrinho, Ana; C Ferreira, Rui

    2014-05-01

    The classic transvenous implantation of a permanent pacemaker in a pectoral location may be precluded by obstruction of venous access through the superior vena cava or recent infection at the implant site. When these barriers to the procedure are bilateral and there are also contraindications or technical difficulties to performing a thoracotomy for an epicardial approach, the femoral vein, although rarely used, can be a viable alternative. We describe the case of a patient with occlusion of both subclavian veins and a high risk for mini-thoracotomy or videothoracoscopy, who underwent implantation of a permanent single-chamber pacemaker via the right femoral vein.

  5. Development and initial testing of a permanently implantable centrifugal pump.

    PubMed

    Nakazawa, T; Takami, Y; Benkowski, R; Ohtsubo, S; Yukio, O; Tayama, E; Ohtsuka, G; Niimi, Y; Glueck, J; Sueoka, A; Schmallegger, H; Schima, H; Wolner, E; Nosé, Y

    1997-07-01

    To be able to salvage heart failure patients, the need for an economical permanent ventricular assist device is increasing. To meet this increasing demand, a miniaturized centrifugal blood pump has been developed as a permanently implantable device. The Gyro permanently implantable model (PI-601) incorporates a sealless design with a blood stagnation free structure. The pump impeller is magnetically coupled to the driver magnet in a sealless manner. This pump is atraumatic and antithrombogenic and incorporates a double pivot bearing system. A miniaturized actuator was utilized in this system in collaboration with the University of Vienna. The priming volume of this pump is 20 ml. The overall size of the pump actuator package is 53 mm in height and 65 mm in diameter, 145 ml of displacement volume, and 305 g in weight. Testing to date has included in vitro hydraulic performance and hemolysis. This pump can provide 5 L/min against a 110 mm Hg total pressure head at 2,000 rpm and 8 L/min against 150 mm Hg at 2,500 rpm. The normalized index of hemolysis (NIH) value of this pump was 0.0028 g/100 L at 5 L/min against 100 mm Hg. A preliminary anatomical study revealed the possibility of the implantability of 2 such systems in biventricular bypass at a preperitoneal location. This system is feasible for use as a permanently implantable biventricular assist device.

  6. Prescription dose in permanent {sup 131}Cs seed prostate implants

    SciTech Connect

    Yue Ning; Heron, Dwight E.; Komanduri, Krishna; Huq, M. Saiful

    2005-08-15

    Recently, {sup 131}Cs seeds have been introduced for prostate permanent seed implants. This type of seed has a relatively short half-life of 9.7 days and has its most prominent emitted photon energy peaks in the 29-34 keV region. Traditionally, 145 and 125 Gy have been prescribed for {sup 125}I and {sup 103}Pd seed prostate implants, respectively. Since both the half-life and dosimetry characteristics of {sup 131}Cs seed are quite different from those of {sup 125}I and {sup 103}Pd, the appropriate prescription dose for {sup 131}Cs seed prostate implant may well be different. This study was designed to use a linear quadratic radiobiological model to determine an appropriate dose prescription scheme for permanent {sup 131}Cs seed prostate implants. In this model, prostate edema was taken into consideration. Calculations were also performed for tumors of different doubling times and for other related radiobiological parameters of different values. As expected, the derived prescription dose values were dependent on type of tumors and types of edema. However, for prostate cancers in which tumor cells are relatively slow growing and are reported to have a mean potential doubling time of around 40 days, the appropriate prescription dose for permanent {sup 131}Cs seed prostate implants was determined to be: 127{sub -12}{sup +5}Gy if the experiences of {sup 125}I seed implants were followed and 121{sub -3}{sup +0}Gy if the experiences of {sup 103}Pd seed implants were followed.

  7. The effect of metal detector gates on implanted permanent pacemakers.

    PubMed

    Copperman, Y; Zarfati, D; Laniado, S

    1988-10-01

    The effect of metal detector security gates, such as are used in airports, was tested in 103 nonselected pacemaker patients. Various types of single and dual chamber units were examined, using telemetry during the test. Pulse rate and duration were measured immediately before and after the procedure. No ill effect was seen on any of the units tested, pacemaker inhibition was not observed, and programmability was not affected. Metal detector security gates have no effect on implanted permanent pacemakers.

  8. Permanent and removable implants for the brachytherapy of brain tumors

    SciTech Connect

    Gutin, P.H.; Phillips, T.L.; Hosobuchi, Y.

    1981-10-01

    Thirty-seven patients harboring primary or metastatic brain tumors were treated with 40 implantations of radioactive sources (/sup 192/Ir, /sup 198/Au, or /sup 125/I) using stereotactic neurosurgical techniques. Most tumors had recurred after surgery, whole brain irradiation, and treatment with all feasible chemotherapeutic agents. Sixteen of the 40 implants were pregnant; 24 were mounted in plastic catheters for removal after the desired dose had been delivered. One or more sources were placed in each tumor to deliver 3500-7350 rad to the tumor's periphery for /sup 198/Au, 4,000-12,000 rad for /sup 192/Ir, and 3,000-20,000 rad for /sup 125/I. Three of the six patients treated with /sup 192/Ir had objective responses for 2, 4, and 12 months, and two stabilized for 8 and 11 months. Seven of the 11 patients treated with /sup 198/Au were evaluable: three responded for 3, 5, and 37 + months, one deteriorating patient with a recurrent tumor stabilized for 6 months, and two deteriorated despite treatment. One patient received an interstitial ''boost'' dose with /sup 198/Au after whole brain irradiation and stabilized for 15 months before developing spinal metastases. Six patients received permanent implants with low activity /sup 125/I. Three of these patients had blioblastomas or anaplastic astrocytomas; all continued to deteriorate despite the interstitial irradiation, presumably because the dose rat was too low. One patient with a low-grade astrocytoma (optic chiasm) responded dramatically to permanent, low activity /sup 125/I implants (11 + months). Another (hypothalamic glioma) had a permanent /sup 125/I implant, responded, as was stable at 9 months when external irradiation was administered. One patient with a suprasellar ''teratoid'' tumor stabilized for 10 months.

  9. Long-term advantages of permanent expandable implants in breast aesthetic surgery.

    PubMed

    Berrino, P; Casabona, F; Santi, P

    1998-06-01

    Permanent expandable implants are widely used in breast reconstructive surgery, but their use in aesthetic surgery is still uncommon. Previous reports on breast expansion-augmentation using permanent expandable implants focused on immediate and early advantages but failed to evaluate long-term benefits, because the reservoir was removed a few months after implantation and the ability to adjust the implant size was lost. Since 1986, we have used permanent expandable implants in 129 women for unilateral or bilateral breast augmentation using the following approach: implants were positioned submuscularly through a transaxillary incision; the filling port was placed a few centimeters below the incision and permanently retained; the implants were positioned underinflated and then overexpanded starting 2 weeks after implantation; after a period of overinflation, deflation to the preoperatively planned volume was scheduled; patients' suggestions regarding final volume adjustments were followed; the effects of repeated overinflations and deflations were investigated in several different conditions. Permanent expandable implants offer unique long-term technical and psychological advantages in the management of highly demanding patients and in the following clinical situations: pregnancy, impending capsular contracture, contralateral progressive ptosis, tubular breasts(s), difficult mammographic examination, spontaneous deflation, and rippling. Disadvantages include economical cost, port-related problems, and repeated requests by patients for volume changes. Saline permanent expandable implants allowed less flexibility in adjusting the breast size and caused discomfort when overexpanded. Permanent expandable implants in breast aesthetic surgery offer several advantages, and because patients can play an active role in deciding volume adjustments, compliance is very high.

  10. Permanent Planar Iodine-125 Implants: The Dosimetric Effect of Geometric Parameters for Idealized Source Configurations

    SciTech Connect

    Cormack, Robert A.

    2007-11-15

    Purpose: To provide dosimetric information about permanent planar {sup 125}I implants in a manner that is useful to the brachytherapist in the operative setting. Methods and Materials: Reference planar permanent implants were simulated for a variety of areas with sources placed uniformly on a 1-cm grid. Implants having variable source spacing and curvature were simulated and compared with the reference implants. Dosimetric measures were calculated at 0.5 and 1.0 cm from the implant plane. Results: A method for calculating dosimetric statistics for permanent implants ranging from 5 x 5 cm to 13 x 13 cm is presented. A formula to predict the reference source strength needed to achieve a desired dosimetric quantity is also presented. The effect of adjusting strand spacing to compensate for source activity is presented and is shown to be an effective means to adjust implants to use source strengths other than the reference strength. The effect of implant curvature compared with flat implants on dosimetric statistics is presented as a function of radius of curvature. Conclusions: The results presented in this work may be used to provide information about dose delivered from planar permanent implants.

  11. Versatile permanent planar implant technique utilizing Iodine-125 seeds imbedded in gelfoam

    SciTech Connect

    Marchese, M.J.; Nori, D.; Anderson, L.L.; Hilaris, B.S.

    1984-05-01

    Tumors attached or adjacent to critical structures can often not be completely resected or resected with adequate surgical margins. Sites involving major blood vessels, the vertebral column or the brain with small residual tumors or suspicious margins often present technical difficulties for standard I-125 or Ir-192 implants. A relatively simple, accurate and inexpensive implant method is decribed using I-125 seeds imbedded in gelfoam to implant permanently into small residual tumors or suspicious margins where standard implant techniques may be unsatisfactory. A method for planning the treatment dose for such an implant is described. Cases involving paraspinal and brain tumors are reported to illustrate the technique.

  12. [Intraoperative and post-implant dosimetry in patients treated with permanent prostate implant brachytherapy].

    PubMed

    Herein, András; Ágoston, Péter; Szabó, Zoltán; Jorgo, Kliton; Markgruber, Balázs; Pesznyák, Csilla; Polgár, Csaba; Major, Tibor

    2015-06-01

    The purpose of our work was to compare intraoperative and four-week post-implant dosimetry for loose and stranded seed implants for permanent prostate implant brachytherapy. In our institute low-dose-rate (LDR) prostate brachytherapy is performed with encapsulated I-125 isotopes (seeds) using transrectal ultrasound guidance and metal needles. The SPOT PRO 3.1 (Elekta, Sweden) system is used for treatment planning. In this study the first 79 patients were treated with loose seed (LS) technique, the consecutive patients were treated with stranded seed (SS) technique. During intraoperative planning the dose constraints were the same for both techniques. All LSs were placed inside the prostate capsule, while with SS a 2 mm margin around the prostate was allowed for seed positioning. The prescribed dose for the prostate was 145 Gy. This study investigated prostate dose coverage in 30-30 randomly selected patients with LS and SS. Four weeks after the implantation native CT and MRI were done and CT/MRI image fusion was performed. The target was contoured on MRI and the plan was prepared on CT data. To assess the treatment plan dose-volume histograms were used. For the target coverage V100, V90, D90, D100, for the dose inhomogeneity V150, V200, and the dose-homogeneity index (DHI), for dose conformality the conformal index (COIN) were calculated. Intraoperative and postimplant plans were compared. The mean V100 values decreased at four-week plan for SS (97% vs. 84%) and for LS (96% vs. 80%) technique, as well. Decrease was observed for all parameters except for the DHI value. The DHI increased for SS (0.38 vs. 0.41) and for LS (0.38 vs. 0.47) technique, as well. The COIN decreased for both techniques at four-week plan (SS: 0.63 vs. 0.57; LS: 0.67 vs. 0.50). All differences were significant except for the DHI value at SS technique. The percentage changes were not significant, except the COIN value. The dose coverage of the target decreased significantly at four-week plans

  13. [Clinical application of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery].

    PubMed

    Ren, C L; Jiang, S L; Xiao, C S; Wang, R; Gao, C Q

    2017-04-25

    Objective: To summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. Methods: From November 2014 to July 2016, 15 patients (9 males and 6 females) with ages ranging from 50 to 73 (63.5±6.2) years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach. Among them, single chamber pacemaker (n=10) and dual chamber pacemaker (n=5) permanent epicardial pacing leads were implanted. Simultaneous procedures included valve replacement in 7 cases, valve replacement combined with atrial fibrillation ablation in 3 cases, coronary artery bypass grafting in 2 cases, aortic root replacement in 2 cases, and valve replacement combined with coronary artery bypass surgery in 1 case. Their parameters of pacemaker including sensitivity, pacing threshold, pacing impedance were measured during surgery and closely followed up at 1 week and 3, 6 months after surgery. Results: All 15 patients with epicardial permanent pacemaker implantation in the same period of cardiac surgery were successfully cured and discharged, without any surgical complications. A total of 20 epicardial electrodes were implanted for them including 5 right atrial electrodes and 15 right ventricular electrodes. The postoperative follow-up period ranged from 3 to 22 months. No electrode fracture and surgical wound infection occurred in those patients, and their impedance, sensing and stimulation thresholds were all in normal ranges during follow-up. Conclusions: For patients with bradycardia who required cardiac surgery, one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery is safe and effective, and the results in the short-term and medium-term are satisfactory, avoiding the risk of staged surgery.

  14. 78 FR 41125 - Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-09

    ... COMMISSION Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting AGENCY... discretion for certain violations of regulations for reporting medical events occurring under an NRC licensee...: Background In SECY-05-0234, ``Adequacy of Medical Event Definitions in 10 CFR 35.3045, and...

  15. Permanent transvenous pacemaker implantation in an Ibizan hound cross with persistent atrial standstill

    PubMed Central

    MacAulay, Kevin

    2002-01-01

    An Ibizan hound cross was referred with a 1-year history of syncope and exercise intolerance. An electrocardiogram showed bradycardia and no P waves; atrial standstill was diagnosed. A permanent artificial endocardial pacemaker was implanted. The lead dislodged and was reimplanted into the right ventricular apex. Capture was once again achieved. PMID:12395764

  16. Transvenous permanent pacemaker implantation in dextrocardia: technique, challenges, outcome, and a brief review of literature.

    PubMed

    Shenthar, Jayaprakash; Rai, Maneesh K; Walia, Rohit; Ghanta, Somasekhar; Sreekumar, Praveen; Reddy, Satish S

    2014-09-01

    Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce. The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement. Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  17. Late-Onset Inadvertent Bleb Formation following Pars Plana M3 Molteno Implant Tube Obstruction

    PubMed Central

    Abdul-Rahman, Anmar M.; Molteno, Anthony

    2017-01-01

    Purpose To report a case of inadvertent bleb formation presenting 18 months after pars plana M3 Molteno implant tube obstruction in a patient with mixed mechanism glaucoma. Materials and Methods An 84-year-old Caucasian male with mixed mechanism glaucoma underwent slit-lamp examination, gonioscopy, colour anterior segment photography and anterior segment optical coherence tomography (AS-OCT). Results An inadvertent bleb developed 18 months after pars plana implant tube re-positioning with a 6/0 Vicryl tie ligature. The bleb was located in the area anterior to the implant plate; it was characterised by a thin, transparent, avascular and multi-cystic wall, with a visible stoma at the posterior edge of the bleb. The bleb was functioning as demonstrated by an intraocular pressure of 6 mm Hg at presentation and a punctate fluorescein uptake pattern of the bleb wall. The bleb over the plate of the Molteno implant was non-functioning, likely secondary to tube obstruction by vitreous in the early postoperative period. AS-OCT showed a tract from the anterior chamber commencing at an entry wound through a corneal tunnel to the posterior stoma at the base of the inadvertent bleb. Conclusions We hypothesise that the pathophysiologic factors resulting in an inadvertent bleb are a result of a combination of apoptosis, late-onset wound dehiscence and internal gaping of a centrally placed corneal wound. In addition, aqueous hydrodynamic factors may play a role. PMID:28203200

  18. [TRENDS OF PERMANENT PACEMAKER IMPLANTATION IN A SINGLE CENTER OVER A 20-YEAR PERIOD].

    PubMed

    Antonelli, Dante; Ilan, Limor Bushar; Freedberg, Nahum A; Feldman, Alexander; Turgeman, Yoav

    2015-05-01

    To review the changes in permanent pacemaker implantation indications, pacing modes and patients' demographics over a 20-year period. We retrospectively retrieved data on patients who underwent first implantation of the pacemaker between 1-1-1991 and 31-12-2010. One thousand and nine (1,009) patients underwent a first pacemaker implantation during that period; 535 were men (53%), their mean age was 74.6±19.5 years; the highest rate of implanted pacemaker was in patients ranging in age from 70-79 years, however there was an increasing number of patients aged over 80 years. The median survival time after initial pacemaker implantation was 8 years. Syncope was the most common symptom (62.5%) and atrioventricular block was the most common electrocardiographic indication (56.4%) leading to pacemaker implantation. There was increased utilization of dual chamber and rate responsive pacemakers over the years. There was no difference regarding mode selection between genders. Pacemaker implantation rates have increased over a 20-year period. Dual chamber replaced most of the single ventricular chamber pacemaker and rate responsive pacemakers became the norm. The data of a small volume center are similar to those reported in pacemaker surveys of high volume pacemaker implantation centers. They confirm adherence to the published guidelines for pacing.

  19. Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation

    PubMed Central

    Jang, Sung-Won; Rho, Robert W; Kim, Tae-Seok; Kim, Sung-Hwan; Shin, Woo-Seung; Kim, Ji-Hoon; Oh, Yong-Seog; Lee, Man Young; Zen, Eiwa

    2016-01-01

    Background and Objectives The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM. Materials and Methods Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation. Results Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality. Conclusion Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan. PMID:27721856

  20. Concomitant Use of the Subcutaneous Implantable Cardioverter Defibrillator and a Permanent Pacemaker.

    PubMed

    Huang, Jason; Patton, Kristen K; Prutkin, Jordan M

    2016-11-01

    The subcutaneous implantable cardioverter defibrillator (S-ICD) is a novel implanted defibrillator for the prevention of sudden cardiac death that avoids intravascular access. Use of this device is limited by its inability to provide backup pacing. Combined use of the S-ICD with a permanent pacemaker may be the optimal choice in certain situations though experience with the use of both devices together remains limited. We reviewed our single-center experience with the S-ICD from March 2011 to November 2015. Four patients with concomitant use of the S-ICD and a permanent pacemaker were identified. Clinical indication for device therapy, operative details, and subsequent follow-up was reviewed. During implantation, S-ICD sensing of paced morphologies was evaluated at maximal voltage output. After S-ICD implant, if feasible, the upper rate was adjusted to ≤50% of the S-ICD tachycardia zone to minimize risk of inappropriate shocks. After a mean follow-up of over 1 year, no adverse events occurred, including no inappropriate shock, lead malfunction, or device infection. One patient had a total of eight appropriate shocks, while another individual had no inappropriate shocks despite having a unipolar pacing lead. In unique situations, combined use of the S-ICD and a permanent pacemaker may be preferable to alternative options. In our experience, this approach was successful in varying conditions including complex congenital heart disease, recurrent device infection, and limited vascular access. © 2016 Wiley Periodicals, Inc.

  1. Online gamma-camera imaging of 103Pd seeds (OGIPS) for permanent breast seed implantation

    NASA Astrophysics Data System (ADS)

    Ravi, Ananth; Caldwell, Curtis B.; Keller, Brian M.; Reznik, Alla; Pignol, Jean-Philippe

    2007-09-01

    Permanent brachytherapy seed implantation is being investigated as a mode of accelerated partial breast irradiation for early stage breast cancer patients. Currently, the seeds are poorly visualized during the procedure making it difficult to perform a real-time correction of the implantation if required. The objective was to determine if a customized gamma-camera can accurately localize the seeds during implantation. Monte Carlo simulations of a CZT based gamma-camera were used to assess whether images of suitable quality could be derived by detecting the 21 keV photons emitted from 74 MBq 103Pd brachytherapy seeds. A hexagonal parallel hole collimator with a hole length of 38 mm, hole diameter of 1.2 mm and 0.2 mm septa, was modeled. The design of the gamma-camera was evaluated on a realistic model of the breast and three layers of the seed distribution (55 seeds) based on a pre-implantation CT treatment plan. The Monte Carlo simulations showed that the gamma-camera was able to localize the seeds with a maximum error of 2.0 mm, using only two views and 20 s of imaging. A gamma-camera can potentially be used as an intra-procedural image guidance system for quality assurance for permanent breast seed implantation.

  2. Monte Carlo calculated doses to treatment volumes and organs at risk for permanent implant lung brachytherapy.

    PubMed

    Sutherland, J G H; Furutani, K M; Thomson, R M

    2013-10-21

    Iodine-125 ((125)I) and Caesium-131 ((131)Cs) brachytherapy have been used with sublobar resection to treat stage I non-small cell lung cancer and other radionuclides, (169)Yb and (103)Pd, are considered for these treatments. This work investigates the dosimetry of permanent implant lung brachytherapy for a range of source energies and various implant sites in the lung. Monte Carlo calculated doses are calculated in a patient CT-derived computational phantom using the EGsnrc user-code BrachyDose. Calculations are performed for (103)Pd, (125)I, (131)Cs seeds and 50 and 100 keV point sources for 17 implant positions. Doses to treatment volumes, ipsilateral lung, aorta, and heart are determined and compared to those determined using the TG-43 approach. Considerable variation with source energy and differences between model-based and TG-43 doses are found for both treatment volumes and organs. Doses to the heart and aorta generally increase with increasing source energy. TG-43 underestimates the dose to the heart and aorta for all implants except those nearest to these organs where the dose is overestimated. Results suggest that model-based dose calculations are crucial for selecting prescription doses, comparing clinical endpoints, and studying radiobiological effects for permanent implant lung brachytherapy.

  3. Monte Carlo calculated doses to treatment volumes and organs at risk for permanent implant lung brachytherapy

    NASA Astrophysics Data System (ADS)

    Sutherland, J. G. H.; Furutani, K. M.; Thomson, R. M.

    2013-10-01

    Iodine-125 (125I) and Caesium-131 (131Cs) brachytherapy have been used with sublobar resection to treat stage I non-small cell lung cancer and other radionuclides, 169Yb and 103Pd, are considered for these treatments. This work investigates the dosimetry of permanent implant lung brachytherapy for a range of source energies and various implant sites in the lung. Monte Carlo calculated doses are calculated in a patient CT-derived computational phantom using the EGsnrc user-code BrachyDose. Calculations are performed for 103Pd, 125I, 131Cs seeds and 50 and 100 keV point sources for 17 implant positions. Doses to treatment volumes, ipsilateral lung, aorta, and heart are determined and compared to those determined using the TG-43 approach. Considerable variation with source energy and differences between model-based and TG-43 doses are found for both treatment volumes and organs. Doses to the heart and aorta generally increase with increasing source energy. TG-43 underestimates the dose to the heart and aorta for all implants except those nearest to these organs where the dose is overestimated. Results suggest that model-based dose calculations are crucial for selecting prescription doses, comparing clinical endpoints, and studying radiobiological effects for permanent implant lung brachytherapy.

  4. Assessment of wrought ASTM F1058 cobalt alloy properties for permanent surgical implants.

    PubMed

    Clerc, C O; Jedwab, M R; Mayer, D W; Thompson, P J; Stinson, J S

    1997-01-01

    The behavior of the ASTM F1058 wrought cobalt-chromium-nickel-molybdenum-iron alloy (commonly referred to as Elgiloy or Phynox) is evaluated in terms of mechanical properties, magnetic resonance imaging, corrosion resistance, and biocompatibility. The data found in the literature, the experimental corrosion and biocompatibility results presented in this article, and its long track record as an implant material demonstrate that the cobalt superalloy is an appropriate material for permanent surgical implants that require high yield strength and fatigue resistance combined with high elastic modulus, and that it can be safely imaged with magnetic resonance.

  5. [Experience of brachytherapy using I-125 seed permanent implants for localized prostate cancer].

    PubMed

    Toya, Kazuhito; Yorozu, Atsunori; Ohashi, Toshio; Okada, Masahiro; Itoh, Reiko; Monma, Tetsuo; Saito, Shiro; Fukada, Junichi; Sugawara, Akitomo; Dokiya, Takushi

    2005-10-01

    We report here our experience of brachytherapy using I-125 seeds for localized prostate cancer in 100 patients. We carried out brachytherapy with I-125 seed permanent implants in 100 patients with localized prostate cancer between September 2003 and October 2004. Preplanning dosimetry was done using transrectal ultrasonic images obtained three or four weeks prior to treatment. Using transrectal ultrasound, we inserted I-125 seeds in the prostate through needles according to the preplanning diagram. We then examined the results on prostate CT performed one month later. It was necessary to describe transrectal ultrasonic image such as preplanning. There were several cases in which the source arrangement of the schedule was corrected immediately before the operation. In the examination after one month, the numerical value at the start of treatment initially was not satisfactory, but we eventually obtained a result that could to be evaluated. We carried out permanent implant brachytherapy for localized prostate cancer using I-125 seeds and reported our experience.

  6. [Behaviour of some serum enzymes after permanent pacemaker implantation (author's transl)].

    PubMed

    Cappelletti, F; Maiolino, P; Allegri, P; Barbieri, E; de Lio, U; Morlino, T; Ometto, R; Vincenzi, M

    1978-01-01

    The behaviour of some serum enzymes (CPK, LDH, alpha HBDH, SGOT) in 50 patients after permanent pacemaker implantation is outlined. Changes of each enzyme were analyzed statistically by applying Student's t test. Most significant changes are represented by the increase in CPK serum concentrations (19 cases). In 14 of them LDH isoenzymes were evaluated and in 4 patients alteration of LDH1/LDH2 ratio suggestive of cardiac "injury" were observed.

  7. Complications of Permanent Hemodialysis Catheter Placement; Need for Better Pre-Implantation Algorithm?

    PubMed

    Premuzic, Vedran; Smiljanic, Ranko; Perkov, Drazen; Gavranic, Bruna Brunetta; Tomasevic, Boris; Jelakovic, Bojan

    2016-08-01

    There is a correlation between central venous cannulation and the development of central venous stenosis. Minor retrosternal vein lesions can be easily missed. Computerized tomographic (CT) venography is the diagnostic procedure of choice. The aim of this study was to examine the complications after catheter implantation in patients with prior permanent catheter placement and to evaluate present diagnostic procedures performed prior to choosing permanent access site in order to reduce possible complications after catheter placement. Complications of permanent CVC insertion in our department were analyzed between October 2011 and February 2015. We have implanted the Tesio twin catheter system and the Hickman Bard dual lumen catheter. All patients with prior permanent dialysis catheter were evaluated with color doppler, while patients with suspected central venous stenosis (CVS) or thrombosis were evaluated with phlebography or CT venography prior to catheter placement. One hundred and ninety-eight permanent dialysis catheters were placed (173 Tesio [87.4%] and 25 Hickman [12.6%]) in 163 patients. There were 125 patients (76.7%) with prior temporary catheter and 61 (48.8%) of them had more than one prior permanent catheter (1.92 catheter per person).There were 4/61 (6.5%) patients with catheter-related complications without prior phlebography and CT venography. Phlebography and CT venography were performed in 30 (24.0%) patients with suspected CVS/thrombosis and with dialysis vintage of 76.23 months (52.78-98.28). Phlebography and CT venography were more sensitive than color doppler in the detection of CVS/thrombosis in patients with prior permanent catheter placements (P < 0.001). Since this diagnostic algorithm was introduced prior to catheter placement there were no catheter insertion-related complications or dysfunctions (P < 0.001). All our procedures on patients with prior permanent catheters followed preliminary color doppler diagnostics. Nevertheless

  8. Dosimetric intercomparison of permanent Ho-166 seed's implants and HDR Ir-192 brachytherapy in breast cancer.

    PubMed

    de Campos, Tarcisio Passos Ribeiro; Nogueira, Luciana Batista; Trindade, Bruno; Cuperschmid, Ethel Mizrahy

    2016-01-01

    To provide a comparative dosimetric analysis of permanent implants of Ho(166)-seeds and temporary HDR Ir(192)-brachytherapy through computational simulation. Brachytherapy with Ir(192)-HDR or LDR based on temporary wires or permanent radioactive seed implants can be used as dose reinforcement for breast radiation therapy. Permanent breast implants have not been a practical clinical routine; although, I(125) and Pd(103)-seeds have already been reported. Biodegradable Ho(166)-ceramic-seeds have been addressed recently. Simulations of implants of nine Ho(166)-seeds and equivalent with HDR Ir(192)-brachytherapy were elaborated in MCNP5, shaped in a computational multivoxel simulator which reproduced a female thorax phantom. Spatial dose rate distributions and dose-volume histograms were generated. Protocol's analysis involving exposure time, seed's activities and dose were performed. Permanent Ho(166)-seed implants presented a maximum dose rate per unit of contained activity (MDR) of 1.1601 μGy h(-1) Bq(-1); and, a normalized MDR in standard points (8 mm, equidistant to 03-seeds - SP1, 10 mm - SP2) of 1.0% (SP1) and 0.5% (SP2), respectively. Ir(192)-brachytherapy presented MDR of 4.3945 × 10(-3) μGy h(-1) Bq(-1); and, 30% (SP1), and 20% (SP2). Therefore, seed's implant activities of 333 MBq (Ho(166)) and 259 GBq (Ir(192)) produced prescribed doses of 58 Gy (SP1; 5d) and 56 Gy (SP1, 5 fractions, 6 min), respectively. Breast Ho(166)-implants of 37-111 MBq are attractive due to the high dose rate near 6-10 mm from seeds, equivalent to Ir(192)-brachytherapy of 259 GBq (3 fractions, 6 min) providing similar dose in standard points at a week; however, with spatial dose distribution better confined. The seed positioning can be adjusted for controlling the breast tumor, in stages I and II, in flat and deep tumors, without any breast volumetric limitation.

  9. Feasibility and efficacy of electrical cardioversion after cardiac resynchronization implantation in patients with permanent atrial fibrillation.

    PubMed

    Turco, Pietro; D'Onofrio, Antonio; Stabile, Giuseppe; Solimene, Francesco; La Rocca, Vincenzo; Vecchione, Filippo; Iuliano, Assunta; Marrazzo, Natale; De Vivo, Stefano; Cavallaro, Ciro; Bianchi, Valter; Agresta, Alessia; Ciardiello, Carmine; De Simone, Antonio

    2012-12-01

    Patients with permanent atrial fibrillation (AF) who undergo cardiac resynchronization therapy (CRT) may spontaneously recover sinus rhythm during follow-up. We tested the feasibility and efficacy of electrical cardioversion attempted after 3 months of CRT in patients with permanent AF and measured the long-term maintenance of sinus rhythm. Twenty-eight consecutive patients with permanent AF in whom CRT defibrillators had been implanted were scheduled for internal electrical cardioversion after 3 months (group A) and were compared with a control group of 27 patients (group B). In group A, 22 patients (79 %) were eligible for cardioversion; sinus rhythm was restored in 18 (82 %) of these, with no procedural complications. After 12 months, 16 patients (58 %) in group A were in sinus rhythm, compared with one group B patient who spontaneously recovered sinus rhythm (4 %, p < 0.001). On 12-month evaluation, ejection fraction had improved in both groups, but a reduction in left ventricular end-systolic volume was recorded only in group A patients (p = 0.018 versus baseline). In patients with permanent AF, the rhythm control strategy consisting of internal cardioversion, performed by means of the implanted cardioverter-defibrillator after 3 months of CRT, was associated with a high rate of sinus rhythm resumption on long-term follow-up and with a better echocardiographic response to CRT than that seen in patients treated according to a rate control strategy.

  10. Implant of permanent pacemaker during acute coronary syndrome: Mortality and associated factors in the ARIAM registry.

    PubMed

    Pola-Gallego-de-Guzmán, María Dolores; Ruiz-Bailén, Manuel; Martínez-Arcos, Maria-Angeles; Gómez-Blizniak, Artur; Castillo Rivera, Ana-Maria; Molinos, Jesus Cobo

    2017-03-01

    Patients with acute coronary syndrome complicated with high degree atrioventricular block still have a high mortality. A low percentage of these patients need a permanent pacemaker (PPM) but mortality and associated factors with the PPM implant in acute coronary syndrome patients are not known. We assess whether PPM implant is an independent variable in the mortality of acute coronary syndrome patients. Also, we explored the variables that remain independently associated with PPM implantation. This was an observational study on the Spanish ARIAM register. The inclusion period was from January 2001 to December 2011. This registry included all Andalusian acute coronary syndrome patients. Follow-up for global mortality was until November 2013. We selected 27,608 cases. In 62 patients a PPM was implanted (0.024%). The mean age in PPM patients was 70.71±11.214 years versus 64.46±12.985 years in patients with no PPM. PPM implant was associated independently with age (odds ratio (OR) 1.031, 95% confidence interval (CI) 1.007-1.055), with left ventricular branch block (OR 6.622, 95% CI 2.439-18.181), with any arrhythmia at intensive care unit admission (OR 2.754, 95% CI 1.506-5.025) and with heart failure (OR 3.344, 95% CI 1.78-8.333). PPM implant was independently associated with mortality (OR 11.436, 95% CI 1.576-83.009). In propensity score analysis PPM implant was still associated with mortality (OR 5.79, 95% CI 3.27-25.63). PPM implant is associated with mortality in the acute coronary syndrome population in the ARIAM registry. Advanced age, heart failure, arrhythmias and left ventricular branch block at intensive care unit admission were found associated factors with PPM implant in acute coronary syndrome patient.

  11. Determination of prescription dose for Cs-131 permanent implants using the BED formalism including resensitization correction

    SciTech Connect

    Luo, Wei Molloy, Janelle; Aryal, Prakash; Feddock, Jonathan; Randall, Marcus

    2014-02-15

    Purpose: The current widely used biological equivalent dose (BED) formalism for permanent implants is based on the linear-quadratic model that includes cell repair and repopulation but not resensitization (redistribution and reoxygenation). The authors propose a BED formalism that includes all the four biological effects (4Rs), and the authors propose how it can be used to calculate appropriate prescription doses for permanent implants with Cs-131. Methods: A resensitization correction was added to the BED calculation for permanent implants to account for 4Rs. Using the same BED, the prescription doses with Au-198, I-125, and Pd-103 were converted to the isoeffective Cs-131 prescription doses. The conversion factor F, ratio of the Cs-131 dose to the equivalent dose with the other reference isotope (F{sub r}: with resensitization, F{sub n}: without resensitization), was thus derived and used for actual prescription. Different values of biological parameters such as α, β, and relative biological effectiveness for different types of tumors were used for the calculation. Results: Prescription doses with I-125, Pd-103, and Au-198 ranging from 10 to 160 Gy were converted into prescription doses with Cs-131. The difference in dose conversion factors with (F{sub r}) and without (F{sub n}) resensitization was significant but varied with different isotopes and different types of tumors. The conversion factors also varied with different doses. For I-125, the average values of F{sub r}/F{sub n} were 0.51/0.46, for fast growing tumors, and 0.88/0.77 for slow growing tumors. For Pd-103, the average values of F{sub r}/F{sub n} were 1.25/1.15 for fast growing tumors, and 1.28/1.22 for slow growing tumors. For Au-198, the average values of F{sub r}/F{sub n} were 1.08/1.25 for fast growing tumors, and 1.00/1.06 for slow growing tumors. Using the biological parameters for the HeLa/C4-I cells, the averaged value of F{sub r} was 1.07/1.11 (rounded to 1.1), and the averaged value of F

  12. External beam radiotherapy boosts to reduce the impact caused by edema in prostate permanent seed implants

    NASA Astrophysics Data System (ADS)

    Yue, Ning; Mori, Jonathan; Nath, Ravinder; Heron, Dwight E.; Saiful Huq, M.

    2006-05-01

    In prostate permanent seed implants, it has been shown that edema caused by the surgical procedure decreases dose coverage and hence may reduce treatment efficacy. This reduction in treatment efficacy has been characterized by an increase in tumour cell survival, and biomathematical models have been developed to calculate the tumour cell survival increases in seed implanted prostates of different edema magnitudes and durations. External beam boosts can be utilized to neutralize the negative impact of edema so that originally desired treatment efficacy can be achieved. In this study, a linear quadratic model is used to determine fractionation sizes of the external beam boosts for both 125I and 103Pd seed implants. Calculations were performed for prostates of different edema magnitudes and durations, and for tumour cells of different repair rates and repopulation rates.

  13. Adjuvant stereotactic permanent seed breast implant: A boost series in view of partial breast irradiation

    SciTech Connect

    Jansen, Nicolas . E-mail: nicolas.jansen@chu.ulg.ac.be; Deneufbourg, Jean-Marie; Nickers, Philippe

    2007-03-15

    Purpose: The aim of this study was to use permanent seed implants in the breast and describe our experience with 15 cases, using iodine seed implants as a tumor bed boost. Methods and Materials: Breasts were fixed with a thermoplastic sheet, a template bridge applied, the thorax scanned and the images rotated to be perpendicular to the implant axis. Skin, heart, and lung were delineated. A preplan was made, prescribing 50 Gy to the clinical target volume (CTV), consisting in this boost series of nearly a quadrant. Iodine (125) seeds were stereotactically implanted through the template, and results were checked with a postplan computed tomographic (CT) scan. Results: The breast was immobilized reproducibly. Simulation, scanning, and implant were performed without difficulties. Preplan CTV D90% (the dose delivered to 90% of the CTV) was 66 Gy, and postoperative fluoroscopic or CT scan checks were satisfactory. Pre- and postplan dose-volume histogram showed good organ sparing: mean postplan skin, heart, and lung V30 Gy (the organ volume receiving a dose of 30 Gy) of 2 {+-} 2.2 mL, 0.24 {+-} 0.34 mL, and 3.5 {+-} 5 mL, respectively. No short-term toxicity above Grade 1 was noted, except for transient Grade 3 neuropathy in 1 patient. Conclusions: Seeds remained in the right place, as assessed by fluoroscopy, absence of significant pre- to postplan dose-volume histogram change for critical organs, and total irradiated breast volume. The method could be proposed as a boost when high dosimetric selectivity is required (young patients after cardiotoxic chemotherapy for left-sided cancer). This boost series was a preliminary step before testing partial breast irradiation by permanent seed implant in a prospective trial.

  14. Permanent implants for lip augmentation: Results from a retrospective study and presentation of tips and tricks.

    PubMed

    Guida, S; Mandel, V D; Farnetani, F; Manola, C M; Rubino, G; Ruzzu, S; Pellacani, G; Longo, C; Urtis, G G

    2017-05-01

    Requests for lip augmentation are increasing because of expanding media exposure and consumer needs. Temporary effects can be obtained by several techniques, but a recent procedure consisting of lip prosthesis implantation, offering a permanent result, is emerging. Accordingly, the implantation of solid lip prosthesis represents an innovation in the field of esthetic medicine and surgery. A total of 100 women with atrophic or hypoplastic lips were treated with lip implants. The treatment was performed in a single session, and controls were scheduled at fixed time intervals. A standard digital photo was used for measurement and analysis. Data concerning patient satisfaction and complications of the technique were collected and analyzed. Variations to the original technique were also discussed. Patient evaluation revealed that a permanent and natural result without discomfort for the patient and/or the partner was reached with the implantation of silicone prosthesis in the upper and/or lower lip. Swelling, bruising, and malpositions were the most frequent adverse events. A case of severe edema was reported. Practical tricks acquired through experience were discussed to prevent complications. One of the most widespreading methods for lip remodeling is hyaluronic acid injections. Nevertheless, hyaluronic acid has a variable duration, and it is not always the first choice. This context allowed for the development of other techniques such as the implantation of silicone prosthesis. The advantages of this prosthesis are as follows: safety, definitive result, and reversibility considering the possibility to remove the implanted prosthesis in the case of a request. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Temporal trends in permanent pacemaker implantation: a population-based study.

    PubMed

    Uslan, Daniel Z; Tleyjeh, Imad M; Baddour, Larry M; Friedman, Paul A; Jenkins, Sarah M; St Sauver, Jennifer L; Hayes, David L

    2008-05-01

    Limited data exist regarding temporal trends in permanent pacemaker (PPM) implantation. To describe trends in incidence and comorbidities of PPM recipients, we conducted a retrospective population-based cohort study over a 30-year period. All 1291 adult residents of Olmsted County, Minnesota, undergoing PPM implantation between 1975 and 2004 were included in the study. Trends in PPM implantation incidence, pacing mode and indication, and comorbidities (via Charlson Comorbidity Index [CCI]) were assessed through the Rochester Epidemiology Project. Permanent pacemaker recipients were compared with age- and sex-matched PPM-free controls from the population. Adjusted implantation incidence rates increased from 36.6 per 100,000 person-years during 1975 to 1979 to 99 per 100,000 person-years during 2000 to 2004 (P < .0001). After adjusting for age (hazard ratio [HR] 1.06 per year), male sex (HR 1.28), and implant year (HR 0.98), the HR for death among PPM recipients by CCI quartiles was 1.0, 1.79, 2.29, and 3.91 for CCI of 0 to 1 (reference), 2 to 3, 4 to 6, and > or = 7, respectively (P < .0001). Overall, PPM recipients had higher CCI than the population-based controls (P = .04), with higher mean CCI noted since 1990. Mean age-adjusted CCI increased from 3.15 to 4.60 among the cases (P < .0001) and from 3.06 to 3.54 among the age- and sex-matched controls (P = .047). There have been significant increases in incidence of PPM implantation over 30 years, and PPM recipients have had an age-independent increase in comorbidities relative to the underlying population, especially over the past 15 years.

  16. Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve.

    PubMed

    Zaman, Sarah; McCormick, Liam; Gooley, Robert; Rashid, Hashrul; Ramkumar, Satish; Jackson, Damon; Hui, Samuel; Meredith, Ian T

    2017-07-01

    To determine the incidence and predictors of permanent pacemaker (PPM) requirement following transcatheter aortic valve replacement (TAVR) with the mechanically expanded Lotus(TM) Valve System (Boston Scientific). Pacemaker implantation is the most common complication following TAVR. Predictors of pacing following TAVR with the Lotus valve have not been systematically assessed. Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited at a single-centre. Patients with a pre-existing PPM were excluded. Baseline ECG, echocardiographic and multiple detector computed tomography as well as procedural telemetry and depth of implantation were independently analyzed in a blinded manner. The primary endpoint was 30-day incidence of pacemaker requirement (PPM implantation or death while pacing-dependent). Multivariate analysis was performed to identify independent predictors of the primary endpoint. A total of 104 consecutive patients underwent TAVR with the Lotus valve with 9/104 (9%) with a pre-existing PPM excluded. New or worsened procedural LBBB occurred in 78%. Thirty-day incidence of the primary pacing endpoint was 28%. The most common indication for PPM implantation was complete heart block (CHB) (69%). Independent predictors of the primary endpoint included pre-existing RBBB (hazard ratio [HR] 2.8, 95% CI 1.1-7.0; P = 0.032) and depth of implantation below the noncoronary cusp (NCC) (HR 2.4, 95% CI 1.0-5.7; P = 0.045). Almost a third of Lotus valve recipients require pacemaker implantation within 30 days. The presence of pre-existing RBBB and the depth of prosthesis implantation below the NCC were significant pacing predictors. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. An automated, fast and accurate registration method to link stranded seeds in permanent prostate implants

    NASA Astrophysics Data System (ADS)

    Westendorp, Hendrik; Nuver, Tonnis T.; Moerland, Marinus A.; Minken, André W.

    2015-10-01

    The geometry of a permanent prostate implant varies over time. Seeds can migrate and edema of the prostate affects the position of seeds. Seed movements directly influence dosimetry which relates to treatment quality. We present a method that tracks all individual seeds over time allowing quantification of seed movements. This linking procedure was tested on transrectal ultrasound (TRUS) and cone-beam CT (CBCT) datasets of 699 patients. These datasets were acquired intraoperatively during a dynamic implantation procedure, that combines both imaging modalities. The procedure was subdivided in four automatic linking steps. (I) The Hungarian Algorithm was applied to initially link seeds in CBCT and the corresponding TRUS datasets. (II) Strands were identified and optimized based on curvature and linefits: non optimal links were removed. (III) The positions of unlinked seeds were reviewed and were linked to incomplete strands if within curvature- and distance-thresholds. (IV) Finally, seeds close to strands were linked, also if the curvature-threshold was violated. After linking the seeds an affine transformation was applied. The procedure was repeated until the results were stable or the 6th iteration ended. All results were visually reviewed for mismatches and uncertainties. Eleven implants showed a mismatch and in 12 cases an uncertainty was identified. On average the linking procedure took 42 ms per case. This accurate and fast method has the potential to be used for other time spans, like Day 30, and other imaging modalities. It can potentially be used during a dynamic implantation procedure to faster and better evaluate the quality of the permanent prostate implant.

  18. Prostatic edema in {sup 125}I permanent prostate implants: Dynamical dosimetry taking volume changes into account

    SciTech Connect

    Leclerc, Ghyslain; Lavallee, Marie-Claude; Roy, Rene; Vigneault, Eric; Beaulieu, Luc

    2006-03-15

    The purpose of this study is to determine the impact of edema on the dose delivered to the target volume. An evaluation of the edema characteristics was first made, and then a dynamical dosimetry algorithm was developed and used to compare its results to a standard clinical (static) dosimetry. Source positions and prostate contours extracted from 66 clinical cases on images taken at different points in time (planning, implant day, post-implant evaluation) were used, via the mean interseed distance, to characterize edema [initial increase ({delta}r{sub 0}), half-life ({tau})]. An algorithm was developed to take into account the edema by summing a time series of dose-volume histograms (DVHs) with a weight based on the fraction of the dose delivered during the time interval considered. The algorithm was then used to evaluate the impact of edema on the dosimetry of permanent implants by comparing its results to those of a standard clinical dosimetry. The volumetric study yielded results as follows: the initial prostate volume increase was found to be 1.58 (ranging from 1.15 to 2.48) and the edema half-life, approximately 30 days (range: 3 to 170 days). The dosimetric differences in D{sub 90} observed between the dynamic dosimetry and the clinical one for a single case were up to 15 Gy and depended on the edema half-life and the initial volume increase. The average edema half-life, 30 days, is about 3 times longer than the previously reported 9 days. Dosimetric differences up to 10% of the prescription dose are observed, which can lead to differences in the quality assertion of an implant. The study of individual patient edema resorption with time might be necessary to extract meaningful clinical correlation or biological parameters in permanent implants.

  19. Third-generation mobile phones (UMTS) do not interfere with permanent implanted pacemakers.

    PubMed

    Ismail, Mohamed M; Badreldin, Akmal M A; Heldwein, Matthias; Hekmat, Khosro

    2010-07-01

    Third-generation mobile phones, UMTS (Universal Mobile Telecommunication System), were recently introduced in Europe. The safety of these devices with regard to their interference with implanted pacemakers is as yet unknown and is the point of interest in this study. The study comprised 100 patients with permanent pacemaker implantation between November 2004 and June 2005. Two UMTS cellular phones (T-Mobile, Vodafone) were tested in the standby, dialing, and operating mode with 23 single-chamber and 77 dual-chamber pacemakers. Continuous surface electrocardiograms (ECGs), intracardiac electrograms, and marker channels were recorded when calls were made by a stationary phone to cellular phone. All pacemakers were tested under a "worst-case scenario," which includes a programming of the pacemaker to unipolar sensing and pacing modes and inducing of a maximum sensitivity setting during continuous pacing of the patient. Patients had pacemaker implantation between June 1990 and April 2005. The mean age was 68.4 +/- 15.1 years. Regardless of atrial and ventricular sensitivity settings, both UMTS mobile phones (Nokia 6650 and Motorola A835) did not show any interference with all tested pacemakers. In addition, both cellular phones did not interfere with the marker channels and the intracardiac ECGs of the pacemakers. Third-generation mobile phones are safe for patients with permanent pacemakers. This is due to the high-frequency band for this system (1,800-2,200 MHz) and the low power output between 0.01 W and 0.25 W.

  20. Implantation of octacalcium phosphate collagen composites (OCP/Col) after extraction of canine deciduous teeth achieved undisturbed permanent tooth eruption.

    PubMed

    Kanda, Naofumi; Matsui, Keiko; Kawai, Tadashi; Edamatsu, Hiroshi; Tanuma, Yuji; Suzuki, Osamu; Takahashi, Tetsu; Kamakura, Shinji

    2016-12-01

    Composite of synthetic octacalcium phosphate and collagen (OCP/Col) enhances bone regeneration if implanted into human, canine, or rodent bone defects. This study was designed to investigate the influence on eruption of the permanent successor tooth and alveolar height of OCP/Col implantation into extraction cavities of deciduous teeth. Disks of OCP/Col prepared from synthetic granules of octacalcium phosphate (OCP) and porcine atelocollagen, and commercially available sintered porous β-tricalcium phosphate (β-TCP) was implanted into the prepared defect of eleven male beagle dogs by extraction of two deciduous premolars. Untreated group had nothing implanted into the prepared defect, and physiological group (Physiol group) was observed without any treatment. Periodical macroscopic and radiographic examinations were performed until the period equivalent to the physiological eruption of permanent successor teeth (P3 and P4). Although no unerupted permanent successor teeth were observed among the OCP/Col, Untreated, and Physiol groups, two permanent successor teeth were unerupted in the β-TCP group. No significant difference of the alveolar heights or the eruptive position in P3 and P4 was observed between OCP/Col and Physiol groups. OCP/Col implantation in the alveolar region that included the unerupted permanent successor teeth would cause no disturbance of permanent tooth eruption and preserve the alveolar ridge. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. [Permanent implant prostate cancer brachytherapy: 2013 state-of-the art].

    PubMed

    Cosset, J-M; Hannoun-Lévi, J-M; Peiffert, D; Delannes, M; Pommier, P; Pierrat, N; Nickers, P; Thomas, L; Chauveinc, L

    2013-04-01

    With an experience of more than 25 years for the pioneers (and more than 14 years in France), permanent implant brachytherapy using iodine 125 seeds (essentially) is now recognized as a valuable alternative therapy for localized low-risk prostate cancer patients. The possible extension of the indications of exclusive brachytherapy towards selected patients in the intermediate-risk group has now been confirmed by several studies. Moreover, for the other patients in the intermediate-risk group and for the patients in the high-risk group, brachytherapy, as an addition to external radiotherapy, could represent one of the best ways to escalate the dose. Different permanent implant brachytherapy techniques have been proposed; preplanning or real-time procedure, loose or stranded seeds (or both), manual or automatic injection of the seeds. The main point here is the ability to perfectly master the procedure and to comply with the dosimetric constraints, which have been recently redefined by the international societies, such as the GEC-ESTRO group. Mid- and long-term results, which are now available in the literature, indicate relapse-free survival rates of about 90% at 5-10 years, the best results being obtained with satisfactory dosimetric data. Comparative data have shown that the incontinence and impotence rates after brachytherapy seemed to be significantly inferior to what is currently observed after surgery. However, a risk of about 3 to 5% of urinary retention is usually reported after brachytherapy, as well as an irritative urinary syndrome, which may significantly alter the quality of life of the patients, and last several months. In spite of those drawbacks, with excellent long-term results, low rates of incontinence and impotence, and emerging new indications (focal brachytherapy, salvage brachytherapy after localized failure of an external irradiation), permanent implant prostate brachytherapy can be expected to be proposed to an increasing number of patients

  2. Centrifugal blood pump with a hydraulically-levitated impeller for a permanently implantable biventricular assist device.

    PubMed

    Watanabe, Kuniyoshi; Ichikawa, Seiji; Asai, Toshimasa; Motomura, Tadashi; Hata, Atsushi; Ito, Seiichi; Shinohara, Toshiyuki; Tsujimura, Shinichi; Glueck, Julia A; Oestmann, Daniel J; Nosé, Yukihiko

    2004-06-01

    A permanently implantable biventricular assist device (BVAD) system has been developed with a centrifugal pump which is activated by a hydraulically-levitated impeller. The pump impeller floats hydraulically into the top contact position; this position prevents thrombus formation by creating a washout effect at the bottom bearing area, a common stagnant region. The pump was subjected to in vitro studies using a pulsatile mock circulation loop to confirm the impeller's top contact position and the swinging motion produced by the pulsation. Eleven in vivo BVAD studies confirmed that this swinging motion eliminated blood clot formation. Twenty-one pumps im-planted for up to three months did not reveal any thrombosis in the pumps or downstream organs. One exception was a right pump which was exposed to severe low flow due to the kinking of the outflow graft by the accidental pulling of the flow meter cable. Three ninety-day BVAD studies were achieved without thrombus formation.

  3. Realization of a permanent implantable pulsatile impeller heart with magnetically suspended motor.

    PubMed

    Qian, K X; Zheng, M

    1997-07-01

    A permanent impeller heart that could work for years was once an idea. However, now this idea is turning into reality through the use of the magnetically suspended motor. Recently, with our implantable pulsatile impeller pump, 3 left ventricular assisted calves survived for about 2 months (62, 54, and 46 days, respectively). The termination of the experiments was related to wear of the mechanical bearing, which resulted in vibration of the rotor and pump failure. All the experimental animals were in good condition prior to pump failure. It seemed as if the experiments could have lasted indefinitely if the bearing had not failed. All the hematological and biochemical data of the calves remained in normal or acceptable ranges; neither blood damage nor organ dysfunction of any animal was detected. During autopsy, no severe thrombus formation was found in the pump or vessels although a low dose of heparin (0.5-0.8 g/h) was given to increase the activated coagulation time (ACT) to 1.5-2.0 times its normal value. To solve the problem of bearing wear, a magnetically suspended motor was investigated and applied to the impeller pump. On the opposite sides of a disc connected to the rotor, 2 permanent magnet rings were embedded, one for driving and the other for axial suspension. Because both the driving and suspending coils with iron cores attract the disc, no radial bearing was needed. This newly devised impeller heart promises to have long-term and permanent applications.

  4. Dose calculation for permanent prostate implants incorporating spatially anisotropic linearly time-resolving edema

    SciTech Connect

    Monajemi, T. T.; Clements, Charles M.; Sloboda, Ron S.

    2011-04-15

    Purpose: The objectives of this study were (i) to develop a dose calculation method for permanent prostate implants that incorporates a clinically motivated model for edema and (ii) to illustrate the use of the method by calculating the preimplant dosimetry error for a reference configuration of {sup 125}I, {sup 103}Pd, and {sup 137}Cs seeds subject to edema-induced motions corresponding to a variety of model parameters. Methods: A model for spatially anisotropic edema that resolves linearly with time was developed based on serial magnetic resonance imaging measurements made previously at our center to characterize the edema for a group of n=40 prostate implant patients [R. S. Sloboda et al., ''Time course of prostatic edema post permanent seed implant determined by magnetic resonance imaging,'' Brachytherapy 9, 354-361 (2010)]. Model parameters consisted of edema magnitude, {Delta}, and period, T. The TG-43 dose calculation formalism for a point source was extended to incorporate the edema model, thus enabling calculation via numerical integration of the cumulative dose around an individual seed in the presence of edema. Using an even power piecewise-continuous polynomial representation for the radial dose function, the cumulative dose was also expressed in closed analytical form. Application of the method was illustrated by calculating the preimplant dosimetry error, RE{sub preplan}, in a 5x5x5 cm{sup 3} volume for {sup 125}I (Oncura 6711), {sup 103}Pd (Theragenics 200), and {sup 131}Cs (IsoRay CS-1) seeds arranged in the Radiological Physics Center test case 2 configuration for a range of edema relative magnitudes ({Delta}=[0.1,0.2,0.4,0.6,1.0]) and periods (T=[28,56,84] d). Results were compared to preimplant dosimetry errors calculated using a variation of the isotropic edema model developed by Chen et al. [''Dosimetric effects of edema in permanent prostate seed implants: A rigorous solution,'' Int. J. Radiat. Oncol., Biol., Phys. 47, 1405-1419 (2000

  5. Comparison of phacoemulsification and planned extracapsular cataract extraction in combined pars plana vitrectomy and posterior chamber intraocular lens implantation.

    PubMed

    Hsu, Sheng-Yao; Wu, Wen-Chung

    2005-01-01

    To compare two kinds of cataract removal methods combined with pars plana vitrectomy and posterior chamber intraocular lens (PC-IOL) implantation. Cataract removal was performed by either phacoemulsification or extracapsular cataract extraction (ECCE) and followed by pars plana vitrectomy and PC-IOL implantation. Between May 1996 and June 2001, 31 and 22 patients with cataract and vitreoretinal disease were treated by phacoemulsification and ECCE, respectively, combined with pars plana vitrectomy and PC-IOL implantation. Preoperative demographic data and postoperative vision, astigmatism change, and complications were analyzed. The mean age of patients in the phacoemulsification and ECCE groups was 62.5 and 63.4 years, respectively. Diabetes mellitus was the most common underlying disease resulting in vitreous opacity. Vision improved in 87.1% of the phacoemulsification group and 59.1% of the ECCE group. The change in astigmatism after surgery was 0.92+/-1.08 D (P = .001) in the ECCE group and 0.25+/-0.74 D (P = .087) in the phacoemulsification group. There were fewer postoperative complications, including recurrent vitreous hemorrhage, increased intraocular pressure, and iris changes in the phacoemulsification group than in the ECCE group. Phacoemulsification and ECCE combined with pars plana vitrectomy and PC-IOL implantation are both effective surgical methods to achieve better and more rapid visual rehabilitation for patients with combined cataract and vitreoretinal disease. In this study, phacoemulsification combined with pars plana vitrectomy and PC-IOL implantation resulted in greater improvement in vision, less astigmatism change, and fewer postoperative complications.

  6. NOTE: Optimal needle arrangement for intraoperative planning in permanent I-125 prostate implants

    NASA Astrophysics Data System (ADS)

    Thompson, S. A.; Fung, A. Y. C.; Zaider, M.

    2002-08-01

    One limitation of intraoperative planning of permanent prostate implants is that needles must already be in the gland before planning images are acquired. Improperly placed needles often restrict the capability of generating optimal seed placement. We developed guiding principles for the proper layout of needles within the treatment volume. The Memorial Sloan-Kettering Cancer Center planning system employs a genetic algorithm to find the optimal seed implantation pattern consistent with pre-assigned constraints (needle geometry, uniformity, conformity and the avoidance of high doses to urethra and rectum). Ultrasound volumes for twelve patients with I-125 implants were used to generate six plans per patient (total 72 plans) with different needle arrangements. The plans were evaluated in terms of V100 (percentage prostate volume receiving at least the prescription dose), U135 (percentage urethra volume receiving at least 135% of prescription dose), and CI (conformity index, the ratio of treatment volume to prescription dose volume.) The method termed POSTCTR, in which needles were placed on the periphery of the largest ultrasound slice and posterior central needles were placed as needed, consistently gave superior results for all prostate sizes. Another arrangement, labelled POSTLAT, where the needles were placed peripherally with additional needles in the posterior lateral lobes, also gave satisfactory results. We advocate two needle arrangements, POSTCTR and POSTLAT, with the former giving better results.

  7. Combined pars plana vitrectomy and artificial iris diaphragm implant after globe rupture.

    PubMed

    Rossi, Tommaso; Boccassini, Barbara; Iossa, Mario; Lesnoni, Guido; Mutolo, Maria Giulia; Mutolo, P Alessandro

    2009-04-01

    Retinal detachment (RD) associated with aniridia due to globe rupture (GR) is an uncommon condition with a severe prognosis. Surgical technique must address anterior and posterior segment issues secondary to the altered compartmentalization and increased risk for corneal toxicity. The purpose of this paper is to report a series of GR patients undergoing combined pars plana vitrectomy (PPV) and artificial iris diaphragm (AID) implant for the repair of RD associated to aniridia. The authors retrospectively reviewed 12 consecutive patients operated on by a single surgeon. Surgery consisted of a standard three-port PPV with extensive bimanual dissection of vitreous base and ciliary body membrane and combined AID implant. Office visits included Snellen visual acuity (VA), intraocular pressure measurement, biomicroscopy and indirect ophthalmoscopy. AID prosthesis included aniridic IOLs, Heimann's PMMA and silicone diaphragm. Mean age was 53 years and mean follow-up was 19 months. At the end of follow-up, seven patients gained more than two lines (58.3%), two lost their vision (16.6%) and three were unchanged (25%). Seven patients (58.3%) had a VA better than 20/400 and one (8%) 20/40 vision. Eight patients (66.6%) retained a clear cornea, two (16.6%) had minimal corneal oedema and two (16.6%) corneal decompensation. Implanted prosthesis included two silicone diaphragms, four PMMA diaphragms and six aniridic IOLs. After an average 1.6 operations, the retina was completely attached in six patients (50%), partially attached in four (33.3%) and detached in two (16.6%). RD associated to GR carries a guarded prognosis both due to RD complexity and hypotony. The combined repair of RD and aniridia after GR offers the advantage of addressing all issues at one time allowing correct eye compartmentalization and better tamponade effect. Successful anatomical and functional results can be achieved although multiple surgeries are often needed.

  8. Real-Time Intraoperative CT Assessment of Quality of Permanent Interstitial Seed Implantation for Prostate Cancer

    PubMed Central

    Zelefsky, Michael J; Worman, Mick; Cohen, Gilad N.; Pei, Xin; Kollmeier, Marisa; Yamada, Josh; Cox, Brett; Zhang, Zhigang; Bieniek, Eva; Dauer, Lawrence; Zaider, Marco

    2014-01-01

    Objectives Evaluate real-time kilovoltage cone-beam computed tomography (CBCT) during prostate brachytherapy for intraoperative dosimetric assessment and correcting deficient dose regions. Methods Twenty patients were evaluated intraoperatively with a mobile CBCT unit immediately after implantation while still anesthetized. The source-detector system is enclosed into a circular CT-like geometry with a bore that accommodates patients in the lithotomy position. After seed deposition, CBCT scans were obtained, Dosimetry was evaluated and compared to standard postimplantation CT-based assessment. In eight patients deposited seeds were localized in the intraoperative CBCT frame of reference and registered to the intraoperative transrectal ultrasound (TRUS) images. With this information, a second intraoperative plan was generated to ascertain if additional seeds were needed to achieve the planned prescription dose. Final dosimetry was compared with postimplantation scan assessment. Results Mean differences between dosimetric parameters from the intraoperative CBCT and post-implant CT scans were <0.5% for V100, D90, and V150 target values. Mean percentage differences for average urethral doses were not significantly different. Differences for D5 (maximum dose) of the urethra were <4%. The dose to 2 cc of the rectum differed by 10% on average. After fusion of implanted seed coordinates from the intraoperative CBCT scans onto the intraoperative TRUS images, dosimetric outcomes were similar to postimplantation CT dosimetric results. Conclusions Intraoperative CT-based dosimetric evaluation of prostate permanent seed implantation prior to anesthesia reversal is feasible and may avert misadministration of dose delivery. Dosimetric measurements based on the intraoperative CBCT scans are dependable and correlate well with postimplant diagnostic CT evaluation. PMID:20430423

  9. Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: insights from a Brazilian registry.

    PubMed

    Gensas, Caroline S; Caixeta, Adriano; Siqueira, Dimytri; Carvalho, Luiz A; Sarmento-Leite, Rogério; Mangione, José A; Lemos, Pedro A; Colafranceschi, Alexandre S; Caramori, Paulo; Ferreira, Maria Cristina; Abizaid, Alexandre; Brito, Fábio S

    2014-08-01

    The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI. Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis. At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p=0.07), have pre-dilation (68.42% vs. 60.07%, p=0.15), receive CoreValve (93.68% vs. 82.55%, p=0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p<0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56-11.49; p=0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20-8.82; p<0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02-3.02; p=0.04) were independent predictors of PPM implantation. PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. Dosimetric variations in permanent breast seed implant due to patient arm position.

    PubMed

    Watt, Elizabeth; Husain, Siraj; Sia, Michael; Brown, Derek; Long, Karen; Meyer, Tyler

    2015-01-01

    Planning and delivery for permanent breast seed implant (PBSI) are performed with the ipsilateral arm raised; however, changes in implant geometry can be expected because of healing and anatomical motion as the patient resumes her daily activities. The purpose of this study is to quantify the effect of ipsilateral arm position on postplan dosimetry. Twelve patients treated at the Tom Baker Cancer Centre were included in this study. Patients underwent two postimplant CT scans on the day of implant (Day 0) and two scans approximately 8 weeks later (Day 60). One scan at each time was taken with the ipsilateral arm raised, recreating the planning scan position, and the other with both arms down in a relaxed position beside the body, recreating a more realistic postimplant arm position. Postplans were completed on all four scans using deformable image registration (MIM Maestro). On the Day 0 scan, the V200 for the evaluation planning target volume was significantly increased in the arm-down position compared with the arm-up position. Lung, rib, and chest wall dose were significantly reduced at both time points. Left anterior descending coronary artery, heart, and skin dose showed no significant differences at either time point. Although some dosimetric indices show significant differences between the arm-up and arm-down positions, the magnitude of these differences is small and the values remain indicative of implant quality. Despite the delivery of the majority of dose with the arm down, it is reasonable to use CT scans taken in the arm-up position for postplanning. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  11. "Breast in a Day": Examining Single-Stage Immediate, Permanent Implant Reconstruction in Nipple-Sparing Mastectomy.

    PubMed

    Choi, Mihye; Frey, Jordan D; Alperovich, Michael; Levine, Jamie P; Karp, Nolan S

    2016-08-01

    Nipple-sparing mastectomy with immediate, permanent implant reconstruction offers patients a prosthetic "breast in a day" compared to tissue expander techniques requiring multiple procedures. Patients undergoing nipple-sparing mastectomy with immediate, permanent implant reconstruction were reviewed with patient demographics and outcomes analyzed. Of 842 nipple-sparing mastectomies from 2006 to June of 2015, 160 (19.0 percent) underwent immediate, permanent implant reconstruction. The average age and body mass index were 46.5 years and 23.3 kg/m. The majority of implants were either Allergan Style 20 (48.1 percent) or Style 15 (22.5 percent). The average implant size was 376.2 ml, and 91.3 percent of reconstructions used acellular dermal matrix. The average number of reconstructive operations was 1.3. Follow-up was 21.9 months. The most common major complication was major mastectomy flap necrosis (8.1 percent). The rate of reconstructive failure was 5.6 percent and implant loss was 4.4 percent. The most common minor complication was minor mastectomy flap necrosis (14.4 percent). The rates of full-thickness and partial-thickness nipple necrosis were 4.4 and 7.5 percent, respectively. Age older than 50 years (p = 0.0276) and implant size greater than 400 ml (p = 0.0467) emerged as independent predictors of overall complications. Obesity (p = 0.4073), tobacco use (p = 0.2749), prior radiation therapy (p = 0.4613), and acellular dermal matrix (p = 0.5305) were not associated with greater complication rates. Immediate, permanent implant reconstruction in nipple-sparing mastectomy provides patients with a breast in a day in less than two procedures, with a low complication rate. Therapeutic, IV.

  12. Bypassing the learning curve in permanent seed implants using state-of-the-art technology

    SciTech Connect

    Beaulieu, Luc . E-mail: beaulieu@phy.ulaval.ca; Evans, Dee-Ann Radford; Aubin, Sylviane; Angyalfi, Steven; Husain, Siraj; Kay, Ian; Martin, Andre-Guy; Varfalvy, Nicolas; Vigneault, Eric; Dunscombe, Peter

    2007-01-01

    Purpose: The aim of this study was to demonstrate, based on clinical postplan dose distributions, that technology can be used efficiently to eliminate the learning curve associated with permanent seed implant planning and delivery. Methods and Materials: Dose distributions evaluated 30 days after the implant of the initial 22 consecutive patients treated with permanent seed implants at two institutions were studied. Institution 1 (I1) consisted of a new team, whereas institution 2 (I2) had performed more than 740 preplanned implantations over a 9-year period before the study. Both teams had adopted similar integrated systems based on three-dimensional (3D) transrectal ultrasonography, intraoperative dosimetry, and an automated seed delivery and needle retraction system (FIRST, Nucletron). Procedure time and dose volume histogram parameters such as D90, V100, V150, V200, and others were collected in the operating room and at 30 days postplan. Results: The average target coverage from the intraoperative plan (V100) was 99.4% for I1 and 99.9% for I2. D90, V150, and V200 were 191.4 Gy (196.3 Gy), 75.3% (73.0%), and 37.5% (34.1%) for I1 (I2) respectively. None of these parameters shows a significant difference between institutions. The postplan D90 was 151.2 Gy for I1 and 167.3 Gy for I2, well above the 140 Gy from the Stock et al. analysis, taking into account differences at planning, results in a p value of 0.0676. The procedure time required on average 174.4 min for I1 and 89 min for I2. The time was found to decrease with the increasing number of patients. Conclusion: State-of-the-art technology enables a new brachytherapy team to obtain excellent postplan dose distributions, similar to those achieved by an experienced team with proven long-term clinical results. The cost for bypassing the usual dosimetry learning curve is time, with increasing team experience resulting in shorter treatment times.

  13. Bypassing the learning curve in permanent seed implants using state-of-the-art technology.

    PubMed

    Beaulieu, Luc; Evans, Dee-Ann Radford; Aubin, Sylviane; Angyalfi, Steven; Husain, Siraj; Kay, Ian; Martin, André-Guy; Varfalvy, Nicolas; Vigneault, Eric; Dunscombe, Peter

    2007-01-01

    The aim of this study was to demonstrate, based on clinical postplan dose distributions, that technology can be used efficiently to eliminate the learning curve associated with permanent seed implant planning and delivery. Dose distributions evaluated 30 days after the implant of the initial 22 consecutive patients treated with permanent seed implants at two institutions were studied. Institution 1 (I1) consisted of a new team, whereas institution 2 (I2) had performed more than 740 preplanned implantations over a 9-year period before the study. Both teams had adopted similar integrated systems based on three-dimensional (3D) transrectal ultrasonography, intraoperative dosimetry, and an automated seed delivery and needle retraction system (FIRST, Nucletron). Procedure time and dose volume histogram parameters such as D90, V100, V150, V200, and others were collected in the operating room and at 30 days postplan. The average target coverage from the intraoperative plan (V100) was 99.4% for I1 and 99.9% for I2. D90, V150, and V200 were 191.4 Gy (196.3 Gy), 75.3% (73.0%), and 37.5% (34.1%) for I1 (I2) respectively. None of these parameters shows a significant difference between institutions. The postplan D90 was 151.2 Gy for I1 and 167.3 Gy for I2, well above the 140 Gy from the Stock et al. analysis, taking into account differences at planning, results in a p value of 0.0676. The procedure time required on average 174.4 min for I1 and 89 min for I2. The time was found to decrease with the increasing number of patients. State-of-the-art technology enables a new brachytherapy team to obtain excellent postplan dose distributions, similar to those achieved by an experienced team with proven long-term clinical results. The cost for bypassing the usual dosimetry learning curve is time, with increasing team experience resulting in shorter treatment times.

  14. [A permanent implantable pulsatile impeller heart with a specially devised needle bearing].

    PubMed

    Qian, K; Zeng, P; Ru, W; Yuan, H; Feng, Z; Li, L

    2001-03-01

    The author's implantable pulsatile impeller pump can assist the circulation of the calves for several months. The termination of the experiments was related to wear of the mechanical bearing, which resulted in vibration of the rotor and pump failure. It seemed as if the experiments could have lasted indefinitely if the bearing had not failed. To solve the problem of bearing wear, a specially devised rolling bearing was investigated and applied to the impeller pump. Its service life is more than 10 years due to the wear-proof roller made of ultra-highmolecular weight polythene. This newly devised impeller heart promises to have long-term and permanent applications. Compared with the magnetic bearing, the rolling bearing has the advantages of simpler construction and control, no consumption of energy, and better reliability.

  15. Essure Permanent Birth Control

    MedlinePlus

    ... and Prosthetics Essure Permanent Birth Control Essure Permanent Birth Control Share Tweet Linkedin Pin it More sharing options ... Essure System Essure is a a permanently implanted birth control device for women (female sterilization). Implantation of Essure ...

  16. Permanent implantation of peripheral nerve stimulator for combat injury-related ilioinguinal neuralgia.

    PubMed

    Banh, Diem Phuc T; Moujan, Pablo M; Haque, Quazi; Han, Tae-Hyung

    2013-01-01

    A peripheral nerve stimulator (PNS) can be an alternative for long-term pain relief refractory to conventional therapeutic modalities. We present a case of chronic incapacitating ilioinguinal neuralgia, which was successfully managed with permanent implantation of a peripheral nerve stimulator. A 26-year-old active duty African American man was referred to the University Pain Clinic with left ilioinguinal neuralgia due to shrapnel injury during his military service 6 years prior to his visit. Most of the shrapnel were surgically removed, but the patient subsequently developed left lower abdominal pain. Multiple surgeries, including inguinal herniorrhaphy, varicocelectomy, and orchiectomy, failed to provide satisfactory relief of his neuralgia. Other therapies tried resulting in limited outcomes were multiple ilioinguinal nerve blocks and cryoanalgesia. A trial of PNS was successful and the implantation of permanent leads was carried out. At his 3-month visit, the patient reported to have minimal pain, was tapered off oral analgesics, was able to return to work, and had resumed his normal daily activities. Recent technological advances in programming software and surgical techniques have led to renewed interest in PNS for the treatment of chronic refractory peripheral nerve injury. Despite our limited understanding of its exact mechanism of action, it can be considered as a therapeutic potential for a few carefully selected, intractable cases. Its minimally invasive and reversible features make PNS a favorable option for these patients. The stringent and rigorous screening procedures for suitable candidacy, documentation of previously failed treatments, psychiatric evaluation, and 3-5 days of preplacement trial, improve the success rate.

  17. Evaluation of Death among the Patients Undergoing Permanent Pacemaker Implantation: A Competing Risks Analysis

    PubMed Central

    GHAEM, Haleh; GHORBANI, Mohammad; ZARE DORNIANI, Samira

    2017-01-01

    Background: Permanent artificial pacemaker is one of the important therapies for treatment of cardiac conduction system problems. The present study aimed to determine the association between some predictive variables and all-cause and cause-specific mortality in the patients who had undergone pacemaker implantation. Methods: This study was conducted on 1207 patients who had undergone permanent pacemaker implantation in the hospitals affiliated with Shiraz University of Medical Sciences, Iran, from Mar 2002 to Mar 2012. The variables that existed in the patients’ medical records included sex, diabetes mellitus, obesity, cerebrovascular accident, cardiomegaly, smoking, hypertension, ischemic heart disease, congenital heart disease, sick sinus syndrome, and atrial fibrillation. Competing risks model was used to assess the association between the predictive variables and cause-specific (i.e., cardiac and vascular) mortality. Results: The patients’ mean age was 66.32±17.92 yr (70.62±14.45 yr in the patients with single-chamber pacemakers vs. 61.91±17.69 yr in those with two-chamber pacemakers) (P<0.001). Sick sinus syndrome and age increased the risk of all-cause mortality, while two-chamber pacemaker decreased this risk. Obesity increased the risk of cardiac death, and diabetes mellitus and heart valve disease increased the risk of vascular death. Conclusion: The variables predicting mortality in all-cause model were completely different from those in cause-specific model. Moreover, death in such patients may occur due to reasons other than pacemaker. Therefore, future studies, particularly prospective ones, are recommended to use competing risks models. PMID:28828325

  18. Evaluation of Death among the Patients Undergoing Permanent Pacemaker Implantation: A Competing Risks Analysis.

    PubMed

    Ghaem, Haleh; Ghorbani, Mohammad; Zare Dorniani, Samira

    2017-06-01

    Permanent artificial pacemaker is one of the important therapies for treatment of cardiac conduction system problems. The present study aimed to determine the association between some predictive variables and all-cause and cause-specific mortality in the patients who had undergone pacemaker implantation. This study was conducted on 1207 patients who had undergone permanent pacemaker implantation in the hospitals affiliated with Shiraz University of Medical Sciences, Iran, from Mar 2002 to Mar 2012. The variables that existed in the patients' medical records included sex, diabetes mellitus, obesity, cerebrovascular accident, cardiomegaly, smoking, hypertension, ischemic heart disease, congenital heart disease, sick sinus syndrome, and atrial fibrillation. Competing risks model was used to assess the association between the predictive variables and cause-specific (i.e., cardiac and vascular) mortality. The patients' mean age was 66.32±17.92 yr (70.62±14.45 yr in the patients with single-chamber pacemakers vs. 61.91±17.69 yr in those with two-chamber pacemakers) (P<0.001). Sick sinus syndrome and age increased the risk of all-cause mortality, while two-chamber pacemaker decreased this risk. Obesity increased the risk of cardiac death, and diabetes mellitus and heart valve disease increased the risk of vascular death. The variables predicting mortality in all-cause model were completely different from those in cause-specific model. Moreover, death in such patients may occur due to reasons other than pacemaker. Therefore, future studies, particularly prospective ones, are recommended to use competing risks models.

  19. Permanent pacemaker implantation after isolated aortic valve replacement: incidence, indications, and predictors.

    PubMed

    Dawkins, Sam; Hobson, Alex R; Kalra, Paul R; Tang, Augustine T M; Monro, James L; Dawkins, Keith D

    2008-01-01

    Conducting system defects are common in patients with aortic valve disease. Aortic valve replacement may result in further conduction abnormalities and necessitate permanent pacemaker implantation (PPM). We sought to identify the contemporary incidence and predictors for early postoperative PPM in patients undergoing isolated aortic valve replacement. Data were analyzed from 354 consecutive patients undergoing isolated aortic valve replacement at a referral cardiac unit during a 30-month period; data were unavailable on 4 patients and a further 8 had undergone preoperative PPM. Results for the remaining 342 patients (97%; mean age, 67 +/- 14 years), of whom 212 were males, are presented. The major indications for aortic valve replacement were valvular stenosis (n = 224), regurgitation (n = 70), or infective endocarditis (n = 25). Preoperative conducting system disease was present in 26% of patients. In-hospital mortality was 1.8% (6 of 342 patients). Postoperatively 29 patients (8.5%) required early PPM, of which 26 were during the index admission. Patients with preoperative conducting system disease (16% versus 6%; p = 0.004) and valvular regurgitation (16% versus 7%; p = 0.01) were more likely to require PPM as opposed to those without. Preoperative conducting system disease was the only independent predictor of PPM (p < 0.01); the relative risk of PPM requirement in this group was 2.88 (95% confidence interval, 1.31 to 6.33). Permanent pacemaker implantation requirement after aortic valve replacement is a common occurrence, and should be discussed as part of the preoperative consent process. Preexisting conducting disease and preoperative aortic regurgitation were predictors of PPM requirement.

  20. One piece ultracompact totally implantable electromechanical total artificial heart for permanent use.

    PubMed

    Takatani, Setsuo; Sakamoto, Tohru; Ohuchi, Katsuhiro; Nakamura, Makoto; Mizuno, Tomohiro; Arai, Hirokuni

    2002-01-01

    An ultracompact, one piece, totally implantable electromechanical total artificial heart (TAH) has been developed as a permanent replacement for failing hearts. It consists of left and right pusher plate blood pumps (stroke volume 55 ml) made of titanium alloy (Ti-6Al-7Nb) sandwiching a miniaturized electromechanical actuator between them. The diameter of the TAH is 90 mm, with a thickness of 70 mm, yielding an overall volume of 400 ml. It weighs 450 g. Although it is miniaturized, it provided a maximum pump output of 8 L/min against a left afterload of 100 mm Hg. It required approximately 12 watts to provide a pump output of 6.5 L/min with maximum efficiency of 13.5%. To balance left and right flow, the right stroke length was made 10% shorter than the left, and an auxiliary compliance chamber was used to compensate for additional flow differences between them. Motor commutation pulses and a Hall effect pusher plate sensor signal were used in the controller to implement the left master alternate variable rate mode. The calf fitting study revealed excellent anatomic compatibility, and the first successful survivor was obtained in December 2001. Studies of system endurance and biocompatibility are required to ensure long-term reliability. This TAH is promising for permanent replacement of the failing heart as well as for bridge to heart transplantation for the smaller size group of end-stage cardiac patients.

  1. Antithrombogenicity of the Gyro permanently implantable pump with the RPM dynamic suspension system for the impeller.

    PubMed

    Ichikawa, Seiji; Nonaka, Kenji; Motomura, Tadashi; Ishitoya, Hiroshi; Watanabe, Kuniyoshi; Ashizawa, Satoshi; Shinohara, Toshiyuki; Sumikura, Hirohito; Ichihashi, Fumiyuki; Oestmann, Daniel; Nosé, Yukihiko

    2003-10-01

    In 1995, a group at Baylor College of Medicine started to develop the NEDO biventricular assist device (BVAD) using two Gyro permanently implantable (PI) centrifugal pumps. This pump consists of a sealless pump housing and an impeller supported with a double pivot bearing. In May 2001, an RPM dynamic suspension system (RPM-DS) for the impeller was developed to improve durability and antithrombogenicity without a complex magnetic suspension system. From March 2000 to March 2002, eight BVAD bovine experimental studies were performed for more than 1 month. Two pumps were implanted in two cases without the RPM-DS (group A) and in six cases with the RPM-DS (group B). In group A, the survival period was 45 and 50 days. The primary reason for termination was an increase in the requiring power, which was related to deposition of white thrombus on the bottom bearing. In group B, the survival period was 37, 48, 51, 60, 80, and 90 days. The reasons for termination were not related to thrombus formation. No thrombus was observed in the pumps except for one right pump. In that experiment, the thrombus formation may have occurred when that pump had a low flow rate at a level of 1 L/min for 6 hr. These studies demonstrate the apparent antithrombogenic effect of RPM-DS. The NEDO BVAD is ready to move into a 3-month preclinical system evaluation.

  2. Development of the Marseilles pulsatile rotary blood pump for permanent implantable left ventricular assistance.

    PubMed

    Montiès, J R; Havlik, P; Mesana, T; Trinkl, J; Tourres, J L; Demunck, J L

    1994-07-01

    We have developed a low-speed, double-lobed hypocycloidal pump that furnishes a pulsatile flow without valves. The pump is coupled to a specially designed electric motor. The motor/pump unit is totally implantable and has been extensively tested in vitro and in vivo in animals. Because this pump is volumetric, it is necessary to control speed precisely to avoid overpumping. Our control system, which is based on analysis of the motor current wave form, can detect and prevent negative pressures before they occur. The physical properties and hemocompatibility of several construction materials have been studied to determine their suitability for clinical use. These materials include a graphite substrate, titanium nitrate surface coating, boric carbon, and amorphous diamond. The pumps currently being tested are made of titanium, but clinical versions will be made of composite materials selected from this preliminary study. In vivo testing of this pump confirmed its good hemodynamic performance, low hemolysis rate, and biocompatibility (i.e., low heat, noise, and vibration levels). Animal experiments were terminated after 15 days because of mechanical failure related to the accumulation of blood components on moving parts. A new pump in which the mechanism is completely sealed from the blood flow has been designed and will soon be tested. If this sealed design is effective, the pump should be ready for use as a permanent implantable ventricular assistance device.

  3. 125I Seed Permanent Implantation as a Palliative Treatment for Stage III and IV Hypopharyngeal Carcinoma

    PubMed Central

    Li, Lei; Yang, Jie; Li, Xiaojiang; Wang, Xiaoli; Ren, Yanxin; Fei, Jimin; Xi, Yan; Sun, Ruimei; Ma, Jing

    2016-01-01

    Objectives. The aim of this study was to investigate the feasibility and safety of percutaneous 125I seed permanent implantation for advanced hypopharyngeal carcinoma from toxicity, tumor response, and short-term outcome. Methods. 125I seeds implant procedures were performed under computed tomography for 34 patients with advanced hypopharyngeal carcinoma. We observed the local control rate, overall survival, and acute or late toxicity rate. Results. In the 34 patients (stage III, n=6; stage IV, n=28), the sites of origin were pyriform sinus (n=29) and postcricoid area (n=5). All patients also received one to four cycles of chemotherapy after seed implantation. The post-plan showed that the actuarial D90 of 125I seeds ranged from 90 to 158 Gy (median, 127 Gy). The mean follow-up was 12.3 months (range, 3.4 to 43.2 months). The local control was 2.1–31.0 months with a median of 17.7 months (95% confidence interval [CI], 13.4 to 22.0 months). The 1-, 2-, and 3-year local controls were 65.3%, 28.6%, and 9.5% respectively. Twelve patients (35%) died of local recurrence, fourteen patients (41%) died of distant metastases, and three patients (9%) died of recurrence and metastases at the same time. Five patients (15%) still survived to follow-up. At the time of analysis, the median survival time was 12.5 months (95% CI, 9.5 to 15.4 months). The 1-, 2-, and 3-year overall survival rates were 55.2%, 20.3%, and 10.9%, respectively. Five patients (15%) experienced grade 3 toxic events and nine patients (26%) have experienced grade 2 toxic events. Conclusion. This review shows relatively low toxicity for interstitial 125I seed implantation in the patients with advanced stage hypopharyngeal cancer. The high local control results suggest that 125I seed brachytherapy implant as a salvage or palliative treatment for advanced hypopharyngeal carcinoma merit further investigation. PMID:27440132

  4. Bicuspid aortic valve increases risk of permanent pacemaker implant following aortic root replacement.

    PubMed

    Guglielmetti, Laura; Nazif, Tamim; Sorabella, Robert; Akkoc, Deniz; Kantor, Alex; Gomez, Andres; Wang, Catherine; Takayama, Hiroo; Dizon, Jose; Borger, Michael; George, Isaac

    2016-09-01

    We aimed to assess the incidence and possible differences in postoperative conduction delay after aortic root replacement (ARR) in bicuspid aortic valve (BAV) patients compared with a tricuspid aortic valve (TAV). A total of 380 patients undergoing ARR at our institution between 2005 and 2013 were included in the analysis. Patients were stratified by aortic valve anatomy: BAV, n = 191 vs TAV, n = 189. Electrocardiographic and echocardiographic data were retrospectively analysed at different time points (pre-, postoperatively and at follow-up). Primary outcome of interest was permanent pacemaker (PPM) implantation within 30 days, the composite of new PPM or new left fascicular or bundle branch block (PPM or LBBB) was the secondary outcome of interest. Age range was 24-89.5 years and incidence of preoperative moderate to severe aortic stenosis was 9.7%. BAV patients had higher incidence of PPM implantation within 30 days (5.8 vs 1.6% in TAV, P = 0.053); moreover, the composite of PPM or LBBB was also more frequent in BAV (8.4 vs 2.1%, P = 0.010). BAV was independently associated with PPM insertion (OR 4.08, P = 0.047) and also an independent predictor of PPM or LBBB in multiple regression (OR 4.96, P = 0.006). Significantly higher incidence of PPM implantation or LBBB may exist after ARR in bicuspid patients and BAV was confirmed to be an independent predictor for postoperative conduction disturbances by multivariable regression. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  5. A Case of Adult-Onset Acute Rheumatic Fever With Long-Lasting Atrioventricular Block Requiring Permanent Pacemaker Implantation.

    PubMed

    Oba, Yusuke; Watanabe, Hiroaki; Nishimura, Yoshioki; Ueno, Shuichi; Nagashima, Takao; Imai, Yasushi; Shimpo, Masahisa; Kario, Kazuomi

    2015-01-01

    A 45-year-old hypertensive Japanese woman presented with epigastric pain on inspiration, fever, complete atrioventricular block and polyarthritis. Her antistreptolysin O levels were markedly elevated. A diagnosis of rheumatic fever was made according to the modified Jones criteria. She was prescribed loxoprofen sodium, which was partially effective for her extracardiac clinical symptoms. However, she had syncope due to complete atrioventricular block with asystole longer than 10 seconds. Consequently, we implanted a permanent pacemaker. Although we prescribed prednisolone, the efficacy of which was limited for the patient's conduction disturbance, the complete atrioventricular block persisted. In our systematic review of 12 similar cases, the duration of complete heart block was always transient and there was no case requiring a permanent pacemaker. We thus encountered a very rare case of adult-onset acute rheumatic fever with persistent complete atrioventricular block necessitating permanent pacemaker implantation.

  6. [Syncope of unknown origin in patients with permanent auriculoventricular block with an implanted pacemaker. Usefulness of the tilt table test].

    PubMed

    Márquez, Manlio F; Encarnación-Roa, Carmen F; Hermosillo, Antonio G; Benítez-Pinto, William J; Cárdenas, Manuel

    2002-04-01

    Four female patients aged 26 to 71 years, with permanent complete AV heart block and an implanted pacemaker had syncope or presyncope after the pacemaker implantation. As part of the study protocol the tilt table test was done. Neurological disease, arrhythmias, pacemaker syndrome or dysfunction of the stimulation system were ruled out. A head up tilt was performed, isosorbide was used as pharmacological challenge, since the basal test was negative. In three patients this test was positive: in one patient possibly caused by postural orthostatic tachycardia syndrome, and two with neurally mediated syncope. In one patient it was not possible a diagnosis. The head-up tilt test is a useful procedure to identify the etiology of the appearance of syncope or presyncope after a pacemaker implantation in patients with complete and permanent AV block.

  7. Class solution for inversely planned permanent prostate implants to mimic an experienced dosimetrist

    SciTech Connect

    Lessard, Etienne; Kwa, Stefan L. S.; Pickett, Barby; Roach, Mach III; Pouliot, Jean

    2006-08-15

    The purpose of this paper is to present a method for the selection of inverse planning parameters and to establish a set of inverse planning parameters (class solution) for the inverse planning included in a commercial permanent prostate implant treatment planning system. The manual planning of more than 750 patients since 1996 led to the establishment of general treatment planning rules. A class solution is tuned to fulfill the treatment planning rules and generate equivalent implants. For ten patients, the inverse planning is compared with manual planning performed by our experienced physicist. The prostate volumes ranged from 17 to 51 cc and are implanted with low activity I-125 seeds. Dosimetric indices are calculated for comparison. The inverse planning needed about 15 s for each optimization (400 000 iterations on a 2.5 GHz PC). In comparison, the physicist needed about 20 min to perform each manual plan. A class solution is found that consistently produces dosimetric indices equivalent or better than the manual planning. Moreover, even with strict seed placement rules, the inverse planning can produce adequate prostate dose coverage and organ at risk protection. The inverse planning avoids implant with seeds outside of the prostate and too close to the urethra. It also avoids needles with only one seed and needles with three consecutive seeds. This reduces the risk of complication due to seed misplacement and edema. The inverse planning also uses a smaller number of needles, reducing the cause of trauma. The quality of the treatment plans is independent of the gland size and shape. A class solution is established that consistently and rapidly produces equivalent dosimetric indices as manual planning while respecting severe seed placement rules. The class solution can be used as a starting point for every patient, dramatically reducing the time needed to plan individual patient treatments. The class solution works with inverse preplanning, intraoperative

  8. Effects of Appropriate Prolonged Sacral Neuromodulation Testing in Improving Implantation Rate of a Permanent Implantable Pulse Generator in Patients with Refractory Lower Urinary Tract Dysfunctions in Mainland China

    PubMed Central

    Zhang, Peng; Zhang, Jian-Zhong; Wu, Li-Yang; Zhang, Xiao-Dong

    2017-01-01

    Background: Sacral neuromodulation (SNM) has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator (IPG) implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms (LUTS) in mainland China. Methods: From January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy. In this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications (such as pain, infection, and electrode displacement) and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness. Results: Among 51 patients receiving SNM therapy, 19 patients (mean age 45.0 ± 16.9 years) had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients (mean age 46.7 ± 15.3 years) received Stage II permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage I–II conversion was 62.7% (32/51) in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% (8/51), which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% (27/32) of the patients received Stage II implantation within 4

  9. Ultracompact, completely implantable permanent use electromechanical ventricular assist device and total artificial heart.

    PubMed

    Honda, N; Inamoto, T; Nogawa, M; Takatani, S

    1999-03-01

    An ultracompact, completely implantable permanent use electromechanical ventricular assist device (VAD) and total artificial heart (TAH) intended for 50-60 kg size patients have been developed. The TAH and VAD share a miniature electromechanical actuator that comprises a DC brushless motor and a planetary roller screw. The rotational force of the motor is converted into the rectilinear force of the roller screw to actuate the blood pump. The TAH is a one piece design with left and right pusher plate type blood pumps sandwiching an electromechanical actuator. The VAD is one half of the TAH with the same actuator but a different pump housing and a backplate. The blood contacting surfaces, including those of the flexing diaphragm and pump housing, of both the VAD and TAH were made of biocompatible polyurethane. The diameter, thickness, volume, and weight of the VAD are 90 mm, 56 mm, 285 cc, and 380 g, respectively, while those of the TAH are 90 mm, 73 mm, 400 cc, and 440 g, respectively. The design stroke volume of both the VAD and TAH is 60 cc with the stroke length being 12 mm. The stroke length and motor speed are controlled solely based on the commutation signals of the motor. An in vitro study revealed that a maximum pump flow of 7.5 L/min can be obtained with a pump rate of 140 bpm against a mean afterload of 100 mm Hg. The power requirement ranged from 4 to 6 W to deliver a 4-5 L/min flow against a 100 mm Hg afterload with the electrical-to-hydraulic efficiency being 19-20%. Our VAD and TAH are the smallest of the currently available devices and suitable for bridge to transplant application as well as for permanent circulatory support of 50-60 kg size patients.

  10. Defining the rectal dose constraint for permanent radioactive seed implantation of the prostate.

    PubMed

    Albert, Michele; Song, Jun S; Schultz, Delray; Cormack, Robert A; Tempany, Clare M; Haker, Steve; Devlin, Phillip M; Beard, Clair; Hurwitz, Mark D; Suh, Wonsuk W; Jolesz, Ferenc; D'Amico, Anthony V

    2008-01-01

    This study was performed to define the rectal dose constraint that would predict late rectal bleeding requiring argon plasma coagulation (APC) following prostate brachy mono-therapy. Between February 1999 and April 2002, 91 patients with low risk prostate cancer underwent permanent I(125) radioactive seed implantation without the use of supplemental external beam radiation or androgen suppression therapy. Patients received both CT and MRI scans 6 weeks postimplant for evaluation of dosimetry. The CT and MRI scans were fused. Rectal volumes were contoured on the T2 weighted MR images. For those patients requiring APC, the date on which a patient reported rectal bleeding was recorded. A Cox regression analysis was performed to assess whether there was a significant association between the rectal volume (continuous) exceeding 100 Gy time rectal bleeding. Comparisons of estimates of rectal bleeding requiring APC were made using a 2-sided log rank test. There was a significant association (hazard ratio = 5.6 [95% confidence interval: 1.3, 23.8]; P = 0.002) between the rectal volume exceeding 100 Gy and rectal bleeding requiring APC. After a median follow-up of 4.25 (1-6) years, no patient with less than a median value of 8 cc of rectum exceeding 100 Gy required APC, whereas 20% (P = 0.004) were estimated to require APC within 3 years following treatment. Keeping the rectal volume receiving more than 100 Gy below 8 cc will minimize the risk of rectal bleeding requiring APC following I(125) permanent prostate brachy mono-therapy.

  11. Short- and long-term need for permanent pacemaker after transcatheter implantation of the Edwards Sapien aortic valve prosthesis.

    PubMed

    Moreno, Raúl; Calvo, Luis; Sánchez-Recalde, Angel; Galeote, Guillermo; Jiménez-Valero, Santiago; López, Teresa; Plaza, Ignacio; González-Davia, Rosa; Ramírez, Ulises; Mesa, Jose Maria; Moreno-Gomez, Isidro; López-Sendón, José-Luis

    2015-11-01

    A permanent pacemaker is frequently needed after transcatheter aortic valve implantation, but the available data are mainly on the CoreValve system. To evaluate the need for new permanent pacemaker after implantation of the Edwards Sapien device, as well as related factors. We included the first 100 patients treated with the Edwards Sapien device at our institution. Of these, 12 had a permanent pacemaker before the procedure, and thus our study population was the remaining 88 patients. A permanent pacemaker was indicated in eight patients (9.1%) during hospitalization or at 30 days. After discharge, another four patients needed a pacemaker (at 42 days and three, 18, and 30 months). Two variables were associated with the need for pacemaker during hospitalization: previous dialysis (13% vs. 1%, p=0.042) and complete right bundle branch block before the procedure (25% vs. 5%, p=0.032). More than one month after the procedure, the characteristics associated with the need for pacemaker were plasma creatinine level (2.5±1.7 vs. 1.3±0.6 mg/dl, p=0.001) and previous myocardial infarction (50% vs. 10%, p=0.013). The rate of pacemaker implantation with the Edwards Sapien device was 9.1%. Right bundle branch block and dialysis were associated with this complication.

  12. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block

    PubMed Central

    Liao, Jo-Nan; Chao, Tze-Fan; Tuan, Ta-Chuan; Kong, Chi-Woon; Chen, Shih-Ann

    2016-01-01

    Abstract A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing. A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality. A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan–Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups. The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction. PMID:27583889

  13. Intraoperative 3D ultrasound guidance system for permanent breast seed implantation

    NASA Astrophysics Data System (ADS)

    Michael, Justin; Morton, Daniel; Batchelar, Deidre; Hilts, Michelle; Fenster, Aaron

    2017-03-01

    Permanent breast seed implantation (PBSI) is a single-visit technique for accelerated partial breast irradiation that uses a template and needles to implant seeds of Pd-103 under 2D ultrasound (US) guidance. The short treatment time is advantageous given the widely hypothesized link between treatment burden and mastectomy use. However, limitations of 2D US contribute to high operator dependence and seed placement error that we aim to address by developing a 3D US guidance system. A 3D US scanner for PBSI and a mechanism for template localization have been developed and validated. The 3D US system mechatronically moves and tracks a 2D US transducer over a 5 cm translation and 60° tilt, reconstructing the 2D images into a 3D volume as they are acquired. Additionally, a localizing arm, tracked via encoded joints and mounted to the scanner, determines template position by localizing divots on a modified needle template. Volume reconstruction was validated using linear measurements of a grid phantom and volumetric measurements of two surgical cavity phantoms. Localizing arm measurement accuracy was established using a testing jig with divots at known positions. Imaging volume was rigidly registered to scanner geometry using a string phantom mounted to a test jig. Lastly, volunteer scans were conducted to demonstrate clinical applicability. Median linear and average volumetric measurements were within +/-1.4% of nominal and +/-4.1% of water displacement measurements, respectively. Median measurement accuracy of the localizing arm was 0.475 mm. Imaging volume target registration error was 0.458 mm. Volunteer scans produced clinical quality images.

  14. The selection criteria of temporary or permanent luting agents in implant-supported prostheses: in vitro study.

    PubMed

    Alvarez-Arenal, Angel; Gonzalez-Gonzalez, Ignacio; deLlanos-Lanchares, Hector; Brizuela-Velasco, Aritza; Ellacuria-Echebarria, Joseba

    2016-04-01

    The use of temporary or permanent cements in fixed implant-supported prostheses is under discussion. The objective was to compare the retentiveness of one temporary and two permanent cements after cyclic compressive loading. The working model was five solid abutments screwed to five implant analogs. Thirty Cr-Ni alloy copings were randomized and cemented to the abutments with one temporary (resin urethane-based) or two permanent (resin-modified glass ionomer, resin-composite) cements. The retention strength was measured twice: once after the copings were cemented and again after a compressive cyclic loading of 100 N at 0.72 Hz (100,000 cycles). Before loading, the retention strength of resin composite was 75% higher than the resin-modified glass ionomer and 2.5 times higher than resin urethanebased cement. After loading, the retentiveness of the three cements decreased in a non-uniform manner. The greatest percentage of retention loss was shown by the temporary cement and the lowest by the permanent resin composite. However, the two permanent cements consistently show high retention values. The higher the initial retention of each cement, the lower the percentage of retention loss after compressive cyclic loading. After loading, the resin urethane-based cement was the most favourable cement for retrieving the crowns and resin composite was the most favourable cement to keep them in place.

  15. The selection criteria of temporary or permanent luting agents in implant-supported prostheses: in vitro study

    PubMed Central

    Gonzalez-Gonzalez, Ignacio; Brizuela-Velasco, Aritza; Ellacuria-Echebarria, Joseba

    2016-01-01

    PURPOSE The use of temporary or permanent cements in fixed implant-supported prostheses is under discussion. The objective was to compare the retentiveness of one temporary and two permanent cements after cyclic compressive loading. MATERIALS AND METHODS The working model was five solid abutments screwed to five implant analogs. Thirty Cr-Ni alloy copings were randomized and cemented to the abutments with one temporary (resin urethane-based) or two permanent (resin-modified glass ionomer, resin-composite) cements. The retention strength was measured twice: once after the copings were cemented and again after a compressive cyclic loading of 100 N at 0.72 Hz (100,000 cycles). RESULTS Before loading, the retention strength of resin composite was 75% higher than the resin-modified glass ionomer and 2.5 times higher than resin urethanebased cement. After loading, the retentiveness of the three cements decreased in a non-uniform manner. The greatest percentage of retention loss was shown by the temporary cement and the lowest by the permanent resin composite. However, the two permanent cements consistently show high retention values. CONCLUSION The higher the initial retention of each cement, the lower the percentage of retention loss after compressive cyclic loading. After loading, the resin urethane-based cement was the most favourable cement for retrieving the crowns and resin composite was the most favourable cement to keep them in place. PMID:27141259

  16. Postimplantation Analysis Enables Improvement of Dose-Volume Histograms and Reduction of Toxicity for Permanent Seed Implantation

    SciTech Connect

    Wust, Peter Postrach, Johanna; Kahmann, Frank; Henkel, Thomas; Graf, Reinhold; Cho, Chie Hee; Budach, Volker; Boehmer, Dirk

    2008-05-01

    Purpose: To demonstrate how postimplantation analysis is useful for improving permanent seed implantation and reducing toxicity. Patients and Methods: We evaluated 197 questionnaires completed by patients after permanent seed implantation (monotherapy between 1999 and 2003). For 70% of these patients, a computed tomography was available to perform postimplantation analysis. The index doses and volumes of the dose-volume histograms (DVHs) were determined and categorized with respect to the date of implantation. Differences in symptom scores relative to pretherapeutic status were analyzed with regard to follow-up times and DVH descriptors. Acute and subacute toxicities in a control group of 117 patients from an earlier study (June 1999 to September 2001) by Wust et al. (2004) were compared with a matched subgroup from this study equaling 110 patients treated between October 2001 and August 2003. Results: Improved performance, identifying a characteristic time dependency of DVH parameters (after implantation) and toxicity scores, was demonstrated. Although coverage (volume covered by 100% of the prescription dose of the prostate) increased slightly, high-dose regions decreased with the growing experience of the users. Improvement in the DVH and a reduction of toxicities were found in the patient group implanted in the later period. A decline in symptoms with follow-up time counteracts this gain of experience and must be considered. Urinary and sexual discomfort was enhanced by dose heterogeneities (e.g., dose covering 10% of the prostate volume, volume covered by 200% of prescription dose). In contrast, rectal toxicities correlated with exposed rectal volumes, especially the rectal volume covered by 100% of the prescription dose. Conclusion: The typical side effects occurring after permanent seed implantation can be reduced by improving the dose distributions. An improvement in dose distributions and a reduction of toxicities were identified with elapsed time between

  17. Atrioventricular nodal ablation versus antiarrhythmic drugs after permanent pacemaker implantation for bradycardia-tachycardia syndrome.

    PubMed

    Nagamoto, Yasutsugu; Inage, Tomohito; Yoshida, Teruhisa; Takeuchi, Tomohiro; Gondo, Takeki; Fukuda, Yujiro; Takii, Eiichi; Murotani, Kenta; Imaizumi, Tsutomu

    2012-03-01

    Patients often require antiarrhythmic drugs to control tachycardia after permanent pacemaker implantation (PMI) for bradycardia-tachycardia syndrome. We compared atrioventricular nodal ablation (AVNA) to antiarrhythmic drugs after PMI for bradycardia-tachycardia syndrome. Twenty-eight symptomatic patients with bradycardia-tachycardia syndrome, all of which had a long pause after termination of paroxysmal atrial fibrillation, underwent PMI with RV lead placement at the mid-septum site. Among these patients, 14 underwent PMI and AVNA (AVNA group). The remaining 14 patients underwent PMI only, and continued to take anti-arrhythmic drugs (drug group). We compared cardiac function (cardio-thoracic ratio on chest X-ray, left atrial diameter, left ventricular end-diastolic dimension, and left ventricular-ejection fraction by echocardiography), exercise tolerance (6-min walking distance), symptoms, and the number of antiarrhythmic drugs just before and 6 months after PMI. Baseline characteristics were similar between the two groups, except for the number of antiarrhythmic drugs. Six months after PMI, cardiac function, exercise tolerance, and symptoms did not differ significantly between the two groups. Compared to the drug group (p < 0.01), the number of antiarrhythmic drugs was significantly smaller in the AVNA group 6 months after PMI. Patients who underwent AVNA concurrently with PMI with RV lead placement at the mid-septum site for bradycardia-tachycardia syndrome were able to reduce the intake of drugs and improve their tachycardia-related symptoms while maintaining cardiac function and exercise tolerance.

  18. Poster — Thur Eve — 41: Considerations for Patients with Permanently Implant Radioactive Sources Requiring Unrelated Surgery

    SciTech Connect

    Basran, P. S; Beckham, WA; Baxter, P

    2014-08-15

    Permanent implant of sealed radioactive sources is an effective technique for treating cancer. Typically, the radioactive sources are implanted in and near the disease, depositing dose locally over several months. There may be instances where these patients must undergo unrelated surgical procedures when the radioactive material remains active enough to pose risks. This work explores these risks, discusses strategies to mitigate those risks, and describes a case study for a permanent I-125 prostate brachytherapy implant patient who developed colo-rectal cancer and required surgery 6 months after brachytherapy. The first consideration is identifying the risk from unwarranted radiation to the patient and staff before, during, and after the surgical procedure. The second is identifying the risk the surgical procedure may have on the efficacy of the brachytherapy implant. Finally, there are considerations for controlling for radioactive substances from a regulatory perspective. After these risks are defined, strategies to mitigate those risks are considered. These strategies may include applying the concepts of ALARA, the use of protective equipment and developing a best practice strategy with the operating room team. We summarize this experience with some guidelines: If the surgical procedure is near (ex: 5 cm) of the implant; and, the surgical intervention may dislodge radioisotopes enough to compromise treatment or introduces radiation safety risks; and, the radioisotope has not sufficiently decayed to background levels; and, the surgery cannot be postponed, then a detailed analysis of risk is advised.

  19. Development of the Baylor Gyro permanently implantable centrifugal blood pump as a biventricular assist device.

    PubMed

    Nonaka, K; Linneweber, J; Ichikawa, S; Yoshikawa, M; Kawahito, S; Mikami, M; Motomura, T; Ishitoya, H; Nishimura, I; Oestmann, D; Glueck, J; Schima, H; Wolner, E; Shinohara, T; Nosé, Y

    2001-09-01

    The Baylor Gyro permanently implantable centrifugal blood pump (Gyro PI pump) has been under development since 1995 at Baylor College of Medicine. Excellent results were achieved as a left ventricular assist device (LVAD) with survival up to 284 days. Based on these results, we are now focusing on the development of a biventricular assist device (BVAD) system, which requires 2 pumps to be implanted simultaneously in the preperitoneal space. Our hypothesis was that the Gyro PI pump would be an appropriate device for an implantable BVAD system. The Gyro PI 700 pump is fabricated from titanium alloy and has a 25 ml priming volume, pump weight of 204 g, height of 45 mm, and pump diameter of 65 mm. This pump can provide 5 L/min against 100 mm Hg at 2,000 rpm. In this study, 6 half-Dexter healthy calves have been used as the experimental model. The right pump was applied between the infundibular of the right ventricle and the main pulmonary artery. The left pump was applied between the apex of the left ventricle and the thoracic descending aorta. As for anticoagulation, heparin was administered at the first postoperative week and then converted to warfarin sodium from the second week after surgery. Both pump flow rates were controlled maintaining a pulmonary arterial flow of less than 160 ml/kg/min for the sake of avoidance of pulmonary congestion. Blood sampling was done to assess visceral organ function, and the data regarding pump performance were collected. After encountering the endpoint, which the study could not keep for any reasons, necropsy and histopathological examinations were performed. The first 2 cases were terminated within 1 week. Deterioration of the pump flow due to suction phenomenon was recognized in both cases. To avoid the suction phenomenon, a flexible conduit attached on the inlet conduit was designed and implanted. After using the flexible inflow conduit, the required power and the rotational speed were reduced. Furthermore, the suction

  20. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures.

    PubMed

    Greenspon, Arnold J; Patel, Jasmine D; Lau, Edmund; Ochoa, Jorge A; Frisch, Daniel R; Ho, Reginald T; Pavri, Behzad B; Kurtz, Steven M

    2012-10-16

    This study sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. The Medicare National Coverage Determination for permanent pacemaker, which emphasized single-chamber pacing, has not changed significantly since 1985. We sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. We queried the Nationwide Inpatient Sample to identify permanent pacemaker implants between 1993 and 2009 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for dual-chamber (DDD), single-ventricular (VVI), single-atrial (AAI), or biventricular (BiV) devices. Annual permanent pacemaker implantation rates and patient demographics were analyzed. Between 1993 and 2009, 2.9 million patients received permanent pacemakers in the United States. Overall use increased by 55.6%. By 2009, DDD use increased from 62% to 82% (p < 0.001), whereas single-chamber ventricular pacemaker use fell from 36% to 14% (p = 0.01). Use of DDD devices was higher in urban, nonteaching hospitals (79%) compared with urban teaching hospitals (76%) and rural hospitals (72%). Patients with private insurance (83%) more commonly received DDD devices than Medicaid (79%) or Medicare (75%) recipients (p < 0.001). Patient age and Charlson comorbidity index increased over time. Hospital charges ($2011) increased 45.3%, driven by the increased cost of DDD devices. There is a steady growth in the use of permanent pacemakers in the United States. Although DDD device use is increasing, whereas single-chamber ventricular pacemaker use is decreasing. Patients are becoming older and have more medical comorbidities. These trends have important health care policy implications. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Aesthetic and oncologic outcomes after one-stage immediate breast reconstruction using a permanent biodimensional expandable implant.

    PubMed

    Agusti, A; Ward, A; Montgomery, C; Mohammed, K; Gui, G P H

    2016-02-01

    Immediate breast reconstruction (IBR) with implants is the commonest method of reconstructive surgery after mastectomy. With careful patient selection, a stable implant pocket can be created at the primary operation to decrease the likelihood of further surgery to adjust the reconstructed side. One-stage IBR is cost effective but failed procedures requiring early revision may be costly as permanent expanders are expensive. Data were prospectively collected on all women undergoing a planned one-stage immediate breast reconstruction between 1997 and 2010. All patients had a Style 150 implant (Allergan, Marlow, UK). Descriptive statistics, Kaplan-Meier plots and, where applicable, Cox Proportional Hazards Regression was used to compare outcomes between groups. 249 planned one-stage IBRs were performed in 193 women, median age 45 years (range 20-77) with median follow-up of 101 months (range 27-159 months). 18/193 (9%) patients required implant exchange at 12 months and 66% of patients maintained their original implants at the time of census. Implant assisted latissimus appears to be robust even when radiotherapy was delivered. Disease free survival and breast cancer mortality were as expected for the breast cancer stage treated. With careful patient selection, one-stage implant IBR using a definitive anatomical expandable implant provides good long term reconstruction and safe oncologic outcome. Direct to implant decision algorithms may be influenced by future developments in acellular dermal matrix technology, but the ability to create a single-stage stable implant pocket with good surgical technique should not be forgotten. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. [Permanent iodine-125 implants brachytherapy: results after 10 years of experience in Liège University Hospital].

    PubMed

    Hermesse, J; Nickers, P; Reul, O; Coucke, P

    2014-01-01

    Permanent implant iodine-125 brachytherapy is an attractive treatment option for men with localized prostate cancer and is an alternative approach to radical prostatectomy. Overall survival and biochemical relapse free survival are similar with both treatments but the toxicity is different. More potency preservation, less incontinence and one day hospitalisation are attractive for the patient with brachytherapy. On the other side, pre-existing obstructive or irritative urinary symptoms at baseline have to guide the patient to a surgical approach. A patient has to be able to select one of these two therapeutic opportunities through a complete transparent information. In this paper, we related our permanent implant iodine-125 brachytherapy experience. Overall survival, biochemical relapse free survival and registred toxicity are similar to those published in the literature.

  3. SU-E-T-123: Anomalous Altitude Effect in Permanent Implant Brachytherapy Seeds

    SciTech Connect

    Watt, E; Spencer, DP; Meyer, T

    2015-06-15

    Purpose: Permanent seed implant brachytherapy procedures require the measurement of the air kerma strength of seeds prior to implant. This is typically accomplished using a well-type ionization chamber. Previous measurements (Griffin et al., 2005; Bohm et al., 2005) of several low-energy seeds using the air-communicating HDR 1000 Plus chamber have demonstrated that the standard temperature-pressure correction factor, P{sub TP}, may overcompensate for air density changes induced by altitude variations by up to 18%. The purpose of this work is to present empirical correction factors for two clinically-used seeds (IsoAid ADVANTAGE™ {sup 103}Pd and Nucletron selectSeed {sup 125}I) for which empirical altitude correction factors do not yet exist in the literature when measured with the HDR 1000 Plus chamber. Methods: An in-house constructed pressure vessel containing the HDR 1000 Plus well chamber and a digital barometer/thermometer was pumped or evacuated, as appropriate, to a variety of pressures from 725 to 1075 mbar. Current measurements, corrected with P{sub TP}, were acquired for each seed at these pressures and normalized to the reading at ‘standard’ pressure (1013.25 mbar). Results: Measurements in this study have shown that utilization of P{sub TP} can overcompensate in the corrected current reading by up to 20% and 17% for the IsoAid Pd-103 and the Nucletron I-125 seed respectively. Compared to literature correction factors for other seed models, the correction factors in this study diverge by up to 2.6% and 3.0% for iodine (with silver) and palladium respectively, indicating the need for seed-specific factors. Conclusion: The use of seed specific altitude correction factors can reduce uncertainty in the determination of air kerma strength. The empirical correction factors determined in this work can be applied in clinical quality assurance measurements of air kerma strength for two previously unpublished seed designs (IsoAid ADVANTAGE™ {sup 103}Pd and

  4. Impact of interseed attenuation and tissue composition for permanent prostate implants

    SciTech Connect

    Carrier, Jean-Francois; Beaulieu, Luc; Therriault-Proulx, Francois; Roy, Rene

    2006-03-15

    The purpose is to evaluate the impact of interseed attenuation and prostate composition for prostate treatment plans with {sup 125}I permanent seed implants using the Monte Carlo (MC) method. The effect of seed density (number of seeds per prostate unit volume) is specifically investigated. The study focuses on treatment plans that were generated for clinical cases. For each plan, four different dose calculation techniques are compared: TG-43 based calculation, superposition MC, full MC with water prostate, and full MC with realistic prostate tissue. The prostate tissue description is from the ICRP report 23 (W. S. Snyer, M. J. Cook, E. S. Nasset, L. R. Karkhausen, G. P. Howells, and I. H. Tipton, ''Report of the task group on reference man,'' Technical Report 23, International Commission on Radiological Protection, 1974). According to the comparisons, the seed density has an influence on interseed attenuation. A plan with a typical low seed density (42 0.6 mCi seeds in a 26 cm{sup 3} prostate) suffers a 1.2% drop in the CTV D{sub 90} value due to interseed attenuation. A drop of 3.0% is calculated for a higher seed density (75 0.3 mCi seeds, same prostate). The influence of the prostate composition is similar for all seed densities and prostate sizes. The difference between MC simulations in water and MC simulations in prostate tissue is between 4.4% and 4.8% for the D{sub 90} parameter. Overall, the effect on D{sub 90} is ranging from 5.8% to 12.8% when comparing clinically approved TG-43 and MC simulations in prostate tissue. The impact varies from one patient to the other and depends on the prostate size and the number of seeds. This effect can reach a significant level when reporting correlations between clinical effect and deposited dose.

  5. Impact of interseed attenuation and tissue composition for permanent prostate implants.

    PubMed

    Carrier, Jean-François; Beaulieu, Luc; Therriault-Proulx, François; Roy, René

    2006-03-01

    The purpose is to evaluate the impact of interseed attenuation and prostate composition for prostate treatment plans with 125I permanent seed implants using the Monte Carlo (MC) method. The effect of seed density (number of seeds per prostate unit volume) is specifically investigated. The study focuses on treatment plans that were generated for clinical cases. For each plan, four different dose calculation techniques are compared: TG-43 based calculation, superposition MC, full MC with water prostate, and full MC with realistic prostate tissue. The prostate tissue description is from the ICRP report 23 (W. S. Snyer, M. J. Cook, E. S. Nasset, L. R. Karkhausen, G. P. Howells, and I. H. Tipton, "Report of the task group on reference man," Technical Report 23, International Commission on Radiological Protection, 1974). According to the comparisons, the seed density has an influence on interseed attenuation. A plan with a typical low seed density (42 0.6 mCi seeds in a 26 cm3 prostate) suffers a 1.2% drop in the CTV D90 value due to interseed attenuation. A drop of 3.0% is calculated for a higher seed density (75 0.3 mCi seeds, same prostate). The influence of the prostate composition is similar for all seed densities and prostate sizes. The difference between MC simulations in water and MC simulations in prostate tissue is between 4.4% and 4.8% for the D90 parameter. Overall, the effect on D90 is ranging from 5.8% to 12.8% when comparing clinically approved TG-43 and MC simulations in prostate tissue. The impact varies from one patient to the other and depends on the prostate size and the number of seeds. This effect can reach a significant level when reporting correlations between clinical effect and deposited dose.

  6. [Morbimortality of infective endocarditis associated with permanent cardiovascular implantable electronic devices].

    PubMed

    Pérez-Baztarrica, Gabriel; Salvaggio, Flavio; Blanco, Norberto; Mazzetti, Héctor; Levin, Ricardo; Botbol, Alejandro; Porcile, Rafael

    2013-12-01

    Infective endocarditis (IE) associated with permanent cardiovascular implantable electronic devices (CIEDs) is a complication of low frequency, but high mortality without adequate treatment. Progress on the knowledge of this disease and the development of therapeutic strategies such as early diagnosis, antibiotic management and better extraction techniques, among others, have improved the prognosis of these patients. The objectives of this study were to evaluate the in-hospital and out-of-hospital morbidity, and analyze some factors that explain the differences among the published mortality data. Patients diagnosed with IE associated with CIEDs were studied, retrospectively, between March/2002 and March/2011. We analyzed baseline, diagnostic and therapeutic characteristics, and in-hospital and out-of-hospital courses of the disease. We included 26 cases treated in our hospital, 23 of whom were referred from other centers for diagnosis and treatment. The average age of the patients was 67.5 years. All patients received antibiotics for six weeks and underwent complete removal of the device system, in 95% of patients by percutaneous extraction and 2 patients required a median sternotomy, atriotomy and epicardial pacemaker placement. Mortality was 4% and the follow up mortality was zero. The in-hospital morbidity was 31%. In the follow-ups there were no reinfections or other complications. In conclusion, IE is a serious condition that has a high morbidity with prolonged hospital stays, but with a low mortality. The explanation may lie in the use percutaneous extraction techniques, experience, complete extraction of the device system, the time of reimplantation of the new device and early treatment, among other factors.

  7. Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic valve implantation with the CoreValve prosthesis.

    PubMed

    Baan, Jan; Yong, Ze Yie; Koch, Karel T; Henriques, José P S; Bouma, Berto J; Vis, Marije M; Cocchieri, Riccardo; Piek, Jan J; de Mol, Bas A J M

    2010-03-01

    Cardiac conduction disorders and requirement for permanent pacemaker implantation (PPI) are not uncommon after surgical aortic valve replacement and have important clinical implications. We aimed to investigate the incidence of cardiac conduction disorders after percutaneous aortic valve implantation (PAVI) and to identify possible clinical factors associated with their development. We studied 34 patients (mean age 80 +/- 8 years, 18 male) who underwent PAVI with the CoreValve bioprosthesis (Corevalve Inc, Irvine, CA). Electrocardiographic evaluation was performed pre- and postprocedurally, and at 1-week and 1-month follow-up. Other clinical variables were obtained from the medical history, echocardiography, and angiography. After PAVI, 7 patients required PPI, all of whom developed total atrioventricular block within 3 days postprocedurally. A smaller left ventricular outflow tract diameter (20.3 +/- 0.5 vs 21.6 +/- 1.8 cm, P = .01), more left-sided heart axis (-20 degrees +/- 29 degrees vs 19 degrees +/- 36 degrees , P = .02), more mitral annular calcification (10 +/- 1 vs 5 +/- 4 mm, P = .008), and a smaller postimplantation indexed effective orifice area (0.86 +/- 0.20 vs 1.10 +/- 0.26 cm(2)/m(2), P = .04) were associated with PPI. The incidence of new left bundle-branch block (LBBB) was 65% and was associated with a deeper implantation of the prosthesis: 10.2 +/- 2.3 mm in the new-LBBB group versus 7.7 +/- 3.1 mm in the non-LBBB group (P = .02). Percutaneous aortic valve implantation with the CoreValve prosthesis results in a high incidence of total atrioventricular block requiring PPI and new-onset LBBB. Preexisting disturbance of cardiac conduction, a narrow left ventricular outflow tract, and the severity of mitral annular calcification predict the need for permanent pacing, whereas the only factor shown to be predictive for new-onset LBBB is the depth of prosthesis implantation.

  8. Influence of Prostatic Edema on {sup 131}CS Permanent Prostate Seed Implants: A Dosimetric and Radiobiological Study

    SciTech Connect

    Kehwar, Than S.; Jones, Heather A.; Huq, M. Saiful; Smith, Ryan P.

    2011-06-01

    Purpose: To study the influence of prostatic edema on postimplant physical and radiobiological parameters using {sup 131}Cs permanent prostate seed implants. Methods and Materials: Thirty-one patients with early prostate cancer who underwent {sup 131}Cs permanent seed implantation were evaluated. Dose-volume histograms were generated for each set of prostate volumes obtained at preimplantation and postimplantion days 0, 14, and 28 to compute quality indices (QIs) and fractional doses at level x (FD{sub x}). A set of equations for QI, FD{sub x}, and biologically effective doses at dose level D{sub x} (BED{sub x}) were defined to account for edema changes with time after implant. Results: There were statistically significant differences found between QIs of pre- and postimplant plans at day 0, except for the overdose index (ODI). QIs correlated with postimplant time, and FD{sub x} was found to increase with increasing postimplant time. With the effect of edema, BED at different dose levels showed less improvement due to the short half-life of {sup 131}Cs, which delivers about 85% of the prescribed dose before the prostate reaches its original volume due to dissipation of edema. Conclusions: Results of the study show that QIs, FD{sub x}, and BEDs at the level of D{sub x} changed from preneedle plans to postimplant plans and have statistically significant differences (p < 0.05), except for the ODI (p = 0.106), which suggests that at the time of {sup 131}C seed implantation, the effect of edema must be accounted for when defining the seed positions, to avoid the possibility of poor dosimetric and radiobiologic results for {sup 131}Cs seed implants.

  9. Analysis of postoperative PSA changes after ultrasound-guided permanent [125I] seed implantation for the treatment of prostate cancer.

    PubMed

    Bian, X L; Wang, C Z; Wang, Y; Li, Y N; Zhang, L Z; Liu, L

    2015-06-29

    The aim of this study was to explore postoperative changes in prostate-specific antigen (PSA) levels and risk factors that influence the clinical effects of ultrasound-guided permanent [(125)I] seed implantation in the treatment of prostate cancer. From July 2009 to December 2012, 41 prostate cancer patients who underwent transrectal ultrasound-guided [(125)I] seed implantation were followed up for 3-56 months. The patients were divided into 2 groups according to their results: group A, benign rebound group, 31 cases; and group B, biochemical relapse group, 10 cases. A blood analysis of group A showed that the initial PSA rise after a nadir occurred postoperatively at 16.8 ± 1.2 months, and in 65.8% (27/41) patients the rise occurred during 15-27 weeks. For group B, the initial PSA rise after a nadir occurred postoperatively at 30.2 ± 2.1 months, and the difference in the time parameter of the initial PSA rise after the nadir was statistically significant between the 2 groups (P < 0.01). During treatment, age was shown to be a risk factor for group A (P = 0.0027, P < 0.01). Postoperative changes in PSA levels after ultrasound-guided permanent [(125)I] seed implantation contributed to the assessment of the clinical treatment effects.

  10. Inverse planning optimization for hybrid prostate permanent-seed implant brachytherapy plans using two source strengths.

    PubMed

    Cunha, J Adam M; Pickett, Barby; Pouliot, Jean

    2010-06-03

    The purpose is to demonstrate the ability to generate clinically acceptable prostate permanent seed implant plans using two seed types which are identical except for their activity. The IPSA inverse planning algorithms were modified to include multiple dose matrices for the calculation of dose from different sources, and a selection algorithm was implemented to allow for the swapping of source type at any given source position. Five previously treated patients with a range of prostate volumes from 20-48 cm3 were re-optimized under two hybrid scenarios: (1) using 0.32 and 0.51 mGy m2 / h 125I, and (2) using 0.64 and 0.76 mGy m2 / h 125I. Isodose lines were generated and dosimetric indices , V150Prostate, D90Prostate, V150Urethra, V125Urethra, V120Urethra,V100Urethra, and D10Urethra were calculated. The algorithm allows for the generation of single-isotope, multi-activity hybrid brachytherapy plans. By dealing with only one radionuclide, but of different activity, the biology is unchanged from a standard plan. All V100Prostate were within 2.3 percentage points for every plan and always above the clinically desirable 95%. All V150Urethra were identically zero, and V120Urethra is always below the clinically acceptable value of 1.0 cm3. Clinical optimization times for the hybrid plans are still under one minute, for most cases. It is possible to generate clinically advantageous brachytherapy plans (i.e. obtain the same quality dose distribution as a standard single-activity plan) while incorporating leftover seeds from a previous patient treatment. This method will allow a clinic to continue to provide excellent patient care, but at a reduced cost. Multi-activity hybrid plans were equal in quality (as measured by the standard dosimetric indices) to plans with seeds of a single activity. Despite the expanded search space, optimization times for these studies were still under two minutes on a modern day laptop and can be reduced to below one minute in a clinical setting

  11. [Evaluation of patients' satisfaction after breast reconstruction with latissimus dorsi myocutaneous flap and immediate permanent breast implant].

    PubMed

    Bognár, Gábor; Gőgh, Bettina; Novák, András; István, Gábor

    2014-04-01

    Current surgical treatment modalities for breast reconstruction include latissimus dorsi mycotaneous flap with immediate permanent breast implant (LDI). The aim of the present study was to analyze reconstruction with LDI in terms of quality of life, cosmesis and patient satisfaction. A chart analysis was carried out with the first ten patients who underwent breast reconstruction with LDI. The patients were interviewed and self-assessment quality of life was administered. They also underwent assessment of satisfaction and cosmesis. The high satisfaction and cosmesis scores in the breast reconstruction group indicate the superior results that can be achieved with breast reconstruction.

  12. A Radiation Badge Survey for Family Members Living With Patients Treated With a {sup 103}Pd Permanent Breast Seed Implant

    SciTech Connect

    Keller, Brian M. Pignol, Jean-Philippe; Rakovitch, Eileen; Sankreacha, Raxa; O'Brien, Peter

    2008-01-01

    Purpose: Sixty-seven patients with early-stage breast cancer were treated in a Phase I/II clinical trial using a {sup 103}Pd permanent breast seed implant as adjuvant radiotherapy after breast-conserving surgery. We report the dose received by family members living with these patients and compare measured doses with theoretical worst-case scenario estimates. Methods and Materials: Exposure-rate measurements were taken at 1 m from the patient by using a calibrated low-energy survey meter. Landauer (Landauer Inc., Glenwood, IL) Luxel badges, with sensitivity of 0.01 mSv, were given to family members to wear after the implantation. Badge readings for 33 spouses and 28 other family members were used to estimate effective doses, and these were compared with theory. Results: Average preimplantation planning target volume from computed tomography was 50.3 ml (range, 18.0-96.7 ml), and average preimplantation distance between the skin and the most anterior planning target volume margin was 0.57 cm. The average maximum exposure rate was measured to be 2.4 {+-} 1.1 mR/h, and average measured dose to a spouse was 0.99 {+-} 1.0 mSv. The calculated exposure rates and spousal doses using preimplantation computed tomography scan data overestimated those measured. Average measured family member dose (excluding spouses) was 0.20 {+-} 0.58 mSv. Conclusions: Based on measured and calculated spousal doses, a permanent breast seed implant using {sup 103}Pd is safe for the public. However, it is recommended that extra precautions in the way of a breast patch be used when patients with an implant will be in the vicinity of toddlers or pregnant women.

  13. Immediate permanent implant reconstruction following mastectomy with capsule preservation in patients with prior augmentation mammoplasty.

    PubMed

    Elliott, L Franklyn; Chu, Carrie K; Daniel, Jarrod; Harper, Garrett; Bergey, Patricia

    2014-01-01

    Prior breast augmentation in patients desiring post-mastectomy reconstruction provides a unique opportunity for capsular preservation and immediate, single-step implant reconstruction. We report a case series of a single-surgeon experience with immediate implant reconstruction after skin-sparing mastectomy in patients with prior subpectoral augmentation. Final implant volumes, complications, and outcomes were examined. Twenty patients (15 bilateral, total 35 breasts) were included. Eighteen (90%) patients were treated for cancer. Mean augmentation-to-reconstruction interval was 9 years (range, 3-19 years). Mean patient age was 45.1 years (range, 37-64 years). Eight patients (40%) received postoperative chemotherapy and two (10%) radiation. Mean mastectomy weight was 321 g. Mean weight of the implants removed was 346 g. Mean volume of new implants was 487 mL. All patients underwent capsulotomy (100% superior, 85% medial, 30% inferior, 5% lateral). Mean operative time was less than 1 hour for bilateral reconstruction. With average follow-up of 25.6 months, 2 patients were re-operated on for asymmetry (implant malposition, synmastia). Thirty-day complications included 1 implant loss due to infection, 1 drain placement with implant salvage, 1 hematoma requiring evacuation, and 1 cellulitis treated with antibiotics. There were no late complications and no capsular contractures. None have required further oncologic surgery. No cancer recurrences have been detected. In patients who desire prosthetic reconstruction similar to their original submuscular augmentation, capsule preservation and implant replacement with a larger prosthetic inserted within the old capsule is safe, fast, and aesthetically pleasing without compromising oncologic principles.

  14. Predictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation.

    PubMed

    Pecha, Simon; Schäfer, Timm; Yildirim, Yalin; Ahmadzade, Teymour; Willems, Stephan; Reichenspurner, Hermann; Wagner, Florian Mathias

    2014-03-01

    Concomitant surgical atrial fibrillation (AF) ablation is a safe and feasible procedure, recommended in guidelines. Pacemaker dependency is a known complication of AF ablation. We sought to determine independent predictors for pacemaker implantation after surgical AF ablation. Between January 2003 and November 2012, 594 patients underwent concomitant surgical AF ablation. Various energy sources, including cryoablation (n = 139), unipolar radiofrequency (n = 278), and bipolar radiofrequency (n = 177), were used. Left atrial (n = 463, 77.9%) and biatrial (n = 131, 22.1%) ablation was performed. Univariate and multivariate logistic regression analysis was used to identify independent predictors for pacemaker implantation within 30 days after surgical AF ablation. The mean patient's age was 68.6 ± 9.4 years, and 66.8% were male. No major ablation-related complications occurred. A total of 41 (6.9%) of patients received pacemaker implantation during the 30-day follow-up period. Indications for pacemaker implantation were atrioventricular block in 25 (60.9%) of patients, sinus bradycardia or sinus arrest in 9 (22.0%) of patients, and bradyarrhythmia in 7 (17.1%) of patients. Demographic data, type of surgical procedure, and type of energy source did not have a significant impact on pacemaker implantation rate. However, biatrial ablation led to a significant pacemaker implantation rate compared with isolated left-sided ablation (6.3% vs 13.6%; P = .028). Concomitant surgical AF ablation showed a pacemaker implantation rate of 6.9% after 30-day follow-up. Univariate and multivariate analysis showed biatrial lesion set as the only statistically significant predictor for pacemaker implantation after surgical AF ablation. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Influence of breast composition and interseed attenuation in dose calculations for post-implant assessment of permanent breast 103Pd seed implant

    NASA Astrophysics Data System (ADS)

    Afsharpour, Hossein; Pignol, Jean-Philippe; Keller, Brian; Carrier, Jean-François; Reniers, Brigitte; Verhaegen, Frank; Beaulieu, Luc

    2010-08-01

    The impact of tissue heterogeneity and interseed attenuation is studied in post-implant evaluation of five clinical permanent breast 103Pd seed implants using the Monte Carlo (MC) dose calculation method. Dose metrics for the target (PTV) as well as an organ at risk (skin) are used to visualize the differences between a TG43-like MC method and more accurate MC methods capable of considering the breast tissue heterogeneity as well as the interseed attenuation. PTV dose is reduced when using a breast tissue model instead of water in MC calculations while the dose to the skin is increased. Furthermore, we investigate the effect of varying the glandular/adipose proportion of the breast tissue on dose distributions. The dose to the PTV (skin) decreases (increases) with the increasing adipose proportion inside the breast. In a complete geometry and compared to a TG43-like situation, the average PTV D90 reduction varies from 3.9% in a glandular breast to 35.5% when the breast consists entirely of adipose. The skin D10 increases by 28.2% in an entirely adipose breast. The results of this work show the importance of an accurate and patient-dependent breast tissue model to be used in the dosimetry for this kind of low energy implant.

  16. Transcatheter Heart Valve Selection and Permanent Pacemaker Implantation in Patients With Pre-Existent Right Bundle Branch Block.

    PubMed

    van Gils, Lennart; Tchetche, Didier; Lhermusier, Thibault; Abawi, Masieh; Dumonteil, Nicolas; Rodriguez Olivares, Ramón; Molina-Martin de Nicolas, Javier; Stella, Pieter R; Carrié, Didier; De Jaegere, Peter P; Van Mieghem, Nicolas M

    2017-03-03

    Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre-existent right bundle branch block and categorize for different transcatheter heart valves. We pooled data on 306 transcatheter aortic valve replacement patients from 4 high-volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM. Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post-transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at 30-day and 1-year follow-up was present in 81% at 89%, respectively. Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker dependency remained high during follow-up. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by

  17. Computed tomography (CT)-guided interstitial permanent implantation of (125)I seeds for refractory chest wall metastasis or recurrence.

    PubMed

    Jiang, Ping; Liu, Chen; Wang, Junjie; Yang, Ruijie; Jiang, Yuliang; Tian, Suqing

    2015-02-01

    To evaluate the efficacy and safety of 125I seeds implantation for refractory chest wall (CW) metastasis or recurrence under CT guidance. In addition we assessed initial data obtained on the therapeutic response for refractory CW metastasis or recurrence. Twenty consecutive patients underwent permanent implantation of 125I seeds (from Jul. 2004 to Jan. 2011) under computed tomography (CT) guidance. Postoperative dosimetry was routinely performed for all patients. The actuarial D90 of the implanted 125I seeds ranged from 100 Gy to 160 Gy (median: 130 Gy). The activity of 125I seeds ranged from 0.5 mCi to 0.78 mCi (median: 0.71 mCi). The total number of seeds implanted ranged from 8 to 269 (median: 53). The follow-up period ranged from 3 to 54 months (median: 11.5 months). The survival and local control probabilities were calculated by the Kaplan-Meier method. Among all the 20 patients, 3 patients had complete remission CR (15%), 12 patients had partial remission PR (60%), 5 patients had stable disease SD. The 1-, 2-, 3- and 4-year tumor control rates were all 88.7% respectively. The 1- and 2-, 3-, 4-year cancer specific survival rates were 56.5% and 47.1%, 47.1%, 47.1% respectively. The 1- and 2-, 3-, 4-year overall survival rates were 53.3% and 35.6%, 35.6%, 35.6% respectively, with a median survival of 15 months (95% CI, 7.0-22.9). Mild brachial plexus injury was seen in one patient; grade 1 or 2 skin reactions were seen in 6 patients (30%) who had received external beam radiation therapy (EBRT) before. No grade 3 and 4 skin side effects were found. Rib fracture, ulceration, pneumothorax or hemopneumothorax were not seen. Interstitial permanent implantation of 125I seeds under CT guidance is feasible, efficacious and safe for refractory CW metastasis or recurrence. © The Author(s) 2014.

  18. American Brachytherapy Society recommends no change for prostate permanent implant dose prescriptions using iodine-125 or palladium-103.

    PubMed

    Rivard, Mark J; Butler, Wayne M; Devlin, Phillip M; Hayes, John K; Hearn, Robert A; Lief, Eugene P; Meigooni, Ali S; Merrick, Gregory S; Williamson, Jeffrey F

    2007-01-01

    In 2004, the American Association of Physicists in Medicine (AAPM) issued a report outlining recommended 125I and 103Pd datasets for consistency in calculating brachytherapy dose distributions. In 2005, to aid evaluating the clinical impact of implementing these datasets, the AAPM assessed the historical dependence of how prescribed doses differed from administered doses for 125I and 103Pd for permanent implantation of the prostate. Consequently, the American Brachytherapy Society (ABS) considered the nature of these changes towards issuing recommended dose prescriptions for 125I and 103Pd interstitial brachytherapy implants for monotherapy and standard boosts. An investigation was performed of the 2005 AAPM analysis to determine changes in administered dose while affixing prescribed dose using 2004 AAPM 125I and 103Pd brachytherapy dosimetry datasets for prostate implants. For 125I and 103Pd, administered dose would change by +1.4% and +4.2%, respectively. The biological and societal impact of changing prescribed dose was considered. Based on the need for clinical constancy and in recognition of overall uncertainties, the ABS recommends immediate implementation of the 2004 AAPM consensus brachytherapy dosimetry datasets and no changes to 125I and 103Pd dose prescriptions at this time. Radiation oncologists should continue to prescribe monotherapy doses of 145 Gy and 125 Gy for 125I and 103Pd, respectively, and standard boost doses of 100-110 Gy and 90-100 Gy for 125I and 103Pd, respectively.

  19. Predictors of Permanent Pacemaker Implantation After Coronary Artery Bypass Grafting and Valve Surgery in Adult Patients in Current Surgical Era.

    PubMed

    Al-Ghamdi, Bandar; Mallawi, Yaseen; Shafquat, Azam; Ledesma, Alexandra; AlRuwaili, Nadiah; Shoukri, Mohamed; Khan, Shahid; Al Sanei, Aly

    2016-08-01

    Permanent pacemaker (PPM) implantation after cardiac surgery is required in 0.4-6% of patients depending on cardiac surgery type. PPM implantation in the early postoperative period may reduce morbidity and postoperative hospital stay. We performed a retrospective review of electronic medical records of adult patients with coronary artery bypass grafting (CABG), valve surgery, or both, over a 3-year period. Our aim was to identify predictors of PPM requirements and PPM dependency on follow-up in the current surgical era. After exclusion of patients with congenital heart disease, patients who already had a PPM or implantable cardioverter defibrillator (ICD), and patients with an indication for PPM or ICD before surgery, we identified 1,234 adult patients who underwent cardiac surgery between January 2007 and December 2009. A retrospective review of electronic medical records and pacemaker clinic data was performed. Patients' mean age was 46.65 ± 16 years, and 59% were males. CABG was performed in 575 (46.6%) cases, aortic valve replacement in 263 (21.3%), mitral valve replacement in 333 (27%), and tricuspid valve replacement in 76 patients (6.2%). Twenty patients (1.6%) required implantation of a PPM postoperatively. Indications for PPM implantation included complete atrioventricular (AV) block in 13 (65%), sick sinus syndrome in three (15%), and atrial fibrillation (AF) with a slow ventricular rate in four (20%). Predictors for PPM requirement by multivariate analysis were the presence of pulmonary hypertension (P-HTN), reoperation, and left bundle branch block (LBBB) (P < 0.05). Late follow-up was available in 18 patients, at 84.5 ± 30 months. Eleven patients (61%) were PPM dependent on long-term follow-up. Patients at high risk for PPM implantation after cardiac surgery include those with P-HTN, reoperation, and pre-existing LBBB. Of those receiving a PPM, about one-third will recover at least partially at long-term follow-up. We recommend preoperative

  20. Predictors of Permanent Pacemaker Implantation After Coronary Artery Bypass Grafting and Valve Surgery in Adult Patients in Current Surgical Era

    PubMed Central

    Al-Ghamdi, Bandar; Mallawi, Yaseen; Shafquat, Azam; Ledesma, Alexandra; AlRuwaili, Nadiah; Shoukri, Mohamed; Khan, Shahid; Al Sanei, Aly

    2016-01-01

    Background Permanent pacemaker (PPM) implantation after cardiac surgery is required in 0.4-6% of patients depending on cardiac surgery type. PPM implantation in the early postoperative period may reduce morbidity and postoperative hospital stay. We performed a retrospective review of electronic medical records of adult patients with coronary artery bypass grafting (CABG), valve surgery, or both, over a 3-year period. Our aim was to identify predictors of PPM requirements and PPM dependency on follow-up in the current surgical era. Methods After exclusion of patients with congenital heart disease, patients who already had a PPM or implantable cardioverter defibrillator (ICD), and patients with an indication for PPM or ICD before surgery, we identified 1,234 adult patients who underwent cardiac surgery between January 2007 and December 2009. A retrospective review of electronic medical records and pacemaker clinic data was performed. Results Patients’ mean age was 46.65 ± 16 years, and 59% were males. CABG was performed in 575 (46.6%) cases, aortic valve replacement in 263 (21.3%), mitral valve replacement in 333 (27%), and tricuspid valve replacement in 76 patients (6.2%). Twenty patients (1.6%) required implantation of a PPM postoperatively. Indications for PPM implantation included complete atrioventricular (AV) block in 13 (65%), sick sinus syndrome in three (15%), and atrial fibrillation (AF) with a slow ventricular rate in four (20%). Predictors for PPM requirement by multivariate analysis were the presence of pulmonary hypertension (P-HTN), reoperation, and left bundle branch block (LBBB) (P < 0.05). Late follow-up was available in 18 patients, at 84.5 ± 30 months. Eleven patients (61%) were PPM dependent on long-term follow-up. Conclusions Patients at high risk for PPM implantation after cardiac surgery include those with P-HTN, reoperation, and pre-existing LBBB. Of those receiving a PPM, about one-third will recover at least partially at long

  1. SU-E-T-12: A Comparative Dosimetric Study of Pre and Post Prostate Iodine-125 Permanent Seed Implants

    SciTech Connect

    Liu, X; Rahimian, J; Goy, B; Cosmatos, H; Qian, Y

    2015-06-15

    Purpose: Post-implant dosimetry has become the gold standard for prostate implant evaluation. The goal of this research is to compare the dosimetry between pre-plan and post-plan in permanent prostate seed implant brachytherapy. Methods: A retrospective study of 91 patients treated with Iodine-125 prostate seed implant between year 2012∼2014 were performed. All plans were created using a VariSeed 8.0 planning system. Pre-plan ultrasound images were acquired using 0.5 cm slice thickness. Post-plan CT images acquired about 1–4 weeks after implant, fused with the preplan ultrasound images. The prostate and urethra contours were generated using the fusion of ultrasound and CT images. Iodine-125 seed source activities varied between 0.382 to 0.414 mCi per seed. The loading patterns varied slightly between patients depending on the prostate size. Statistical analysis of pre and post plans for prostate and urethra volumes, V100%, V150% and D90, and urethra D10 were performed and reported. Results: The pre and post implant average prostate size was 36.90cc vs. 38.58cc; V100% was 98.33% vs. 96.89%; V150% was 47.09% vs. 56.95%; D90 was 116.35Gy vs. 116.12Gy, urethra volume was 1.72cc vs. 1.85cc, urethra D10% was 122.0% vs. 135.35%, respectively. There was no statistically significant difference between the pre and post-plan values for D90(p-value=0.43). However, there are significant differences between other parameters most likely due to post surgical edema; prostate size (p-value= 0.00015); V100% (p-value=3.7803E-07); V150% (p-value=1.49E-09); urethra volume (p-value= 2.77E-06); Urethra D10 (p-value=7.37E-11). Conclusion: The post-plan dosimetry using CT image set showed similar D90 dose coverage to the pre-plan using the ultrasound image dataset. The study showed that our prostate seed implants have consistently delivered adequate therapeutic dose to the prostate while sparing urethra. Future studies to correlate dose versus biochemical response using patients’ PSA

  2. Ultrasound-guided permanent implantation of peripheral nerve stimulation (PNS) system for neuropathic pain of the extremities: original cases and outcomes.

    PubMed

    Huntoon, Marc A; Burgher, Abram H

    2009-11-01

    Our objective is to describe our experience applying a minimally invasive, ultrasound-assisted technique for peripheral nerve stimulation (PNS) trial and permanent implantation in patients with neuropathic extremity pain. Retrospective case series and review of the literature. Setting. Tertiary referral center and academic medical center. Patients with upper or lower extremity neuropathic pain resistant to other therapies who responded to an ultrasound-guided peripheral nerve block at a proximal location. Interventions. Ultrasound-assisted through-the-needle placement of percutaneous neurostimulation electrodes on target major peripheral nerves for fully percutaneous trial, staged trial or permanent implantation of PNS system. A PNS trial period of 3-7 days was used. Pain relief at last follow-up, complications, therapeutic limitations due to technique as applied. Results. Six of eight (75%) patients and 7/9 (78%) peripheral nerves had a successful trial and underwent permanent PNS system implantation using a minimally invasive, ultrasound-assisted technique from November 2007 to December 2008. All but one patient with an implanted PNS system had > or =50% pain relief at last follow-up and 3/7 (43%) permanent systems were associated with > or =80% relief. Loss of paresthesia required revision to dual-lead systems in upper extremity radial nerve PNS. Infection led to explant in one case. In a small series of patients, a minimally invasive, ultrasound-assisted technique for PNS trial, and permanent PNS implantation proved feasible. Patients without adequate analgesia during neurostimulation trial avoided surgical incision and those undergoing permanent implantation were not subjected to the potential morbidity associated with nerve dissection.

  3. Brachytherapy optimization using radiobiological-based planning for high dose rate and permanent implants for prostate cancer treatment

    NASA Astrophysics Data System (ADS)

    Seeley, Kaelyn; Cunha, J. Adam; Hong, Tae Min

    2017-01-01

    We discuss an improvement in brachytherapy--a prostate cancer treatment method that directly places radioactive seeds inside target cancerous regions--by optimizing the current standard for delivering dose. Currently, the seeds' spatiotemporal placement is determined by optimizing the dose based on a set of physical, user-defined constraints. One particular approach is the ``inverse planning'' algorithms that allow for tightly fit isodose lines around the target volumes in order to reduce dose to the patient's organs at risk. However, these dose distributions are typically computed assuming the same biological response to radiation for different types of tissues. In our work, we consider radiobiological parameters to account for the differences in the individual sensitivities and responses to radiation for tissues surrounding the target. Among the benefits are a more accurate toxicity rate and more coverage to target regions for planning high-dose-rate treatments as well as permanent implants.

  4. Histopathological comparison of biodegradable polymer and permanent polymer based sirolimus eluting stents in a porcine model of coronary stent implantation.

    PubMed

    Koppara, Tobias; Joner, Michael; Bayer, Gerd; Steigerwald, Kristin; Diener, Tobias; Wittchow, Eric

    2012-06-01

    Biodegradable stent coatings were recently introduced as a potential solution to overcome sustained inflammatory responses observed with permanent polymer-based drug-eluting stents. In a preliminary study, selected biodegradable or permanent polymer-based sirolimus-eluting stent (SES) formulations were screened for effectiveness in comparison to bare metal stents (BMS) at 28 days. Subsequently, the most favourable SES formulation was compared to commercially available SES (Cypher™) at 28, 90 and 180 days to investigate the histopathologic response as well as tissue, blood and organ pharmacokinetics. Overlapping SES implantation was conducted to evaluate vascular healing at 28 days in this particular setting. SES with biodegradable poly (L-lactide) polymer (PLLA) or poly(lactide-co-glycolide) showed the most favourable outcome with regards to reductions in neointimal area in comparison to BMS at 28 days. The PLLA SES showed a similar reduction in neointimal area compared to Cypher™ at 28 days, with significant greater reductions at 90 and 180 days (1.7 ± 0.7 mm² vs. 3.1 ± 1.5 mm², p=0.03 and 1.8 ± 1.2 mm² vs. 3.0 ± 1.5 mm², p=0.01, respectively). Sirolimus vascular tissue concentrations were detectable up to 90 days following implantation. Overlapping stented segments showed favourable histopathologic results with respect to fibrin deposition and endothelialisation at 28 days. In conclusion, the use of PLLA as drug-eluting matrix resulted in mild inflammatory responses in the presence of effective sirolimus tissue concentrations. The greater efficacy observed at long-term follow-up in PLLA SES compared to Cypher™ may be a multifactorial result of stent design, polymer biocompatibility and improved release kinetics.

  5. SU-F-BRA-03: Integrating Novel Electromagnetic Tracking Hollow Needle Assistance in Permanent Implant Brachytherapy Procedures

    SciTech Connect

    Racine, E; Hautvast, G; Binnekamp, D; Beaulieu, L

    2015-06-15

    Purpose: To report on the results of a complete permanent implant brachytherapy procedure assisted by an electromagnetic (EM) hollow needle possessing both 3D tracking and seed drop detection abilities. Methods: End-to-end in-phantom EM-assisted LDR procedures were conducted. The novel system consisted of an EM tracking apparatus (NDI Aurora V2, Planar Field Generator), a 3D US scanner (Philips CX50), a hollow needle prototype allowing 3D tracking and seed drop detection and a specially designed treatment planning software (Philips Healthcare). A tungsten-doped 30 cc spherical agarose prostate immersed in gelatin was used for the treatment. A cylindrical shape of 0.8 cc was carved along its diameter to mimic the urethra. An initial plan of 26 needles and 47 seeds was established with the system. The plan was delivered with the EM-tracked hollow needle, and individual seed drop locations were recorded on the fly. The phantom was subsequently imaged with a CT scanner from which seed positions and contour definitions were obtained. The DVHs were then independently recomputed and compared with those produced by the planning system, both before and after the treatment. Results: Of the 47 seeds, 45 (96%) were detected by the EM technology embedded in the hollow needle design. The executed plan (from CT analysis) differed from the initial plan by 2%, 14% and 8% respectively in terms of V100, D90 and V150 for the prostate, and by 8%, 7% and 10% respectively in terms of D5, V100 and V120 for the urethra. Conclusion: The average DVH deviations between initial and executed plans were within a 5% tolerance imposed for this proof-of-concept assessment. This relatively good concordance demonstrates the feasibility and potential benefits of combining EM tracking and seed drop detection for real-time dosimetry validation and assistance in permanent implant brachytherapy procedures. This project has been entirely funded by Philips Healthcare.

  6. Tolerance and Acceptance Results of a Palladium-103 Permanent Breast Seed Implant Phase I/II Study

    SciTech Connect

    Pignol, Jean-Philippe Rakovitch, Eileen; Keller, Brian M.; Sankreacha, Raxa; Chartier, Carole

    2009-04-01

    Purpose: To test, in a prospective Phase I/II trial, a partial breast irradiation technique using a {sup 103}Pd permanent breast seed implant (PBSI) realized in a single 1-h procedure under sedation and local freezing. Methods and Materials: Eligible patients had infiltrating ductal carcinoma {<=}3 cm in diameter, surgical margin {>=}2 mm, no extensive intraductal component, no lymphovascular invasion, and negative lymph nodes. Patients received a permanent seed implant, and a minimal peripheral dose of 90 Gy was prescribed to the clinical target volume, with a margin of 1.5 cm. Results: From May 2004 to April 2007, 67 patients received the PBSI treatment. The procedure was well tolerated, with 17% of patients having significant pain after the procedure. Only 1 patient (1.5%) had an acute skin reaction (Grade 3 according to the National Cancer Institute Common Toxicity Criteria). The rates of acute moist desquamation, erythema, and indurations were 10.4%, 42%, and 27%, respectively. At 1 year the rate of Grade 1 telangiectasia was 14%. The rate of skin reaction decreased from 65% to 28% when skin received less than the 85% isodose. According to a Radiation Therapy Oncology Group questionnaire, 80-90% of patients were very satisfied with their treatment, and the remainder were satisfied. One patient (1.5%) developed an abscess, which resolved after the use of antibiotics. There was no recurrence after a median follow-up of 32 months (range, 11-49 months). Conclusions: The feasibility, safety, and tolerability of PBSI compares favorably with that of external beam and other partial breast irradiation techniques.

  7. Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-year Canadian experience

    SciTech Connect

    Martin, Andre-Guy; Roy, Jean; Beaulieu, Luc; Pouliot, Jean; Harel, Francois; Vigneault, Eric . E-mail: Eric.Vigneault@chuq.qc.ca

    2007-02-01

    Purpose: To report outcomes and toxicity of the first Canadian permanent prostate implant program. Methods and Materials: 396 consecutive patients (Gleason {<=}6, initial prostate specific antigen (PSA) {<=}10 and stage T1-T2a disease) were implanted between June 1994 and December 2001. The median follow-up is of 60 months (maximum, 136 months). All patients were planned with fast-simulated annealing inverse planning algorithm with high activity seeds ([gt] 0.76 U). Acute and late toxicity is reported for the first 213 patients using a modified RTOG toxicity scale. The Kaplan-Meier biochemical failure-free survival (bFFS) is reported according to the ASTRO and Houston definitions. Results: The bFFS at 60 months was of 88.5% (90.5%) according to the ASTRO (Houston) definition and, of 91.4% (94.6%) in the low risk group (initial PSA {<=}10 and Gleason {<=}6 and Stage {<=}T2a). Risk factors statistically associated with bFFS were: initial PSA >10, a Gleason score of 7-8, and stage T2b-T3. The mean D90 was of 151 {+-} 36.1 Gy. The mean V100 was of 85.4 {+-} 8.5% with a mean V150 of 60.1 {+-} 12.3%. Overall, the implants were well tolerated. In the first 6 months, 31.5% of the patients were free of genitourinary symptoms (GUs), 12.7% had Grade 3 GUs; 91.6% were free of gastrointestinal symptoms (GIs). After 6 months, 54.0% were GUs free, 1.4% had Grade 3 GUs; 95.8% were GIs free. Conclusion: The inverse planning with fast simulated annealing and high activity seeds gives a 5-year bFFS, which is comparable with the best published series with a low toxicity profile.

  8. Analysis of a five year experience of permanent pacemaker implantation at a Nigerian Teaching Hospital: need for a national database

    PubMed Central

    Falase, Bode; Sanusi, Michael; Johnson, Adeyemi; Akinrinlola, Fola; Ajayi, Reina; Oke, David

    2013-01-01

    Introduction Permanent pacemaker implantation is available in Nigeria. There is however no national registry or framework for pacemaker data collection. A pacemaker database has been developed in our institution and the results are analyzed in this study. Methods The study period was between January 2008 and December 2012. Patient data was extracted from a prospectively maintained database which was designed to include the fields of the European pacemaker patient identification code. Results Of the 51 pacemaker implants done, there were 29 males (56.9%) and 22 females (43.1%). Mean age was 68.2±12.7 years. Clinical indications were syncopal attacks in 25 patients (49%), dizzy spells in 15 patients (29.4%), bradycardia with no symptoms in 10 patients (17.7%) and dyspnoea in 2 patients (3.9%). The ECG diagnosis was complete heart block in 27 patients (53%), second degree heart block in 19 patients (37.2%) and sick sinus syndrome with bradycardia in 5 patients (9.8%). Pacemaker modes used were ventricular pacing in 29 patients (56.9%) and dual chamber pacing in 22 patients (43.1%). Files have been closed in 20 patients (39.2%) and 31 patients (60.8%) are still being followed up with median follow up of 26 months, median of 5 visits and 282 pacemaker checks done. Complications seen during follow up were 3 lead displacements (5.9%), 3 pacemaker infections (5.9%), 2 pacemaker pocket erosions (3.9%), and 1 pacemaker related death (2%). There were 5 non-pacemaker related deaths (9.8%). Conclusion Pacemaker data has been maintained for 5 years. We urge other implanting institutions in Nigeria to maintain similar databases and work towards establishment of a national pacemaker registry. PMID:24498465

  9. Analysis of a five year experience of permanent pacemaker implantation at a Nigerian Teaching Hospital: need for a national database.

    PubMed

    Falase, Bode; Sanusi, Michael; Johnson, Adeyemi; Akinrinlola, Fola; Ajayi, Reina; Oke, David

    2013-01-01

    Permanent pacemaker implantation is available in Nigeria. There is however no national registry or framework for pacemaker data collection. A pacemaker database has been developed in our institution and the results are analyzed in this study. The study period was between January 2008 and December 2012. Patient data was extracted from a prospectively maintained database which was designed to include the fields of the European pacemaker patient identification code. Of the 51 pacemaker implants done, there were 29 males (56.9%) and 22 females (43.1%). Mean age was 68.2±12.7 years. Clinical indications were syncopal attacks in 25 patients (49%), dizzy spells in 15 patients (29.4%), bradycardia with no symptoms in 10 patients (17.7%) and dyspnoea in 2 patients (3.9%). The ECG diagnosis was complete heart block in 27 patients (53%), second degree heart block in 19 patients (37.2%) and sick sinus syndrome with bradycardia in 5 patients (9.8%). Pacemaker modes used were ventricular pacing in 29 patients (56.9%) and dual chamber pacing in 22 patients (43.1%). Files have been closed in 20 patients (39.2%) and 31 patients (60.8%) are still being followed up with median follow up of 26 months, median of 5 visits and 282 pacemaker checks done. Complications seen during follow up were 3 lead displacements (5.9%), 3 pacemaker infections (5.9%), 2 pacemaker pocket erosions (3.9%), and 1 pacemaker related death (2%). There were 5 non-pacemaker related deaths (9.8%). Pacemaker data has been maintained for 5 years. We urge other implanting institutions in Nigeria to maintain similar databases and work towards establishment of a national pacemaker registry.

  10. Real-time intraoperative computed tomography assessment of quality of permanent interstitial seed implantation for prostate cancer.

    PubMed

    Zelefsky, Michael J; Worman, Mick; Cohen, Gilad N; Pei, Xin; Kollmeier, Marisa; Yamada, Josh; Cox, Brett; Zhang, Zhigang; Bieniek, Eva; Dauer, Lawrence; Zaider, Marco

    2010-11-01

    To evaluate the use of real-time kilovoltage cone-beam computed tomography (CBCT) during prostate brachytherapy for intraoperative dosimetric assessment and correcting deficient dose regions. A total of 20 patients were evaluated intraoperatively with a mobile CBCT unit immediately after implantation while still anesthetized. The source detector system was enclosed in a circular CT-like geometry with a bore that accommodates patients in the lithotomy position. After seed deposition, the CBCT scans were obtained. The dosimetry was evaluated and compared with the standard postimplantation CT-based assessment. In 8 patients, the deposited seeds were localized in the intraoperative CBCT frame of reference and registered to the intraoperative transrectal ultrasound images. With this information, a second intraoperative plan was generated to ascertain whether additional seeds were needed to achieve the planned prescription dose. The final dosimetry was compared with the postimplantation scan assessment. The mean differences between the dosimetric parameters from the intraoperative CBCT and postimplant CT scans were < .5% for percentage of volume receiving 100% of the prescription dose, minimal dose received by 90% of the prostate, and percentage of volume receiving 150% of the prescription dose. The minimal dose received by 5% (maximal dose) of the urethra differed by 8% on average and for the rectum an average difference of approximately 18% was observed. After fusion of the implanted seed coordinates from the intraoperative CBCT scans to the intraoperative transrectal ultrasound images, the dosimetric outcomes were not significantly different from the postimplantation CT dosimetric results. Intraoperative CT-based dosimetric evaluation of prostate permanent seed implantation before anesthesia reversal is feasible and might avert misadministration of dose delivery. The dosimetric measurements using the intraoperative CBCT scans were dependable and correlated well with

  11. Acute urinary morbidity after a permanent 125I implantation for localized prostate cancer.

    PubMed

    Ohga, Saiji; Nakamura, Katsumasa; Shioyama, Yoshiyuki; Tatsugami, Katsunori; Sasaki, Tomonari; Nonoshita, Takeshi; Yoshitake, Tadamasa; Asai, Kaori; Hirata, Hideki; Naito, Seiji; Honda, Hiroshi

    2014-11-01

    We evaluated the predictive factors of acute urinary morbidity (AUM) after prostate brachytherapy. From November 2005 to January 2007, 62 patients with localized prostate cancer were treated using brachytherapy. The (125)Iodine ((125)I) seed-delivering method was a modified peripheral pattern. The prescribed dose was 144 Gy. Urinary morbidity was scored at 3 months after implantation. The clinical and treatment parameters were analysed for correlation with AUM. In particular, in this study, Du90 (the minimal dose received by 90% of the urethra), Dup90 (the minimal dose received by 90% of the proximal half of the urethra on the bladder side) and Dud90 (the minimal dose received by 90% of the distal half of the urethra on the penile side) were analysed. We found that 43 patients (69.4%) experienced acute urinary symptoms at 3 months after implantation. Of them, 40 patients had Grade 1 AUM, one patient had Grade 2 pain, and two patients had Grade 2 urinary frequency. None of the patients had ≥Grade 3. Univariate and multivariate analysis revealed that Du90 and Dup90 were significantly correlated with AUM. In this study, Du90 and Dup90 were the most significant predictors of AUM after prostate brachytherapy.

  12. SU-E-J-166: Sensitivity of Clinically Relevant Dosimetric Parameters to Contouring Uncertainty During Post Implant Dosimetry of Prostate Permanent Seed Implants

    SciTech Connect

    Mashouf, S; Ravi, A; Morton, G; Song, W

    2015-06-15

    Purpose: There is a strong evidence relating post-implant dosimetry for permanent seed prostate brachytherpy to local control rates. The delineation of the prostate on CT images, however, represents a challenge as it is difficult to confidently identify the prostate borders from soft tissue surrounding it. This study aims at quantifying the sensitivity of clinically relevant dosimetric parameters to prostate contouring uncertainty. Methods: The post-implant CT images and plans for a cohort of 43 patients, who have received I–125 permanent prostate seed implant in our centre, were exported to MIM Symphony LDR brachytherapy treatment planning system (MIM Software Inc., Cleveland, OH). The prostate contours in post-implant CT images were expanded/contracted uniformly for margins of ±1.00mm, ±2.00mm, ±3.00mm, ±4.00mm and ±5.00mm (±0.01mm). The values for V100 and D90 were extracted from Dose Volume Histograms for each contour and compared. Results: The mean value of V100 and D90 was obtained as 92.3±8.4% and 108.4±12.3% respectively (Rx=145Gy). V100 was reduced by −3.2±1.5%, −7.2±3.0%, −12.8±4.0%, −19.0±4.8%, − 25.5±5.4% for expanded contours of prostate with margins of +1mm, +2mm, +3mm, +4mm, and +5mm, respectively, while it was increased by 1.6±1.2%, 2.4±2.4%, 2.7±3.2%, 2.9±4.2%, 2.9±5.1% for the contracted contours. D90 was reduced by −6.9±3.5%, −14.5±6.1%, −23.8±7.1%, − 33.6±8.5%, −40.6±8.7% and increased by 4.1±2.6%, 6.1±5.0%, 7.2±5.7%, 8.1±7.3% and 8.1±7.3% for the same set of contours. Conclusion: Systematic expansion errors of more than 1mm may likely render a plan sub-optimal. Conversely contraction errors may Result in labeling a plan likely as optimal. The use of MRI images to contour the prostate should results in better delineation of prostate organ which increases the predictive value of post-op plans. Since observers tend to overestimate the prostate volume on CT, compared with MRI, the impact of the

  13. Effect of 1. 5 tesla nuclear magnetic resonance imaging scanner on implanted permanent pacemakers

    SciTech Connect

    Hayes, D.L.; Holmes, D.R. Jr.; Gray, J.E.

    1987-10-01

    Patients with a permanent pacemaker are currently restricted from diagnostic nuclear magnetic resonance (NMR) imaging because of potential adverse effects on the pacemaker by the magnet. Previous work has shown that NMR imaging will result in asynchronous pacing of the pulse generator within a given distance of the magnet. The radiofrequency signal generated by the system may also result in rapid cardiac pacing, which may have deleterious effects. This study utilized a 1.5 tesla unit in an in vivo laboratory animal to evaluate the unit's effects on eight different pulse generators from two manufacturers. All pacemakers functioned in an asynchronous mode when placed within a certain distance of the magnet. In addition, transient reed switch inhibition was observed. Seven of the eight pulse generators paced rapidly when exposed to the radiofrequency signal and there was a dramatic decrease in arterial blood pressure. Whether effective rapid cardiac pacing would occur could not be predicted before exposure to the magnetic resonance unit. Nuclear magnetic resonance imaging with high magnetic fields in patients with a pacemaker should continue to be avoided until the mechanism of the rapid cardiac pacing can be further delineated and either predicted or prevented.

  14. Consequences of dose heterogeneity on the biological efficiency of ¹⁰³Pd permanent breast seed implants.

    PubMed

    Afsharpour, Hossein; Reniers, Brigitte; Landry, Guillaume; Pignol, Jean-Philippe; Keller, Brian M; Verhaegen, Frank; Beaulieu, Luc

    2012-02-07

    Brachytherapy is associated with highly heterogeneous spatial dose distributions. This heterogeneity is usually ignored when estimating the biological effective dose (BED). In addition, the heterogeneities of the medium including the tissue heterogeneity (TH) and the interseed attenuation (ISA) are also contributing to the heterogeneity of the dose distribution, but they are both ignored in Task Group 43 (TG43)-based protocols. This study investigates the effect of dose heterogeneity, TH and ISA on metrics that are commonly used to quantify biological efficiency in brachytherapy. The special case of 29 breast cancer patients treated with permanent (103)Pd seed implant is considered here. BED is compared to equivalent uniform BED (EUBED) capable of considering the spatial heterogeneity of the dose distribution. The effects of TH and ISA on biological efficiency of treatments are taken into account by comparing TG43 with Monte Carlo (MC) dose calculations for each patient. The effect of clonogenic repopulation is also considered. The analysis is performed for different sets of (α/β, α) ratios of (2, 0.3), (4, 0.27) and (10, 0.3) [Gy, Gy(-1)] covering the whole range of reported α/β values in the literature. BED is sometimes larger and sometimes smaller than EUBED(TG43) indicating that the effect of the dose heterogeneity is not similar among patients. The effect of the dose heterogeneity can be characterized by using the D(99) dose metric. For each set of the radiobiological parameters considered, a D(99) threshold is found over which dose heterogeneity will cause an overestimation of the biological efficiencies while the inverse happens for smaller D(99) values. EUBED(MC) is always larger than EUBED(TG43) indicating that by neglecting TH and ISA in TG43-based dosimetry algorithms, the biological efficiencies may be underestimated by about 10 Gy. Overall, by going from BED to the more accurate EUBED(MC) there is a gain of about 9.6 to 13 Gy on the biological

  15. Influence of source batch S{sub K} dispersion on dosimetry for prostate cancer treatment with permanent implants

    SciTech Connect

    Nuñez-Cumplido, E. Hernandez-Armas, J.; Perez-Calatayud, J.; Casares-Magaz, O.

    2015-08-15

    Purpose: In clinical practice, specific air kerma strength (S{sub K}) value is used in treatment planning system (TPS) permanent brachytherapy implant calculations with {sup 125}I and {sup 103}Pd sources; in fact, commercial TPS provide only one S{sub K} input value for all implanted sources and the certified shipment average is typically used. However, the value for S{sub K} is dispersed: this dispersion is not only due to the manufacturing process and variation between different source batches but also due to the classification of sources into different classes according to their S{sub K} values. The purpose of this work is to examine the impact of S{sub K} dispersion on typical implant parameters that are used to evaluate the dose volume histogram (DVH) for both planning target volume (PTV) and organs at risk (OARs). Methods: The authors have developed a new algorithm to compute dose distributions with different S{sub K} values for each source. Three different prostate volumes (20, 30, and 40 cm{sup 3}) were considered and two typical commercial sources of different radionuclides were used. Using a conventional TPS, clinically accepted calculations were made for {sup 125}I sources; for the palladium, typical implants were simulated. To assess the many different possible S{sub K} values for each source belonging to a class, the authors assigned an S{sub K} value to each source in a randomized process 1000 times for each source and volume. All the dose distributions generated for each set of simulations were assessed through the DVH distributions comparing with dose distributions obtained using a uniform S{sub K} value for all the implanted sources. The authors analyzed several dose coverage (V{sub 100} and D{sub 90}) and overdosage parameters for prostate and PTV and also the limiting and overdosage parameters for OARs, urethra and rectum. Results: The parameters analyzed followed a Gaussian distribution for the entire set of computed dosimetries. PTV and

  16. Verification of air-kerma strength of 125I seed for permanent prostate implants in Japan.

    PubMed

    Sumida, Iori; Koizumi, Masahiko; Takahashi, Yutaka; Ogata, Toshiyuki; Akino, Yuichi; Isohashi, Fumiaki; Konishi, Koji; Yoshioka, Yasuo; Inoue, Takehiro

    2009-12-01

    To assure the physical quality of brachytherapy, we investigated the difference between measured and manufacturer's stated source strengths in a single model SourceTech Medical (STM)1251 (125)I seed. A well-type ionization chamber with a single-seed holder was used to measure the source strength of 2412 (125)I seeds before implant in 34 patients. The air-kerma strength was 0.450 U for all cases. The mean source strength for each patient was measured and compared with the manufacturer's stated value. The deviation from the measured value was compared with the tolerance range of the American Association of Physicists in Medicine (AAPM) TG-56 report's recommendation. The measured source strength was higher than the manufacturer's stated value, with a median difference of 1% (range, 2% to 5%). Sixteen of the total of 2412 seeds (0.7%) were more than 5% different from the manufacturer's stated value. The median SD from the mean value was 2.2% (range, 1.1% to 2.5%) for all patients. This is the first report of a single-seed assay performed for the model STM1251 (125)I seed. In this study the manufacturer's stated strength agreed well with the measured value. Nevertheless, the advisability of performing a single-seed assay at every institution should be considered, by referring to the appropriate regulations; for example, those used in the United States.

  17. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing.

    PubMed

    Liao, Jo-Nan; Chao, Tze-Fan; Tuan, Ta-Chuan; Kong, Chi-Woon; Chen, Shih-Ann

    2016-08-01

    A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing.A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality.A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan-Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups.The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction.

  18. [Conduction disturbances and permanent cardiac pacing after transcatheter implantation of the CoreValve aortic bioprosthesis: initial single centre experience].

    PubMed

    Czerwińska, Katarzyna; Hryniewiecki, Tomasz; Oręziak, Artur; Dąbrowski, Maciej; Michałowska, Ilona; Witkowski, Adam; Demkow, Marcin; Stępińska, Janina; Orłowska Baranowska, Ewa; Rużyłło, Witold

    2012-01-01

    The rate of significant conduction disturbances requiring permanent pacemaker implantation (PPI) following surgical aortic valve replacement (AVR) is 2-8%. Transcatheter aortic valve implantation (TAVI) is an alternative management approach in patients with severe aortic stenosis who are not considered candidates for AVR. The TAVI using the CoreValve (CV) bioprosthesis is associated with a nearly 30% rate of conduction disturbances requiring postprocedural PPI. To provide an initial evaluation of the rate of conduction disturbances and the need for PPI, and to analyse factors that increase the risk of this complication in patients undergoing TAVI using CV bioprosthesis. In addition, we evaluated the rate of permanent conduction disturbances in patients who underwent PPI at one year after TAVI. We studies 22 initial patients in a single centre who underwent CV bioprosthesis implantation in 2009-2010. After exclusion of 6 patients with preprocedural PPI, we ultimately evaluated 16 patients. Uni- and multivariate analyses were performed using χ(2), Fisher, and Wilcoxon tests, and logistic regression analysis was performed using the SAS software. Overall, 8 (50%) patients in our study group required PPI after TAVI (TAVI + PPI), and the remaining 8 patients did not require PPI (TAVI). The most common indication for PPI was complete heart block. The decision to implant a pacemaker was made on average at 9 ± 7 days following TAVI (range 3 to 22 days). When we analysed risk factors for PPI that were unrelated to the TAVI procedure, we found that the TAVI + PPI group was characterised (vs the TAVI group) by a significantly larger diameter of the native aortic valve (p = 0.03) and a larger left ventricular outflow tract (LVOT) dimension in the frontal (p = 0.02) and the corresponding frontal dimension in the transverse view (p = 0.01) by computed tomography angiography. Logistic regression analysis showed that the risk of PPI increased more than 2.5 times for each increase

  19. Retrospective comparison of semipermanent and permanent cementation of implant-supported single crowns and FDPs with regard to the incidence of survival and complications.

    PubMed

    Schwarz, Stefanie; Schröder, Christin; Corcodel, Nicoleta; Hassel, Alexander Jochen; Rammelsberg, Peter

    2012-05-01

    To retrospectively compare the fixation modalities semipermanent and permanent for all cemented single crowns and Fixed Dental Prostheses (FDPs) placed at the Department of Prosthodontics in the years 2002 to 2010 with regard to the incidence of survival and complications. Two hundred forty-one patients (48.5% male, mean age 57.3 years) received 166 FDPs and 232 single crowns. A total of 50.6% of the FDPs and 54.7% of the single crowns were fixed using semipermanent cements. Aside from fixation, age, gender, type, location, and material of the suprastructures were assessed as possible factors affecting complications, namely de-cementation, chipping, framework, or abutment fracture. During an observation period of up to 6.6 years (mean 2.24 years; standard deviation 1.38), the survival rates were 96.4% and 100% for FDPs (semipermanent/permanent cementation), and 98.4% and 92.4% for single crowns (semipermanent/permanent). The success rates achieved, counting every complication, for the FDPs were 61.9% and 70.7% (semipermanent/permanent) and for single crowns were 75.6% and 77.1% (semipermanent/permanent). The cement used had a significant effect on loss of retention of the FDPs (p = .006), but no significant effect on the retention of the single crowns. Cementation procedure exhibited no significant impact on chipping for both FDPs and single crowns. The frequency of framework or abutment fractures was too low for further statistical analyses. Both semipermanent and permanent cementation of FDPs and single crowns resulted in high survival rates. Within the limitations of the study design, because of the amount of chairside aftercare required, implant-borne FDPs could be recommended for permanent cementation. © 2011 Wiley Periodicals, Inc.

  20. Clinical Profile and Early Complications after Single and Dual Chamber Permanent Pacemaker Implantation at Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal.

    PubMed

    Khanal, J; Poudyal, R R; Devkota, S; Thapa, S; Dhungana, R R

    2015-01-01

    Permanent pacemaker implantation is a minimally invasive surgical procedure in the management of patients with cardiac problems. However, complications during and after implantation are not uncommon. There is lack of evidences in rate of complications with the selection of pacemakers in Nepal. Therefore, this study was performed to compare the frequency of implantation and complication rate between single chamber and dual chamber pacemaker. The present study is based on all consecutive pacemaker implantations in a single centre between April 2014 and May 2015. A total of 116 patients were categorized into two cohorts according to the type of pacemaker implanted- single chamber or dual chamber. All patients had regular 2-weeks follow-up intervals with standardized documentation of all relevant patient data till 6-week after implantation. Data were presented as means ± standard deviation (SD) for continuous variables and as proportions for categorical variables. Comparison of continuous variables between the groups was made with independent Student's t-test. For discrete variables distribution between groups were compared with Chi-square test. The mean age (±SD) of total population at implant was 64.08 (± 15.09) years. Dual chamber units were implanted in 44 (37.93%) of patients, single chamber in 72 (62.06%). Only 14 women (31.81%) received dual chamber compared with 42 women (58.33%) who received single chamber (Chi-square=18, DF=1, P = 0.0084). Complete atrioventricular block was the commonest (56.03%) indication for permanent pacemaker insertion followed by sick sinus syndrome (33.62%), symptomatic high-grade AV block (11.20%). Hypertension (dual chamber 21.55%, single chamber 40.51%) was the most common comorbidity in both cohorts. Complications occurred in 11 (9.48%) patients. More proportion of complication occurred in single chamber group (9 patients, 12.50%) than in dual chamber (2 patients, 4.54%). Complications occurring in dual chamber group include

  1. Randomized non-inferiority trial of Bicalutamide and Dutasteride versus LHRH agonists for prostate volume reduction prior to I-125 permanent implant brachytherapy for prostate cancer.

    PubMed

    Gaudet, Marc; Vigneault, Éric; Foster, William; Meyer, François; Martin, André-Guy

    2016-01-01

    To determine the efficacy and toxicity of a 3-month regimen of Dutasteride and Bicalutamide compared to LHRH agonists for prostate volume (PV) reduction prior to permanent implant prostate brachytherapy (PIPB). Patients with low-risk or low-tier intermediate risk prostate cancer eligible for PIPB with a prostate volume greater than 50 cc were randomized to either Dutasteride 0.5 mg Bicalutamide 50 mg daily and Tamoxifen 10 mg daily for 3 months (D+B group) or to a 3 month dose of an LHRH agonist and Bicalutamide daily for 1 month (LHRH group). Their PV was measured at baseline and at pre-implant. Non-inferiority analysis was completed for the relative (%) PV reduction. IPSS and EPIC questionnaires were completed at baseline, pre-implant and at 1, 3, 6, 12, 18 and 24 months post-treatment. IPSS and EPIC comparisons were based on superiority analysis 60 patients were randomized (31 to LHRH group and 29 to D+B group). Mean relative PV reduction (SD) was 35.5% (8.9) in the LHRH group and 31.7% (9.6) in the D+B group. The upper bound of the 95% confidence for the interval for the difference between groups favouring LHRH agonists for PV reduction was 8.6 which did not cross the 10% non-inferiority margin meaning D+B is non-inferior to LHRH agonist for PV reduction, although 5/29 (17%) of those in the D+B group required longer duration of D+B to achieve adequate volume reduction. There were no statistically significant differences in IPSS scores over the entire follow-up period. EPIC sexual summary score was significantly better in the D+B group at pre-implant, 1 month, 3 months post-implant. Dutasteride and Bicalutamide is a regimen of non-inferior efficacy to LHRH agonist based regimens for prostate volume reduction prior to permanent implant prostate brachytherapy. D+B has less sexual toxicity compared to LHRH agonists prior to implant and for the first 6 months after implant. D+B is therefore an option to be considered for prostate volume reduction prior to PIPB

  2. Metallic artifact mitigation and organ-constrained tissue assignment for Monte Carlo calculations of permanent implant lung brachytherapy.

    PubMed

    Sutherland, J G H; Miksys, N; Furutani, K M; Thomson, R M

    2014-01-01

    in generated phantoms, this erroneous assignment is reduced, generally resulting in higher doses. Lung-constrained tissue assignment also results in increased doses in regions of interest due to a reduction in the erroneous assignment of adipose to voxels within lung contours. Differences in dose metrics calculated for different computational phantoms are sensitive to radionuclide photon spectra with the largest differences for (103)Pd seeds and smallest but still considerable differences for (131)Cs seeds. Despite producing differences in CT images, dose metrics calculated using the STR, fan beam + STR, and 3D median filter techniques produce similar dose metrics. Results suggest that the accuracy of dose distributions for permanent implant lung brachytherapy is improved by applying lung-constrained tissue assignment schemes to metallic artifact corrected images.

  3. Metallic artifact mitigation and organ-constrained tissue assignment for Monte Carlo calculations of permanent implant lung brachytherapy

    SciTech Connect

    Sutherland, J. G. H.; Miksys, N.; Thomson, R. M.; Furutani, K. M.

    2014-01-15

    assignment within lung contours are employed in generated phantoms, this erroneous assignment is reduced, generally resulting in higher doses. Lung-constrained tissue assignment also results in increased doses in regions of interest due to a reduction in the erroneous assignment of adipose to voxels within lung contours. Differences in dose metrics calculated for different computational phantoms are sensitive to radionuclide photon spectra with the largest differences for{sup 103}Pd seeds and smallest but still considerable differences for {sup 131}Cs seeds. Conclusions: Despite producing differences in CT images, dose metrics calculated using the STR, fan beam + STR, and 3D median filter techniques produce similar dose metrics. Results suggest that the accuracy of dose distributions for permanent implant lung brachytherapy is improved by applying lung-constrained tissue assignment schemes to metallic artifact corrected images.

  4. Metallic artifact mitigation and organ-constrained tissue assignment for Monte Carlo calculations of permanent implant lung brachytherapy

    SciTech Connect

    Sutherland, J. G. H.; Miksys, N.; Thomson, R. M.; Furutani, K. M.

    2014-01-15

    assignment within lung contours are employed in generated phantoms, this erroneous assignment is reduced, generally resulting in higher doses. Lung-constrained tissue assignment also results in increased doses in regions of interest due to a reduction in the erroneous assignment of adipose to voxels within lung contours. Differences in dose metrics calculated for different computational phantoms are sensitive to radionuclide photon spectra with the largest differences for{sup 103}Pd seeds and smallest but still considerable differences for {sup 131}Cs seeds. Conclusions: Despite producing differences in CT images, dose metrics calculated using the STR, fan beam + STR, and 3D median filter techniques produce similar dose metrics. Results suggest that the accuracy of dose distributions for permanent implant lung brachytherapy is improved by applying lung-constrained tissue assignment schemes to metallic artifact corrected images.

  5. Photon counting readout pixel array in 0.18-μm CMOS technology for on-line gamma-ray imaging of 103palladium seeds for permanent breast seed implant (PBSI) brachytherapy

    NASA Astrophysics Data System (ADS)

    Goldan, A. H.; Karim, K. S.; Reznik, A.; Caldwell, C. B.; Rowlands, J. A.

    2008-03-01

    Permanent breast seed implant (PBSI) brachytherapy technique was recently introduced as an alternative to high dose rate (HDR) brachytherapy and involves the permanent implantation of radioactive 103Palladium seeds into the surgical cavity of the breast for cancer treatment. To enable accurate seed implantation, this research introduces a gamma camera based on a hybrid amorphous selenium detector and CMOS readout pixel architecture for real-time imaging of 103Palladium seeds during the PBSI procedure. A prototype chip was designed and fabricated in 0.18-μm n-well CMOS process. We present the experimental results obtained from this integrated photon counting readout pixel.

  6. Factors predicting and having an impact on the need for a permanent pacemaker after CoreValve prosthesis implantation using the new Accutrak delivery catheter system.

    PubMed

    Muñoz-García, Antonio J; Hernández-García, José M; Jiménez-Navarro, Manuel F; Alonso-Briales, Juan H; Domínguez-Franco, Antonio J; Fernández-Pastor, Julia; Peña Hernández, Jose; Barrera Cordero, Alberto; Alzueta Rodríguez, Javier; de Teresa-Galván, Eduardo

    2012-05-01

    The purpose of this study was to evaluate the need for a permanent pacemaker after transcatheter aortic valve implantation with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) using the new Accutrak delivery system (Medtronic, Inc.). The need for a permanent pacemaker is a recognized complication after transcatheter aortic valve implantation with the CoreValve prosthesis. Between April 23, 2008 and May 31, 2011, 195 consecutive patients with symptomatic aortic valve stenosis underwent transcatheter aortic valve implantation using the self-expanding CoreValve prosthesis. In 124 patients, the traditional delivery system was used, and in 71 patients, the Accutrak delivery system was used. There were no significant differences in baseline electrocardiographic characteristics between the traditional system and the Accutrak patients: PR interval: 153 ± 46 mm versus 165 ± 30 mm, p = 0.12; left bundle branch block: 22 (20.2%) versus 8 (12.7%), p = 0.21; right bundle branch block: 21 (19.3%) versus 8 (12.7%), p = 0.26. The depth of the prosthesis in the left ventricular outflow tract was greater with the traditional system than with the Accutrak system (9.6 ± 3.2 mm vs. 6.4 ± 3 mm, p < 0.001) and the need for a permanent pacemaker was higher with traditional system than with Accutrak (35.1% vs. 14.3%, p = 0.003). The predictors of the need for a pacemaker were the depth of the prosthesis in the left ventricular outflow tract (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 1.08 to 1.34, p < 0.001), pre-existing right bundle branch block (HR: 3.5, 95% CI: 1.68 to 7.29, p = 0.001), and use of the traditional system (HR: 27, 95% CI: 2.81 to 257, p = 0.004). The new Accutrak delivery system was associated with less deep prosthesis implantation in the left ventricular outflow tract, which could be related to the lower rate of permanent pacemaker requirement. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All

  7. First permanent implant of nerve stimulation leads activated by surface electrodes, enabling hand grasp and release: the stimulus router neuroprosthesis.

    PubMed

    Gan, Liu Shi; Ravid, Einat; Kowalczewski, Jan Andrzej; Olson, Jaret Lawrence; Morhart, Michael; Prochazka, Arthur

    2012-05-01

    . More than 150 000 neuroprostheses (NPs) have been implanted in people to restore bodily function in a variety of neural disorders. The authors developed a novel NP, the Stimulus Router System (SRS), in which only passive leads are implanted. Each lead picks up a portion of the current delivered through the skin by an external stimulator. . The authors report on the first human implant of an SRS. . The recipient was a tetraplegic man with bilateral hand paralysis. Three SRS leads were implanted in his right forearm to activate the finger extensors, finger flexors, and thumb flexor. A wristlet containing a surface stimulator and electrodes was used to pass trains of electrical pulses through the skin to each lead. Hand opening and grasp were controlled via a wireless earpiece that sensed small tooth-clicks and transmitted signals to the wristlet. . The current required to activate the muscles was less than half that required prior to implantation and below perceptual threshold. Maximal grip force and hand opening aperture were both larger using the SRS. The implanted leads have remained functional for 3 years. The recipient reported various tasks of daily life that improved during SRS usage. An electronic counter revealed mean monthly usage of 18.5 hours, equivalent to 55 hours of continuous manual activity. . This first implant of the SRS indicates that it can be effective and reliable and has potential to provide an alternative to existing NPs.

  8. Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement – Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation

    PubMed Central

    Young Lee, Mark; Chilakamarri Yeshwant, Srinath; Chava, Sreedivya; Lawrence Lustgarten, Daniel

    2015-01-01

    Transcatheter aortic valve replacement (TAVR) has emerged as a valuable, minimally invasive treatment option in patients with symptomatic severe aortic stenosis at prohibitive or increased risk for conventional surgical replacement. Consequently, patients undergoing TAVR are prone to peri-procedural complications including cardiac conduction disturbances, which is the focus of this review. Atrioventricular conduction disturbances and arrhythmias before, during or after TAVR remain a matter of concern for this high-risk group of patients, as they have important consequences on hospital duration, short- and long-term medical management and finally on decisions of device-based treatment strategies (pacemaker or defibrillator implantation). We discuss the mechanisms of atrioventricular disturbances and characterise predisposing factors. Using validated clinical predictors, we discuss strategies to minimise the likelihood of creating permanent high-grade heart block, and identify factors to expedite the decision to implant a permanent pacemaker when the latter is unavoidable. We also discuss optimal pacing strategies to mitigate the possibility of pacing-induced cardiomyopathy. PMID:26835105

  9. First report of a permanent breast {sup 103}Pd seed implant as adjuvant radiation treatment for early-stage breast cancer

    SciTech Connect

    Pignol, Jean-Philippe . E-mail: Jean-Philippe.Pignol@sw.ca; Keller, Brian; Rakovitch, Eileen; Sankreacha, Raxa; Easton, Harry; Que, William

    2006-01-01

    Purpose: A new technique of adjuvant partial breast irradiation using {sup 103}Pd permanent breast seed implants (PBSI) is presented. The procedure is performed in a single 1-hour session under local anesthesia. Methods and Materials: Patients referred to a single institution for adjuvant radiotherapy after lumpectomy for an infiltrating ductal carcinoma {<=}3 cm in diameter, surgical margin {>=}2 mm, no extensive in situ carcinoma, no lymphovascular invasion, and minimal or negative lymph node involvement were offered a PBSI. Results: Between May and December 2004, 31 eligible patients underwent CT scan and ultrasound simulations assessing PBSI feasibility. Fifteen were excluded because of feasibility issues, and 16 received PBSI. A minimal peripheral dose of 90 Gy was prescribed to the planning target volume corresponding to the clinical target volume identified on the CT scan plus a margin of 1 cm. The procedure was well tolerated; 56% of the patients reported no pain during the procedure, and 46% of the patients developed National Cancer Institute Common Toxicity Criteria Grade 1 acute reaction. None experienced toxicity Grade 2 or 3. Conclusions: Permanent breast seed implantation seems feasible and well tolerated on these preliminary clinical data and represents an ultimate step in the reduction of treatment fraction for partial breast irradiation.

  10. First permanent human implant of the Stimulus Router System, a novel neuroprosthesis: preliminary testing of a polarity reversing stimulation technique.

    PubMed

    Gan, Liu Shi; Ravid, Einat N; Kowalczewski, Jan; Gauthier, Michel; Olson, Jaret; Morhart, Michael; Prochazka, Arthur

    2011-01-01

    Neuroprostheses (NPs) are electrical stimulators that help to restore sensory or motor functions lost as a result of neural damage. The Stimulus Router System (SRS) is a new type of NP developed in our laboratory. The system uses fully implanted, passive leads to "capture" and "route" some of the current flowing between pairs of surface electrodes to the vicinity of the target nerves, hence eliminating the need for an implanted stimulator. In June 2008, 3 SRS leads were implanted in a tetraplegic man for restoration of grasp and release. To reduce the size of the external wristlet and thereby optimize usability, we recently implemented a polarity reversing stimulation technique that allowed us to eliminate a reference electrode. Selective activation of three target muscles was achieved by switching the polarities of the stimulus current delivered between pairs of surface electrodes located over the pick-up terminals of the implanted leads and reducing the amplitude of the secondary phases of the stimulus pulses.

  11. Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation.

    PubMed

    Ozcan, C; Jahangir, A; Friedman, P A; Patel, P J; Munger, T M; Rea, R F; Lloyd, M A; Packer, D L; Hodge, D O; Gersh, B J; Hammill, S C; Shen, W K

    2001-04-05

    In patients with atrial fibrillation that is refractory to drug therapy, radio-frequency ablation of the atrioventricular node and implantation of a permanent pacemaker are an alternative therapeutic approach. The effect of this procedure on long-term survival is unknown. We studied all patients who underwent ablation of the atrioventricular node and implantation of a permanent pacemaker at the Mayo Clinic between 1990 and 1998. Observed survival was compared with the survival rates in two control populations: age- and sex-matched members of the Minnesota population between 1970 and 1990 and consecutive patients with atrial fibrillation who received drug therapy in 1993. A total of 350 patients (mean [+/-SD] age, 68+/-11 years) were studied. During a mean of 36+/-26 months of follow-up, 78 patients died. The observed survival rate was significantly lower than the expected survival rate based on the general Minnesota population (P<0.001). Previous myocardial infarction (P<0.001), a history of congestive heart failure (P=0.02), and treatment with cardiac drugs after ablation (P=0.03) were independent predictors of death. Observed survival among patients without these three risk factors was similar to expected survival (P=0.43). None of the 26 patients with lone atrial fibrillation died during follow-up (37+/-27 months). The observed survival rate among patients who underwent ablation was similar to that among 229 controls with atrial fibrillation (mean age, 67+/-12 years) who received drug therapy (P=0.44). In the absence of underlying heart disease, survival among patients with atrial fibrillation after ablation of the atrioventricular node is similar to expected survival in the general population. Long-term survival is similar for patients with atrial fibrillation, whether they receive ablation or drug therapy. Control of the ventricular rate by ablation of the atrioventricular node and permanent pacing does not adversely affect long-term survival.

  12. Implantation of permanent pacemaker and ICD leads in children using a three-dimensional electroanatomic mapping system as an aid to fluoroscopy.

    PubMed

    Silver, Eric S; Nash, Mary C; Liberman, Leonardo

    2015-04-01

    Three-dimensional electroanatomic mapping systems (3D mapping) allow the creation of an anatomic representation of the cardiac anatomy and real-time monitoring of transvenous pacing catheters. Their use to facilitate pacemaker (PM) and implantable cardioverter defibrillator (ICD) lead placement in the pediatric population has not been well defined. We sought to review our experience using 3D mapping as an adjunct to fluoroscopy for positioning of permanent PM and ICD leads in pediatric patients. We performed a retrospective review of all patients ≤21 years of age who underwent PM or ICD implantation with the aid of the Ensite Velocity system (Ensite) from May 2012 to September 2014. Fluoroscopy was utilized in addition to 3D mapping to aid obtaining vascular access, to visualize fixation of the lead to the myocardium, and to evaluate lead length within the vasculature. Nineteen patients (mean age 14.6 ± 4.4 years) underwent placement of active fixation PM leads (N = 17) and/or ICD leads (N = 10) with the aid of Ensite. All leads were successfully placed (eight atrial, 19 ventricular). Fluoroscopic exposure was a mean of 3.2 minutes (± 2.8, 0.1-10.5). There was one lead dislodgement. Ensite was used successfully as an adjunct to fluoroscopy in all patients in whom it was attempted to aid the placement of permanent transvenous PM and ICD leads. Future evaluation could focus on the use of 3D mapping systems to further minimize or eliminate fluoroscopy from PM and ICD implantations. ©2015 Wiley Periodicals, Inc.

  13. Development of virtual patient models for permanent implant brachytherapy Monte Carlo dose calculations: interdependence of CT image artifact mitigation and tissue assignment

    NASA Astrophysics Data System (ADS)

    Miksys, N.; Xu, C.; Beaulieu, L.; Thomson, R. M.

    2015-08-01

    This work investigates and compares CT image metallic artifact reduction (MAR) methods and tissue assignment schemes (TAS) for the development of virtual patient models for permanent implant brachytherapy Monte Carlo (MC) dose calculations. Four MAR techniques are investigated to mitigate seed artifacts from post-implant CT images of a homogeneous phantom and eight prostate patients: a raw sinogram approach using the original CT scanner data and three methods (simple threshold replacement (STR), 3D median filter, and virtual sinogram) requiring only the reconstructed CT image. Virtual patient models are developed using six TAS ranging from the AAPM-ESTRO-ABG TG-186 basic approach of assigning uniform density tissues (resulting in a model not dependent on MAR) to more complex models assigning prostate, calcification, and mixtures of prostate and calcification using CT-derived densities. The EGSnrc user-code BrachyDose is employed to calculate dose distributions. All four MAR methods eliminate bright seed spot artifacts, and the image-based methods provide comparable mitigation of artifacts compared with the raw sinogram approach. However, each MAR technique has limitations: STR is unable to mitigate low CT number artifacts, the median filter blurs the image which challenges the preservation of tissue heterogeneities, and both sinogram approaches introduce new streaks. Large local dose differences are generally due to differences in voxel tissue-type rather than mass density. The largest differences in target dose metrics (D90, V100, V150), over 50% lower compared to the other models, are when uncorrected CT images are used with TAS that consider calcifications. Metrics found using models which include calcifications are generally a few percent lower than prostate-only models. Generally, metrics from any MAR method and any TAS which considers calcifications agree within 6%. Overall, the studied MAR methods and TAS show promise for further retrospective MC dose

  14. Radiofrequency ablation and percutaneous permanent iodine-125 implantation as salvage therapy for giant recurrent sclerosing epithelioid fibrosarcoma of the chest wall: A case report

    PubMed Central

    KE, SHAN; DING, XUE-MEI; GAO, JUN; WANG, SHAO-HONG; ZHANG, JUN; KONG, JIAN; SUN, WEN-BING

    2015-01-01

    Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft-tissue sarcoma for which there is no standardized treatment regimen available. The current treatment options for SEF are resection, radiation and chemotherapy. Surgical resection remains the mainstay of therapy for SEF. However, SEF is an aggressive tumor that is prone to repeated local recurrence if not widely excised. Radiation and chemotherapy are less commonly used due to the insensitivity of SEF to these therapies. The treatment of recurrent SEF is even more challenging. The present study describes a patient who presented with a giant recurrent SEF arising from the chest wall that was accompanied by emergent bleeding. The patient was a 70-year-old male who had multiple comorbid diseases, including hypertension and chronic cardiac dysfunction. A computed tomography (CT) scan indicated the involvement of the sternum and anterior mediastinum. However, the patient refused any further surgery. Subsequent to careful discussion and consideration, radiofrequency (RF) ablation and percutaneous iodine-125 implantation was administered. The emergent bleeding was successfully stopped and the tumor was eliminated using RF ablation. Percutaneous iodine-125 implantation under CT guidance established effective control on the growth of the tumor involving the mediastinum. Despite this, the tumor recurred 6 months after treatment. The patient refused any further treatment and was discharged. In conclusion, RF ablation and percutaneous permanent iodine-125 implantation is a feasible and safe salvage therapy for patients with recurrent SEF of the chest wall. PMID:26137032

  15. Élaboration de couches minces de carbone par ablation laser femtoseconde pour application aux biomatériaux implantables

    NASA Astrophysics Data System (ADS)

    Loir, A.-S.; Garrelie, F.; Donnet, C.; Subtil, J.-L.; Belin, M.; Forest, B.; Rogemond, F.; Laporte, P.

    2005-06-01

    Des films de tetrahedral amorphous-Carbon (ta-C) ont été déposés, sous vide poussé, par ablation d'une cible de graphite avec un laser Ti : saphir (durée d'impulsion 170 fs, fréquence de répétition 1 kHz, énergie maximale par impulsion 1,5 mJ, longueur d'onde 800 nm) sur substrats standard et sur biomatériaux (acier AISI 316L, polyéthylène à très haut poids moléculaire). Les propriétés de ces couches (structure, propriétés nanomécaniques et tribologiques) ont été caractérisées, en fonction des conditions d'élaboration, en examinant l'intérêt de l'utilisation d'un laser femtoseconde et leur capacité à satisfaire aux exigences spécifiques du domaine biomédical. Les propriétés d'adhérence des films ont été considérablement améliorées lors du dépôt sur des substrats en acier inoxydable préalablement préparés par décapage ionique in situ sous atmosphère d'argon. La surface hémisphérique d'une tête fémorale, en acier inoxydable, de prothèse de hanche de diamètre 22,2 mm a été revêtue d'un film de DLC adhérent et homogène en épaisseur. La résistance à l'usure de ce revêtement sera quantifiée à l'aide d'un simulateur de marche durant un million de cycles (correspondant à une année d'activité physique d'un être humain).

  16. Lévitation magnétique par association d'aimants permanents et de supraconducteurs à haute température critique

    NASA Astrophysics Data System (ADS)

    Hiebel, P.; Tixador, P.; Chaud, X.

    1995-06-01

    Since their discovery in the years 1986/87, the high critical temperature superconductors have reached nowadays performances interesting enough to conceive passive magnetic bearings and suspensions which would combined permanent magnets and naturally stable superconducting pellets. After underlining the principal factors that affect the superconductormagnet interaction, different experimental results are given about vertical and axial forces with some stiffness values. The magnetization curve of a superconductor help to understand the hysteretic behavior of the force as a function of the distance between superconductor and magnet. So called simple and hybrid structures of superconducting magnetic suspension are presented. Finally simple numerical simulations allow to draw some interesting conclusions about both geometry and best fitting structure of permanent magnets. Depuis leur découverte dans les années 1986/87, les supraconducteurs à haute température critique ont désormais atteint des performances intéressantes et rendent envisageables des paliers et suspensions magnétiques passives associant aimants permanents et pastilles supraconductrices naturellement stables. Après avoir indiqué les termes importants influençant l'interaction supraconducteur - aimant, différents relevés expérimentaux sont donnés pour les forces verticales et transversales avec quelques valeurs de raideurs. La courbe d'aimantation d'un supraconducteur permet de comprendre le comportement hystérétique de la force en fonction de la distance supraconducteur-aimant. Les structures dites simple et hybride des suspensions magnétiques supraconductrices sont présentées. Enfin quelques simulations numériques simples permettent de dégager quelques conclusions intéressantes quant aux géométries respectives et aux structures d'aimants permanents les mieux adaptées.

  17. Successful permanent catheter implantation after percutaneous transluminal angioplasty to the right subclavian and inominate vein stenosis in a hemodialysis patient.

    PubMed

    Nishioka, Hiroaki; Morimoto, Satoshi; Yurugi, Takatomi; Nishikawa, Mitsushige; Iwasaka, Toshiji; Maki, Kei

    2010-02-01

    Difficulties in gaining vascular access have become one of the major problems in long-term hemodialysis patients. We report a case with an extreme vascular access problem, which was solved by the placement of a permanent central vein catheter after successful angioplasty to the right subclavian and inominate vein stenosis. A 78-year-old woman with end-stage renal disease due to diabetic nephropathy had been on hemodialysis since 1982. She had a history of four procedures that created an arteriovenous fistula during the first four years. In 1986 she was switched to peritoneal dialysis. However, hemodialysis was restarted with a regular arteriovenous fistula in 1991 because of repeated peritonitis, and from 1993 a superficialized brachial artery was used until the artery was exhausted. Since 1997, a permanent central vein catheter was utilized and reinsertion was required four times due to catheter infection during a 6-year period. In 2004, difficulty was experienced in reinserting a new central venous catheter because of multiple stenotic and occlusive lesions of the central veins. Percutaneous transluminal angioplasty was carried out in the stenotic right subclavian and inominate veins, and after successful angioplasty, a permanent central vein catheter could be placed into the right subclavian vein as a vascular access for hemodialysis. Pretreatment with percutaneous transluminal angioplasty of the stenotic central veins before inserting a permanent catheter may be a useful strategy in patients that experience difficulty in the insertion of a catheter.

  18. 50th Anniversary of the first successful permanent pacemaker implantation in the United States: historical review and future directions.

    PubMed

    Beck, Hiroko; Boden, William E; Patibandla, Sushmitha; Kireyev, Dmitriy; Gutpa, Vipul; Campagna, Franklin; Cain, Michael E; Marine, Joseph E

    2010-09-15

    June 2010 marks the 50th anniversary of the first successful human cardiac pacemaker implantation in the United States. On June 6, 1960, in Buffalo, New York, Dr. William Chardack implanted a pacemaker, designed and built by Wilson Greatbatch, an electrical engineer and inventor, in a 77-year old man with complete atrioventricular block, extending the patient's life by 18 months. This landmark event ushered in a new era of implantable cardiac pacemakers with batteries and leads of high reliability and increasing durability. Over the past half century, the field of electrophysiology and implantable devices for the management of cardiac conduction disturbances has evolved dramatically. Today's pacemakers include increasingly complex features such as telemetry monitoring, auto programmability, and hemodynamic sensors. New-generation leads present a sophisticated design with improved geometry and steroid-eluting tips to reduce chronic inflammation, maintaining a low pacing threshold and high sensing capability. The lithium iodide battery remains the mainstay of implantable pacemaker systems, exhibiting a multiple-year lifespan, slow terminal decay, and a reduced size and cost of production. Although Greatbatch's first successful pacemaker implantation remains a seminal scientific contribution to modern cardiovascular disease management, emerging developments in this field may challenge its preeminence. Important challenges such as imaging compatibility, lead durability, and infection prevention are being addressed. Novel concepts such as leadless and biologic pacing are under active investigation. In conclusion, Greatbatch's historic achievement 50 years ago reminds us that technologic progress is timeless, as efforts to enhance clinical outcomes and the quality of life continue unimpeded into the 21st century. © 2010 Published by Elsevier Inc.

  19. Moving Toward Focal Therapy in Prostate Cancer: Dual-Isotope Permanent Seed Implants as a Possible Solution

    SciTech Connect

    Todor, Dorin A.; Barani, Igor J.; Lin, Peck-Sun; Anscher, Mitchell S.

    2011-09-01

    Purpose: To compare the ability of single- and dual-isotope prostate seed implants to escalate biologically effective dose (BED) to foci of disease while reducing prescription dose to the prostate. Methods and Materials: Nine plans, using {sup 125}I, {sup 103}Pd, and {sup 131}Cs alone and in combination were created retrospectively for 2 patients. Ultrasound and MRI/MRS datasets were used for treatment planning. Voxel-by-voxel BED was calculated for single- and dual-isotope plans. Equivalent uniform BED (EUBED) was used to compare plans. The MRS-positive planning target volumes (PTV{sub i}) were delineated along with PTV (prostate + 5 mm), rectum, and urethra. Single-isotope implants, prescribed to conventional doses, were generated to achieve good PTV coverage. The PTV{sub i} were prospectively used to generate implants using mixtures of isotopes. For mixed-radioisotope implants, we also explored the impact on EUBED of lowering prescription doses by 15%. Results: The EUBED of PTV{sub i} in the setting of primary {sup 125}I implant increased 20-66% when {sup 103}Pd and {sup 131}Cs were used compared with {sup 125}I boost. Decreasing prescription dose by 15% in mixed-isotope implants results in a potential 10% reduction in urethral EUBED with preservation of PTV coverage while still boosting PTV{sub i} (up to 80%). When radiobiologic parameters corresponding to more-aggressive disease are assigned to foci, faster-decaying isotopes used in mixed implants have the potential to preserve the equivalent biological effect of mono-isotope implants considering less-aggressive disease distributed in the entire prostate. Conclusions: This is a hypothesis-generating study proposing a treatment paradigm that could be the middle ground between whole-gland irradiation and focal-only treatment. The use of two isotopes concurrent with decreasing the minimal peripheral dose is shown to increase EUBED of selected subvolumes while preserving the therapeutic effect at the level of the

  20. Implanting permanent left ventricular assist devices in patients on veno-arterial extracorporeal membrane oxygenation support: do we really need a cardiopulmonary bypass machine?

    PubMed

    Abdeen, Muhammad S K M; Albert, Alexander; Maxhera, Bujar; Hoffmann, Till; Petrov, Georgi; Sixt, Stephan; Roussel, Elisabeth; Westenfeld, Ralf; Lichtenberg, Artur; Saeed, Diyar

    2016-09-01

    Selected patients who failed to be weaned off temporary veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support may be considered for long-term left ventricular assist devices (LVADs). Activation of the systemic inflammatory response due to the cardiopulmonary bypass (CPB) machine and its associated deleterious effects on the coagulation system have been well documented. The aim of the study was to compare the outcome of patients receiving VAD on VA-ECMO with patients who were converted to CPB at the time of VAD implantation. Data of patients undergoing LVAD implantation between January 2010 and September 2015 were retrospectively reviewed. Inclusion criteria were patients with prior VA-ECMO. Perioperative characteristics and postoperative outcome of patients who received LVAD after VA-ECMO with (CPB group) or without CPB (no-CPB group) were compared. A total of 110 permanent VADs were implanted during this time frame. Forty patients had VA-ECMO prior to VAD implantation and met the inclusion criteria. The CPB was used in 23 patients and 17 patients received VAD on VA-ECMO without using CPB. The preoperative characteristics of the patients were comparable except for lower body mass index, higher international normalized ratio (INR) and higher rate of preoperative intra-aortic balloon pump usage in the CPB group (P = 0.035, 0.008 and 0.003, respectively). The incidence of postoperative right VAD implantation and survival rate was comparable between both groups. However, the chest tube blood loss and amount of blood product usage was higher in the CPB group. The total blood loss in the first 24 h after surgery (2469 ± 2067 vs 1080 ± 941 ml, P= 0.05) and number of units of intraoperative fresh frozen plasma administered (4 ± 3 vs 1 ± 2, P= 0.02) remained higher in the CPB group even after adjustment for differences in preoperative INR value by propensity score matching. This study demonstrates that the CPB machine can be safely omitted when a long

  1. Safety and efficacy of a biomimetic monolayer of permanently bound multiphosphonic acid molecules on dental implants: 3 years post-loading results from a pilot quadruple-blinded randomised controlled trial.

    PubMed

    Esposito, Marco; Dojcinovic, Ivan; Buchini, Sabrina; Péchy, Péter; Aronsson, Björn-Owe

    To evaluate the safety and clinical efficacy of a novel surface treatment (SurfLink, Nano Bridging Molecules, Gland, Switzerland) on titanium dental implants. SurfLink consists of a monolayer of permanently bound multiphosphonic acid molecules, which mimics the surface of naturally occurring hydroxyapatite. Twenty-three patients requiring at least two single dental implants had their sites randomised according to a split-mouth design to receive one titanium grade 4 implant treated with SurfLink and one untreated control implant. Additional SurfLink-treated implants were placed if needed. Implants were submerged for 3 months in mandibles and 6 months in maxillae, then loaded with definitive metal-ceramic crowns and followed for 3 years after loading. Outcome measures were crown/implant failures, any complication, radiographic peri-implant marginal bone level changes and marginal bleeding. Three patients dropped out but all remaining patients were followed up to 3-years post-loading. No implant failed. Complications were reported for three patients, affecting both types of implant in two patients and only SurfLink implant in one patient. No differences for complications between the two implant types was observed (McNemar test, P = 1, difference in proportions = -0.04, 95% CI: -0.22 to 0.14). No bleeding was observed when a periodontal probe was run in the peri-implant soft tissues around any of the implants, with the exception of three implants affected by peri-implantitis. There were no statistically significant differences in marginal bone level changes between the two groups (at 3 years post-loading P = 0.86, mean difference = -0.05; SD = 1.15; 95% CI: -0.56 to 0.47). Medium-term data (3-years post-loading) of implants with a biomimetic monolayer of permanently bound multiphosphonic acid molecules (SurfLink surface treatment) presented no safety issues. Clinical healing in both control and SurfLink-treated implant groups was uneventful

  2. New method of forced implantation of permanent catheters for hemodialysis into critically stenosed or occluded central veins.

    PubMed

    Przywara, Stanisław; Iłżecki, Marek; Terlecki, Piotr; Zubilewicz, Tomasz

    2014-12-18

    The aim of the study was to report a novel technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins, without preceding angioplasty or stenting. Sixteen patients with central venous occlusive disease, requiring urgent hemodialysis underwent this procedure. Catheterization of stenosis - occlusion was initially performed with soft guidewire, subsequently exchanged to stiff guidewire. Forced insertion of dilators, peel-off sheath throughout the stenosis or occlusion and finally implantation of the catheter completed the procedure. Our technique does not require pre-procedural angioplasty or stent deployment. In all patients postoperative hemodialysis was managed with satisfactory adequacy. No early or late complications related to the procedure occurred. We did not observe any clinically significant aggravation of symptoms of central vein stenosis or occlusion. Complications, not-related to the procedure included one, late skin entry site infection and one, late catheter thrombosis. These were managed without the necessity of catheter exchange. Our technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins without previous balloon predilatation or stenting is simple and diminishes the total cost of the procedure. Provides quick vascular access for hemodialysis in life threatening situations.

  3. Use of SIG device to accurately place permanent miniature dental implants to retain mandibular overdenture. A case report.

    PubMed

    Sussman, Harold I; Goodridge, Opal F

    2006-01-01

    A case of mini-dental implant insertion for retention of a mandibular overdenture in a hospitalized patient has been documented. The additional use of the SIG (drill guide) directional device in the implant placement protocol gave the practitioner more confidence and resulted in the proper alignment of the three ball-top, one-piece fixtures. The three implants were inserted exactly 1 cm apart and parallel to each other. The distal fixtures were approximately 1 cm away from the mental foramina, thereby eliminating the risk of lip paresthesia. Keeper caps were placed in the denture's intaglio after one month. The keeper caps allowed for proper retention of the overdenture. The caps also enabled the patient to easily insert and withdraw his denture, even though he displayed limited manual dexterity. The tissue response was excellent, and oral hygiene was made easier with adequate spacing of the exposed ball-tops. The overall experience for both the operator and the patient was very positive. General dentists should be able to readily master this technique and add it to their armamentarium for the benefit of all their patients.

  4. Prospective study to develop surface landmarks for blind axillary vein puncture for permanent pacemaker and defibrillator lead implantation and compare it to available contrast venography guided technique

    PubMed Central

    Mehrotra, S.; Rohit, Manoj Kumar

    2015-01-01

    Objective To develop surface landmarks for blind axillary vein puncture for pacemaker lead implantation. Methods and results Patients for routine coronary angiography were counseled for participating in our study. 20 patients who gave consent were taken up for axillary venogram after proper positioning at the time of coronary angiogram. The venograms of these 20 patients, were reviewed and the landmarks were used to develop a blind axillary puncture technique. Success rate of 100% was achieved with surface landmark guided axillary vein puncture. The implantation time while using surface landmark guided axillary puncture was not significantly longer than when venography based approach was used. Another interesting observation made from the study was that increasing BMI had a positive correlation with the time taken for venous access, the fluoroscopic time and the volume of contrast used, all the associations being statistically significant. Thus, the surface landmark guided technique is more safe and expeditious in non obese patients and probably in pediatric patients as well. Moreover, the new surface landmark guided approach is a significant safety step in terms of reducing the unwanted and avoidable radiation exposure to the hands. Conclusion The results of this study demonstrate that placement of endocardial permanent pacemaker and ICD leads via the developed surface landmarks is effective and safe and is devoid of the harmful effects of radiation and contrast exposure. PMID:26071292

  5. Etude des défauts profonds dans l'arséniure de gallium implantés en oxygène et co-implantés en silicium par la méthode FTDLTS

    NASA Astrophysics Data System (ADS)

    Le Bloa, A.; Tran Quan, Dang; Guennouni, Z.; Favennec, P. N.

    1994-06-01

    We describe the setting up of our isotherm FTDLTS (Fourier Transform Deep Level Transient Spectroscopy) method which has a better time constant resolution than that of classic DLTS methods. This method has been used to characterize deep levels in O-implanted and (O + Si) co-implanted GaAs. Several deep centers with closely-spaced levels of the U band and the EL2 family levels have been characterized. Discret levels have been obtained. The signatures of these defects are closed, in the first case, to that of the EL3 center, in the second case, to that of the EL0 and EL2 centers. The (Ea= 0.56 eV) level seems to be the Ga-O-Ga complex. The (O + Si) co-implantation favors the ED2 defect formation in 650 ^{circ}C and 900 ^{circ}C annealed samples. On rappelle d'abord la mise en oeuvre d'une nouvelle méthode isotherme appelée FTDLTS (Fourier Transform Deep Level Transient Spectroscopy) dont le pouvoir séparateur en constante de temps est nettement supérieur à celui des méthodes DLTS classiques. On l'applique à la caractérisation des défauts profonds, dans le domaine de températures 200-450 K, des échantillons de GaAs implantés en oxygène et en silicium. Plusieurs défauts à niveau d'énergie discret appartenant à la bande U et dont les signatures, toutes proches de celle de EL3, sont voisines ont été mis en évidence. L'un de ces défauts (Ea = 0,56 eV) semble être le défaut complexe Ga-O-Ga. Trois défauts EDI, ED2 et ED3 de la famille EL2 ont été également mis en évidence ; deux d'entre eux, ED2 et ED3 ont une signature proche de celle de EL0 et EL2 respectivement. La co-implantation de silicium avec l'oxygène favorise, dans nos échantillons recuits à 650 ^{circ}C et à 900 ^{circ}C, la formation de ED2 par rapport à celle de ED1.

  6. Pilot Study Testing the Technical Feasibility and Toxicity of High Dose Rate Brachytherapy Combined with Hyperthermia to Treat Prostate Cancer Recurrences after External Beam Irradiation or Permanent Seed Implant Failure

    DTIC Science & Technology

    2004-07-01

    Jones (Duke): Uposomal chemotherapy and hyperthermia for breast cancer Coordinators: P. Corry, C. Diederich, P. Stauffer -14.00-14.25: P. Corry...infrared), and in preparation: skin and breast ( hyperthermia and ablation studies). These generic models are constructed using data of patients, anatomy... Hyperthermia to Treat Prostate Cancer Recurrences after External Beam Irradiation or Permanent Seed Implant Failure PRINCIPAL INVESTIGATOR: Peter M

  7. Permanent implantation of a reinforced polytetrafluoroethylene vascular graft for treatment of artificial defects of the teat cistern mucosa in cows.

    PubMed

    Metzger, L; Hirsbrunner, G; Waldvogel, A; Eicher, R; Schällibaum, M; Steiner, A

    1999-01-01

    To evaluate use of a reinforced polytetrafluoroethylene vascular graft for treatment of an artificial defect of mucosa of the teat cistern in lactating cows. Prospective study. 9 clinically normal lactating dairy cows. A 20-mm wide circumferential area of mucosa was sharply excised from the cistern of 1 teat on each cow 10 days after spontaneous calving, and the lesion was covered by a graft. After 14 days of passive milk drainage, routine milking was resumed. Follow-up examinations were performed during the next 2 lactation periods and included evaluation of wound healing, location and sonographic appearance of the implant, milk flow and yield, and somatic cell counts. Cows were slaughtered, and teats and mammary glands were examined microscopically. Implants had partially to totally collapsed within 30 to 90 days. Milk flow was significantly increased by day 15 of the first lactation, but decreased significantly by day 300 of lactation 1. At the end of lactation 1, milk flow had ceased in 3 out of 7 quarters. Only 3 of 9 quarters drained through grafted teats were milkable at the end of the study. Somatic cell counts of these quarters were significantly increased in the first lactation period. At necropsy, 2 grafts were in the teat cistern, but only 1 was incorporated into the mucosa by connective tissue. The mucosa was thickened in all teats with grafts, and there was epithelial metaplasia and granulation tissue proliferation. Use of a polytetrafluoroethylene graft can preserve patency in the first lactation period. However, the graft may not be sufficiently incorporated into the mucosa if routine machine milking is resumed 2 weeks after implantation. )

  8. Comparison of permanent 125I seeds implants with two different techniques in 500 cases of prostate cancer

    PubMed Central

    Ricós, Jose Vicente; Tortajada, Maria Isabel; Santos, Miguel Angel; Casanova, Juan; Clemente, Jose; Samper, Josefa; Santamaría, Paula; Arribas, Leoncio

    2015-01-01

    Purpose To perform a comparative study of 500 consecutive 125I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning. Material and methods From 2002 to 2007 we performed 250 implants with fixed stranded seeds (RapidStrand™) and a preplanning system and from 2007 to 2010, 250 with real-time and ProLink™ system. Mean age was 68 and 66, respectively, median PSA (prostate-specific antigen) 7.3 and 7.2, stage T1-T2a in 98% and 94%, and Gleason ≤ 6 in 96% and 86%. Low risk cases were 81% and 71%. The prescribed dose was 145 Gy to the prostate volume, or 108 Gy plus EBRT 46 Gy in some intermediate risk cases. Hormonal treatment was given to 42% and 28%. Results Median follow-up was 48 and 47 months, respectively, 14 patients in the first group and 7 patients in the second developed biochemical failure (BF). Actuarial biochemical relapse-free survival (bRFS) at 5 years increased from 90.2% to 97.2% (low risk from 91.3% to 97.2%, intermediate risk from 84.2% to 97.1%). Biochemical failure was independent of hormone treatment. Rectal complications were G1-2 in 1.2% and 5.2%, respectively. A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%. Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%. An assessment of mean D90 in a sample of patients showed that the dosimetry in postoperative planning based on CT improved from a mean D90 of 143 Gy to 157 Gy. Conclusions The outcome of patients with low risk prostate carcinoma treated with 125I seed is very good with low complications rate. The real-time approach in our hands achieved a more precise seed implantation, better dosimetry, and a statistically non-significant better biochemical control. We have made this our standard technique. PMID:26622228

  9. Low elastic modulus Ti-Ta alloys for load-bearing permanent implants: enhancing the biodegradation resistance by electrochemical surface engineering.

    PubMed

    Kesteven, Jazmin; Kannan, M Bobby; Walter, Rhys; Khakbaz, Hadis; Choe, Han-Choel

    2015-01-01

    In this study, the in vitro degradation behaviour of titanium-tantalum (Ti-Ta) alloys (10-30 wt.% Ta) was investigated and compared with conventional implant materials, i.e., commercially pure titanium (Cp-Ti) and titanium-aluminium-vanadium (Ti6Al4V) alloy. Among the three Ti-Ta alloys studied, the Ti20Ta (6.3×10(-4) mm/y) exhibited the lowest degradation rate, followed by Ti30Ta (1.2×10(-3) mm/y) and Ti10Ta (1.4×10(-3) mm/y). All the Ti-Ta alloys exhibited lower degradation rate than that of Cp-Ti (1.8×10(-3) mm/y), which suggests that Ta addition to Ti is beneficial. As compared to Ti6Al4V alloy (8.1×10(-4) mm/y), the degradation rate of Ti20Ta alloy was lower by ~22%. However, the Ti30Ta alloy, which has closer elastic modulus to that of natural bone, showed ~48% higher degradation rate than that of Ti6Al4V alloy. Hence, to improve the degradation performance of Ti30Ta alloy, an intermediate thin porous layer was formed electrochemically on the alloy followed by calcium phosphate (CaP) electrodeposition. The coated Ti30Ta alloy (3.8×10(-3) mm/y) showed ~53% lower degradation rate than that of Ti6Al4V alloy. Thus, the study suggests that CaP coated Ti30Ta alloy can be a viable material for load-bearing permanent implants.

  10. Early benthic successional processes at implanted substrates in Barkley Submarine Canyon affected by a permanent oxygen minimum zone

    NASA Astrophysics Data System (ADS)

    Cabrera De Leo, F.; Smith, C. R.; Levin, L. A.; Fleury, A.; Aguzzi, J.

    2016-02-01

    With the advent of cabled observatories scientists are now able to have a permanent presence in the deep-seafloor, being able to reveal previously unseen faunal behavior as well as to track long-term changes in biodiversity and ecosystem function. The Ocean Networks Canada 800-km loop seafloor observatory array (NEPTUNE) located in the NE Pacific has instruments measuring a variety of environmental variables ranging from temperature, salinity, oxygen, currents, turbidity, fluorescence, etc, at multiple and very high temporal resolution scales. High-definition video cameras also monitor benthic communities in multiple deep-sea habitats, all at some extent influenced by an oxygen minimum zone (OMZ). In the present study, whale-bone and wood substrates are being used to evaluate bathymetric, regional and inter-basin variations in benthic biodiversity and connectivity, as well as interactions between biodiversity and ecosystem function. In May of 2014 three humpback whale (Megaptera novaeangliae) rib sections, one 20x20x10 cm block of Douglas Fir (Pseudotsunga meniziesii), and a 30x30x30 block of authigenic carbonate were placed with the use of an ROV at 890 m depth inside Barkley Canyon. The substrate packages were placed concentrically, 45-cm away from a HD video camera. Five-minute videos were captured at 2-hr intervals. Preliminary data analysis from 8 months of deployment showed very distinct early community succession patterns between the two organic substrates (bones and wood) and the authigenic carbonate. Whalebones and wood showed amphipod (Orchomene obtusa) abundance peaks mostly contained during the first 60 days after deployment; Amphipod peak abundance rapid decline coincides with rapid growth of bacterial mat on whalebone and wood surfaces. Low abundance, species richness and substrate degradation rates are in agreement with a low oxygen environment of the OMZ in the canyon. Despite the early stages of data analysis, this experiment demonstrates how

  11. Dose escalation to the dominant intraprostatic lesion defined by sextant biopsy in a permanent prostate I-125 implant: a prospective comparative toxicity analysis.

    PubMed

    Gaudet, Marc; Vigneault, Eric; Aubin, Sylviane; Varfalvy, Nicolas; Harel, François; Beaulieu, L; Martin, André-Guy

    2010-05-01

    Using real-time intraoperative inverse-planned permanent seed prostate implant (RTIOP/PSI), multiple core biopsy maps, and three-dimensional ultrasound guidance, we planned a boost volume (BV) within the prostate to which hyperdosage was delivered selectively. The aim of this study was to investigate the potential negative effects of such a procedure. Patients treated with RTIOP/PSI for localized prostate cancer with topographic biopsy results received an intraprostatic boost (boost group [BG]). They were compared with patients treated with a standard plan (reference group [RG]). Plans were generated using a simulated annealing inverse planning algorithm. Prospectively recorded urinary, rectal, and sexual toxicities and dosimetric parameters were compared between groups. The study included 120 patients treated with boost technique who were compared with 70 patients treated with a standard plan. Boost technique did not significantly change the number of seeds (55.1/RG vs. 53.6/BG). The intraoperative prostate V150 was slightly higher in BG (75.2/RG vs. 77.2/BG, p = 0.039). Urethra V100, urethra D90, and rectal D50 were significantly lower in the BG. No significant differences were seen in acute or late urinary, rectal, or sexual toxicities. Because there were no differences between the groups in acute and late toxicities, we believe that BV can be planned and delivered to the dominant intraprostatic lesion without increasing toxicity. It is too soon to say whether a boost technique will ultimately increase local control.

  12. Insights into the need for permanent pacemaker following implantation of the repositionable LOTUS valve for transcatheter aortic valve replacement in 250 patients: results from the REPRISE II trial with extended cohort.

    PubMed

    Dumonteil, Nicolas; Meredith, Ian T; Blackman, Daniel J; Tchétché, Didier; Hildick-Smith, David; Spence, Mark S; Walters, Darren L; Harnek, Jan; Worthley, Stephen G; Rioufol, Gilles; Lefèvre, Thierry; Modine, Thomas; Van Mieghem, Nicolas; Houle, Vicki M; Allocco, Dominic J; Dawkins, Keith D

    2017-09-20

    This analysis aimed to evaluate the incidence and predictors of the need for permanent pacemaker (PPM) implantation following implantation of the repositionable and fully retrievable LOTUS Aortic Valve Replacement System. The prospective, single-arm, multicentre REPRISE II study with extended cohort enrolled 250 symptomatic, high surgical risk patients with severe aortic stenosis for transfemoral transcatheter aortic valve implantation (TAVI) with a 23 mm or 27 mm LOTUS valve. Echocardiography, computed tomography, and electrocardiography data were evaluated by independent core labs. Post TAVI, 32.0% (72/225) of pacemaker-naïve patients underwent new PPM implantation at 30 days. Most (59/72, 82%) patients were implanted for third-degree atrioventricular block, and >10% overstretch of the LVOT by area was observed in 59.7% (43/72) of PPM patients. Significant independent predictors of PPM at 30 days included baseline RBBB (odds ratio [OR] 12.7, 95% CI: 4.5, 36.2; p<0.001) and LVOT overstretch >10% (OR 3.4, 95% CI: 1.7, 6.7; p<0.001). There was a trend towards a lower 30-day PPM rate in patients with a shallower (≤5 mm) implant depth (23.9% ≤5 mm vs. 36.9% >5 mm depth from LCS; p=0.06). Careful attention to valve sizing and implant depth may help to reduce the rate of PPM with the LOTUS valve.

  13. Simulation du comportement thermique en régime permanent d'un moteur asynchrone à refroidissement extérieur. Etude par éléments finis

    NASA Astrophysics Data System (ADS)

    Glises, R.; Hostache, G.; Kauffmann, J. M.

    1994-09-01

    The steady state thermal modelling of an 4kW asynchronous motor is realized. A design has been made thanks to the Flux2D finite element magnetic calculus software converted into a resolution tool of the heat equation. This last is used to simulate the heat flux in fluid and solid areas. A 3D study is effected thanks to two 2D studies. The first concerns a radial view (perpendicular to the mechanical axis) whereas the second is effected for an axial view (parallel to the mechanical axis). Thermal conductivities of the materials and thermal contact resistances of the motor are determined through two different tests creating different overheatings. The first is made with a sinewave supply and pre-determine the thermophysical parameters. The second effected with direct current supplies at the rotor and the stator is used to validate these last parameters. On réalise l'étude du comportement thermique en régime permanent d'un moteur asynchrone de 4kW. Le logiciel de calculs magnétiques par éléments finis flux2D est converti en un outil de résolution de l'équation de la chaleur. Cette dernière équation sert à simuler les transferts thermiques tant dans les domaines fluides que solides. Une pseudo-étude tridimensionnelle est réalisée par le biais de deux études bidimensionnelles : la première effectuée suivant un plan radial (plan perpendiculaire à l'axe du moteur) et la seconde suivant un plan axial (plan parallèle à l'axe). Les conductivités des matériaux et des résistances thermiques de contact composant le moteur sont déterminées à l'aide de deux types d'essais qui induisent des échauffements différents. Le premier est réalisé avec une alimentation sinusoïdale et sert à prédéterminer les paramètres thermophysiques. Le second est effectué avec des alimentations à courant continu tant au stator qu'au rotor et a pour rôle la validation de ces paramètres.

  14. Comparison of Dosimetric and Biologic Effective Dose Parameters for Prostate and Urethra Using {sup 131}Cs and {sup 125}I for Prostate Permanent Implant Brachytherapy

    SciTech Connect

    Sahgal, Arjun; Jabbari, Siavash; Chen, Josephine; Pickett, Barbie; Roach, Mack; Weinberg, Vivian; Hsu, I-C.; Pouliot, Jean

    2008-09-01

    Purpose: To compare the urethral and prostate absolute and biologic effective doses (BEDs) for {sup 131}Cs and {sup 125}I prostate permanent implant brachytherapy (PPI). Methods and Materials: Eight previously implanted manually planned {sup 125}I PPI patients were replanned manually with {sup 131}Cs, and re-planned using Inverse Planning Simulated Annealing. {sup 131}Cs activity and the prescribed dose (115 Gy) were determined from that recommended by IsoRay. The BED was calculated for the prostate and urethra using an {alpha}/{beta} ratio of 2 and was also calculated for the prostate using an {alpha}/{beta} ratio of 6 and a urethral {alpha}/{beta} ratio of 2. The primary endpoints of this study were the prostate D{sub 90} BED (pD{sub 90}BED) and urethral D{sub 30} BED normalized to the maximal potential prostate D{sub 90} BED (nuD{sub 30}BED). Results: The manual plan comparison ({alpha}/{beta} = 2) yielded no significant difference in the prostate D{sub 90} BED (median, 192 Gy{sub 2} for both isotopes). No significant difference was observed for the nuD{sub 30}BED (median, 199 Gy{sub 2} and 202 Gy{sub 2} for {sup 125}I and {sup 131}Cs, respectively). For the inverse planning simulated annealing plan comparisons ({alpha}/{beta} 2), the prostate D{sub 90} BED was significantly lower with {sup 131}Cs than with {sup 125}I (median, 177 Gy{sub 2} vs. 187 Gy{sub 2}, respectively; p = 0.01). However, the nuD{sub 30}BED was significantly greater with {sup 131}Cs than with {sup 125}I (median, 192 Gy{sub 2} vs. 189 Gy{sub 2}, respectively; p = 0.01). Both the manual and the inverse planning simulated annealing plans resulted in a significantly lower prostate D{sub 90} BED (p = 0.01) and significantly greater nuD{sub 30}BED for {sup 131}Cs (p = 0.01), compared with {sup 125}I, when the prostate {alpha}/{beta} ratio was 6 and the urethral {alpha}/{beta} ratio was 2. Conclusion: This report highlights the controversy in comparing the dose to both the prostate and the organs

  15. A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or {sup 125}I Permanent Implant

    SciTech Connect

    Eade, Thomas N.; Horwitz, Eric M. Ruth, Karen; Buyyounouski, Mark K.; D'Ambrosio, David J.; Feigenberg, Steven J.; Chen, David Y.T.; Pollack, Alan

    2008-06-01

    Purpose: To compare the toxicity and biochemical outcomes of intensity-modulated radiation therapy (IMRT) and {sup 125}I transperineal permanent prostate seed implant ({sup 125}I) for patients with low-risk prostate cancer. Methods and Materials: Between 1998 and 2004, a total of 374 low-risk patients (prostate-specific antigen < 10 ng/ml, T1c-T2b, Gleason score of 6 or less, and no neoadjuvant hormones) were treated at Fox Chase Cancer Center (216 IMRT and 158 {sup 125}I patients). Median follow-up was 43 months for IMRT and 48 months for {sup 125}I. The IMRT prescription dose ranged from 74-78 Gy, and {sup 125}I prescription was 145 Gy. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was recorded by using a modified Radiation Therapy Oncology Group scale. Freedom from biochemical failure was defined by using the Phoenix definition (prostate-specific antigen nadir + 2.0 ng/ml). Results: Patients treated by using IMRT were more likely to be older and have a higher baseline American Urological Association symptom index score, history of previous transurethral resection of the prostate, and larger prostate volumes. On multivariate analysis, IMRT was an independent predictor of lower acute and late Grade 2 or higher GU toxicity and late Grade 2 or higher GI toxicity. Three-year actuarial estimates of late Grade 2 or higher toxicity were 2.4% for GI and 3.5% for GU by using IMRT compared with 7.7% for GI and 19.2% for GU for {sup 125}I, respectively. Four-year actuarial estimates of freedom from biochemical failure were 99.5% for IMRT and 93.5% for {sup 125}I (p = 0.09). Conclusions: The IMRT and {sup 125}I produce similar outcomes, although IMRT appears to have less acute and late toxicity.

  16. Postmastectomy Chest Wall Radiation to a Temporary Tissue Expander or Permanent Breast Implant-Is There a Difference in Complication Rates?

    SciTech Connect

    Anderson, Penny R. Freedman, Gary; Nicolaou, Nicos; Sharma, Navesh; Li Tianyu; Topham, Neal; Morrow, Monica

    2009-05-01

    Purpose: The purpose of this study was to evaluate the likelihood of complications and cosmetic results among breast cancer patients who underwent modified radical mastectomy (MRM) and breast reconstruction followed by radiation therapy (RT) to either a temporary tissue expander (TTE) or permanent breast implant (PI). Methods and Materials: Records were reviewed of 74 patients with breast cancer who underwent MRM followed by breast reconstruction and RT. Reconstruction consisted of a TTE usually followed by exchange to a PI. RT was delivered to the TTE in 62 patients and to the PI in 12 patients. Dose to the reconstructed chest wall was 50 Gy. Median follow-up was 48 months. The primary end point was the incidence of complications involving the reconstruction. Results: There was no significant difference in the rate of major complications in the PI group (0%) vs. 4.8% in the TTE group. No patients lost the reconstruction in the PI group. Three patients lost the reconstruction in the TTE group. There were excellent/good cosmetic scores in 90% of the TTE group and 80% of the PI group (p = 0.22). On multivariate regression models, the type of reconstruction irradiated had no statistically significant impact on complication rates. Conclusions: Patients treated with breast reconstruction and RT can experience low rates of major complications. We demonstrate no significant difference in the overall rate of major or minor complications between the TTE and PI groups. Postmastectomy RT to either the TTE or the PI should be considered as acceptable treatment options in all eligible patients.

  17. Dose Escalation to the Dominant Intraprostatic Lesion Defined by Sextant Biopsy in a Permanent Prostate I-125 Implant: A Prospective Comparative Toxicity Analysis

    SciTech Connect

    Gaudet, Marc; Vigneault, Eric; Aubin, Sylviane; Varfalvy, Nicolas; Harel, Francois; Beaulieu, L.; Martin, Andre-Guy

    2010-05-01

    Purpose: Using real-time intraoperative inverse-planned permanent seed prostate implant (RTIOP/PSI), multiple core biopsy maps, and three-dimensional ultrasound guidance, we planned a boost volume (BV) within the prostate to which hyperdosage was delivered selectively. The aim of this study was to investigate the potential negative effects of such a procedure. Methods and Materials: Patients treated with RTIOP/PSI for localized prostate cancer with topographic biopsy results received an intraprostatic boost (boost group [BG]). They were compared with patients treated with a standard plan (reference group [RG]). Plans were generated using a simulated annealing inverse planning algorithm. Prospectively recorded urinary, rectal, and sexual toxicities and dosimetric parameters were compared between groups. Results: The study included 120 patients treated with boost technique who were compared with 70 patients treated with a standard plan. Boost technique did not significantly change the number of seeds (55.1/RG vs. 53.6/BG). The intraoperative prostate V150 was slightly higher in BG (75.2/RG vs. 77.2/BG, p = 0.039). Urethra V100, urethra D90, and rectal D50 were significantly lower in the BG. No significant differences were seen in acute or late urinary, rectal, or sexual toxicities. Conclusions: Because there were no differences between the groups in acute and late toxicities, we believe that BV can be planned and delivered to the dominant intraprostatic lesion without increasing toxicity. It is too soon to say whether a boost technique will ultimately increase local control.

  18. Feasibility of MR Imaging/MR Spectroscopy-Planned Focal Partial Salvage Permanent Prostate Implant (PPI) for Localized Recurrence After Initial PPI for Prostate Cancer

    SciTech Connect

    Hsu, Charles C.; Hsu, Howard; Pickett, Barby; Crehange, Gilles; Hsu, I-Chow Joe; Dea, Ryan; Weinberg, Vivian; Gottschalk, Alexander R.; Kurhanewicz, John; Shinohara, Katsuto; Roach, Mack

    2013-02-01

    Purpose: To assess the feasibility of magnetic resonance imaging (MRI)-planned partial salvage permanent prostate implant (psPPI) among patients with biopsy-proven local recurrence after initial PPI without evidence of distant disease. Methods and Materials: From 2003-2009, 15 patients underwent MRI/magnetic resonance spectroscopy (MRS) planning for salvage brachytherapy (psPPI, I-125 [n=14; 144 Gy]; Pd-103 [n=1; 125 Gy]) without hormone therapy. Full dose was prescribed to areas of recurrence and underdosage, without entire prostate implantation. Limiting urethral and rectal toxicity was prioritized. Follow-up was from salvage date to prostate-specific antigen (PSA) concentration failure (Phoenix criteria = nadir + 2.0; ASTRO = 3 consecutive rises), recurrence, distant metastases, or last follow-up PSA level. Progression-free survival (PFS) was defined as no PSA failure or biopsy-proven recurrence without all-cause mortality. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Results: At salvage, median age was 68 years, and PSA concentration was 3.5 ng/mL (range, 0.9-5.6 ng/mL). Abnormal MRI/MRS findings were evident in 40% of patients. Biopsy-proven recurrences consisted of a single focus (80%) or 2 foci (20%). At recurrence, Gleason score was 6 (67%) or {>=}7 (27%). Median interval between initial and salvage implantation was 69 months (range, 28-132 months). psPPI planning characteristics limited doses to the rectum (mean V100 = 0.5% [0.07 cc]) and urethra (V100 = 12% [0.3 cc]). At median follow-up (23.3 months; range, 8-88 months), treatment failure (n=2) resulted only in localized recurrence; both patients underwent second psPPI with follow-up PSA tests at 12 and 26 months, resulting in 0.6 and 0.7 ng/mL, respectively. American Society for Radiation Oncology PFS rates at 1, 2, and 3 years were 86.7%, 78.4%, and 62.7%, respectively, with 5 patients for whom treatment failed (n=3 with negative transrectal ultrasound

  19. Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study

    SciTech Connect

    Ohashi, Toshio; Yorozu, Atsunori; Saito, Shiro; Tanaka, Nobumichi; Katayama, Norihisa; Kojima, Shinsuke; Maruo, Shinichiro; Kikuchi, Takashi; Dokiya, Takushi; Fukushima, Masanori; Yamanaka, Hidetoshi

    2015-09-01

    Purpose: To assess, in a nationwide multi-institutional cohort study begun in 2005 and in which 6927 subjects were enrolled by 2010, the urinary and rectal toxicity profiles of subjects who enrolled during the first 2 years, and evaluate the toxicity profiles for permanent seed implantation (PI) and a combination therapy with PI and external beam radiation therapy (EBRT). Methods and Materials: Baseline data for 2339 subjects out of 2354 patients were available for the analyses. Toxicities were evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events, and the International Prostate Symptom Scores were recorded prospectively until 36 months after radiation therapy. Results: Grade 2+ acute urinary toxicities developed in 7.36% (172 of 2337) and grade 2+ acute rectal toxicities developed in 1.03% (24 of 2336) of the patients. Grade 2+ late urinary and rectal toxicities developed in 5.75% (133 of 2312) and 1.86% (43 of 2312) of the patients, respectively. A higher incidence of grade 2+ acute urinary toxicity occurred in the PI group than in the EBRT group (8.49% vs 3.66%; P<.01). Acute rectal toxicity outcomes were similar between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late urinary toxicities were 6.04% versus 4.82% for the PI and the EBRT groups, respectively, with no significant differences between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late rectal toxicities were 0.90% versus 5.01% (P<.01) for the PI and the EBRT groups, respectively. The mean of the postimplant International Prostate Symptom Score peaked at 3 months, but it decreased to a range that was within 2 points of the baseline score, which was observed in 1625 subjects (69.47%) at the 1-year follow-up assessment. Conclusions: The acute urinary toxicities observed were acceptable given the frequency and retention, and the late rectal toxicities were more favorable than those of other studies.

  20. Use and uncertainties of mutual information for computed tomography/ magnetic resonance (CT/MR) registration post permanent implant of the prostate.

    PubMed

    Roberson, Peter L; McLaughlin, P William; Narayana, Vrinda; Troyer, Sara; Hixson, George V; Kessler, Marc L

    2005-02-01

    Post-implant dosimetric analysis for permanent implant of the prostate benefits from the use of a computed tomography (CT) dataset for optimal identification of the radioactive source (seed) positions and a magnetic resonance (MR) dataset for optimal description of the target and normal tissue volumes. The CT/MR registration process should be fast and sufficiently accurate to yield a reliable dosimetric analysis. Since critical normal tissues typically reside in dose gradient regions, small shifts in the dose distribution could impact the prediction of complication or complication severity. Standard procedures include the use of the seed distribution as fiducial markers (seed match), a time consuming process that relies on the proper identification of signals due to the same seed on both datasets. Mutual information (MI) is more efficient because it uses image data requiring minimal preparation effort. A comparison of MI registration and seed-match registration was performed for twelve patients. MI was applied to a volume limited to the prostate and surrounding structures, excluding most of the pelvic bone structures (margins around the prostate gland were approximately 2 cm right-left, approximately 1 cm anterior-posterior, and approximately 2 cm superior-inferior). Seeds were identified on a 2 mm slice CT dataset using an automatic seed identification procedure on reconstructed three-dimensional data. Seed positions on the 3 mm slice thickness T2 MR data set were identified using a point-and-click method on each image. Seed images were identified on more than one MR slice, and the results used to determine average seed coordinates for MR images and matched seed pairs between CT and MR images. On average, 42% (19%-64%) of the seeds (19-54 seeds) were identified and matched to their CT counterparts. A least-squares method applied to the CT and MR seed coordinates was used to produce the optimum seed-match registration. MI registration and seed match registration

  1. Potential impact of prostate edema on the dosimetry of permanent seed implants using the new {sup 131}Cs (model CS-1) seeds

    SciTech Connect

    Chen Zhe; Deng Jun; Roberts, Kenneth; Nath, Ravinder

    2006-04-15

    Our aim in this work was to study the potential dosimetric effect of prostate edema on the accuracy of conventional pre- and post-implant dosimetry for prostate seed implants using the newly introduced {sup 131}Cs seed, whose radioactive decay half-life ({approx}9.7 days) is directly comparable to the average edema resolution half-life ({approx}10 days) observed previously by Waterman et al. for {sup 125}I implants [Int. J. Radiat. Oncol. Biol. Phys. 41, 1069-1077 (1998)]. A systematic calculation of the relative dosimetry effect of prostate edema on the {sup 131}Cs implant was performed by using an analytic solution obtained previously [Int. J. Radiat. Oncol. Biol. Phys. 47, 1405-1419 (2000)]. It was found that conventional preimplant dosimetry always overestimates the true delivered dose as it ignores the temporary increase of the interseed distance caused by edema. The overestimation for {sup 131}Cs implants ranged from 1.2% (for a small edema with a magnitude of 10% and a half-life of 2 days) to approximately 45% (for larger degree edema with a magnitude of 100% and a half-life of 25 days). The magnitude of pre- and post-implant dosimetry error for {sup 131}Cs implants was found to be similar to that of {sup 103}Pd implants for typical edema characteristics (magnitude <100%, and half-life <25 days); both of which are worse compared to {sup 125}I implants. The preimplant dosimetry error for {sup 131}Cs implants cannot be compensated effectively without knowing the edema characteristics before the seed implantation. On the other hand, the error resulted from a conventional post-implant dosimetry can be minimized (to within {+-}6%) for {sup 131}Cs implants if the post-implant dosimetry is performed at 10{+-}2 days post seed implantation. This 'optimum' post-implant dosimetry time is shorter than those determined previously for the {sup 103}Pd and {sup 125}I implants at 16{+-}4 days and 6{+-}1 weeks, respectively.

  2. Clinical and Radiographic Evaluation of a Small-Diameter Dental Implant Used for the Restoration of Patients with Permanent Tooth Agenesis (Hypodontia) in the Maxillary Lateral Incisor and Mandibular Incisor Regions: A 36-Month Follow-Up.

    PubMed

    King, Paul; Maiorana, Carlo; Luthardt, Ralph G; Sondell, Katarina; Øland, Jesper; Galindo-Moreno, Pablo; Nilsson, Peter

    2016-01-01

    For patients with narrow, single-tooth edentulous ridges as a result of permanent tooth agenesis (hypodontia) in the maxillary lateral and mandibular incisor regions, dental implant treatment may present a reliable and predictable restorative treatment solution. The aim of the present study was to evaluate the clinical reliability and outcome of small-diameter dental implants placed in a one-stage procedure with early loading replacing maxillary lateral or mandibular incisor teeth. Patients with hypodontia in the maxillary lateral incisor or mandibular incisor region analyzed in this report were selected from a larger prospective multicenter study. Small-diameter dental implants (AstraTech OsseoSpeed TX 3.0 S, Dentsply) of different lengths were placed using a one-stage surgical protocol with a 6- to 10-week healing period before loading. Probing pocket depth, bleeding on probing, and gingival zenith score were assessed after 6, 12, 24, and 36 months. Radiographic examination was assessed at 6, 12, and 36 months. In total, 38 patients were included in this analysis and 62 small-diameter implants were placed. The mean distance between adjacent teeth was 6.30 mm (SD: 1.36). All patients received a titanium transmucosal abutment and cement-retained ceramic crown after 6 to 10 weeks of healing. Two implants were lost during the healing period before loading, providing a total implant survival rate of 96.8%. No implant fractures were reported. Mean marginal bone level change from surgery to follow-up visits at 6, 12, and 36 months were 0.39 mm, 0.22 mm, and 0.23 mm, respectively. The condition of soft tissue was stable at all follow-up visits with clinically insignificant changes in probing depth, bleeding on probing, and gingival zenith score. This study evaluated the behavior over 36 months of AstraTech Osseospeed TX 3.0 S dental implants placed into narrow one-tooth defect edentulous ridges as a result of hypodontia. The data collected highlighted the stability of

  3. Résultats fonctionnels de la chirurgie de la cataracte par phacoalternative avec implantation en chambre postérieure: à propos de 300 cas à Bobo Dioulasso (Burkina Faso)

    PubMed Central

    Diallo, Jean Wenceslas; Meda, Nonfounikoun; Ahnoux-Zabsonre, Ahgbatouhabéba; Yameogo, Claudette; Dolo, Mariam; Sanou, Jérôme; Daboue, Arsène

    2015-01-01

    La cataracte est la première cause de cécité curable dans le monde. Son traitement est chirurgical. Le but de notre travail a été d’évaluer les résultats de la phacoalternative ou la chirurgie de la cataracte à petite incision. Il s'est agi d'une étude transversale descriptive à collecte prospective allant du 1er janvier au 31 septembre 2014, chez des patients âgés d'au moins 40 ans. Les données socio-démographiques, l'acuité visuelle, l'astigmatisme et les complications ont été évalués. Nous avons inclus 300 yeux de 286 patients. L’âge moyen était de 66 ans (écart type 9,93) avec une prédominance masculine de 57,7%. Les co-morbidités étaient dominées par l'hypertension artérielle 30,33% des cas. L'acuité visuelle pré-opératoire était de moins de 1/20è dans 70, 7% des cas. En biométrie, la puissance moyenne était de 21,50 dioptries. L'implant posé a été adéquat dans 60%. Les principales complications per-opératoires étaient le chémosis post-anesthésie 4,67% et l'issue de vitrée moins de 2% des cas. Les complications post opératoires précoces ont été dominées par l’œdème de cornée 26,33%, et les complications tardives par la cataracte secondaire. L'astigmatisme induit était de 1, 12 dioptrie en moyenne (écart type 1,26). Sans correction, les résultats visuels étaient mauvais dans moins de 1%, limites dans 31%, et bons 68% suivants les normes de l'Organisation Mondiale de la Santé. La phacoalternative donne des résultats satisfaisants, avec peu de complications. L'amélioration du plateau technique et la disponibilité d'implants adéquats pourraient les améliorer. PMID:26140073

  4. Commande numérique de moteurs synchrones à aimants permanents de faible puissance

    NASA Astrophysics Data System (ADS)

    Robyns, B.; Fu, Y.; Labrique, F.; Buyse, H.

    1995-08-01

    High performance motion control with permanent magnet synchronous actuators needs complex control strategies. These control strategies lead frequently to algorithms requiring powerful microprocessors for their digital implementation. In this paper, we consider an approach of the control of small power permanent magnets synchronous actuators which allows to design and to implement control algorithms requiring only a reduced computation power, while maintaining satisfactory static and dynamic performance and a good insensitivity to perturbations and parameter uncertainties. L'actionnement électrique à hautes performances par moteurs synchrones à aimants permanents impose des stratégies de commande évoluées liées au comportement dynamique complexe de ces machines. Ces stratégies de commande conduisent fréquemment à des algorithmes dont l'implantation numérique exige des microprocesseurs ayant une puissance de calcul élevée. Dans cet article, nous développons une approche du problème de la commande des moteurs synchrones à aimants permanents de faible puissance qui permet de concevoir et d'implanter des algorithmes de commande ne nécessitant qu'une puissance de calcul réduite, tout en garantissant des performances statiques et dynamiques satisfaisantes ainsi qu'une bonne insensibilité aux perturbations agissant sur le système et aux incertitudes sur les paramètres.

  5. Edema-induced increase in tumour cell survival for 125I and 103Pd prostate permanent seed implants - a bio-mathematical model

    NASA Astrophysics Data System (ADS)

    Yue, Ning; Chen, Zhe; Nath, Ravinder

    2002-04-01

    Edema caused by the surgical procedure of prostate seed implantation expands the source-to-point distances within the prostate and hence decreases the dose coverage. The decrease of dose coverage results in an increase in tumour cell survival. To investigate the effects of edema on tumour cell survival, a bio-mathematical model of edema and the corresponding cell killing by continuous low dose rate irradiation (CLDRI) was developed so that tumour cell surviving fractions can be estimated in an edematous prostate for both 125I and 103Pd seed implants. The dynamic nature of edema and its resolution were modelled with an exponential function V(T) = Vp (1 + M exp(-0.693T/Te)) where Vp is the prostate volume before implantation, M is the edema magnitude and Te is edema half-life (EHL). The dose rate of a radioactive seed was calculated according to AAPM TG43, i.e. Λg(r) αBED), where α is the linear coefficient of the survival curve. The tumour cell survival was calculated for both 125I and 103Pd seed implants and for different tumour potential doubling time (TPDT) (from 5 days to 30 days) and for edemas of different magnitudes (from 0% to 95%) and edema half-lives (from 4 days to 30 days). Tumour cell survival increased with the increase of edema magnitude and EHL. For a typical edema of a half-life of 10 days and a magnitude of 50%, the edema increased tumour cell survival by about 1 and 2 orders of magnitude for 125I and 103Pd seed implants respectively. At the extreme (95% edema magnitude and an edema half-life of 30 days), the increase was more than 3 and 5 orders of magnitude for 125I and 103Pd seed implants respectively. The absolute increases were almost independent of TPDT and the prostate edema did not significantly change the effective treatment time. Tumour cell survival for prostate undergoing CLDRI using 125I or 103Pd seeds may be increased substantially due to the presence of edema caused by surgical trauma. This effect appears to be more pronounced for

  6. Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction: a multi-institutional comparison of short-term complications.

    PubMed

    Davila, Armando A; Mioton, Lauren M; Chow, Geoffrey; Wang, Edward; Merkow, Ryan P; Bilimoria, Karl Y; Fine, Neil; Kim, John Y S

    2013-10-01

    Prosthesis-based techniques are the predominant form of breast reconstruction worldwide, with two-stage tissue expander procedures being the most popular. In the past decade, there has been increasing interest in performing single-stage implant reconstruction immediately following mastectomy as an attempt to simplify the reconstructive course and improve psychosocial morbidity. However, there is a paucity of large-scale, multi-institutional data comparing the outcomes of these two reconstructive strategies. Patients who underwent immediate tissue expander or implant reconstruction following mastectomy from 2006-2010 were identified using standardised operation codes. Demographic information for patients, 30-day outcomes, and adverse events for each type of reconstruction were analysed and compared between groups. A total of 10,561 patients underwent immediate breast reconstruction. There were 9033 patients who underwent tissue expander placement (2752 bilateral), and 1528 patients who underwent immediate implant placement (485 bilateral). Patients who had implant placement demonstrated increased rates of overall complications (6.8% compared with 5.4%, p = 0.02) and prosthesis failure (1.4% compared with 0.8%, p = 0.04). There was no difference in the rate of any surgical site infections (3.9% compared with 3.4%, p = 0.39), reoperation (7.5% compared with 6.9%, p = 0.40), or major medical complications (1.8% compared with 1.6%, p = 0.57). Both immediate one-stage, direct-to-implant, and two-stage tissue expander reconstructions result in low rates of morbidity. One-stage reconstruction suggests a slightly higher complication rate related to prosthesis failure.

  7. Isolated permanent right ventricular assist device implantation with the HeartWare continuous-flow ventricular assist device: first results from the European Registry for Patients with Mechanical Circulatory Support.

    PubMed

    Bernhardt, Alexander M; De By, Theo M M H; Reichenspurner, Hermann; Deuse, Tobias

    2015-07-01

    Isolated right ventricular (RV) dysfunction with preserved left ventricular function is difficult to treat and associated with high mortality. Temporary devices for right ventricular support [right ventricular assist device (RVAD)] are available and have been used for short-term right heart assistance. In some patients, RV function does not recover and long-term devices are needed. Recently, isolated RVAD implantation with a permanent HeartWare HeartWare ventricular assist device (HVAD) device has been reported in patients with acute RV infarction and chronic graft failure. However, isolated implantation on the right side remains rare and is still an off-label use for this pump. To gather European data, we queried the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) database, in which procedures and outcome data for patients receiving mechanical circulatory support are registered. Until May 2014, data of 8 patients (mean age 55.0 ± 17.3 years, 100% males) with an isolated HVAD for RV support were submitted to the EUROMACS registry. All patients were in INTERMACS classes 1-3. Device strategy was rescue therapy in 6 patients (75.0%) and destination therapy in 2 patients (25.0%). Indications for RVAD placement were acute myocardial infarction in 4 (50.0%), failure to wean from cardiopulmonary bypass in 2 (25.0%) and post-cardiotomy RV failure in another 2 patients (25.0%). Intra- and postoperative results of the EUROMACS registry were analysed. Inflow cannulas were implanted into the right atrium (RA) in 6 patients (75.0%) and into the RV in 2 patients (25.0%). CPB was used in 6 patients (75.0%). Four patients (50.0%) survived the first 30 days. During follow-up, 1 patient died after 44 days due to multiorgan failure. In the surviving three patients, 2 patients were transplanted after 29 and 419 days, respectively, and, in 1 patient, the device was explanted for pump thrombosis and recovered RV function. In this very specific and sick

  8. Pericarditis following permanent pacemaker insertion.

    PubMed

    Levy, Yair; Shovman, Ora; Granit, Chava; Luria, David; Gurevitz, Osnat; Bar-Lev, David; Eldar, Michael; Shoenfeld, Yehuda; Glikson, Michael

    2004-10-01

    The appearance of pericarditis following insertion of a permanent pacemaker is not widely acknowledged in the literature. To describe our experience with pericarditis following 395 permanent pacemaker implantations over 2 years. We retrospectively reviewed the medical records of 395 consecutive patients in whom new pacing systems or pacemaker leads had been implanted over a 2 year period. We searched the records for pericarditis that developed within 1 month after pacemaker implantation according to the ICD-9 code. The incidence, clinical picture, response to treatment, and relationship to lead design and location were studied. Eight cases (2%) of pericarditis following implantation were detected. Clinical manifestations in all patients were similar to those of post-pericardiotomy syndrome and included chest pain (n = 7), friction rub (n = 1), fever (n = 2), fatigue (n = 2), pleural effusion (n = 2), new atrial fibrillation (n = 2), elevated erythrocyte sedimentation rate (n = 4), and echcardiographic evidence of pericardial effusion (n = 8). All affected patients had undergone active fixation (screw-in) lead implantation in the atrial position. The incidence of pericarditis with screw-in atrial leads was 3% compared to 0% in other cases (P < 0.05). Pericarditis is not uncommon following pacemaker implantation with active fixation atrial leads. Special attention should be paid to identifying pericardial complications following pacemaker implantation, especially when anticoagulant therapy is resumed or initiated. The use of passive fixation leads is likely to reduce the incidence of pericarditis but this issue should be further investigated.

  9. [An effective and safe alternative to epicardial pacemaker placement for permanent pacemaker implantation in a patient with mechanical tricuspid valve: stimulation of the left ventricle through the coronary sinus].

    PubMed

    Demir, Ahmet Duran; Sen, Nihat; Erbay, Ali Rıza; Atak, Ramazan

    2011-04-01

    Implantation of a transvenous endocardial pacemaker is contraindicated in patients with a mechanical tricuspid valve. An epicardial left ventricular pacemaker lead was placed by a transvenous route through the coronary sinus into the lateral cardiac vein in a 58-year-old woman with mechanical aortic, mitral, and tricuspid valves, for permanent pacing due to chronic atrial fibrillation with a slow ventricular rate accompanied by syncope. This lead was then connected to a single-chamber pacemaker. The patient had no problem in the following three months. Placement of an epicardial pacing lead through the coronary sinus provides a safe and effective pacing in patients with a mechanical tricuspid valve, thus obviating major cardiac surgery.

  10. An analysis of intraoperative versus post-operative dosimetry with CT, CT-MRI fusion and XMR for the evaluation of permanent prostate brachytherapy implants.

    PubMed

    Acher, Peter; Puttagunta, Srikanth; Rhode, Kawal; Morris, Stephen; Kinsella, Janette; Gaya, Andrew; Dasgupta, Prokar; Deehan, Charles; Beaney, Ronald; Popert, Rick; Keevil, Stephen

    2010-08-01

    To assess the agreement between intraoperative and post-operative dosimetry and to identify factors that influence dose calculations of prostate brachytherapy implants. Patients treated with prostate brachytherapy implants underwent post-operative CT and XMR (combined X-ray and MR) imaging. Dose-volume histograms were calculated from CT, XMR and CT-MR fusion data and compared with intraoperative values for two observers. Multiple linear regression models assessed the influences of intraoperative D90, gland oedema, gland volume, source loss and migration, and implanted activity/volume prostate on post-operative D90. Forty-nine patients were studied. The mean D90 differences (95% confidence limits) between intraoperative and post-operative CT, XMR and CT-MR fusion assessments were: 11 Gy (-22, 45), 18 Gy (-13, 49) and 20 Gy (-17, 58) for Observer 1; and 15 Gy (-34, 63), 13 Gy (-29, 55) and 14 Gy (-27, 54) for Observer 2. Multiple linear regression modelling showed that the observed oedema and intraoperative D90 were significant independent variables for the prediction of post-operative D90 values for both observers using all modalities. This is the first study to report Bland-Altman agreement analysis between intraoperative and post-operative dosimetry. Agreement is poor. Post-operative dosimetry is dependent on the intraoperative D90 and the subjectively outlined gland volume. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  11. A permanent breast seed implant as partial breast radiation therapy for early-stage patients: A comparison of palladium-103 and iodine-125 isotopes based on radiation safety considerations

    SciTech Connect

    Keller, Brian; Sankreacha, Raxa; Rakovitch, Eileen; O'Brien, Peter; Pignol, Jean-Philippe . E-mail: Jean-Philippe.Pignol@sw.ca

    2005-06-01

    Purpose: A permanent breast seed implant (PBSI) technique has been developed as a new form of partial adjuvant radiation therapy for early-stage breast cancer. This study compares iodine-125 ({sup 125}I) and palladium-103 ({sup 103}Pd) isotopes by examining the exposure and effective dose (ED) to a patient's partner.Methods and Materials: A low-energy survey meter was used to measure exposure rates as a function of bolus thickness placed over {sup 103}Pd or {sup 125}I seeds. A general mathematical expression for the initial exposure rate at 1 m (x{sub o,1m}) from the skin surface as a function of the implant size, R, and the distance between the skin surface and the implant, d, was derived. Also, a second general equation is proposed to calculate the ED to the patient's partner.Results: The initial exposure rate at 1 meter and the ED are calculated as follows: x{sub o,1m} = (3{alpha})/2R{sup 3}{center_dot}{beta}{sup 3} [e{sup -{beta}}{sup (2R+d)}({beta}R + 1) + e{sup -{beta}}{sup {center_dot}}{sup d}({beta}R - 1)], and ED = aR{sup b} {center_dot} [e{sup -c(2R+d)} {center_dot} (cR + 1) + e{sup -cd} -bar (cR - 1)]. For {sup 125}I, the parameters are: {alpha} = 0.154409, {beta} = 0.388460, a = 197, b = -0.95, and c = 0.38846. For {sup 103}Pd, they are: {alpha} = 0.06877, {beta} = 0.421098, a = 18.6, b -0.78, and c = 0.421098. For implant diameters varying from 2 to 6 cm and skin-to-implant distances varying from 0.7 to 4 cm, the ED is consistently below 2.6 mSv using the {sup 103}Pd isotope, but more than 5 mSv in many instances and possibly up to 20 mSv using {sup 125}I.Conclusions: PBSI using {sup 103}Pd seeds appears safe because the patient's partner ED is consistently below 5 mSv. The{sup 125}I isotope is not recommended for PBSI.

  12. A permanent breast seed implant as partial breast radiation therapy for early-stage patients: a comparison of palladium-103 and iodine-125 isotopes based on radiation safety considerations.

    PubMed

    Keller, Brian; Sankreacha, Raxa; Rakovitch, Eileen; O'brien, Peter; Pignol, Jean-Philippe

    2005-06-01

    A permanent breast seed implant (PBSI) technique has been developed as a new form of partial adjuvant radiation therapy for early-stage breast cancer. This study compares iodine-125 ((125)I) and palladium-103 ((103)Pd) isotopes by examining the exposure and effective dose (ED) to a patient's partner. A low-energy survey meter was used to measure exposure rates as a function of bolus thickness placed over (103)Pd or (125)I seeds. A general mathematical expression for the initial exposure rate at 1 m (x(o,1m)) from the skin surface as a function of the implant size, R, and the distance between the skin surface and the implant, d, was derived. Also, a second general equation is proposed to calculate the ED to the patient's partner. The initial exposure rate at 1 meter and the ED are calculated as follows: x(o,1m) = 3alpha2R(3) ; ;beta(3) [e(-beta(2R+d))(betaR + 1) + e(-betad)(betaR - 1)], and ED = aR(b) [e(-c(2R+d)) (cR + 1) + e(-cd) (cR - 1)]. For (125)I, the parameters are: alpha = 0.154409, beta = 0.388460, a = 197, b = -0.95, and c = 0.38846. For (103)Pd, they are: alpha = 0.06877, beta = 0.421098, a = 18.6, b = -0.78, and c = 0.421098. For implant diameters varying from 2 to 6 cm and skin-to-implant distances varying from 0.7 to 4 cm, the ED is consistently below 2.6 mSv using the (103)Pd isotope, but more than 5 mSv in many instances and possibly up to 20 mSv using (125)I. PBSI using (103)Pd seeds appears safe because the patient's partner ED is consistently below 5 mSv. The(125)I isotope is not recommended for PBSI.

  13. Restoration of ankle movements with the ActiGait implantable drop foot stimulator: a safe and reliable treatment option for permanent central leg palsy.

    PubMed

    Martin, Klaus Daniel; Polanski, Witold Henryk; Schulz, Anne-Kathrin; Jöbges, Michael; Hoff, Hansjoerg; Schackert, Gabriele; Pinzer, Thomas; Sobottka, Stephan B

    2016-01-01

    OBJECT The ActiGait drop foot stimulator is a promising technique for restoration of lost ankle function by an implantable hybrid stimulation system. It allows ankle dorsiflexion by active peroneal nerve stimulation during the swing phase of gait. In this paper the authors report the outcome of the first prospective study on a large number of patients with stroke-related drop foot. METHODS Twenty-seven patients who experienced a stroke and with persisting spastic leg paresis received an implantable ActiGait drop foot stimulator for restoration of ankle movement after successful surface test stimulation. After 3 to 5 weeks, the stimulator was activated, and gait speed, gait endurance, and activation time of the system were evaluated and compared with preoperative gait tests. In addition, patient satisfaction was assessed using a questionnaire. RESULTS Postoperative gait speed significantly improved from 33.9 seconds per 20 meters to 17.9 seconds per 20 meters (p < 0.0001), gait endurance from 196 meters in 6 minutes to 401 meters in 6 minutes (p < 0.0001), and activation time from 20.5 seconds to 10.6 seconds on average (p < 0.0001). In 2 patients with nerve injury, surgical repositioning of the electrode cuff became necessary. One patient showed a delayed wound healing, and in another patient the system had to be removed because of a wound infection. Marked improvement in mobility, social participation, and quality of life was confirmed by 89% to 96% of patients. CONCLUSIONS The ActiGait implantable drop foot stimulator improves gait speed, endurance, and quality of life in patients with stroke-related drop foot. Regarding gait speed, the ActiGait system appears to be advantageous compared with foot orthosis or surface stimulation devices. Randomized trials with more patients and longer observation periods are needed to prove the long-term benefit of this device.

  14. Current status of the gyro centrifugal blood pump--development of the permanently implantable centrifugal blood pump as a biventricular assist device (NEDO project).

    PubMed

    Nosé, Yukihiko; Furukawa, Kojiro

    2004-10-01

    The New Energy and Industrial Technology Development Organization (NEDO) project was started in 1995. The goal is the development of a multipurpose, totally implantable biventricular assist device (BVAD) that can be used for any patient who suffers from severe heart failure. Our C1E3 (two-week pump) centrifugal pump, called the Gyro pump, has three design characteristics: a magnetic coupling and double pivot bearing system, an eccentric inlet port, and secondary vanes on the bottom of the impeller. The pump was miniaturized. The C1E3 evolved into the NEDO PI-601, a totally implantable centrifugal pump for BVAD. The current NEDO PI-710 pump (five-year pump) system includes a centrifugal pump with pivot bearings, a hydraulically-levitated impeller, an rpm-controlled miniaturized actuator (all-in-one actuator plus controller), an emergency clamp on the left outflow, and a Frank-Starling-type flow control. The final mass production model is now finalized, and the final animal study and two-year endurance studies are ongoing.

  15. Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group

    PubMed Central

    Navarro, Rodrigo M.; Machado, Leonardo M.; Maia, Ossires; Wu, Lihteh; Farah, Michel E.; Magalhaes, Octaviano; Arevalo, J. Fernando; Maia, Mauricio

    2015-01-01

    Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised. PMID:26504590

  16. Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group.

    PubMed

    Navarro, Rodrigo M; Machado, Leonardo M; Maia, Ossires; Wu, Lihteh; Farah, Michel E; Magalhaes, Octaviano; Arevalo, J Fernando; Maia, Mauricio

    2015-01-01

    Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised.

  17. Optimal Implantation Depth and Adherence to Guidelines on Permanent Pacing to Improve the Results of Transcatheter Aortic Valve Replacement With the Medtronic CoreValve System: The CoreValve Prospective, International, Post-Market ADVANCE-II Study.

    PubMed

    Petronio, Anna S; Sinning, Jan-Malte; Van Mieghem, Nicolas; Zucchelli, Giulio; Nickenig, Georg; Bekeredjian, Raffi; Bosmans, Johan; Bedogni, Francesco; Branny, Marian; Stangl, Karl; Kovac, Jan; Schiltgen, Molly; Kraus, Stacia; de Jaegere, Peter

    2015-05-01

    The aim of the CoreValve prospective, international, post-market ADVANCE-II study was to define the rates of conduction disturbances and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement with the Medtronic CoreValve System (Minneapolis, Minnesota) using optimized implantation techniques and application of international guidelines on cardiac pacing. Conduction disturbances are a frequent complication of transcatheter aortic valve replacement. The rates of PPI in the published reports vary according to bioprosthesis type and the indications for PPI. The primary endpoint was the 30-day incidence of PPI with Class I/II indications when the Medtronic CoreValve System was implanted at an optimal depth (≤6 mm below the aortic annulus). The timing and resolution of all new-onset conduction disturbances were analyzed. A total of 194 patients were treated. The overall rate of PPI for Class I/II indications was 18.2%. An optimal depth was reached in 43.2% of patients, with a nonsignificantly lower incidence of PPI in patients with depths ≤6 mm, compared with those with deeper implants (13.3% vs. 21.1%; p = 0.14). In a paired analysis, new-onset left bundle branch block and first-degree atrioventricular block occurred in 45.4% and 39.0% of patients, respectively, and resolved spontaneously within 30 days in 43.2% and 73.9%, respectively. In patients with new PPI, the rate of intrinsic sinus rhythm increased from 25.9% at 7 days to 59.3% at 30 days (p = 0.004). Optimal Medtronic CoreValve System deployment and adherence to international guidelines on cardiac pacing are associated with a lower rate of new PPI after transcatheter aortic valve replacement, compared with results reported in previous studies. (CoreValve Advance-II Study: Prospective International Post-Market Study [ADVANCE II]; NCT01624870). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Paced QT interval as a risk factor for new-onset left ventricular systolic dysfunction and cardiac death after permanent pacemaker implantation.

    PubMed

    Cho, Eun Jeong; Park, Seung-Jung; Park, Kyoung Min; On, Young Keun; Kim, June Soo

    2016-01-15

    Prolongation of corrected QT (QTc) interval reflects an increased risk of fatal arrhythmia and cardiac death in various populations. However, it is not clear whether the paced-QTc (p-QTc) interval is associated with new-onset left ventricular systolic dysfunction (new-LVSD) or cardiac death. In 491 consecutive patients (64 ± 14 years) with preserved LV ejection fraction (64 ± 7%), the p-QTc interval was measured within 2 weeks after PPM implantation. We assessed the rates of new-LVSD and cardiac death based on the degree of p-QTc interval. During the follow-up period (78 ± 51 months), new-LVSD and cardiac death were identified in 53 (10.8%) and 26 (5.3%) patients, respectively. Patients with new-LVSD had more frequent atrioventricular block (P=0.041), a higher percentage of ventricular pacing (P=0.005), a longer p-QRS duration (P<0.001), and more prolonged p-QTc interval (P<0.001) compared to those without new-LVSD. There was a graded increase in the rates of new-LVSD (P<0.001) and cardiac death (P=0.001) from the patients in the lowest to those in the highest tertile of the p-QTc interval. Additionally, the incidence of cardiac death was significantly elevated especially in the patients with new-LVSD and wider p-QTc interval. In Cox regression analyses, the p-QTc interval was independently associated with new-LVSD and cardiac death even after adjusted with various relevant confounding factors. Prolonged p-QTc interval was closely associated with new-LVSD and cardiac death after PPM implantation in patients with preserved LV systolic function. The rate of cardiac death significantly increased especially in patients who showed more p-QTc widening along with new-LVSD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Dosimetric characteristics of the new RadioCoil{sup TM} {sup 103}Pd wire line source for use in permanent brachytherapy implants

    SciTech Connect

    Meigooni, A.S.; Zhang, H.; Clark, J.R.; Rachabatthula, V.; Koona, R.A.

    2004-11-01

    Recently, a novel linear brachytherapy source in the form of a coiled wire has become available for use in interstitial implants of various treatment sites such as prostate gland. This source type employs a design completely different from that of most 'seed' sources currently on the market, one which improves upon or eliminates several common problems with such sources. Dosimetric characteristics of these sources with active lengths 0.5 cm to 5.0 cm were determined for clinical application. For 0.5 cm and 1.0 cm active length sources, the dose rate constant, radial dose function, and two-dimensional (2D) anisotropy function were experimentally and theoretically determined following the updated AAPM Task Group 43 (TG-43U1) recommendations. Radial dose functions and/or 'along-away' matrix functions were also obtained for sources with active lengths 2.0 cm to 5.0 cm. Measurements were performed with LiF thermoluminescent dosimeters in Solid Water{sup TM} phantoms. Measured data was compared to Monte Carlo simulated data in Solid Water{sup TM} utilizing the PTRAN code, version 7.43. After finding the data to be in agreement, Monte Carlo calculations were performed in liquid water to obtain clinically applicable dosimetric data as per TG-43U1 recommendations. The results indicated the dose rate constant of the 0.5 cm long RadioCoil{sup TM103}Pd source in Solid Water{sup TM} to be 0.641 cGy h{sup -1} U{sup -1} when measured, and 0.636 cGy h{sup -1} U{sup -1} when simulated by Monte Carlo. The calculated dose rate constant in liquid water was found to be 0.650 cGy h{sup -1} U{sup -1}. These values are comparable to other commercially available sources. Complete dosimetric data and simulation results are described in this paper. Per TG-43U1, clinical treatment planning systems should utilize the values reported for liquid water.

  20. Three-dimensional conformal external beam radiotherapy compared with permanent prostate implantation in low-risk prostate cancer based on endorectal magnetic resonance spectroscopy imaging and prostate-specific antigen level

    SciTech Connect

    Pickett, Barby . E-mail: pickett@radonc17.ucsf.edu; Kurhanewicz, John; Pouliot, Jean; Weinberg, Vivian; Shinohara, Katsuto; Coakley, Fergus; Roach, Mack

    2006-05-01

    Purpose: To evaluate the metabolic response by comparing the time to resolution of spectroscopic abnormalities (TRSA) and the time to prostate-specific antigen level in low-risk prostate cancer patients after treatment with three-dimensional conformal external beam radiotherapy (3D-CRT) compared with permanent prostate implantation (PPI). Recent studies have suggested that the treatment of low-risk prostate cancer yields similar results for patients treated with 3D-CRT or PPI. Methods and Materials: A total of 50 patients, 25 in each group, who had been treated with 3D-CRT or PPI, had undergone endorectal magnetic resonance spectroscopy imaging before and/or at varying times after therapy. The 3D-CRT patients had received radiation doses of {>=}72 Gy compared with 144 Gy for the PPI patients. The spectra from all usable voxels were examined for detectable levels of metabolic signal, and the percentages of atrophic and cancerous voxels were tabulated. Results: The median time to resolution of the spectroscopic abnormalities was 32.2 and 24.8 months and the time to the nadir prostate-specific antigen level was 52.4 and 38.0 months for the 3D-CRT and PPI patients, respectively. Of the 3D-CRT patients, 92% achieved negative endorectal magnetic resonance spectroscopy imaging findings, with 40% having complete metabolic atrophy. All 25 PPI patients had negative endorectal magnetic resonance spectroscopy imaging findings, with 60% achieving complete metabolic atrophy. Conclusion: The results of this study suggest that metabolic and biochemical responses of the prostate are more pronounced after PPI. Our results have not proved PPI is more effective at curing prostate cancer, but they have demonstrated that it may be more effective at destroying prostate metabolism.

  1. Equivalent Biochemical Control and Improved Prostate-Specific Antigen Nadir After Permanent Prostate Seed Implant Brachytherapy Versus High-Dose Three-Dimensional Conformal Radiotherapy and High-Dose Conformal Proton Beam Radiotherapy Boost

    SciTech Connect

    Jabbari, Siavash; Weinberg, Vivian K.; Shinohara, Katsuto; Speight, Joycelyn L.; Gottschalk, Alexander R.; Hsu, I.-C.; Pickett, Barby; McLaughlin, Patrick W.; Sandler, Howard M.; Roach, Mack

    2010-01-15

    Purpose: Permanent prostate implant brachytherapy (PPI), three-dimensional conformal radiotherapy (3D-CRT), and conformal proton beam radiotherapy (CPBRT) are used in the treatment of localized prostate cancer, although no head-to-head trials have compared these modalities. We studied the biochemical control (biochemical no evidence of disease [bNED]) and prostate-specific antigen (PSA) nadir achieved with contemporary PPI, and evaluated it against 3D-CRT and CPBRT. Patients and Methods: A total of 249 patients were treated with PPI at the University of California, San Francisco, and the outcomes were compared with those from a 3D-CRT cohort and the published results of a high-dose CPBRT boost (CPBRTB) trial. For each comparison, subsets of the PPI cohort were selected with patient and disease criteria similar to those of the reference group. Results: With a median follow-up of 5.3 years, the bNED rate at 5 and 7 years achieved with PPI was 92% and 86%, respectively, using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, and 93% using the PSA nadir plus 2 ng/mL definition. Using the ASTRO definition, a 5-year bNED rate of 78% was achieved for the 3D-CRT patients compared with 94% for a comparable PPI subset and 93% vs. 92%, respectively, using the PSA nadir plus 2 ng/mL definition. The median PSA nadir for patients treated with PPI and 3D-CRT was 0.10 and 0.40 ng/mL, respectively (p < .0001). For the CPBRT comparison, the 5-year bNED rate after a CPBRTB was 91% using the ASTRO definition vs. 93% for a similar group of PPI patients. A greater proportion of PPI patients achieved a lower PSA nadir compared with those achieved in the CPBRTB trial (PSA nadir <=0.5 ng/mL, 91% vs. 59%, respectively). Conclusion: We have demonstrated excellent outcomes in low- to intermediate-risk patients treated with PPI, suggesting at least equivalent 5-year bNED rates and a greater proportion of men achieving lower PSA nadirs compared with 3D-CRT or

  2. APPLICATION III: Permanent Magnet

    NASA Astrophysics Data System (ADS)

    Gotoh, Satoshi

    The following sections are included: * Introduction * Superconducting permanent magnet using pinned type superconductor * Magnetization process based on the critical state * Demagnetizing curve and permanent magnetic properties * Demagnetizing field of pinned type II superconductor * Samples and experiments * Sample preparation * Magnetization measurements * Permanent magnetic properties of the melt processed YBCO * QMG processed YBCO * MPMG processed YBCO * Summary * References

  3. Rare earth permanent magnets

    SciTech Connect

    Major-Sosias, M.A.

    1993-10-01

    Permanent magnets were discovered centuries ago from what was known as {open_quotes}lodestone{close_quotes}, a rock containing large quantities of the iron-bearing mineral magnetite (Fe{sub 3}O{sub 4}). The compass was the first technological use for permanent magnetic materials; it was used extensively for navigational purposes by the fifteenth century. During the twentieth century, as new applications for permanent magnets were developed, interest and research in permanent magnetic materials soared. Four major types of permanent magnets have been developed since the turn of the century.

  4. Transcatheter aortic valve implantation with the Edwards Sapien 3 valve: First experiences in Turkey.

    PubMed

    Aslan, Abdullah Nabi; Baştuğ, Serdal; Kasapkara, Hacı Ahmet; Ayhan, Hüseyin; Süygün, Hakan; Keleş, Telat; Durmaz, Tahir; Akar Bayram, Nihal; Bilen, Emine; Bozkurt, Engin

    2016-12-01

    Transcatheter aortic valve implantation (TAVI) has shown promising results in patients with severe aortic stenosis (AS) at high risk for open heart surgery. We aimed to evaluate outcomes of patients who underwent TAVI with Edwards SAPIEN 3 Transcatheter Heart Valve (S3), a second-generation TAVI device. Between November 2014 and June 2016, 31 high-risk patients received balloon-expandable S3 valve at Atatürk Training and Research Hospital that has the largest case series in Turkey. Mean age of the patients was 76.1±12.6 years. Mean Society of Thoracic Surgeons and logistic European System for Cardiac Operative Risk Evaluation scores were 7.8%±3.1 and 31.4%±17.6, respectively. S3 valve was implanted in 27 patients via transfemoral approach and via trans-subclavian approach in 4 patients under local (n=29) or general (n=2) anesthesia. Procedural success rate was 100% (23 mm, n=7; 26 mm, n=16; 29 mm, n=8). Paravalvular aortic regurgitation (PAR) was absent or trivial in 29 (93.6%) patients and mild in 2 (6.4%) patients. Permanent pacemaker implantation (PPI) was required in 2 (6.4%) patients during the procedure, and in-hospital mortality occurred in 1 (3.2%) of those 2 patients. S3 valve is associated with higher rate of device success and lower incidence of PAR, peripheral vascular complications, and need for new PPI.

  5. Permanent Contraception for Women.

    PubMed

    Patil, Eva; Jensen, Jeffrey T

    2016-05-01

    Permanent contraception is a highly desired and commonly used contraceptive option for women around the world who desire never to become pregnant. Current methods of female permanent contraception require surgery. Postpartum tubal ligation and interval surgical tubal ligation are safe and effective, do not interfere with menstrual cycles, and require no ongoing cost or medical checkups. Hysteroscopic tubal occlusion offers a less invasive surgical approach, but requires an imaging study for verification of correct placement. However, not all women have access to a surgeon trained to provide permanent contraception, or they may face other prohibitive logistic or financial burdens. The development of novel permanent contraception methods that are immediately effective and/or nonsurgical could help improve access to and acceptability of permanent contraception. The expansion of permanent contraception options could help women achieve their family planning goals and reduce unintended pregnancies.

  6. Cochlear Implants

    MedlinePlus

    ... Medical Procedures Implants and Prosthetics Cochlear Implants Cochlear Implants Share Tweet Linkedin Pin it More sharing options ... normal ear, ear with hearing loss, and cochlear implant procedure Welcome to the Food and Drug Administration ( ...

  7. Oscillating Permanent Magnets.

    ERIC Educational Resources Information Center

    Michaelis, M. M.; Haines, C. M.

    1989-01-01

    Describes several ways to partially levitate permanent magnets. Computes field line geometries and oscillation frequencies. Provides several diagrams illustrating the mechanism of the oscillation. (YP)

  8. Novel device for expanding Schlemm's canal: a morphological study: Implantation of the Stegmann Canal Expander following viscodilation of Schlemm's canal resulted in permanent expansion of the canal lumen and distension of the trabecular meshwork without complications.

    PubMed

    Grieshaber, Matthias C; Stegmann, Robert; Grieshaber, Hans R; Meyer, Peter

    2015-07-01

    This study was performed to assess any changes in Schlemm's canal (SC) in human autopsy eyes possibly resulting from the injection of a viscoelastic substance and implantation of a new device (the Stegmann Canal Expander, SCE) into SC. After the surgical procedure, eyes were fixed, dissected into quartered segments and examined using light and scanning electron microscopy. Tissue sections displayed a marked dilation of SC and of the collector channels compared with untreated control sections. The SC walls were disrupted in some areas due to viscodilation, but not due to SCE implantation. In all eyes, the entire 9-mm length of the SCE was positioned inside the canal, keeping the canal wide open. The SCE diameter of 240 μm remained unchanged after implantation. Injection of a viscoelastic substance into SC leads to marked dilation of SC and collector channels. Implanting the SCE into SC allowed persistent expansion of SC and stretching of the trabecular meshwork. This may increase the permeability of the trabecular meshwork, reduce its resistance to aqueous humour and maintain circumferential flow within SC. Experimental and clinical studies should determine the impact of this new canal expander in terms of lowering intraocular pressure in glaucoma surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Permanent magnet assembly

    DOEpatents

    Chell, Jeremy; Zimm, Carl B.

    2006-12-12

    A permanent magnet assembly is disclosed that is adapted to provide a magnetic field across an arc-shaped gap. Such a permanent magnet assembly can be used, for example, to provide a time-varying magnetic field to an annular region for use in a magnetic refrigerator.

  10. Permanent tensions in organization.

    PubMed

    Jansson, Noora

    2015-01-01

    The purpose of this paper is to investigate the relationship between permanent tensions and organizational change. This study used paradox theory and a case study. The case organization is a public university hospital in Finland involving several stakeholders. The analysis suggests that the relationship between permanent tensions and organizational change is a paradox that is part of organizational reality. As an organization learns to live with its permanent tensions, the renewal paradox settles into equilibrium. When tensions are provoked, the paradox is disturbed until it finds a new balance. This flexible nature of the paradox is the force that keeps the different stakeholders simultaneously empowered to maintain their unique missions and cohesive in order to benefit from the larger synergy. This research suggests that identification and evaluation of each permanent tension within an organization is important when executing organizational change. The fact that certain tensions are permanent and cannot be solved may have an influence on how planned change initiatives are executed. The results show that permanent tensions may be harnessed for the benefit of an organizational change. This research demonstrates originality by offering an alternative view of tensions, a view which emphasizes not only their permanent and plural nature but their importance for enabling the organization to change at its own, non-disruptive pace. The research also proposes a new concept, the "renewal paradox", to enhance understanding of the relationship between permanent tensions and organizational change.

  11. Management of fluocinolone implant dissociation during implant exchange.

    PubMed

    Yeh, Steven; Cebulla, Colleen M; Witherspoon, S Robert; Emerson, Geoffrey G; Emerson, M Vaughn; Suhler, Eric B; Albini, Thomas A; Flaxel, Christina J

    2009-09-01

    Three patients with chronic, noninfectious uveitis requiring immunosuppressive therapy underwent fluocinolone acetonide (FA) implant exchange complicated by dissociation of the medication reservoir from its anchoring strut. In 2 patients, the medication reservoir descended into the vitreous cavity and required pars plana vitrectomy with intraocular foreign body removal techniques for its retrieval. The use of viscoelastic or perfluorocarbon to elevate the device was helpful in the safe removal of the FA implant device. Surgeons performing FA implant exchange should be aware of this potential complication and anticipate the possible need for vitreoretinal instrumentation and personnel. Patients undergoing FA explantation or exchange should be counseled regarding this potential complication prior to surgery.

  12. THE MEASURES PAR PROJECT

    NASA Astrophysics Data System (ADS)

    Frouin, R. J.; Franz, B.

    2009-12-01

    The solar energy available for photosynthesis, known as PAR, controls the growth of phytoplankton and, therefore, regulates the composition and evolution of marine ecosystems. Knowing the spatial and temporal distribution of PAR over the oceans is critical to understanding biogeochemical cycles of carbon, nutrients, and oxygen, and to address important climate and global change issues such as the fate of anthropogenic atmospheric carbon dioxide. In view of this, a 12-year time series of PAR at the ocean surface, starting in September 1997, is being produced by the NASA Ocean Biology Processing Group from SeaWiFS, MODIS-Terra, and MODIS-Aqua data. The product covers the global oceans, with a spatial resolution of about 9.3x9.3 km (equal area grid) and a temporal resolution of one day. PAR is computed as the difference between the 400-700 nm solar flux incident on the top of the atmosphere (known) and reflected back to space by the atmosphere and surface (derived from satellite radiance), taking into account atmospheric absorption (modeled). Knowledge of pixel composition is not required, eliminating the need for cloud screening and arbitrary assumptions about sub-pixel cloudiness. Combining data from satellite sensors with different equatorial crossing times accounts for the diurnal variability of clouds and, therefore, increases accuracy on a daily time scale. The processing system, including routine check of accuracy and control of quality, is designed to operate during the entire lifetime of SeaWiFS and MODIS, and to accommodate future sensors with ocean-color capabilities. Maps of daily, weekly, and monthly PAR obtained from individual sensors are presented, as well as merged products. Accuracy is quantified in comparisons with other satellite estimates, the National Centers for Environmental Prediction reanalysis product, and in-situ measurements from fixed buoys and platforms. The good statistical performance makes the satellite PAR product suitable for large

  13. Implantable Heart Aid

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Medrad utilized NASA's Apollo technology to develop a new device called the AID implantable automatic pulse generator which monitors the heart continuously, recognizes the onset of ventricular fibrillation and delivers a corrective electrical shock. AID pulse generator is, in effect, a miniaturized version of the defibrillator used by emergency squads and hospitals to restore rhythmic heartbeat after fibrillation, but has the unique advantage of being permanently available to the patient at risk. Once implanted, it needs no specially trained personnel or additional equipment. AID system consists of a microcomputer, a power source and two electrodes which sense heart activity.

  14. Amélioration des performances d'une implantation parallélovectorielle du gradient conjugué par extension du schéma de stockage matriciel

    NASA Astrophysics Data System (ADS)

    Magnin, H.; Coulomb, J. L.

    1993-03-01

    Electromagnetic field computation with the Finite Element (FE) method implies solving of large linear systems of equations. Performances and memory capacities of today computers allow to achieve three-dimensional FE discretizations of electromagnetic problems, but the number of unknowns grows high. So, to improve time to the numerical solution of the linear system(s) thus arising, the use of parallel and/or vector computers has to be envisaged. In this paper, the main constitutive steps of the Pre-conditioned Conjugate Gradient algorithm (PCG) are analysed. After a short recall of our previous work concerning their improvement by use of vector and parallel computations, we show some speedup limitations due to the sparse row-wise matrix storage scheme employed. Then, an extension of this matrix representation is proposed, leading to introduce redundant storage of non-zero coefficients. In spite of the “memory waste” thus implied, it is shown how this extension can be successfully employed to increase the speedup due to parallelism and vectorization on the whole algorithm, and in particular to derive a parallel preconditioner. La résolution par la méthode des éléments finis des équations de l'électromagnétisme conduit à résoudre de grands systèmes d'équations linéaires. Les capacités mémoire et les performances actuelles des systèmes informatiques permettent de traiter les problèmes électromagnétiques par discrétisation tridimensionnelle, mais alors le nombre d'inconnues devient très élevé. Ainsi, la résolution en un temps raisonnable des équations linéaires associées à de telles discrétisations conduit à envisager l'emploi d'ordinateurs à architecture parallèle. Dans cet article, les différentes étapes constitutives de l'algorithme du gradient conjugué préconditionné (GCP) sont analysées. Après un court rappel de nos travaux antérieurs concemant leur amélioration par utilisation de traitements parallèles et vectoriels

  15. Cochlear Implants.

    ERIC Educational Resources Information Center

    Clark, Catherine; Scott, Larry

    This brochure explains what a cochlear implant is, lists the types of individuals with deafness who may be helped by a cochlear implant, describes the process of evaluating people for cochlear implants, discusses the surgical process for implanting the aid, traces the path of sound through the cochlear implant to the brain, notes the costs of…

  16. Cochlear Implants.

    ERIC Educational Resources Information Center

    Clark, Catherine; Scott, Larry

    This brochure explains what a cochlear implant is, lists the types of individuals with deafness who may be helped by a cochlear implant, describes the process of evaluating people for cochlear implants, discusses the surgical process for implanting the aid, traces the path of sound through the cochlear implant to the brain, notes the costs of…

  17. La pelade par plaques

    PubMed Central

    Spano, Frank; Donovan, Jeff C.

    2015-01-01

    Résumé Objectif Présenter aux médecins de famille des renseignements de base pour faire comprendre l’épidémiologie, la pathogenèse, l’histologie et l’approche clinique au diagnostic de la pelade par plaques. Sources des données Une recension a été effectuée dans PubMed pour trouver des articles pertinents concernant la pathogenèse, le diagnostic et le pronostic de la pelade par plaques. Message principal La pelade par plaques est une forme de perte pileuse auto-immune dont la prévalence durant une vie est d’environ 2 %. Des antécédents personnels ou familiaux de troubles auto-immuns concomitants, comme le vitiligo ou une maladie de la thyroïde, peuvent être observés dans un petit sous-groupe de patients. Le diagnostic peut souvent être posé de manière clinique en se fondant sur la perte de cheveux non cicatricielle et circulaire caractéristique, accompagnée de cheveux en « point d’exclamation » en périphérie chez ceux dont le problème en est aux premiers stades. Le diagnostic des cas plus complexes ou des présentations inhabituelles peut être facilité par une biopsie et un examen histologique. Le pronostic varie largement et de mauvais résultats sont associés à une apparition à un âge précoce, une perte importante, la variante ophiasis, des changements aux ongles, des antécédents familiaux ou des troubles auto-immuns concomitants. Conclusion La pelade par plaques est une forme auto-immune de perte de cheveux périodiquement observée en soins primaires. Les médecins de famille sont bien placés pour identifier la pelade par plaques, déterminer la gravité de la maladie et poser le diagnostic différentiel approprié. De plus, ils sont en mesure de renseigner leurs patients à propos de l’évolution clinique de la maladie ainsi que du pronostic général selon le sous-type de patients.

  18. Étude de déformations induites par précipitation d'ions H au cours du recuit du systéme Ag-H implanté

    NASA Astrophysics Data System (ADS)

    Lin, X. W.; Ruault, M.-O.; Saint-Jacques, R. G.

    1988-09-01

    Surface deformation of low-temperature (15 K) H-implanted thin Ag films ( ~ 70 nm) with fluences above 4 × 10 17H/ cm2 (i.e. H/Ag ~ 0.35) was observed by annealing at ~ 100 K at a speed of ~ 2 K/s. By TEM and SEM studies, one can identify this deformation with blister formation in the samples. Using the gas-driven blistering model and the stress-driven model, the following mechanism was proposed: By annealing, the H atoms dissolved in the host lattice at low temperature precipitate very rapidly at ~ 100 K in the form of overpressurized microbubbles. This induces strong stress in the thin films and hence blistering. The application of the stress-driven model formula in this particular case leads to a satisfactory result.

  19. Penile Implants

    MedlinePlus

    Penile Implants Overview By Mayo Clinic Staff Penile implants are devices placed inside the penis to allow men with erectile dysfunction (ED) to get an erection. Penile implants are typically recommended after other treatments for ED ...

  20. Dental Implants.

    PubMed

    Griggs, Jason A

    2017-10-01

    Systematic reviews of literature over the period between 2008 and 2017 are discussed regarding clinical evidence for the factors affecting survival and failure of dental implants. The factors addressed include publication bias, tooth location, insertion torque, collar design, implant-abutment connection design, implant length, implant width, bone augmentation, platform switching, surface roughness, implant coatings, and the use of ceramic materials in the implant body and abutment. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Serving Deaf Students Who Have Cochlear Implants. PEPNet Tipsheet

    ERIC Educational Resources Information Center

    Searls, J. Matt, Comp.

    2010-01-01

    Cochlear implants (CIs) are complex electronic devices surgically implanted under the skin behind the ear. These devices utilize electrodes placed in the inner ear (the cochlea) to stimulate the auditory nerve of individuals with significant permanent hearing loss. Cochlear implants may not be suitable for everyone. They are designed to provide…

  2. Serving Deaf Students Who Have Cochlear Implants. PEPNet Tipsheet

    ERIC Educational Resources Information Center

    Searls, J. Matt, Comp.

    2010-01-01

    Cochlear implants (CIs) are complex electronic devices surgically implanted under the skin behind the ear. These devices utilize electrodes placed in the inner ear (the cochlea) to stimulate the auditory nerve of individuals with significant permanent hearing loss. Cochlear implants may not be suitable for everyone. They are designed to provide…

  3. La pelade par plaques

    PubMed Central

    Spano, Frank; Donovan, Jeff C.

    2015-01-01

    Résumé Objectif Présenter aux médecins de famille des renseignements de base pour faire comprendre les schémas thérapeutiques et les résultats des traitements pour la pelade par plaques, de même que les aider à identifier les patients pour qui une demande de consultation en dermatologie pourrait s’imposer. Sources des données Une recension a été effectuée dans PubMed pour trouver des articles pertinents concernant le traitement de la pelade par plaques. Message principal La pelade par plaques est une forme auto-immune de perte pileuse qui touche à la fois les enfants et les adultes. Même s’il n’y a pas de mortalité associée à la maladie, la morbidité découlant des effets psychologiques de la perte des cheveux peut être dévastatrice. Lorsque la pelade par plaques et le sous-type de la maladie sont identifiés, un schéma thérapeutique approprié peut être amorcé pour aider à arrêter la chute des cheveux et possiblement faire commencer la repousse. Les traitements de première intention sont la triamcinolone intralésionnelle avec des corticostéroïdes topiques ou du minoxidil ou les 2. Les médecins de famille peuvent prescrire ces traitements en toute sécurité et amorcer ces thérapies. Les cas plus avancés ou réfractaires pourraient avoir besoin de diphénylcyclopropénone topique ou d’anthraline topique. On peut traiter la perte de cils avec des analogues de la prostaglandine. Les personnes ayant subi une perte de cheveux abondante peuvent recourir à des options de camouflage ou à des prothèses capillaires. Il est important de surveiller les troubles psychiatriques en raison des effets psychologiques profonds de la perte de cheveux. Conclusion Les médecins de famille verront de nombreux patients qui perdent leurs cheveux. La reconnaissance de la pelade par plaques et la compréhension du processus pathologique sous-jacent permettent d’amorcer un schéma thérapeutique approprié. Les cas plus graves ou r

  4. [INSEE's permanent demographic sample].

    PubMed

    Sautory, O

    1987-01-01

    This article discusses the permanent demographic sample survey developed by France's Institut National de la Statistique et des Etudes Economiques (INSEE), which has been in use in that country since the census of 1968. Approximately one percent of the metropolitan population of France was chosen for inclusion by birthdate. By adding data on marriage, births of children, change of residence, schooling, employment status, and death to each person's file, longitudinal studies of fertility, nuptiality, and mortality can be conducted. Two such studies are included as examples of how the permanent sample survey can be best put to use.

  5. Alkaline "Permanent" Paper.

    ERIC Educational Resources Information Center

    Pacey, Antony

    1991-01-01

    Discussion of paper manufacturing processes and their effects on library materials focuses on the promotion of alkaline "permanent" paper, with less acid, by Canadian library preservation specialists. Standards for paper acidity are explained; advantages of alkaline paper are described, including decreased manufacturing costs; and…

  6. Current status of permanent total artificial hearts.

    PubMed

    Davis, P K; Rosenberg, G; Snyder, A J; Pierce, W S

    1989-01-01

    Pneumatic total artificial heats, although demonstrating utility as temporary mechanical circulatory support devices, have not demonstrated a great deal of promise as permanent cardiac replacements. The increasing number of patients who would be candidates for total heart replacement suggests a large role for a permanent implantable total artificial heart. To that end, the Pennsylvania State University is developing an electric motor-driven total artificial heart; the results with implants in calves are encouraging. In this device, a roller-screw mechanism is used to translate the rotation of a brushless direct-current motor into rectilinear motion of a pusher-plate assembly, which in turn empties the blood sacs. The total artificial heart of the future will function under automatic control without percutaneous leads, and this should provide the patient with a nearly normal life-style. Although further experimental efforts are necessary to prepare the device for clinical trials, the technology to provide a safe and reliable electric blood-pump system is at hand.

  7. Brulures par Diluant

    PubMed Central

    Benbrahim, A.; Jerrah, H.; Diouri, M.; Bahechar, N.; Boukind, E.H.

    2009-01-01

    Summary La flamme de diluant est une cause non rare de brûlure dans le contexte marocain. Nous avons jugé intéressant de faire une étude épidémiologique sur la brûlure par flamme de diluant (BFD) au centre national des brûlés (CNB) du CHU Ibn-Rochd de Casablanca. Ce travail a été réalisé sur une période de 10 mois (septembre 2007/juin 2008). Le but du travail est de montrer les caractéristiques de ce type de brûlures pour les prévenir et ce par l'information sur le diluant, produit causant ces brûlures, et ses différents dangers, la brûlure notamment. Durant cette période, nous avons colligé 17 cas de BFD sur un total de 356 patients admis au CNB pour brûlures aiguës toute étiologie confondue. La moyenne d'age des patients concernés est de 32 ans. Ils sont presque tous de sexe masculin (16 hommes/1 femme) et ont des antécédents de toxicomanie et/ou de délinquance. Tous nos patients sont de bas niveau socio-économique et habitent dans des bidonvilles pour la plupart. La brûlure est souvent secondaire à une agression dans la rue (92% des cas). Concernant les caractéristiques de la brûlure, la surface cutanée brûlée moyenne est de 23%; elle est souvent profonde et siège surtout au niveau des membres supérieurs et du tronc. PMID:21991179

  8. Variable Permanent Magnet Quadrupole

    SciTech Connect

    Mihara, T.; Iwashita, Y.; Kumada, M.; Spencer, C.M.; /SLAC

    2007-05-23

    A permanent magnet quadrupole (PMQ) is one of the candidates for the final focus lens in a linear collider. An over 120 T/m strong variable permanent magnet quadrupole is achieved by the introduction of saturated iron and a 'double ring structure'. A fabricated PMQ achieved 24 T integrated gradient with 20 mm bore diameter, 100 mm magnet diameter and 20 cm pole length. The strength of the PMQ is adjustable in 1.4 T steps, due to its 'double ring structure': the PMQ is split into two nested rings; the outer ring is sliced along the beam line into four parts and is rotated to change the strength. This paper describes the variable PMQ from fabrication to recent adjustments.

  9. Managing Permanent Objects

    DTIC Science & Technology

    1984-11-01

    sorage me hanism is the Chunk Management System ( CMS ). CMS provides a database-like interface for POMW. On first reference to a permanent object POMS...19] M.P. Atkinson, K.J. Chisholm, and W.P. Cockshott. CMS - A Chunk Management System . Technical Report CSR-110-82, Department of Computer Science...database manager . Creating and using emibedded systems is not always bad. In most large programming projets one ends up constructing and using some sort

  10. Permanent magnet design methodology

    NASA Technical Reports Server (NTRS)

    Leupold, Herbert A.

    1991-01-01

    Design techniques developed for the exploitation of high energy magnetically rigid materials such as Sm-Co and Nd-Fe-B have resulted in a revolution in kind rather than in degree in the design of a variety of electron guidance structures for ballistic and aerospace applications. Salient examples are listed. Several prototype models were developed. These structures are discussed in some detail: permanent magnet solenoids, transverse field sources, periodic structures, and very high field structures.

  11. Postoperative permanent pressure alopecia.

    PubMed

    Chang, Zi Yun; Ngian, Jan; Chong, Claudia; Chong, Chin Ted; Liew, Qui Yin

    2016-04-01

    A 49-year-old Chinese female underwent elective laparoscopic assisted Whipple's surgery lasting 12 h. This was complicated by postoperative pressure alopecia at the occipital area of the scalp. Pressure-induced hair loss after general anaesthesia is uncommon and typically temporary, but may be disconcerting to the patient. We report this case of postoperative permanent pressure alopecia due to its rarity in the anaesthesia/local literature, and review the risk factors for its development.

  12. Short-Term and Long-Term Effects of Orthopedic Biodegradable Implants

    PubMed Central

    Amini, Ami R.; Wallace, James S.; Nukavarapu, Syam P.

    2012-01-01

    Presently, orthopedic and oral/maxillofacial implants represent a combined $2.8 billion market, a figure expected to experience significant and continued growth. Although traditional permanent implants have been proved clinically efficacious, they are also associated with several drawbacks, including secondary revision and removal surgeries. Non-permanent, biodegradable implants offer a promising alternative for patients, as they provide temporary support and degrade at a rate matching tissue formation, and thus, eliminate the need for secondary surgeries. These implants have been in clinical use for nearly 25 years, competing directly with, or maybe even exceeding, the performance of permanent implants. The initial implantation of biodegradable materials, as with permanent materials, mounts an acute host inflammatory response. Over time, the implant degradation profile and possible degradation product toxicity mediate long-term biodegradable implant-induced inflammation. However, unlike permanent implants, this inflammation is likely to cease once the material disappears. Implant-mediated inflammation is a critical determinant for implant success. Thus, for the development of a proactive biodegradable implant that has the ability to promote optimal bone regeneration and minimal detrimental inflammation, a thorough understanding of short- and long-term inflammatory events is required. Here, we discuss an array of biodegradable orthopedic implants, their associated short- and long- term inflammatory effects, and methods to mediate these inflammatory events. PMID:22043969

  13. Dental Implants.

    PubMed

    Zohrabian, Vahe M; Sonick, Michael; Hwang, Debby; Abrahams, James J

    2015-10-01

    Dental implants restore function to near normal in partially or completely edentulous patients. A root-form implant is the most frequently used type of dental implant today. The basis for dental implants is osseointegration, in which osteoblasts grow and directly integrate with the surface of titanium posts surgically embedded into the jaw. Radiologic assessment is critical in the preoperative evaluation of the dental implant patient, as the exact height, width, and contour of the alveolar ridge must be determined. Moreover, the precise locations of the maxillary sinuses and mandibular canals, as well as their relationships to the site of implant surgery must be ascertained. As such, radiologists must be familiar with implant design and surgical placement, as well as augmentation procedures utilized in those patients with insufficient bone in the maxilla and mandible to support dental implants.

  14. Penile Implants

    MedlinePlus

    ... Three-piece inflatable implants use a fluid-filled reservoir implanted under the abdominal wall, a pump and ... an erection, you pump the fluid from the reservoir into the cylinders. Afterward, you release the valve ...

  15. Liquids with permanent porosity

    NASA Astrophysics Data System (ADS)

    Giri, Nicola; Del Pópolo, Mario G.; Melaugh, Gavin; Greenaway, Rebecca L.; Rätzke, Klaus; Koschine, Tönjes; Pison, Laure; Gomes, Margarida F. Costa; Cooper, Andrew I.; James, Stuart L.

    2015-11-01

    Porous solids such as zeolites and metal-organic frameworks are useful in molecular separation and in catalysis, but their solid nature can impose limitations. For example, liquid solvents, rather than porous solids, are the most mature technology for post-combustion capture of carbon dioxide because liquid circulation systems are more easily retrofitted to existing plants. Solid porous adsorbents offer major benefits, such as lower energy penalties in adsorption-desorption cycles, but they are difficult to implement in conventional flow processes. Materials that combine the properties of fluidity and permanent porosity could therefore offer technological advantages, but permanent porosity is not associated with conventional liquids. Here we report free-flowing liquids whose bulk properties are determined by their permanent porosity. To achieve this, we designed cage molecules that provide a well-defined pore space and that are highly soluble in solvents whose molecules are too large to enter the pores. The concentration of unoccupied cages can thus be around 500 times greater than in other molecular solutions that contain cavities, resulting in a marked change in bulk properties, such as an eightfold increase in the solubility of methane gas. Our results provide the basis for development of a new class of functional porous materials for chemical processes, and we present a one-step, multigram scale-up route for highly soluble ‘scrambled’ porous cages prepared from a mixture of commercially available reagents. The unifying design principle for these materials is the avoidance of functional groups that can penetrate into the molecular cage cavities.

  16. Permanence can be Defended.

    PubMed

    McGee, Andrew; Gardiner, Dale

    2017-03-01

    In donation after the circulatory-respiratory determination of death (DCDD), the dead donor rule requires that the donor be dead before organ procurement can proceed. Under the relevant limb of the Uniform Determination of Death Act 1981 (USA), a person is dead when the cessation of circulatory-respiratory function is 'irreversible'. Critics of current practice in DCDD have argued that the donor is not dead at the time organs are procured, and so the procurement of organs from these donors violates the dead donor rule. We offer a new argument here in defence of current DCDD practice, and, in particular, of the interpretation of the requirement of 'irreversibility' as permanence.

  17. Permanent Turbidity-Standards

    PubMed Central

    Roessler, William G.; Brewer, Carl R.

    1967-01-01

    Permanent turbidity reference standards suitable for measurement of microbial suspensions were prepared by suspending finely divided titanium dioxide in aryl sulfonamide-formaldehyde or methylstyrene resins. Turbidities of these standards, adjusted to a useful range for microbiological and immunological studies, were compared with other reference standards in use today. Tube holders for a Coleman Photonephelometer and a Nepho-Colorimeter were modified to eliminate the water well and to allow use of optically standardized 10-, 16-, or 18-mm test tubes. The standards and the tube holders have been used satisfactorily for more than 12 years. Images Fig. 5 Fig. 6 PMID:6077410

  18. Postauricular percutaneous power delivery for permanent mechanical circulatory support.

    PubMed

    Westaby, Stephen; Jarvik, Robert; Freeland, Andrew; Pigott, David; Robson, Desiree; Saito, Satoshi; Catarino, Pedro; Frazier, O H

    2002-05-01

    Percutaneous driveline infection continues to detract from both quality and length of life in patients with a left ventricular assist device. We have pursued an alternative route by using a skull-mounted percutaneous pedestal similar to cochlear implant technology. We have now used this method in patients implanted with the Jarvik 2000 heart (Jarvik Heart, Inc, New York, NY) as destination therapy for end-stage (New York Heart Association class IV) heart failure. Four men with cardiomyopathy aged 61 to 72 years received the Jarvik 2000 heart with postauricular power delivery for permanent mechanical circulatory support. The power cable was brought through the second posterior intercostal space and routed through the neck to a percutaneous titanium implant screwed to the skull. This joins with the cable to the external controller and battery. In 3 patients the pedestal healed well and remained free from infection up to 1 year. The system was user friendly, and the whole external apparatus is exchangeable. The second patient had a subdural hematoma. This caused us to improve the preparation and modify the implant procedure. For widespread use, permanent implantable circulatory support requires a reliable, user-friendly device with freedom from powerline infection. Our early experience with the Jarvik 2000 heart suggests that rigid fixation and the vascularity of scalp skin promote healing and reduce the risk of driveline infection.

  19. Cryogenic Permanent Magnet Undulators

    SciTech Connect

    Chavanne, J.; Lebec, G.; Penel, C.; Revol, F.; Kitegi, C.

    2010-06-23

    For an in-vacuum undulator operated at small gaps the permanent magnet material needs to be highly resistant to possible electron beam exposure. At room temperature, one generally uses Sm{sub 2}Co{sub 17} or high coercivity NdFeB magnets at the expense of a limited field performance. In a cryogenic permanent magnet undulator (CPMU), at a temperature of around 150 K, any NdFeB grade reveals a coercivity large enough to be radiation resistant. In particular, very high remanence NdFeB material can be used to build undulators with enhanced field and X-ray brilliance at high photon energy provided that the pre-baking of the undulator above 100 deg. C can be eliminated. The ESRF has developed a full scale 2 m long CPMU with a period of 18 mm. This prototype has been in operation on the ID6 test beamline since January 2008. A significant effort was put into the characterization of NdFeB material at low temperature, the development of dedicated magnetic measurement systems and cooling methods. The measured heat budget with beam is found to be larger than expected without compromising the smooth operation of the device. Leading on from this first experience, new CPMUs are currently being considered for the upgrade of the ESRF.

  20. Par Pond vegetation status 1996

    SciTech Connect

    Mackey, H.E. Jr.; Riley, R.S.

    1996-12-01

    The water level of Par Pond was lowered approximately 20 feet in mid-1991 in order to protect downstream residents from possible dam failure suggested by subsidence on the downstream slope of the dam and to repair the dam. This lowering exposed both emergent and nonemergent macrophyte beds to drying conditions resulting in extensive losses. A survey of the newly emergent, shoreline aquatic plant communities of Par Pond began in June 1995, three months after the refilling of Par Pond to approximately 200 feet above mean sea level. These surveys continued in July, September, and late October, 1995, and into the early spring and late summer of 1996. Communities similar to the pre-drawdown, Par Pond aquatic plant communities continue to become re-established. Emergent beds of maidencane, lotus, waterlily, watershield, and Pontederia are extensive and well developed. Measures of percent cover, width of beds, and estimates of area of coverage with satellite data indicate regrowth within two years of from 40 to 60% of levels prior to the draw down. Cattail occurrence continued to increase during the summer of 1996, especially in the former warm arm of Par Pond, but large beds common to Par Pond prior to the draw down still have not formed. Lotus has invaded and occupies many of the areas formerly dominated by cattail beds. To track the continued development of macrophytes in Par Pond, future surveys through the summer and early fall of 1997, along with the evaluation of satellite data to map the extent of the macrophyte beds of Par Pond, are planned.

  1. Permanent demand pacing for hypersensitive carotid sinus syndrome

    PubMed Central

    Peretz, Dwight I.; Gerein, Alfred N.; Miyagishima, Robert T.

    1973-01-01

    Ten patients with proved hypersensitivity of one or both carotid sinuses and with symptoms of recurrent lightheaded spells and syncope had implanted a permanent transvenous demand pacemaker. In a follow-up course ranging from 6 to 55 months there has been no recurrence of lightheadedness or syncope in any of the patients. Six of the ten have had their battery packs replaced owing to routine battery exhaustion. PMID:4704892

  2. Implantable Microimagers

    PubMed Central

    Ng, David C.; Tokuda, Takashi; Shiosaka, Sadao; Tano, Yasuo; Ohta, Jun

    2008-01-01

    Implantable devices such as cardiac pacemakers, drug-delivery systems, and defibrillators have had a tremendous impact on the quality of live for many disabled people. To date, many devices have been developed for implantation into various parts of the human body. In this paper, we focus on devices implanted in the head. In particular, we describe the technologies necessary to create implantable microimagers. Design, fabrication, and implementation issues are discussed vis-à-vis two examples of implantable microimagers; the retinal prosthesis and in vivo neuro-microimager. Testing of these devices in animals verify the use of the microimagers in the implanted state. We believe that further advancement of these devices will lead to the development of a new method for medical and scientific applications. PMID:27879873

  3. High Productivity Implantation ''PARTIAL IMPLANT''

    SciTech Connect

    Hino, Masayoshi; Miyamoto, Naoki; Sakai, Shigeki; Matsumoto, Takao

    2008-11-03

    The patterned ion implantation 'PARTIAL IMPLANT' has been developed as a productivity improvement tool. The Partial Implant can form several different ion dose areas on the wafer surface by controlling the speed of wafer moving and the stepwise rotation of twist axis. The Partial Implant system contains two implant methods. One method is 'DIVIDE PARTIAL IMPLANT', that is aimed at reducing the consumption of the wafer. The Divide Partial Implant evenly divides dose area on one wafer surface into two or three different dose part. Any dose can be selected in each area. So the consumption of the wafer for experimental implantation can be reduced. The second method is 'RING PARTIAL IMPLANT' that is aimed at improving yield by correcting electrical characteristic of devices. The Ring Partial Implant can form concentric ion dose areas. The dose of wafer external area can be selected to be within plus or minus 30% of dose of wafer central area. So the electrical characteristic of devices can be corrected by controlling dose at edge side on the wafer.

  4. Endodontic implants

    PubMed Central

    Yadav, Rakesh K.; Tikku, A. P.; Chandra, Anil; Wadhwani, K. K.; Ashutosh kr; Singh, Mayank

    2014-01-01

    Endodontic implants were introduced back in 1960. Endodontic implants enjoyed few successes and many failures. Various reasons for failures include improper case selection, improper use of materials and sealers and poor preparation for implants. Proper case selection had given remarkable long-term success. Two different cases are being presented here, which have been treated successfully with endodontic implants and mineral trioxide aggregate Fillapex (Andreaus, Brazil), an MTA based sealer. We suggest that carefully selected cases can give a higher success rate and this method should be considered as one of the treatment modalities. PMID:25298723

  5. Achieving permanency for LGBTQ youth.

    PubMed

    Jacobs, Jill; Freundlich, Madelyn

    2006-01-01

    This article brings together two significant efforts in the child welfare field: achieving permanence for youth in out-of-home care and meeting the needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. During the past several years, a national movement has taken place to assure all children and youth have a permanent family connection before leaving the child welfare system; however, LGBTQ youth are not routinely included in the permanency discussions. At the same time, efforts in addressing the needs of LGBTQ youth have increased, but permanency is rarely mentioned as a need. This article offers models of permanence and practices to facilitate permanence with LGBTQ youth and their families. It also offers a youth-driven, individualized process, using youth development principles to achieve relational, physical, and legal permanence. Reunification efforts are discussed, including services, supports, and education required for youth to return to their family of origin. For those who cannot return home, other family resources are explored. The article also discusses cultural issues as they affect permanence for LGBTQ youth, and, finally, addresses the need for ongoing support services to sustain and support permanency.

  6. The Timing of Implant Exchange in the Development of Capsular Contracture After Breast Reconstruction

    PubMed Central

    Weintraub, Jennifer L.; Kahn, David M.

    2008-01-01

    Objective: Capsular contracture is a common complication associated with reconstructive breast surgery. The optimal time interval between the completion of tissue expansion and placement of the permanent implant is arbitrary and incompletely studied in the literature. The aim of the study was to determine whether the time interval between completion of expansion and placement of the permanent implant would affect the incidence of capsular contracture. Methods: We conducted a retrospective study of 112 patients with breast cancer, including 140 breasts, who underwent postmastectomy tissue expander placement between 1997 and 2004. All patients underwent replacement of tissue expander with a permanent prosthesis. Data were collected retrospectively, including whether the patient smoked, underwent radiation therapy, had saline or silicone implant reconstruction, required reoperation after tissue expander placement or after permanent implant placement, Baker classification, and the interval between completion of expansion and placement of permanent implant. Results: We used a logistic regression model to incorporate the predictors of capsular contracture. Keeping all other predictors constant, we found that the time interval between implant exchange had no effect on capsular contracture. The only significant predictor of capsular contracture was whether the patient required a reoperation after the permanent implant was placed (P = .0001). Conclusions: Allowing the capsule around a tissue expander to mature does not significantly affect development of capsular contracture. However, a complication that necessitates disrupting the periprosthetic capsule of the permanent implant with an operation significantly increases odds of developing contracture. PMID:18587490

  7. Optimization of permanent breast seed implant dosimetry incorporating tissue heterogeneity

    NASA Astrophysics Data System (ADS)

    Mashouf, Shahram

    Seed brachytherapy is currently used for adjuvant radiotherapy of early stage prostate and breast cancer patients. The current standard for calculation of dose around brachytherapy sources is based on the AAPM TG43 formalism, which generates the dose in homogeneous water medium. Recently, AAPM task group no. 186 (TG186) emphasized the importance of accounting for heterogeneities. In this work we introduce an analytical dose calculation algorithm in heterogeneous media using CT images. The advantages over other methods are computational efficiency and the ease of integration into clinical use. An Inhomogeneity Correction Factor (ICF) is introduced as the ratio of absorbed dose in tissue to that in water medium. ICF is a function of tissue properties and independent of the source structure. The ICF is extracted using CT images and the absorbed dose in tissue can then be calculated by multiplying the dose as calculated by the TG43 formalism times ICF. To evaluate the methodology, we compared our results with Monte Carlo simulations as well as experiments in phantoms with known density and atomic compositions. The dose distributions obtained through applying ICF to TG43 protocol agreed very well with those of Monte Carlo simulations and experiments in all phantoms. In all cases, the mean relative error was reduced by at least a factor of two when ICF correction factor was applied to the TG43 protocol. In conclusion we have developed a new analytical dose calculation method, which enables personalized dose calculations in heterogeneous media using CT images. The methodology offers several advantages including the use of standard TG43 formalism, fast calculation time and extraction of the ICF parameters directly from Hounsfield Units. The methodology was implemented into our clinical treatment planning system where a cohort of 140 patients were processed to study the clinical benefits of a heterogeneity corrected dose.

  8. Achieving Permanency for LGBTQ Youth

    ERIC Educational Resources Information Center

    Jacobs, Jill; Freundlich, Madelyn

    2006-01-01

    This article brings together two significant efforts in the child welfare field: achieving permanence for youth in out-of-home care and meeting the needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. During the past several years, a national movement has taken place to assure all children and youth have a permanent family…

  9. Permanent-Magnet Meissner Bearing

    NASA Technical Reports Server (NTRS)

    Robertson, Glen A.

    1994-01-01

    Permanent-magnet meissner bearing features inherently stable, self-centering conical configuration. Bearing made stiffer or less stiff by selection of magnets, springs, and spring adjustments. Cylindrical permanent magnets with axial magnetization stacked coaxially on rotor with alternating polarity. Typically, rare-earth magnets used. Magnets machined and fitted together to form conical outer surface.

  10. Permanent-Magnet Meissner Bearing

    NASA Technical Reports Server (NTRS)

    Robertson, Glen A.

    1994-01-01

    Permanent-magnet meissner bearing features inherently stable, self-centering conical configuration. Bearing made stiffer or less stiff by selection of magnets, springs, and spring adjustments. Cylindrical permanent magnets with axial magnetization stacked coaxially on rotor with alternating polarity. Typically, rare-earth magnets used. Magnets machined and fitted together to form conical outer surface.

  11. [The Object Permanence Fallacy.] Commentary.

    ERIC Educational Resources Information Center

    Bradley, Ben S.

    1996-01-01

    Suggests that Greenberg's challenge to the centrality of object permanence in developmental thinking reveals that developmentalists' theories about childhood speak about their own self-images. Notes that developmentalists have been guilty of not only the object permanence fallacy but also the genetic fallacy, or the mistaken belief that describing…

  12. The "Permanent" Patient Problem.

    PubMed

    Bruce, Courtenay R; Majumder, Mary A

    2014-01-01

    Patients who enter the health care system for acute care may become "permanent" patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. Legal, professional, and ethical norms prohibit physician and acute care hospital "dumping" of these patients. However, limitless use of hospital resources for indefinite stays is untenable. In the absence of hospital policy addressing this specific issue, the availability of financial support will be determined by health care professionals' willingness to advocate for the patient and negotiate with hospital administrators and the ability and willingness of administrators to authorize the use of hospital resources. We propose five mid-level ethical principles to guide advocacy and administrative decision-making about provision of financial support for post-acute care for those patients who cannot afford it. We use two actual, de-identified cases to illustrate how these principles can be used to make reasoned, consistent decisions about the provision of post-acute financial support. © 2014 American Society of Law, Medicine & Ethics, Inc.

  13. Conduction Abnormalities and Pacemaker Implantations After SAPIEN 3 Vs SAPIEN XT Prosthesis Aortic Valve Implantation.

    PubMed

    Husser, Oliver; Kessler, Thorsten; Burgdorf, Christof; Templin, Christian; Pellegrini, Costanza; Schneider, Simon; Kasel, Albert Markus; Kastrati, Adnan; Schunkert, Heribert; Hengstenberg, Christian

    2016-02-01

    Transcatheter aortic valve implantation is increasingly used in patients with aortic stenosis. Post-procedural intraventricular conduction abnormalities and permanent pacemaker implantations remain a serious concern. Recently, the Edwards SAPIEN 3 prosthesis has replaced the SAPIEN XT. We sought to determine the incidences of new-onset intraventricular conduction abnormalities and permanent pacemaker implantations by comparing the 2 devices. We analyzed the last consecutive 103 patients undergoing transcatheter aortic valve implantation with SAPIEN XT before SAPIEN 3 was used in the next 105 patients. To analyze permanent pacemaker implantations and new-onset intraventricular conduction abnormalities, patients with these conditions at baseline were excluded. Electrocardiograms were recorded at baseline, after the procedure, and before discharge. SAPIEN 3 was associated with higher device success (100% vs 92%; P=.005) and less paravalvular leakage (0% vs 7%; P<.001). The incidence of permanent pacemaker implantations was 12.6% (23 of 183) with no difference between the 2 groups (SAPIEN 3: 12.5% [12 of 96] vs SAPIEN XT: 12.6% [11 of 87]; P=.99). SAPIEN 3 was associated with a higher rate of new-onset intraventricular conduction abnormalities (49% vs 27%; P=.007) due to a higher rate of fascicular blocks (17% vs 5%; P=.021). There was no statistically significant difference in transient (29% [20 of 69] vs persistent 19% [12 of 64]; P=.168) left bundle branch blocks (28% [19 of 69] vs 17% [11 of 64]; P=.154) when SAPIEN 3 was compared with SAPIEN XT. We found a trend toward a higher rate of new-onset intraventricular conduction abnormalities with SAPIEN 3 compared with SAPIEN XT, although this did not result in a higher permanent pacemaker implantation rate. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  14. About Implantable Contraception

    MedlinePlus

    ... TV, Video Games, and the Internet About Implantable Contraception KidsHealth > For Parents > About Implantable Contraception Print A ... How Much Does It Cost? What Is Implantable Contraception? Implantable contraception (often called the birth control implant) ...

  15. Exploration of locomotion in the ParA/ParB system

    NASA Astrophysics Data System (ADS)

    Jindal, Lavisha; Emberly, Eldon

    2015-03-01

    In many bacteria the ParA/ParB system is responsible for actively segregating DNA during replication. ParB precessively moves by hydrolyzing DNA bound ParA-ATP forming a depleted ParA region in its wake. Recent in-vitro experiments have shown that a ParB covered bead can traverse a ParA bound DNA substrate. It has been suggested that the formation of a gradient in ParA leads to diffusion-ratchet like motion of the ParB bead but its origin and potential consequences requires investigation. We have developed a deterministic model for the in-vitro ParA/ParB system and show that any amount of spatial noise in ParA can lead to the spontaneous formation of its gradient. The velocity of the bead is independent of this noise but depends on the scale over which ParA exerts a force on the bead and the scale over which ParB hydrolyzes ParA from the substrate. There is a particular ratio of these scales at which the velocity is a maximum. We also explore the effects of cooperative vs independent rebinding of ParA to the substrate. Our model shows how the driving force for ParB originates and highlights necessary conditions for directed motion in the in-vitro system that may provide insight into the in-vivo behaviour of the ParA/ParB system.

  16. Deglutition Syncope Associated With Ventricular Asystole in a Patient With Permanent Atrial Fibrillation

    PubMed Central

    Lee, Ga Yeon; Chang, Bok Soon; Song, Jae-Uk; Ok, Chang Soo; Sohn, Seo-Young; Jo, Hyun Chul; Noh, Hye-Jin; Choi, Soo Hee; Kim, Jun Hyung

    2010-01-01

    Deglutition syncope is a situational syncope that is diagnosed only by a detailed history. We report deglutition syncope in a 62-year-old man, who had permanent atrial fibrillation. The patient had no structural or functional abnormalities of the esophagus. During syncopal attacks, his electrocardiography showed ventricular asystole that was sustained for 12 seconds. The patient was successfully treated by implantation of a permanent pacemaker. PMID:20182597

  17. Diagnostic imaging for dental implant therapy.

    PubMed

    Nagarajan, Aishwarya; Perumalsamy, Rajapriya; Thyagarajan, Ramakrishnan; Namasivayam, Ambalavanan

    2014-01-01

    Dental implant is a device made of alloplastic (foreign) material implanted into the jaw bone beneath the mucosal layer to support a fixed or removable dental prosthesis. Dental implants are gaining immense popularity and wide acceptance because they not only replace lost teeth but also provide permanent restorations that do not interfere with oral function or speech or compromise the self-esteem of a patient. Appropriate treatment planning for replacement of lost teeth is required and imaging plays a pivotal role to ensure a satisfactory outcome. The development of pre-surgical imaging techniques and surgical templates helps the dentist place the implants with relative ease. This article focuses on various types of imaging modalities that have a pivotal role in implant therapy.

  18. Diagnostic Imaging for Dental Implant Therapy

    PubMed Central

    Nagarajan, Aishwarya; Perumalsamy, Rajapriya; Thyagarajan, Ramakrishnan; Namasivayam, Ambalavanan

    2014-01-01

    Dental implant is a device made of alloplastic (foreign) material implanted into the jaw bone beneath the mucosal layer to support a fixed or removable dental prosthesis. Dental implants are gaining immense popularity and wide acceptance because they not only replace lost teeth but also provide permanent restorations that do not interfere with oral function or speech or compromise the self-esteem of a patient. Appropriate treatment planning for replacement of lost teeth is required and imaging plays a pivotal role to ensure a satisfactory outcome. The development of pre-surgical imaging techniques and surgical templates helps the dentist place the implants with relative ease. This article focuses on various types of imaging modalities that have a pivotal role in implant therapy. PMID:25379354

  19. Malignant ascites in patients with terminal cancer is effectively treated with permanent peritoneal catheter

    PubMed Central

    Mortensen, Frank V.; Madsen, Hans Henrik Torp

    2015-01-01

    Background Malignant ascites is a pathological condition caused by intra- or extra-abdominal disseminated cancer. The object of treatment is palliation. In search of an effective and minimally invasive palliative treatment of malignant ascites placement of a permanent intra peritoneal catheter has been suggested. Purpose To evaluate our experiences with treatment of malignant ascites by implantation of a permanent PleurX catheter. Material and Methods A retrospective study was conducted, comprising 20 consecutive patients with terminal cancer, who had a permanent PleurX catheter implanted because of malignant ascites in the period from February to November 2014. Using the patients’ medical records, we retrieved data on patients and procedures. Results The technical success rate was 100%. Catheter patency was 95.2%, one catheter was removed due to dislocation. Ten patients (50.0%) experienced minor adverse events. No procedural difficulties were reported and there was no need for additional treatment of malignant ascites after catheter implantation. Median residual survival after catheter implantation was 27 days. Conclusion Implantation of a permanent PleurX catheter is a minimally invasive and effective procedure with only minor adverse events and a high rate of catheter patency in patients with malignant ascites caused by terminal cancer disease. PMID:26346641

  20. Periodic permanent magnet focused klystron

    DOEpatents

    Ferguson, Patrick; Read, Michael; Ives, R Lawrence

    2015-04-21

    A periodic permanent magnet (PPM) klystron has beam transport structures and RF cavity structures, each of which has permanent magnets placed substantially equidistant from a beam tunnel formed about the central axis, and which are also outside the extent of a cooling chamber. The RF cavity sections also have permanent magnets which are placed substantially equidistant from the beam tunnel, but which include an RF cavity coupling to the beam tunnel for enhancement of RF carried by an electron beam in the beam tunnel.

  1. Topology optimized permanent magnet systems

    NASA Astrophysics Data System (ADS)

    Bjørk, R.; Bahl, C. R. H.; Insinga, A. R.

    2017-09-01

    Topology optimization of permanent magnet systems consisting of permanent magnets, high permeability iron and air is presented. An implementation of topology optimization for magnetostatics is discussed and three examples are considered. The Halbach cylinder is topology optimized with iron and an increase of 15% in magnetic efficiency is shown. A topology optimized structure to concentrate a homogeneous field is shown to increase the magnitude of the field by 111%. Finally, a permanent magnet with alternating high and low field regions is topology optimized and a Λcool figure of merit of 0.472 is reached, which is an increase of 100% compared to a previous optimized design.

  2. Bacterial biofilms and capsular contracture in patients with breast implants.

    PubMed

    Rieger, U M; Mesina, J; Kalbermatten, D F; Haug, M; Frey, H P; Pico, R; Frei, R; Pierer, G; Lüscher, N J; Trampuz, A

    2013-05-01

    It has been hypothesized that bacterial biofilms on breast implants may cause chronic inflammation leading to capsular contracture. The association between bacterial biofilms of removed implants and capsular contracture was investigated. Breast implants explanted between 2006 and 2010 at five participating centres for plastic and reconstructive surgery were investigated by sonication. Bacterial cultures derived from sonication were correlated with patient, surgical and implant characteristics, and the degree of capsular contracture. The study included 121 breast implants from 84 patients, of which 119 originated from women and two from men undergoing gender reassignment. Some 50 breast prostheses were implanted for reconstruction, 48 for aesthetic reasons and 23 implants were used as temporary expander devices. The median indwelling time was 4·0 (range 0·1-32) years for permanent implants and 3 (range 1-6) months for temporary devices. Excluding nine implants with clinical signs of infection, sonication cultures were positive in 40 (45 per cent) of 89 permanent implants and in 12 (52 per cent) of 23 temporary devices. Analysis of permanent implants showed that a positive bacterial culture after sonication correlated with the degree of capsular contracture: Baker I, two of 11 implants; Baker II, two of ten; Baker III, nine of 23; and Baker IV, 27 of 45 (P < 0·001). The most frequent organisms were Propionibacterium acnes (25 implants) and coagulase-negative staphylococci (21). Sonication cultures correlated with the degree of capsular contracture, indicating the potential causative role of bacterial biofilms in the pathogenesis of capsular contracture. NCT01138891 (http://www.clinicaltrials.gov). © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

  3. Cochlear implant

    MedlinePlus

    ... bilateral cochlear implantation: a review. Curr Opin Otolaryngol Head Neck Surg . 2007;15(5):315-318. PMID: 17823546. ... BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

  4. Histrelin Implant

    MedlinePlus

    ... implant (Supprelin LA) is used to treat central precocious puberty (CPP; a condition causing children to enter puberty too soon, resulting in faster than normal bone growth and development of sexual characteristics) in girls ...

  5. Breast Implants

    MedlinePlus

    ... in the United States: saline-filled and silicone gel-filled. Both types have a silicone outer shell. ... them. Provide information on saline-filled and silicone gel-filled breast implants, including data supporting a reasonable ...

  6. Cochlear implants.

    PubMed

    Connell, Sarah S; Balkany, Thomas J

    2006-08-01

    Cochlear implants are cost-effective auditory prostheses that safely provide a high-quality sensation of hearing to adults who are severely or profoundly deaf. In the past 5 years, progress has been made in hardware and software design, candidate selection, surgical techniques, device programming, education and rehabilitation,and, most importantly, outcomes. Cochlear implantation in the elderly is well tolerated and provides marked improvement in auditory performance and psychosocial functioning.

  7. Tattoos and Permanent Make-Up

    MedlinePlus

    ... Information by Audience For Women Tattoos and Permanent Make-up Share Tweet Linkedin Pin it More sharing options ... your skin. Permanent tattoos last a lifetime . Permanent Make-Up : A needle inserts colored ink into your skin ...

  8. Contraceptive implants.

    PubMed

    McDonald-Mosley, Raegan; Burke, Anne E

    2010-03-01

    Implantable contraception has been extensively used worldwide. Implants are one of the most effective and reversible methods of contraception available. These devices may be particularly appropriate for certain populations of women, including women who cannot use estrogen-containing contraception. Implants are safe for use by women with many chronic medical problems. The newest implant, Implanon (Organon International, Oss, The Netherlands), is the only device currently available in the United States and was approved in 2006. It is registered for 3 years of pregnancy prevention. Contraceptive implants have failure rates similar to tubal ligation, and yet they are readily reversible with a return to fertility within days of removal. Moreover, these contraceptive devices can be safely placed in the immediate postpartum period, ensuring good contraceptive coverage for women who may be at risk for an unintended pregnancy. Irregular bleeding is a common side effect for all progestin-only contraceptive implants. Preinsertion counseling should address possible side effects, and treatment may be offered to women who experience prolonged or frequent bleeding.

  9. Par Pond Fish, Water, and Sediment Chemistry

    SciTech Connect

    Paller, M.H.; Wike, L.D.

    1996-06-01

    The objectives of this report are to describe the Par Pond fish community and the impact of the drawdown and refill on the community, describe contaminant levels in Par Pond fish, sediments, and water and indicate how contaminant concentrations and distributions were affected by the drawdown and refill, and predict possible effects of future water level fluctuations in Par Pond.

  10. Epidural fibrosis after permanent catheter insertion and infusion.

    PubMed

    Aldrete, J A

    1995-11-01

    Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.

  11. Directed and persistent movement arises from mechanochemistry of the ParA/ParB system

    NASA Astrophysics Data System (ADS)

    Hu, Longhua; Vecchiarelli, Anthony G.; Mizuuchi, Kiyoshi; Neuman, Keir C.; Liu, Jian

    The segregation of DNA prior to cell division is essential for faithful genetic inheritance. In many bacteria, segregation of the low-copy-number plasmids involves an active partition system composed of ParA ATPase and its stimulator protein ParB. Recent experiments suggest that ParA/ParB system motility is driven by a diffusion-ratchet mechanism in which ParB-coated plasmid both creates and follows a ParA gradient on the nucleoid surface. However, the detailed mechanism of ParA/ParB-mediated directed and persistent movement remains unknown. We develop a theoretical model describing ParA/ParB-mediated motility. We show that the ParA/ParB system can work as a Brownian ratchet, which effectively couples the ATPase-dependent cycling of ParA-nucleoid affinity to the motion of the ParB bound cargo. Paradoxically, the resulting processive motion relies on quenching diffusive plasmid motion through a large number of transient ParA/ParB-mediated tethers to the nucleoid surface. Our work sheds light on a new emergent phenomenon in which non-motor proteins work collectively via mechanochemical coupling to propel cargos -- an ingenious solution shaped by evolution to cope with the lack of processive motor proteins in bacteria.

  12. Two cases of malignant glaucoma unresolved by pars plana vitrectomy

    PubMed Central

    Hosoda, Yoshikatsu; Akagi, Tadamichi; Yoshimura, Nagahisa

    2014-01-01

    Malignant glaucoma, which is characterized by a shallow or flat anterior chamber with high intraocular pressure, can usually be resolved by pars plana vitrectomy with anterior hyaloidectomy. We describe two cases in which malignant glaucoma was refractory to conventional treatment and complete vitrectomy. Case one an 88-year-old woman with pseudoexfoliation glaucoma underwent trabeculotomy and subsequently developed malignant glaucoma. Four months after transient recovery by pars plana vitrectomy, the malignant glaucoma recurred. She underwent peripheral iridectomy and local zonulectomy with successful control of her intraocular pressure. In case two, an 85-year-old man had a history of pseudoexfoliation glaucoma. Seven months after phacoemulsification and intraocular lens implantation, he developed malignant glaucoma that was refractory to pars plana vitrectomy. He underwent peripheral iridectomy, goniosynechialysis and trabectome surgery resulting in the successful control of his intraocular pressure. In rare cases of malignant glaucoma refractive to vitrectomy, peripheral iridectomy with or without local zonulectomy is a reasonable and minimally invasive surgical procedure. PMID:24729683

  13. Implant experience with an implantable hemodynamic monitor for the management of symptomatic heart failure.

    PubMed

    Steinhaus, David; Reynolds, Dwight W; Gadler, Fredrik; Kay, G Neal; Hess, Mike F; Bennett, Tom

    2005-08-01

    Management of congestive heart failure is a serious public health problem. The use of implantable hemodynamic monitors (IHMs) may assist in this management by providing continuous ambulatory filling pressure status for optimal volume management. The Chronicle system includes an implanted monitor, a pressure sensor lead with passive fixation, an external pressure reference (EPR), and data retrieval and viewing components. The tip of the lead is placed near the right ventricular outflow tract to minimize risk of sensor tissue encapsulation. Implant technique and lead placement is similar to that of a permanent pacemaker. After the system had been successfully implanted in 148 patients, the type and frequency of implant-related adverse events were similar to a single-chamber pacemaker implant. R-wave amplitude was 15.2 +/- 6.7 mV and the pressure waveform signal was acceptable in all but two patients in whom presence of artifacts required lead repositioning. Implant procedure time was not influenced by experience, remaining constant throughout the study. Based on this evaluation, permanent placement of an IHM in symptomatic heart failure patients is technically feasible. Further investigation is warranted to evaluate the use of the continuous hemodynamic data in management of heart failure patients.

  14. Parallel Climate Analysis Toolkit (ParCAT)

    SciTech Connect

    Smith, Brian Edward

    2013-06-30

    The parallel analysis toolkit (ParCAT) provides parallel statistical processing of large climate model simulation datasets. ParCAT provides parallel point-wise average calculations, frequency distributions, sum/differences of two datasets, and difference-of-average and average-of-difference for two datasets for arbitrary subsets of simulation time. ParCAT is a command-line utility that can be easily integrated in scripts or embedded in other application. ParCAT supports CMIP5 post-processed datasets as well as non-CMIP5 post-processed datasets. ParCAT reads and writes standard netCDF files.

  15. Overproduction and localization of Mycobacterium tuberculosis ParA and ParB proteins

    PubMed Central

    Maloney, Erin; Madiraju, Murty; Rajagopalan, Malini

    2011-01-01

    SUMMARY The ParA and ParB family proteins are required for accurate partitioning of replicated chromosomes. The Mycobacterium tuberculosis genome contains parB, parA and two parA homologs, Rv1708 and Rv3213c. It is unknown if parA and its homologs are functionally related. To understand the roles of ParA and ParB proteins in M. tuberculosis cell cycle, we have evaluated the consequences of their overproduction and visualized their localization patterns in M. smegmatis. We show that cells overproducing of ParA, Rv1708 and Rv3213c and ParB are filamentous and multinucleoidal indicating defects in cell cycle progression. Visualization of green-fluorescent protein fusions of ParA and its homologues showed similar localization patterns with foci at poles, quarter-cell, midcell positions and spiral-like structures indicating that they are functionally related. On the other hand, the ParBGFP fusion protein localized only to the cell poles. The cyan and yellow fluorescent fusion proteins of ParA and ParB, respectively, colocalized at the cell poles indicating that these proteins interact and possibly associate with the chromosomal origin of replication. Collectively our results suggest that the M. tuberculosis Par proteins play important roles in cell cycle progression. PMID:20006309

  16. suPAR: The Molecular Crystal Ball

    PubMed Central

    Thunø, Maria; Macho, Betina; Eugen-Olsen, Jesper

    2009-01-01

    soluble urokinase Plasminogen Activator Receptor (suPAR) levels reflect inflammation and elevated suPAR levels are found in several infectious diseases and cancer. suPAR exists in three forms; suPARI-III, suPARII-III and suPARI which show different properties due to structural differences. Studies suggest that full-length suPAR is a regulator of uPAR/uPA by acting as uPA-scavenger, whereas the cleaved suPARII-III act as a chemotactic agent promoting the immune response via the SRSRY sequence in the linker-region. This review focus on the various suPAR fragments and their involvement in inflammation and pathogenic processes. We focus on the molecular mechanisms of the suPAR fragments and the link to the inflammatory process, as this could lead to medical applications in infectious and pathological conditions. PMID:19893210

  17. Subdermal progestin implant contraception.

    PubMed

    Darney, P D

    1991-08-01

    Sustained-release progestin contraceptives are a new approach to meeting a worldwide need for more effective and acceptable birth control. These contraceptive systems provide low, stable levels of synthetic progestins for periods of months to several years. Unlike earlier injectable and oral contraceptives, they do not cause peaks in progestin levels beyond those required for effective contraception, nor do they employ estrogens. For these reasons, sustained-release progestin systems are without some of the health risks attributed to birth control pills, and they are more effective, as well as easy to use, and completely reversible. They share common side effects, the most frequent of which is irregular menstrual bleeding caused by the erratic shedding of hypotrophic endometrium. Despite this and other minor side effects, most users find the sustained-release systems acceptable alternatives to other methods of contraception. Permanent or biodegradable subdermal implants, injections, intrauterine and intracervical devices, and vaginal rings are all employed as delivery systems for contraceptive progestins. The Norplant (Wyeth Ayerst, Radnor, PA) system, consisting of six silastic tubes filled with levonorgestrel and implanted under the skin, was recently approved by the US Food and Drug Administration and is already used by more than a half million women worldwide. The other sustained-release systems are in various stages of development, at least several years away from general use. When these new methods complete clinical trials, women will be able to choose from among implants, injections, or pellets with various durations of action, all providing convenient, highly effective contraception with low risk to health.

  18. Qualitative permanence of Lotka-Volterra equations.

    PubMed

    Hofbauer, Josef; Kon, Ryusuke; Saito, Yasuhisa

    2008-12-01

    In this paper, we consider permanence of Lotka-Volterra equations. We investigate the sign structure of the interaction matrix that guarantees the permanence of a Lotka-Volterra equation whenever it has a positive equilibrium point. An interaction matrix with this property is said to be qualitatively permanent. Our results provide both necessary and sufficient conditions for qualitative permanence.

  19. Infection in permanent circulatory support: experience from the REMATCH trial.

    PubMed

    Holman, William L; Park, Soon J; Long, James W; Weinberg, Alan; Gupta, Lopa; Tierney, Anita R; Adamson, Robert M; Watson, John D; Raines, Edward P; Couper, Gregory S; Pagani, Francis D; Burton, Nelson A; Miller, Leslie W; Naka, Yoshifumi

    2004-12-01

    This analysis of the REMATCH Trial focuses on infection, which was an important source of morbidity and mortality. We use the information to suggest ways to decrease the incidence and effects of device-related infection. Patients were randomized prospectively to receive left ventricular assist devices (LVADs) or optimal medical management (OMM) for end-stage heart failure. Infection variables included sepsis adjudicated as the cause of death; sepsis reported as a serious adverse event; percutaneous site or pocket infection; and pump housing, inflow- or outflow-tract infection. We compared the incidence and prevalence of events between groups and generated time-related descriptions. Survival with LVAD (n=68 patients) was superior to OMM survival (n=61 patients) with a 47% decrease in risk of death (p <0.001), but the aggregate adverse event rate was greater for patients with LVADs (risk ratio, 2.29; 95% confidence interval, 1.85-2.84). Freedom from sepsis in patients with LVADs was 58% at 1 year and 48% at 2 years after implantation with superior survival in non-septic patients (60% vs 39% at 1 year and 38% vs 8% at 2 years in non-septic vs septic patients with LVADs, p <0.06). Percutaneous site or pocket infection did not affect survival (p=0.86). The hazard for onset of sepsis peaked within the first 3 weeks after implantation. Survival is improved with permanent LVAD implantation compared with OMM therapy. However, infection causes substantial morbidity and mortality. Decreasing infections will increase survival and decrease morbidity in permanent LVAD recipients and will improve the risk-benefit ratio for permanent LVAD therapy.

  20. Additive manufacturing of permanent magnets

    SciTech Connect

    Paranthaman, M. P.; Nlebedim, I. C.; Johnson, F.; McCall, S. K.

    2016-10-28

    Here, permanent magnets enable energy conversion. Motors and generators are used to convert both electrical to mechanical energy and mechanical to electrical energy, respectively. They are precharged (magnetized) prior to being used in an application and must remain magnetized during operation. In addition, they should generate sufficient magnetic flux for a given application. Nevertheless permanent magnets can be demagnetized (discharged of their magnetization) by other magnetic materials in their service vicinity, temperature changes (thermal demagnetization), microstructural degradations and the magnet’s internal demagnetizing field. Therefore a permanent magnet can be qualified based on the properties that measure its ability to withstand demagnetization and to supply sufficient magnetic flux required for a given application. Some of those properties are further discussed below. Additive manufacturing followed by exchange spring magnets will be discussed afterwards.

  1. Additive manufacturing of permanent magnets

    DOE PAGES

    Paranthaman, M. P.; Nlebedim, I. C.; Johnson, F.; ...

    2016-10-28

    Here, permanent magnets enable energy conversion. Motors and generators are used to convert both electrical to mechanical energy and mechanical to electrical energy, respectively. They are precharged (magnetized) prior to being used in an application and must remain magnetized during operation. In addition, they should generate sufficient magnetic flux for a given application. Nevertheless permanent magnets can be demagnetized (discharged of their magnetization) by other magnetic materials in their service vicinity, temperature changes (thermal demagnetization), microstructural degradations and the magnet’s internal demagnetizing field. Therefore a permanent magnet can be qualified based on the properties that measure its ability to withstandmore » demagnetization and to supply sufficient magnetic flux required for a given application. Some of those properties are further discussed below. Additive manufacturing followed by exchange spring magnets will be discussed afterwards.« less

  2. Lodestone: Nature's own permanent magnet

    NASA Technical Reports Server (NTRS)

    Wasilewski, P.

    1976-01-01

    Magnetic hysteresis and microstructural details are presented which explain why the class of magnetic iron ores defined as proto-lodestones, can behave as permanent magnets, i.e. lodestones. Certain of these proto-lodestones which are not permanent magnets can be made into permanent magnets by charging in a field greater than 1000 oersted. This fact, other experimental observations, and field evidence from antiquity and the middle ages, which seems to indicate that lodestones are found as localized patches within massive ore bodies, suggests that lightning might be responsible for the charging of lodestones. The large remanent magnetization, high values of coercive force, and good time stability for the remanent magnetization are all characteristics of proto-lodestone iron ores which behave magnetically as fine scale ( 10 micrometer) intergrowths when subjected to magnetic hysteresis analysis. The magnetic results are easily understood by analysis of the complex proto lodestone microstructural patterns observable at the micrometer scale and less.

  3. Directed and persistent movement arises from mechanochemistry of the ParA/ParB system

    PubMed Central

    Hu, Longhua; Vecchiarelli, Anthony G.; Mizuuchi, Kiyoshi; Neuman, Keir C.; Liu, Jian

    2015-01-01

    The segregation of DNA before cell division is essential for faithful genetic inheritance. In many bacteria, segregation of low-copy number plasmids involves an active partition system composed of a nonspecific DNA-binding ATPase, ParA, and its stimulator protein ParB. The ParA/ParB system drives directed and persistent movement of DNA cargo both in vivo and in vitro. Filament-based models akin to actin/microtubule-driven motility were proposed for plasmid segregation mediated by ParA. Recent experiments challenge this view and suggest that ParA/ParB system motility is driven by a diffusion ratchet mechanism in which ParB-coated plasmid both creates and follows a ParA gradient on the nucleoid surface. However, the detailed mechanism of ParA/ParB-mediated directed and persistent movement remains unknown. Here, we develop a theoretical model describing ParA/ParB-mediated motility. We show that the ParA/ParB system can work as a Brownian ratchet, which effectively couples the ATPase-dependent cycling of ParA–nucleoid affinity to the motion of the ParB-bound cargo. Paradoxically, this resulting processive motion relies on quenching diffusive plasmid motion through a large number of transient ParA/ParB-mediated tethers to the nucleoid surface. Our work thus sheds light on an emergent phenomenon in which nonmotor proteins work collectively via mechanochemical coupling to propel cargos—an ingenious solution shaped by evolution to cope with the lack of processive motor proteins in bacteria. PMID:26647183

  4. Permanent circulatory support systems at the Pennsylvania State University.

    PubMed

    Weiss, W J; Rosenberg, G; Snyder, A J; Cleary, T J; Gaumond, R P; Geselowitz, D B; Pierce, W S

    1990-02-01

    Permanent circulatory support systems are required for patients in whom myocardial damage is irreversible and cardiac transplantation is not possible. Two systems are described which provide long term circulatory support: the left ventricular assist system and the total artificial heart. These systems are based on the design of a pusher plate actuated blood pump, driven by a small brushless dc electric motor and rollerscrew driver. An implantable motor controller maintains suitable physiologic flow rates for both systems and controls left-right balance in the total artificial heart. Other parts of the system include an intra-thoracic compliance chamber, transcutaneous energy and data transmission system, and internal and external batteries.

  5. Cochlear Implants

    MedlinePlus

    ... outside of the body, behind the ear. A second part is surgically placed under the skin. An implant does not restore normal hearing. It can help a person understand speech. Children and adults can benefit from them. National Institute on Deafness and Other Communication Disorders

  6. Experimental implantation of epiretinal retina implants (EPI-RET) with an IOL-type receiver unit

    NASA Astrophysics Data System (ADS)

    Gerding, H.; Benner, F. P.; Taneri, S.

    2007-03-01

    The purpose of this paper is to investigate the surgical feasibility of implantation and long-term structural outcome of retina implant devices with an anterior IOL receiver, a connecting microcable and posterior segment epiretinal microcontacts. Implantation of epiretinal retina (EPI-RET) implants was performed as a one-step surgical procedure including phacoemulsification and pars plana vitrectomy in two adult rabbits. Implants were mechanically stabilized in an anterior position by the lens capsule and in the posterior segment by microtacks with a soft contact collar. Follow-up (6 and 9 months) included regular clinical examination, anterior and posterior segment photography and finally pathohistological evaluation. Implantation was uneventful in case 1 and complicated by vitreous space haemorrhage in case 2. At the end of follow-up, the retina was partially detached in animal 1 and subtotally detached in animal 2. Common features of tissue reaction in both cases were the formation of cyclitic membranes extending around and posterior to the anterior IOL receiver. In addition to that severe proliferations developed around microcables, microcontacts and microtacks forming a tissue capsule around posterior segment foreign materials. Retinal areas in contact to implant devices presented a severe structural damage and disorganization. Results of this preliminary trial suggest that the application of epiretinal prostheses with large diameter IOL receivers may be a critical issue and can give rise to an unfavourable outcome. Further systematic investigation ought to be performed involving a larger number of animals, modified implants and perhaps other species.

  7. [Ambroise Paré, landlord].

    PubMed

    Pion-Graff, Joëlle; Bonnichon, Philippe

    2010-01-01

    Paré is well-known through many papers. His incomes allowed him to have a middle-class Parisian living. It is impossible to have an accurate knowledge of his fortune before his death but we have a good idea of his landed property. In fact as a Parishioner of Saint-Andre-des-Arts Church he probably was a landlord only in Paris and its vicinity with a building (rue de l'Hirondelle), two houses (rue Garancière), Meudon, Cormeille-en-Parisis and La-Ville-Du-Bois which the authors describe the present state of.

  8. Microfilm Permanence and Archival Quality

    ERIC Educational Resources Information Center

    Avedon, Don M.

    1972-01-01

    The facts about microfilm permanence and archival quality are presented in simple terms. The major factors, including the film base material, the film emulsion, processing, and storage conditions are reviewed. The designations on the edge of the film are explained and a list of refernces provided. (14 references) (Author)

  9. Magnetic Fields: Visible and Permanent.

    ERIC Educational Resources Information Center

    Winkeljohn, Dorothy R.; Earl, Robert D.

    1983-01-01

    Children will be able to see the concept of a magnetic field translated into a visible reality using the simple method outlined. Standard shelf paper, magnets, iron filings, and paint in a spray can are used to prepare a permanent and well-detailed picture of the magnetic field. (Author/JN)

  10. Aachen keratoprosthesis as temporary implant for combined vitreoretinal surgery and keratoplasty: report on 10 clinical applications.

    PubMed

    Langefeld, S; Kompa, S; Redbrake, C; Brenman, K; Kirchhof, B; Schrage, N F

    2000-09-01

    A new keratoprosthesis was used during pars plana vitrectomy in order to test the optical quality, watertightness, short-term biocompatibility and handling of the new device. The implantability was also tested, given that this keratoprosthesis might in future be left in place for several months. This Aachen keratoprosthesis (Aachen-KPro) is developed to be used as permanent implant to restore vision in corneal blind patients. The Aachen-KPro was used during pars plana vitrectomy in 10 patients with opaque corneas. In four cases, trauma precipitated the ocular disease. Eye burn was the cause of corneal and retinal disorders in another four cases. One patient had a history of congenital glaucoma with myopia, and one of uveitis with corneal dystrophy. After trephination of 6.5 mm in diameter, the Aachen-KPro, composed of soft silicone rubber, was temporarily placed in the trephination hole. After completion of the vitrectomy, the Aachen-KPro was replaced by a 7 mm corneal graft. Intraoperative use of the Aachen-KPro allowed uncomplicated intraoperative handling, smooth adaptation to the corneal rim in the trephination hole, and an undistorted view of the central and peripheral retina. Leakage, even during scleral depression, could be avoided by individual suturing of the scleral rim. After a follow-up period of 1-10 months, the retina was still attached in all cases. The corneal graft was clear after surgery in four eyes, and edema was found in three cases. Amnion or conjunctiva was placed over three patients' transplants. We report the first temporary implantations of a new keratoprosthesis in 10 patients. Its flexibility and good optical qualities allowed control of intraoperative procedures. The outcome and prognosis of the vitreoretinal surgery and keratoplasty were related to the primary diagnosis. The Aachen-KPro has shown advantages, especially in eyes where the anterior eye segment is severely damaged by eye burn or previous surgical interventions. In the

  11. Implantable Myoelectric Sensors (IMESs) for Intramuscular Electromyogram Recording

    PubMed Central

    Weir, Richard F. ff.; Troyk, Phil R.; DeMichele, Glen A.; Kerns, Douglas A.; Schorsch, Jack F.; Maas, Huub

    2011-01-01

    We have developed a multichannel electrogmyography sensor system capable of receiving and processing signals from up to 32 implanted myoelectric sensors (IMES). The appeal of implanted sensors for myoelectric control is that electromyography (EMG) signals can be measured at their source providing relatively cross-talk-free signals that can be treated as independent control sites. An external telemetry controller receives telemetry sent over a transcutaneous magnetic link by the implanted electrodes. The same link provides power and commands to the implanted electrodes. Wireless telemetry of EMG signals from sensors implanted in the residual musculature eliminates the problems associated with percutaneous wires, such as infection, breakage, and marsupialization. Each implantable sensor consists of a custom-designed application-specified integrated circuit that is packaged into a bio-compatible RF BION capsule from the Alfred E. Mann Foundation. Implants are designed for permanent long-term implantation with no servicing requirements. We have a fully operational system. The system has been tested in animals. Implants have been chronically implanted in the legs of three cats and are still completely operational four months after implantation. PMID:19224729

  12. Short Implants: New Horizon in Implant Dentistry

    PubMed Central

    Gulati, Manisha; Garg, Meenu; Pathak, Chetan

    2016-01-01

    The choice of implant length is an essential factor in deciding the survival rates of these implants and the overall success of the prosthesis. Placing an implant in the posterior part of the maxilla and mandible has always been very critical due to poor bone quality and quantity. Long implants can be placed in association with complex surgical procedures such as sinus lift and bone augmentation. These techniques are associated with higher cost, increased treatment time and greater morbidity. Hence, there is need for a less invasive treatment option in areas of poor bone quantity and quality. Data related to survival rates of short implants, their design and prosthetic considerations has been compiled and structured in this manuscript with emphasis on the indications, advantages of short implants and critical biomechanical factors to be taken into consideration when choosing to place them. Studies have shown that comparable success rates can be achieved with short implants as those with long implants by decreasing the lateral forces to the prosthesis, eliminating cantilevers, increasing implant surface area and improving implant to abutment connection. Short implants can be considered as an effective treatment alternative in resorbed ridges. Short implants can be considered as a viable treatment option in atrophic ridge cases in order to avoid complex surgical procedures required to place long implants. With improvement in the implant surface geometry and surface texture, there is an increase in the bone implant contact area which provides a good primary stability during osseo-integration. PMID:27790598

  13. Short Implants: New Horizon in Implant Dentistry.

    PubMed

    Jain, Neha; Gulati, Manisha; Garg, Meenu; Pathak, Chetan

    2016-09-01

    The choice of implant length is an essential factor in deciding the survival rates of these implants and the overall success of the prosthesis. Placing an implant in the posterior part of the maxilla and mandible has always been very critical due to poor bone quality and quantity. Long implants can be placed in association with complex surgical procedures such as sinus lift and bone augmentation. These techniques are associated with higher cost, increased treatment time and greater morbidity. Hence, there is need for a less invasive treatment option in areas of poor bone quantity and quality. Data related to survival rates of short implants, their design and prosthetic considerations has been compiled and structured in this manuscript with emphasis on the indications, advantages of short implants and critical biomechanical factors to be taken into consideration when choosing to place them. Studies have shown that comparable success rates can be achieved with short implants as those with long implants by decreasing the lateral forces to the prosthesis, eliminating cantilevers, increasing implant surface area and improving implant to abutment connection. Short implants can be considered as an effective treatment alternative in resorbed ridges. Short implants can be considered as a viable treatment option in atrophic ridge cases in order to avoid complex surgical procedures required to place long implants. With improvement in the implant surface geometry and surface texture, there is an increase in the bone implant contact area which provides a good primary stability during osseo-integration.

  14. Use of Metallic Endosseous Implants as a Tooth Substitute

    DTIC Science & Technology

    1975-11-25

    REPORT NUMBER 4 USE OF METALLIC ENDOSSEOUS IMPLANTS AS A TOOTH SUBSTITUTE ANNUAL REPORT Marvin B. Weiss, D.D.S., and William Rostoker, PhD. November...70-C-0114 USE OF METALLIC ENDOSSEOUS IMPLANTS AS A TOOTH SUBSTITUTE INTRODUCTION: OBJECTIVE The object of the study is to evaluate the viability of an...artificial metallic prosthesis as a tooth replacement when placed permanently in- to the jaw bone. The tooth substitute consists of two parts; (1) the

  15. An implantable fluidic vibrational energy harvester

    NASA Astrophysics Data System (ADS)

    Inoue, S.; Takahashi, T.; Kumemura, M.; Fujita, H.; Toshiyoshi, H.

    2016-11-01

    Targeting implantable medical devices such as respiratory pace-maker, we have developed a proof-of-concept level energy harvester device that could earn electric power of 44 μW/cm2 by the fluidic motion in a PDMS microchannel placed on a silicon substrate with built-in permanent electrical charges or so-called electrets. The motion of the working fluid will be operated by the heart beat or breathing as a final shape of the energy harvesting system.

  16. A mini axial and a permanent maglev radial heart pump.

    PubMed

    Qian, Kun-Xi; Ru, Wei-Min; Wang, Hao; Jing, Teng

    2007-05-31

    The implantability and durability have been for decades the focus of artificial heart R&D. A mini axial and a maglev radial pump have been developed to meet with such requirements.The mini axial pump weighing 27g (incl.5g rotor) has an outer diameter of 21mm and a length of 10mm in its largest point, but can produce a maximal blood flow of 6l/min with 50mmHg pressure increase. Therefore, it is suitable for the patients of 40-60kg body weight. For other patients of 60-80kg or 80-100kg body weight, the mini axial pumps of 23mm and 25mm outer diameter had been developed before, these devices were acknowledged to be the world smallest LVADs by Guinness World Record Center in 2004.The permanent maglev radial pump weighing 150g is a shaft-less centrifugal pump with permanent magnetic bearings developed by the author. It needs no second coil for suspension of the rotor except the motor coil, different from all other maglev pumps developed in USA, Japan, European, etc. Thus no detecting and controlling systems as well as no additional power supply for maglev are necessary. The pump can produce a blood flow up to as large as 10l/min against 100mmHg pressure.An implantable and durable blood pump will be a viable alternative to natural donor heart for transplantation.

  17. Automated phenotyping of permanent crops

    NASA Astrophysics Data System (ADS)

    McPeek, K. Thomas; Steddom, Karl; Zamudio, Joseph; Pant, Paras; Mullenbach, Tyler

    2017-05-01

    AGERpoint is defining a new technology space for the growers' industry by introducing novel applications for sensor technology and data analysis to growers of permanent crops. Serving data to a state-of-the-art analytics engine from a cutting edge sensor platform, a new paradigm in precision agriculture is being developed that allows growers to understand the unique needs of each tree, bush or vine in their operation. Autonomous aerial and terrestrial vehicles equipped with multiple varieties of remote sensing technologies give AGERpoint the ability to measure key morphological and spectral features of permanent crops. This work demonstrates how such phenotypic measurements combined with machine learning algorithms can be used to determine the variety of crops (e.g., almond and pecan trees). This phenotypic and varietal information represents the first step in enabling growers with the ability to tailor their management practices to individual plants and maximize their economic productivity.

  18. PAR for the Course: A Congruent Pedagogical Approach for a PAR Methods Class

    ERIC Educational Resources Information Center

    Hammond, Joyce D.; Hicks, Maria; Kalman, Rowenn; Miller, Jason

    2005-01-01

    In the past two years, three graduate students and a senior faculty member have co-taught a participatory action research (PAR) course to undergraduate and graduate students. In this article the co-teachers advocate a set of pedagogical principles and practices in a PAR-oriented classroom that establishes congruency with community PAR projects in…

  19. Pacemaker implantation complication rates in elderly and young patients.

    PubMed

    Ozcan, Kazım Serhan; Osmonov, Damirbek; Altay, Servet; Dönmez, Cevdet; Yıldırım, Ersin; Türkkan, Ceyhan; Güngör, Barış; Ekmekçi, Ahmet; Alper, Ahmet Taha; Gürkan, Kadir; Erdinler, Izzet

    2013-01-01

    To evaluate the complication rate differences between elderly and younger patients who receive a permanent pacemaker implantation. We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. The frequency of complications due to the pacemaker implantation procedure was evaluated and compared between young (<70 years old) and elderly (≥70 years old) patients. Among 574 patients with a permanent pacemaker, 259 patients (45.1%) were below and 315 patients (54.9%) were above or at 70 years of age. There were 240 (92.7%) and 19 (7.3%) dual-chamber pacemaker (DDD) and single-chamber pacemaker (VVI) implanted patients in the younger group, and 291 (76.8%) and 73 (23.2%) DDD and VVI pacemaker implanted patients in the elderly group, respectively. The complication rate was 39 (15.1%) out of 259 young patients and 24 (7.6%) out of 315 elderly patients. Postprocedural complications were statistically lower in the elderly patients than in younger patients (P = 0.005). A pacemaker implantation performed by an experienced operator is a safe procedure for patients of advanced age. The patients who are above 70 years old may have less complication rates than the younger patients.

  20. Simplifying fixed implant dental prosthetics.

    PubMed

    Tischler, Michael

    2011-01-01

    Through following the FPPD protocol for multiple adjacent implants, and delivering final abutments, picking up the metal framework, and delivering provisionals, many benefits are gained. The benefits of following the FPPD protocol are as follows: The restorative dentist is trying-in and delivering the final abutments in one visit as opposed to removing them and placing them multiple times. This requires less chair time and time for the patient. It also reduces the mechanical stress on the abutment screw and implant body due to the elimination of multiple try-in appointments. When the metal framework is tried-in and verified for fit, the restorative dentist has the opportunity check the retention, check the margins, and make any corrections that might be needed. The abutments will be staying in the mouth when the framework is picked up. This metal try-in allows for a verification of the bite to be given to the dental lab. The delivery of provisionals manufactured by the dental laboratory offers many advantages in the FPPD technique. The patient has a form of tooth much earlier in the traditional appointment sequence. The patient can now offer feedback to the doctor and laboratory for fabrication of the permanent prosthesis with regards to shape and color. The laboratory-fabricated provisionals offer progressive loading to the implants through having a reduced occlusion yet allowing food to stimulate the implants. Overall, the FPPD technique offers shorter appointment times, more rapid delivery of fixed supported teeth, improved doctor-technician communication, and less mechanical wear on the implant parts.

  1. Altered expectations on dental implant therapy; views of patients referred for treatment of peri-implantitis.

    PubMed

    Abrahamsson, Kajsa H; Wennström, Jan L; Berglundh, Tord; Abrahamsson, Ingemar

    2017-04-01

    The aim was to explore patients' reactions on being diagnosed with peri-implantitis, their opinions on dental implant therapy and expectations on treatment of the disease. The study subjects were patients referred to a specialist clinic for treatment of peri-implantitis. The method of grounded theory was used in collecting and analyzing data. Audiotaped, thematized open-ended interviews were conducted. The interviews were transcribed verbatim and consecutively analyzed in hierarchical coding processes that continued until saturation was met (n = 15). In the analysis, a conceptual model was generated that illuminated a process among patients. From having very high initial expectations on dental implant therapy as a permanent solution of oral/dental problems, patients realized that dental implants, such as teeth, require continuous care and that there is no guarantee for that dental implants provides a treatment alternative free from future problems. The core concept of the model "altered expectations on dental implant therapy" was composed of three main categories: "initial expectations on dental implant therapy and living with dental implants", "being referred to periodontist and become diagnosed with peri-implantitis" and "investing again in an expensive therapy with no guarantee for the future". Patients may have unrealistically high expectations on dental implant therapy. The results illuminate the importance of patient-centered communication in dentistry and that treatment decisions should be based not only on professional expertise but also on expectations, abilities, wishes and life circumstances of the individual patient. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Par Pond vegetation status Summer 1995 -- Summary

    SciTech Connect

    Mackey, H.E. Jr.; Riley, R.S.

    1996-01-01

    The water level of Par Pond was lowered approximately 20 feet in mid-1991 in order to protect downstream residents from possible dam failure suggested by subsidence on the downstream slope of the dam and to repair the dam. This lowering exposed both emergent and nonemergent macrophyte beds to drying conditions resulting in extensive losses. A survey of the newly emergent, shoreline aquatic plant communities of Par Pond began in June 1995, three months after the refilling of Par Pond to approximately 200 feet above mean sea level. These surveys continued in July, September, and late October, 1995. Communities similar to the pre-drawdown, Par Pond aquatic plant communities are becoming re-established. Emergent beds of maidencane, lotus, waterlily, and watershield are extensive and well developed. Cattail occurrence continued to increase during the summer, but large beds common to Par Pond prior to the drawdown have not formed. Estimates from SPOT HRV, remote sensing satellite data indicated that as much as 120 hectares of emergent wetlands vegetation may have been present along the Par Pond shoreline by early October, 1995. To track the continued development of macrophytes in Par Pond, future surveys throughout 1996 and 1997, along with the continued evaluation of satellite data to map the areal extent of the macrophyte beds of Par Pond, are planned.

  3. Teaching Object Permanence: An Action Research Study

    ERIC Educational Resources Information Center

    Bruce, Susan M.; Vargas, Claudia

    2013-01-01

    "Object permanence," also known as "object concept" in the field of visual impairment, is one of the most important early developmental milestones. The achievement of object permanence is associated with the onset of representational thought and language. Object permanence is important to orientation, including the recognition of landmarks.…

  4. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  5. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  6. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  7. Teaching Object Permanence: An Action Research Study

    ERIC Educational Resources Information Center

    Bruce, Susan M.; Vargas, Claudia

    2013-01-01

    "Object permanence," also known as "object concept" in the field of visual impairment, is one of the most important early developmental milestones. The achievement of object permanence is associated with the onset of representational thought and language. Object permanence is important to orientation, including the recognition of landmarks.…

  8. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Permanent offices. 401.3 Section 401.3 Foreign Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District of...

  9. uPAR induces epithelial–mesenchymal transition in hypoxic breast cancer cells

    PubMed Central

    Lester, Robin D.; Jo, Minji; Montel, Valérie; Takimoto, Shinako; Gonias, Steven L.

    2007-01-01

    Hypoxia activates genetic programs that facilitate cell survival; however, in cancer, it may promote invasion and metastasis. In this study, we show that breast cancer cells cultured in 1.0% O2 demonstrate changes consistent with epithelial–mesenchymal transition (EMT). Snail translocates to the nucleus, and E-cadherin is lost from plasma membranes. Vimentin expression, cell migration, Matrigel invasion, and collagen remodeling are increased. Hypoxia-induced EMT is accompanied by increased expression of the urokinase-type plasminogen activator receptor (uPAR) and activation of cell signaling factors downstream of uPAR, including Akt and Rac1. Glycogen synthase kinase-3β is phosphorylated, and Snail expression is increased. Hypoxia-induced EMT is blocked by uPAR gene silencing and mimicked by uPAR overexpression in normoxia. Antagonizing Rac1 or phosphatidylinositol 3-kinase also inhibits development of cellular properties associated with EMT in hypoxia. Breast cancer cells implanted on chick chorioallantoic membranes and treated with CoCl2, to model hypoxia, demonstrate increased dissemination. We conclude that in hypoxia, uPAR activates diverse cell signaling pathways that cooperatively induce EMT and may promote cancer metastasis. PMID:17664334

  10. Dental Implant Surgery

    MedlinePlus

    Dental implant surgery Overview By Mayo Clinic Staff Dental implant surgery is a procedure that replaces tooth roots ... that look and function much like real ones. Dental implant surgery can offer a welcome alternative to dentures ...

  11. Hip Implant Systems

    MedlinePlus

    ... Medical Devices Products and Medical Procedures Implants and Prosthetics Metal-on-Metal Hip Implants Hip Implants Share ... femoral head) is removed and replaced with a prosthetic ball made of metal or ceramic, and the ...

  12. Reuse of permanent cardiac pacemakers.

    PubMed Central

    Rosengarten, M D; Portnoy, D; Chiu, R C; Paterson, A K

    1985-01-01

    Cardiac pacemakers are part of a growing group of expensive implantable electronic devices; hospitals in which 100 pacemakers are implanted per year must budget over $300 000 for these devices. This cost represents a considerable burden to health care resources. Since the "life-span" of modern pacemakers often exceeds that of the patients who receive them, the recovery and reuse of these devices seems logical. Pacemakers can be resterilized and tested with current hospital procedures. Reuse should be acceptable under Canadian law, but the manner in which the pacemakers are recovered and the patients selected should follow careful guidelines. Every patient should provide written informed consent before receiving a recovered pacemaker. Properly executed, reuse of pacemakers should provide a high level of health care while maintaining or reducing the cost of these devices. PMID:4016637

  13. Permanent makeup: indications and complications.

    PubMed

    De Cuyper, Christa

    2008-01-01

    Cosmetic tattoos, simulating makeup, have become very popular in the last decades; the technique of micropigmentation consists of implantation of pigment into the skin using a tattoo pen. The procedure can also be used to camouflage vitiligo, to mask scars, and as an adjunct to reconstructive surgery. Risks and complications include infections, allergic reactions, scarring, fanning, fading, and dissatisfaction about color and shape. Lasers offer the best cosmetic result for removal of unwanted tattoos.

  14. [Cochlear implants].

    PubMed

    Lehnhardt, E; Battmer, R D; Nakahodo, K; Laszig, R

    1986-07-01

    Since the middle of 1984, the HNO-Klinik der Medizinischen Hochschule Hannover has provided deaf adults with a 22-channel cochlear implant (CI) device of Clark-NUCLEUS. The digital working system consists of an implantable stimulator/receiver and an externally worn speech processor. Energy and signals are transmitted transcutaneously via a transmitter coil. During the prevailing 26 operations (April 1986) the electrode array could be inserted at least 17 mm into the cochlea. The threshold and comfort levels of all patients were adjusted very quickly; the dynamic range usually grows during the first postoperative weeks. The individual rehabilitation results vary greatly, but all patients show a significant increase of vowel and consonant comprehension while using the speech processor and an improvement of words understood per minute in speech tracking from lip-reading alone to lip-reading with speech processor. Four months after surgery seven of 17 patients (group I) are able to understand on average 42.7 words per minute by speech tracking without lip-reading. Six patients (group II) recognise 69.2% of vowels and 42.5% of consonants by speech processor alone. Four patients (group III) can correctly repeat only vowels (52.3%) without lip-reading, but using the speech processor together with lip reading they have an improvement in consonant understanding of 37.9% and under freefield conditions they are able to understand up to 17.8% numbers of the Freiburg speech test.

  15. Permanent-File-Validation Utility Computer Program

    NASA Technical Reports Server (NTRS)

    Derry, Stephen D.

    1988-01-01

    Errors in files detected and corrected during operation. Permanent File Validation (PFVAL) utility computer program provides CDC CYBER NOS sites with mechanism to verify integrity of permanent file base. Locates and identifies permanent file errors in Mass Storage Table (MST) and Track Reservation Table (TRT), in permanent file catalog entries (PFC's) in permit sectors, and in disk sector linkage. All detected errors written to listing file and system and job day files. Program operates by reading system tables , catalog track, permit sectors, and disk linkage bytes to vaidate expected and actual file linkages. Used extensively to identify and locate errors in permanent files and enable online correction, reducing computer-system downtime.

  16. Implantable diagnostic and therapeutic devices in children

    PubMed Central

    Le, T-N.; Gouw, S.C.; Hoorntje, T.M.; Sreeram, N.

    2002-01-01

    Many advances have been made in the use of implantable diagnostic and therapeutic devices in adults. In children the indications for and diagnostic and therapeutic value of these devices still have to be determined. Our aim is to provide an overview of the clinical use of diagnostic and therapeutic devices in children. The role of implantable loop recorders (ILR), the feasibility and safety of transvenous pacing in neonates, the value of permanent pacing in children with recurrent syncope or reflex anoxic seizures and the role of implantable cardioverter defibrillator devices are highlighted with relevant case histories. ImagesFigure 1a and bFigure 2aFigure 2b and 2c PMID:25696046

  17. Implant marketing: cost effective implant dentistry.

    PubMed

    Wohrle, P S; Levin, R P

    1996-01-01

    The application of the KAL-Technique to the field of implant dentistry allows both patients and dental practices to benefit. It is an exciting advance that decreases frustration and stress in providing implant procedures and lowers overall costs. Professionals using the KAL-Technique report significant predictability in achieving passive framework fit. They are also lowering overall cost of implant cases, which increases the number of patients who can accept implant treatment. It has been well established that the more individuals in a practice that receive implants, the more referrals a practice will gain. This is because implant patients find tremendous advances in the quality of life, and do not hesitate to tell others who can take advantage of this opportunity. Implant dentistry is one of the fastest growing fields in dentistry today. While some other areas of dentistry begin to decline in volume and need, implant dentistry provides the opportunity to keep practices strong and to insure long-term success.

  18. Permanent cardiac pacing in patients with end-stage renal disease undergoing dialysis.

    PubMed

    Wang, I-Kuan; Lin, Kuo-Hung; Lin, Shih-Yi; Lin, Cheng-Li; Chang, Chiz-Tzung; Yen, Tzung-Hai; Sung, Fung-Chang

    2016-12-01

    Studies investigating the risk of cardiac dysrhythmia warranting permanent pacemaker therapy for end-stage renal disease (ESRD) patients are limited. This study investigated the incidence rate of permanent cardiac pacing in dialysis patients. Using the Taiwan National Health Insurance Database, we identified 28 471 newly diagnosed ESRD patients in 2000-2010 [9700 on peritoneal dialysis (PD) and 18 771 on hemodialysis (HD)] and 113 769 randomly selected controls without kidney disease, frequency-matched by sex, age and diagnosis date. We also established propensity score-matched HD and PD cohorts with 9700 patients each. Incidence rates and hazard ratios (HRs) of implantation were evaluated by the end of 2011. Complications were also evaluated among patients with implantation. The incidence rates of permanent pacemaker implantation were 5.93- and 3.50-fold greater in HD and PD patients than in controls (1.44 and 0.85 versus 0.24 per 1000 person-years, respectively). The adjusted HRs (aHRs) of implantation were 3.26 [95% confidence interval (CI) = 2.41-4.42] and 2.36 (95% CI = 1.56-3.58) for HD and PD patients, respectively, compared with controls. The pacemaker implantation rate was 0.33 per 1000 person-years greater in the propensity score-matched HD cohort than in the PD cohort, with an aHR of 1.30 (95% CI = 0.82-2.05) for the HD cohort compared with the PD cohort. Dialysis patients are at an increased risk of dysrhythmia requiring pacemaker implantation compared with the general population. The risks are not significantly different between HD and PD patients. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  19. Method of making permanent magnets

    DOEpatents

    McCallum, R.W.; Dennis, K.W.; Lograsso, B.K.; Anderson, I.E.

    1993-09-07

    A method for making an isotropic permanent magnet comprises atomizing a melt of a rare earth-transition metal alloy (e.g., an Nd--Fe--B alloy enriched in Nd and B) under conditions to produce protectively coated, rapidly solidified, generally spherical alloy particles. Wherein a majority of the particles are produced/size classified within a given size fraction (e.g., 5 to 40 microns diameter) exhibiting optimum as-atomized magnetic properties and subjecting the particles to concurrent elevated temperature and elevated isotropic pressure for a time effective to yield a densified, magnetically isotropic magnet compact having enhanced magnetic properties and mechanical properties. 13 figures.

  20. Method of making permanent magnets

    DOEpatents

    McCallum, R. William; Dennis, Kevin W.; Lograsso, Barbara K.; Anderson, Iver E.

    1993-09-07

    A method for making an isotropic permanent magnet comprises atomizing a melt of a rare earth-transition metal alloy (e.g., an Nd--Fe--B alloy enriched in Nd and B) under conditions to produce protectively coated, rapidly solidified, generally spherical alloy particles wherein a majority of the particles are produced/size classified within a given size fraction (e.g., 5 to 40 microns diameter) exhibiting optimum as-atomized magnetic properties and subjecting the particles to concurrent elevated temperature and elevated isotropic pressure for a time effective to yield a densified, magnetically isotropic magnet compact having enhanced magnetic properties and mechanical properties.

  1. Apical Ballooning Syndrome: A Complication of Dual Chamber Pacemaker Implantation

    PubMed Central

    Abu Sham'a, Raed A. H; Asher, Elad; Luria, David; Berger, Michael; Glikson, Michael

    2009-01-01

    Apical ballooning is a cardiac syndrome (Takotsubo Cardiomyopathy) described as a typical form of acute transient left ventricular dysfunction. While its onset has often been associated with emotionally or physically stressful situations, it has an overall favorable prognosis. We describe here a case of transient apical ballooning following permanent pacemaker implantation. PMID:19652736

  2. Apical ballooning syndrome: a complication of dual chamber pacemaker implantation.

    PubMed

    Abu Sham'a, Raed A H; Asher, Elad; Luria, David; Berger, Michael; Glikson, Michael

    2009-07-01

    Apical ballooning is a cardiac syndrome (Takotsubo Cardiomyopathy) described as a typical form of acute transient left ventricular dysfunction. While its onset has often been associated with emotionally or physically stressful situations, it has an overall favorable prognosis. We describe here a case of transient apical ballooning following permanent pacemaker implantation.

  3. Integration between a percutaneous implant and the porcine small bowel.

    PubMed

    Johansson, Martin L; Thomsen, Peter; Hultén, Leif; Halvorsen, Per Steinar; Fosse, Erik; Edwin, Bjørn

    2011-07-01

    Inflammatory bowel diseases, cancer or trauma may require removal of all or part of the intestines, leaving the patient with a need to wear external stoma appliances for collection of bowel contents. By connecting the small bowel to a percutaneous port, equipped with a sealing lid, a fully continent and leak proof stoma can be created without a need for permanently wearing stoma appliance. The prerequisites for a connection between a permanent, transabdominal implant and a visceral organ are largely unexplored. Stoma ports made of titanium were implanted in the abdominal wall of domestic pigs and a branch of distal ileum was inserted through the ports. After being followed for 1-3 weeks, the ports were removed and subjected to histological evaluation to study the influence of their shape, structure, and position on the tissue response. Particular focus was attended to the attachment of the ileal serosal surface to the implants inner structure consisting of a titanium mesh. Macroscopic examination revealed fistulas and formation of abscesses in 4 of 11 the retrieved implants. Histological examination revealed regenerated and well-vascularized collagenous tissue around the mesh structure inside the implant. The integration was complete or partial for 10 of 11 ports. Despite various degrees of inflammation and tissue ingrowth, it was demonstrated for the first time that the serosal surface of ileum was firmly attached to the internal structure of the implant. These experiments provide a basis for optimization of the implant and surgical procedure before long-term functional animal experiments.

  4. High-performance permanent magnets

    NASA Astrophysics Data System (ADS)

    Goll, D.; Kronmüller, H.

    High-performance permanent magnets (pms) are based on compounds with outstanding intrinsic magnetic properties as well as on optimized microstructures and alloy compositions. The most powerful pm materials at present are RE-TM intermetallic alloys which derive their exceptional magnetic properties from the favourable combination of rare earth metals (RE=Nd, Pr, Sm) with transition metals (TM=Fe, Co), in particular magnets based on (Nd,Pr)2Fe14B and Sm2(Co,Cu,Fe,Zr)17. Their development during the last 20 years has involved a dramatic improvement in their performance by a factor of >15 compared with conventional ferrite pms therefore contributing positively to the ever-increasing demand for pms in many (including new) application fields, to the extent that RE-TM pms now account for nearly half of the worldwide market. This review article first gives a brief introduction to the basics of ferromagnetism to confer an insight into the variety of (permanent) magnets, their manufacture and application fields. We then examine the rather complex relationship between the microstructure and the magnetic properties for the two highest-performance and most promising pm materials mentioned. By using numerical micromagnetic simulations on the basis of the Finite Element technique the correlation can be quantitatively predicted, thus providing a powerful tool for the further development of optimized high-performance pms.

  5. High-performance permanent magnets.

    PubMed

    Goll, D; Kronmüller, H

    2000-10-01

    High-performance permanent magnets (pms) are based on compounds with outstanding intrinsic magnetic properties as well as on optimized microstructures and alloy compositions. The most powerful pm materials at present are RE-TM intermetallic alloys which derive their exceptional magnetic properties from the favourable combination of rare earth metals (RE = Nd, Pr, Sm) with transition metals (TM = Fe, Co), in particular magnets based on (Nd.Pr)2Fe14B and Sm2(Co,Cu,Fe,Zr)17. Their development during the last 20 years has involved a dramatic improvement in their performance by a factor of > 15 compared with conventional ferrite pms therefore contributing positively to the ever-increasing demand for pms in many (including new) application fields, to the extent that RE-TM pms now account for nearly half of the worldwide market. This review article first gives a brief introduction to the basics of ferromagnetism to confer an insight into the variety of (permanent) magnets, their manufacture and application fields. We then examine the rather complex relationship between the microstructure and the magnetic properties for the two highest-performance and most promising pm materials mentioned. By using numerical micromagnetic simulations on the basis of the Finite Element technique the correlation can be quantitatively predicted, thus providing a powerful tool for the further development of optimized high-performance pms.

  6. Bilayer Implants

    PubMed Central

    Schagemann, Jan C.; Rudert, Nicola; Taylor, Michelle E.; Sim, Sotcheadt; Quenneville, Eric; Garon, Martin; Klinger, Mathias; Buschmann, Michael D.; Mittelstaedt, Hagen

    2016-01-01

    Objective To compare the regenerative capacity of 2 distinct bilayer implants for the restoration of osteochondral defects in a preliminary sheep model. Methods Critical sized osteochondral defects were treated with a novel biomimetic poly-ε-caprolactone (PCL) implant (Treatment No. 2; n = 6) or a combination of Chondro-Gide and Orthoss (Treatment No. 1; n = 6). At 19 months postoperation, repair tissue (n = 5 each) was analyzed for histology and biochemistry. Electromechanical mappings (Arthro-BST) were performed ex vivo. Results Histological scores, electromechanical quantitative parameter values, dsDNA and sGAG contents measured at the repair sites were statistically lower than those obtained from the contralateral surfaces. Electromechanical mappings and higher dsDNA and sGAG/weight levels indicated better regeneration for Treatment No. 1. However, these differences were not significant. For both treatments, Arthro-BST revealed early signs of degeneration of the cartilage surrounding the repair site. The International Cartilage Repair Society II histological scores of the repair tissue were significantly higher for Treatment No. 1 (10.3 ± 0.38 SE) compared to Treatment No. 2 (8.7 ± 0.45 SE). The parameters cell morphology and vascularization scored highest whereas tidemark formation scored the lowest. Conclusion There was cell infiltration and regeneration of bone and cartilage. However, repair was incomplete and fibrocartilaginous. There were no significant differences in the quality of regeneration between the treatments except in some histological scoring categories. The results from Arthro-BST measurements were comparable to traditional invasive/destructive methods of measuring quality of cartilage repair. PMID:27688843

  7. Retrograde weight implantation for correction of lagophthalmos.

    PubMed

    Kao, Chuan-Hsiang; Moe, Kris S

    2004-09-01

    Gold weight implantation is the most commonly used method for surgical correction of paralytic lagophthalmos. Numerous techniques for placement of the weight have been described, yet complications with these methods continue to occur (implant migration or extrusion, wound infection, failure to correct the lagophthalmos, and excessive postoperative ptosis). We developed a retrograde, postlevator aponeurosis method for implantation to improve the placement and fixation of the weight. This study describes the rationale, technique, and surgical outcome of the retrograde approach. Retrospective analysis. Data maintained and collected on 25 consecutive cases of retrograde upper lid weight implantation for paralytic lagophthalmos. Pre- and postoperative photographs were obtained, and patients were followed for at least 6 months. All procedures were performed by or under the direction of a single surgeon at tertiary academic medical centers (University of California, San Diego and University of Zurich, Switzerland). Twenty-five consecutive patients were evaluated, 16 male and 9 female, ranging in age from 27 to 86 years. There were no surgical failures or perioperative complications and no instances of implant migration or extrusion. One patient developed a delayed infection requiring removal of the implant, and one patient required replacement of the gold weight with a platinum chain implant to better fit the contour of her eyelid. Retrograde implantation allows more accurate placement of the weight while creating a permanent circumferential seal for fixation. The procedure is minimally invasive, less traumatic than previous methods, and produces an excellent cosmetic result. The efficacy has been demonstrated in the outcome of the 25 cases described in this study.

  8. Comparative cactus architecture and par interception

    SciTech Connect

    Geller, G.N.; Nobel, P.S. )

    1987-07-01

    Because CO{sup 2} uptake by cacti can be limited by low levels of photosynthetically active radiation (PAR) and because plant form affects PAR interception, various cactus forms were studied using a computer model, field measurements, and laboratory phototropic studies. Model predictions indicated that CO{sub 2} uptake by individual stems at an equinox was greatest when the stem were vertical, but at the summer and the winter solstice CO{sub 2} uptake was greatest for stems titled 30{degree} away from the equator. Stem tilting depended on form and taxonomic group. Not only can the shape of cacti be affected by PAR, but also shape influences PAR interception and hence CO{sub 2} uptake.

  9. [Bilateral cochlear implantation].

    PubMed

    Kronenberg, Jona; Migirov, Lela; Taitelbaum-Swead, Rikey; Hildesheimer, Minka

    2010-06-01

    Cochlear implant surgery became the standard of care in hearing rehabilitation of patients with severe to profound sensorineural hearing loss. This procedure may alter the lives of children and adults enabling them to integrate with the hearing population. In the past, implantation was performed only in one ear, despite the fact that binaural hearing is superior to unilateral, especially in noisy conditions. Cochlear implantation may be performed sequentially or simultaneously. The "sensitive period" of time between hearing loss and implantation and between the two implantations, when performed sequentially, significantly influences the results. Shorter time spans between implantations improve the hearing results after implantation. Hearing success after implantation is highly dependent on the rehabilitation process which includes mapping, implant adjustments and hearing training. Bilateral cochlear implantation in children is recommended as the proposed procedure in spite of the additional financial burden.

  10. Long-Term Retrievability of IVC Filters: Should We Abandon Permanent Devices?

    SciTech Connect

    Berczi, V. Bottomley, J. R.; Thomas, S. M.; Taneja, S.; Gaines, P. A.; Cleveland, T. J.

    2007-09-15

    Thromboembolic disease produces a considerable disease burden, with death from pulmonary embolism in the UK alone estimated at 30,000-40,000 per year. Whilst it is unproven whether filters actually improve longevity, the morbidity and mortality associated with thromboembolic disease in the presence of contraindications to anticoagulation is high. Thus complications associated with filter insertion, and whilst they remain in situ, must be balanced against the alternatives. Permanent filters remain in situ for the remainder of the patient's life and any complications from the filters are of significant concern. Filters that are not permanent are therefore attractive in these circumstances. Retrievable filters, to avoid or decrease long-term filter complications, appear to be a significant advance in the prevention of pulmonary embolism. In this review, we discuss the safety and effectiveness of both permanent and retrievable filters as well as the retrievability of retrievable inferior vena cava (IVC) filters, to explore whether the use of permanent IVC filters can be abandoned in favor of retrievable filters. Currently four types of retrievable filters are available: the Recovery filter (Bard Peripheral Vascular, Tempe, AZ, USA), the Guenther Tulip filter (Cook, Bloomington, IN, USA), the OptEase Filter (Cordis, Roden, The Netherlands), and the ALN filter (ALN Implants Chirurgicaux, Ghisonaccia, France). Efficacy and safety data for retrievable filters are as yet based on small series, with a total number of fewer than 1,000 insertions, and follow-up is mostly short term. Current long-term data are poor and insufficient to warrant the long-term implantation of these devices into humans. The case of fractured wire from a Recovery filter that migrated to the heart causing pericardial tamponade requiring open heart surgery is a reminder that any new endovascular device remaining in situ in the long term may produce unexpected problems. We should also bear in mind that

  11. A Report on the Development of Rare Earth-Cobalt Permanent Magnet Technology - Japan.

    DTIC Science & Technology

    1981-07-01

    of the rare earth permanent magnets (REPM), gave the opening plenary address in which he reviewed the history of the field and presented a summary of...implantation applications, e.g., for fixing dentures to gums. Initial inhibitory effects on the growth of several standard strains 9 of tumor cells were...axis lattice constant which shows a linear temperature dependence over the whole range. This anomaly is considerably reduced on the partial substitution

  12. Permanent pacing is a risk factor for the development of heart failure.

    PubMed

    Freudenberger, Ronald S; Wilson, Alan C; Lawrence-Nelson, Janet; Hare, Joshua M; Kostis, John B

    2005-03-01

    No previous study has examined the importance of right ventricular pacing as a risk factor for the development of heart failure (HF) in subjects without a history of HF. A cohort study of patients who underwent initial pacemaker implantation (n = 11,426) was conducted to test the hypothesis that patients with ventricular dyssynchrony created by permanent pacing would develop HF, as shown by new HF hospitalizations or HF-related deaths, at a higher rate than matched controls.

  13. Is CO2 ice permanent?

    NASA Technical Reports Server (NTRS)

    Lindner, Bernhard Lee

    1992-01-01

    Carbon dioxide ice has been inferred to exist at the south pole in summertime, but Earth based measurements in 1969 of water vapor in the Martian atmosphere suggest that all CO2 ice sublined from the southern polar cap and exposed underlying water ice. This implies that the observed summertime CO2 ice is of recent origin. It appears possible to construct an energy balance model that maintains seasonal CO2 ice at the south pole year round and still reasonably simulates the polar cap regression and atmospheric pressure data. This implies that the CO2 ice observed in the summertime south polar cap could be seasonal in origin, and that minor changes in climate could cause CO2 ice to completely vanish, as would appear to have happened in 1969. However, further research remains before it is certain whether the CO2 ice observed in the summertime south polar cap is seasonal or is part of a permanent reservoir.

  14. New permanent magnets; manganese compounds.

    PubMed

    Coey, J M D

    2014-02-12

    The exponential growth of maximum energy product that prevailed in the 20th century has stalled, leaving a market dominated by two permanent magnet materials, Nd2Fe14B and Ba(Sr)Fe12O19, for which the maximum theoretical energy products differ by an order of magnitude (515 kJ m(-3) and 45 kJ m(-3), respectively). Rather than seeking to improve on optimized Nd-Fe-B, it is suggested that some research efforts should be devoted to developing appropriately priced alternatives with energy products in the range 100-300 kJ m(-3). The prospects for Mn-based hard magnetic materials are discussed, based on known Mn-based compounds with the tetragonal L10 or D022 structure or the hexagonal B81 structure.

  15. Permanent deformation of flexible pavements

    NASA Astrophysics Data System (ADS)

    Brown, S. F.; Broderick, B. V.; Pappin, J. W.

    1980-06-01

    Seven pairs of pavements with granular bases were tested under controlled conditions. One pavement in each pair contained fabric inclusions. An improved testing facility was developed, including: (1) servo-hydraulic system for the loading carriage; (2) amplification and read-out system for pressure cells; (3) linearizing unit for strain coils; (4) transducers for measuring vertical and resilient deflection; (5) techniques for measuring in situ strain on fabric inclusions; (6) extensive use of nuclear density meter to monitor pavement and foundation materials. The following conclusions are drawn: (1) No improvement in performance resulted from fabric inclusions. (2) No consistent reduction in in-situ stresses, resilient strains, or permanent strains was observed as a result of fabric inclusion. (3) No consistent improvement in densities resulted from fabric inclusions. (4) Some slip apparently occurred between fabric and soil on those pavements which involved large deformations. The slip occurred between fabric and crushed limestone base rather than between fabric and silty-clay subgrade.

  16. Steady-state permanent magnet MPD thruster

    SciTech Connect

    Arakawa, Y.; Sasoh, A.

    1987-01-01

    A steady-state MPD arc thruster with permanent magnets has been made. The effect of the permanent magnets on thruster performance and the plasma acceleration mechanism was examined through measurements of thrust, chamber pressure, current densities, and plasma properties in the exhaust plume. Experimental results show that the use of the permanent magnets is desirable in steady-state MPD thrusters of the greater than 10 kW power range. 7 references.

  17. Permanence of Stochastic Lotka-Volterra Systems

    NASA Astrophysics Data System (ADS)

    Liu, Meng; Fan, Meng

    2017-04-01

    This paper proposes a new definition of permanence for stochastic population models, which overcomes some limitations and deficiency of the existing ones. Then, we explore the permanence of two-dimensional stochastic Lotka-Volterra systems in a general setting, which models several different interactions between two species such as cooperation, competition, and predation. Sharp sufficient criteria are established with the help of the Lyapunov direct method and some new techniques. This study reveals that the stochastic noises play an essential role in the permanence and characterize the systems being permanent or not.

  18. Augmented railgun using a permanent magnet

    SciTech Connect

    Katsuki, S.; Akiyama, H.; Eguchi, N.; Sueda, T.; Soejima, M.; Maeda, S.; Sato, K.N.

    1995-08-01

    The use of a permanent magnet instead of an electromagnet has been proposed for the augmentation of the magnetic field of a railgun driven by a current of approximately 20 kA. A permanent magnet has the following advantages in comparison with conventional augmentations using additional turns: (1) simple configuration of the system, (2) temporally and spatially constant magnetic fields, and (3) high efficiency. Here, the operation of a conventional railgun and that of an augmented railgun using a permanent magnet are compared experimentally, and the usefulness of the permanent magnet is described. {copyright} {ital 1995} {ital American} {ital Institute} {ital of} {ital Physics}.

  19. The effect of radiofrequency catheter ablation on permanent pacemakers: an experimental study.

    PubMed

    Chin, M C; Rosenqvist, M; Lee, M A; Griffin, J C; Langberg, J J

    1990-01-01

    Radiofrequency current is being investigated as an alternative to direct current shock for transcatheter ablation of cardiac arrhythmias. Permanent pacemakers are known to be susceptible to high frequency electromagnetic interference. This study was performed to examine the effects of transcatheter radiofrequency ablation on permanent pacemakers in a worst-case scenario. Nineteen pulse generators representing 16 models from seven manufacturers were acutely implanted in 12 dogs to assess their function during and after ablation. Pulse generators were implanted subcutaneously in the neck and connected to a transvenous permanent pacing lead positioned in the right ventricular apex. A 6F quadripolar electrode catheter was positioned approximately 1 cm from the tip of the permanent pacing lead. Radiofrequency current from an electrosurgical unit was applied between the distal electrode of the catheter and a large diameter skin electrode placed below the left scapula. Three additional ablation sessions were performed with the catheter situated 4-5 cm from the permanent pacing lead. Each ablation consisted of 15 W of radiofrequency power, delivered for up to 30 seconds. Twelve pulse generators were falsely inhibited during radiofrequency ablation while programmed to the VVI or DDD mode, nine of which continued to be inhibited while programmed to the VOO or DOO mode. Five pulse generators paced at abnormal rates, including three examples of one pulse generator model that displayed pacemaker runaway. Runaway was observed during eight ablations, resulting in two episodes of ventricular fibrillation. Eleven pulse generators reverted to noise mode behavior during ablation. Only three pulse generators were unaffected during ablation. No reprogramming or pacing system malfunctions were observed after cessation of radiofrequency current application or during ablations greater than 4 cm from the permanent lead.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Comparison of biochemical failure definitions for permanent prostate brachytherapy

    SciTech Connect

    Kuban, Deborah A. . E-mail: dakuban@mdanderson.org; Levy, Larry B.; Potters, Louis; Beyer, David C.; Blasko, John C.; Moran, Brian J.; Ciezki, Jay P.; Zietman, Anthony L.; Zelefsky, Michael J.; Pisansky, Thomas M.; Elshaikh, Mohamed; Horwitz, Eric M.

    2006-08-01

    Purpose: To assess prostate-specific antigen (PSA) failure definitions for patients with Stage T1-T2 prostate cancer treated by permanent prostate brachytherapy. Methods and Materials: A total of 2,693 patients treated with radioisotopic implant as solitary treatment for T1-T2 prostatic adenocarcinoma were studied. All patients had a pretreatment PSA, were treated at least 5 years before analysis, 1988 to 1998, and did not receive hormonal therapy before recurrence. Multiple PSA failure definitions were tested for their ability to predict clinical failure. Results: Definitions which determined failure by a certain increment of PSA rise above the lowest PSA level to date (nadir + x ng/mL) were more sensitive and specific than failure definitions based on PSA doubling time or a certain number of PSA rises. The sensitivity and specificity for the nadir + 2 definition were 72% and 83%, vs. 51% and 81% for 3 PSA rises. The surgical type definitions (PSA exceeding an absolute value) could match this sensitivity and specificity but only when failure was defined as exceeding a PSA level in the 1-3 ng/mL range and only when patients were allowed adequate time to nadir. When failure definitions were compared by time varying covariate regression analysis, nadir + 2 ng/mL retained the best fit. Conclusions: For patients treated by permanent radioisotopic implant for prostate cancer, the definition nadir + 2 ng/mL provides the best surrogate for failure throughout the entire follow-up period, similar to patients treated by external beam radiotherapy. Therefore, the same PSA failure definition could be used for both modalities. For brachytherapy patients with long-term follow-up, at least 6 years, defining failure as exceeding an absolute PSA level in the 0.5 ng/mL range may be reasonable.

  1. Technique of after-loading interstitial implants.

    PubMed

    Syed, A M; Feder, B H

    1977-01-01

    Interstitial implants are either removable or permanent (and occasionally a combination of both). Permanent implants are generally utilized where tumors are not accessible enough to permit easy removal of sources or where accurate source distribution is less critical. They are useful for cancers of the lung, pancreas, prostate, bladder, lymph nodes, etc. Radon and gold-198 have been largely replaced by iodine-125. Our major interests are in the removable after-loading iridium-192 implant techniques. Template (steel guide) and non-template (plastic tube) techniques are utilized. Templates are preferred where the tumor volume can only be approached from one side and where accurate positioning of sources would otherwise be difficult. They are useful for cancers of the cervix, vagina, urethra, and rectum. Non-template (plastic tube) techniques are preferred where the tumor volume can be approached from at least two sides and where templates are either not feasible or not essential for accurate positioning of sources. The single needle non-template approach is useful for cancers of lip, nodes, and breast (plastic button) and for cancers of the oral cavity and oropharynx (gold button). The paired needle non-template approach is useful for cancers of the gum, retromolar trigone, and base of tongue (loop technique) and for cancers of the palate (arch technique). Procedures for each technique are described in detail.

  2. Techniques for measuring intercepted and absorbed PAR in corn canopies

    NASA Technical Reports Server (NTRS)

    Gallo, K. P.; Daughtry, C. S. T.

    1984-01-01

    The quantity of radiation potentially available for photosynthesis that is captured by the crop is best described as absorbed photosynthetically active radiation (PAR). Absorbed PAR (APAR) is the difference between descending and ascending fluxes. The four components of APAR were measured above and within two planting densities of corn (Zea mays L.) and several methods of measuring and estimating APAR were examined. A line quantum sensor that spatially averages the photosynthetic photon flux density provided a rapid and portable method of measuring APAR. PAR reflectance from the soil (Typic Argiaquoll) surface decreased from 10% to less than 1% of the incoming PAR as the canopy cover increased. PAR reflectance from the canopy decreased to less than 3% at maximum vegetative cover. Intercepted PAR (1 - transmitted PAR) generally overestimated absorbed PAR by less than 4% throughout most of the growing season. Thus intercepted PAR appears to be a reasonable estimate of absorbed PAR.

  3. Norplant implants.

    PubMed

    Henley, E

    1993-06-01

    This letter to the editor is in response to 3 articles on the use of the Norplant implant contraceptive in The Indian Health Service (IHS) Provider. Norplant and the FDA-approved Depo-Provera now expand contraceptive options for women. All IHS and 638 sites might be able to offer both options. Several of the authors expressed concern regarding decreased Norplant effectiveness in heavier patients. Norplant is still more effective than any other currently available reversible contraceptive in the US at all weights. Many experts feel the current silastic capsule provides adequate hormone levels even in heavier women. The Crow Service Unit has initiated their Norplant program, although the Wyeth consent form seems unnecessarily extensive. The Albuquerque Service Unit consent form simply describes the procedure and confirms that patients have read and understand the fact sheet. The theoretical risk of thromboembolism is vastly outweighed by the potential benefit of reliable contraception in high risk alcoholic women, except perhaps in women with severe liver disease. While Norplant is expensive, programs need to consider the actual cost of a pregnancy, potential complications, and the financial and social costs of unintended pregnancy. For those in difficult straits, the manufacturer has set up a foundation for obtaining Norplant free of charge. Depo-Provera comes in a 150 mg dose vial that is given every 3 months. The mean time to ovulation is 4.5 months from the last dose. The adverse reaction spectrum is similar to Norplant as they are both progesterone-related agents. Providers and clinics should reduce barriers to family planning by giving out more pill packs at a time; letting adolescents who wish to delay their first pelvic exam have 3 months of pills without an exam; making condoms available in exam rooms rather than through pharmacy prescriptions; and increasing patient accessibility to the morning-after pill.

  4. Protease-activated receptor (PAR) 1 and PAR4 differentially regulate factor V expression from human platelets.

    PubMed

    Duvernay, Matthew; Young, Summer; Gailani, David; Schoenecker, Jonathan; Hamm, Heidi E; Hamm, Heidi

    2013-04-01

    With the recent interest of protease-activated receptors (PAR) 1 and PAR4 as possible targets for the treatment of thrombotic disorders, we compared the efficacy of protease-activated receptor (PAR)1 and PAR4 in the generation of procoagulant phenotypes on platelet membranes. PAR4-activating peptide (AP)-stimulated platelets promoted thrombin generation in plasma up to 5 minutes earlier than PAR1-AP-stimulated platelets. PAR4-AP-mediated factor V (FV) association with the platelet surface was 1.6-fold greater than for PAR1-AP. Moreover, PAR4 stimulation resulted in a 3-fold greater release of microparticles, compared with PAR1 stimulation. More robust FV secretion and microparticle generation with PAR4-AP was attributable to stronger and more sustained phosphorylation of myosin light chain at serine 19 and threonine 18. Inhibition of Rho-kinase reduced PAR4-AP-mediated FV secretion and microparticle generation to PAR1-AP-mediated levels. Thrombin generation assays measuring prothrombinase complex activity demonstrated 1.5-fold higher peak thrombin levels on PAR4-AP-stimulated platelets, compared with PAR1-AP-stimulated platelets. Rho-kinase inhibition reduced PAR4-AP-mediated peak thrombin generation by 25% but had no significant effect on PAR1-AP-mediated thrombin generation. In conclusion, stimulation of PAR4 on platelets leads to faster and more robust thrombin generation, compared with PAR1 stimulation. The greater procoagulant potential is related to more efficient FV release from intracellular stores and microparticle production driven by stronger and more sustained myosin light chain phosphorylation. These data have implications about the role of PAR4 during hemostasis and are clinically relevant in light of recent efforts to develop PAR antagonists to treat thrombotic disorders.

  5. Management of the posterior capsule during pediatric intraocular lens implantation.

    PubMed

    Buckley, E G; Klombers, L A; Seaber, J H; Scalise-Gordy, A; Minzter, R

    1993-06-15

    One of the major obstacles in pediatric intraocular lens implantation has been the subsequent dense opacification of the posterior capsule. We used a modification of the standard pediatric cataract surgical procedure, which involved endocapsular cataract extraction, posterior chamber intraocular lens implantation, pars plana posterior capsulotomy, and pars plana anterior vitrectomy in 20 consecutive patients with unilateral traumatic, radiation-induced, and developmental cataracts. Visual axes were rapidly restored in all patients without further intervention for posterior capsule opacification. Visual acuity returned to 20/40 or better in all patients and 75% of all patients (15 patients) reached maximum improvement by five weeks. No complications attributed to intraoperative removal of the posterior capsule occurred.

  6. First permanent molars with molar incisor hypomineralisation.

    PubMed

    Fitzpatrick, Laura; O'Connell, Anne

    2007-01-01

    Molar incisor hypomineralisation (MIH) is a common enamel defect presenting in the first permanent molars (FPM) and permanent incisors. This article presents the clinical findings and management considerations for the FPM with MIH to the general practitioner. The various treatment options are described with emphasis placed on early diagnosis as the most important prognostic factor.

  7. PREFORMED METAL CROWNS FOR THE PERMANENT DENTITION.

    PubMed

    Millar, Lynsey M; Cairns, Alison M; Fowler, Lauren

    2015-11-01

    Preformed metal crowns have a range of uses in paediatric dentistry in both the primary and permanent dentition. This article provides an overview of their use in permanent teeth, including teeth that have been affected by molar incisor hypomineralisation, caries, developmental defects and tooth surface loss. The indications for use are described, along with the clinical technique for placement

  8. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District of... of the Commission shall have full charge and control of said offices, respectively....

  9. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District of... of the Commission shall have full charge and control of said offices, respectively....

  10. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District of... of the Commission shall have full charge and control of said offices, respectively....

  11. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District of... of the Commission shall have full charge and control of said offices, respectively....

  12. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey.

    PubMed

    Bongiorni, Maria Grazia; Proclemer, Alessandro; Dobreanu, Dan; Marinskis, Germanas; Pison, Laurent; Blomstrom-Lundqvist, Carina

    2013-11-01

    The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to the tools and techniques used for cardiac implantable electronic devices procedures in the European countries. Responses to the questionnaire were received from 62 members of the EHRA research network. The survey involved high-, medium-, and low-volume implanting centres, performing, respectively, more than 200, 100-199 and under 100 implants per year. The following topics were explored: the side approach for implantation, surgical techniques for pocket incision, first venous access for lead implantation, preference of lead fixation, preferred coil number for implantable cardioverter-defibrillator (ICD) leads, right ventricular pacing site, generator placement site, subcutaneous ICD implantation, specific tools and techniques for cardiac resynchronization therapy (CRT), lead implantation sequence in CRT, coronary sinus cannulation technique, target site for left ventricular lead placement, strategy in left ventricular lead implant failure, mean CRT implantation time, optimization of the atrioventricular (AV) and ventriculo-ventricular intervals, CRT implants in patients with permanent atrial fibrillation, AV node ablation in patients with permanent AF. This panoramic view allows us to find out the operator preferences regarding the techniques and tools for device implantation in Europe. The results showed different practices in all the fields we investigated, nevertheless the survey also outlines a good adherence to the common standards and recommendations.

  13. ParCAT: Parallel Climate Analysis Toolkit

    SciTech Connect

    Smith, Brian E.; Steed, Chad A.; Shipman, Galen M.; Ricciuto, Daniel M.; Thornton, Peter E.; Wehner, Michael; Williams, Dean N.

    2013-01-01

    Climate science is employing increasingly complex models and simulations to analyze the past and predict the future of Earth s climate. This growth in complexity is creating a widening gap between the data being produced and the ability to analyze the datasets. Parallel computing tools are necessary to analyze, compare, and interpret the simulation data. The Parallel Climate Analysis Toolkit (ParCAT) provides basic tools to efficiently use parallel computing techniques to make analysis of these datasets manageable. The toolkit provides the ability to compute spatio-temporal means, differences between runs or differences between averages of runs, and histograms of the values in a data set. ParCAT is implemented as a command-line utility written in C. This allows for easy integration in other tools and allows for use in scripts. This also makes it possible to run ParCAT on many platforms from laptops to supercomputers. ParCAT outputs NetCDF files so it is compatible with existing utilities such as Panoply and UV-CDAT. This paper describes ParCAT and presents results from some example runs on the Titan system at ORNL.

  14. PAR2 regulates regeneration, transdifferentiation, and death

    PubMed Central

    Piran, Ron; Lee, Seung-Hee; Kuss, Pia; Hao, Ergeng; Newlin, Robbin; Millán, José Luis; Levine, Fred

    2016-01-01

    Understanding the mechanisms by which cells sense and respond to injury is central to developing therapies to enhance tissue regeneration. Previously, we showed that pancreatic injury consisting of acinar cell damage+β-cell ablation led to islet cell transdifferentiation. Here, we report that the molecular mechanism for this requires activating protease-activated receptor-2 (PAR2), a G-protein-coupled receptor. PAR2 modulation was sufficient to induce islet cell transdifferentiation in the absence of β-cells. Its expression was modulated in an islet cell type-specific manner in murine and human type 1 diabetes (T1D). In addition to transdifferentiation, PAR2 regulated β-cell apoptosis in pancreatitis. PAR2's role in regeneration is broad, as mice lacking PAR2 had marked phenotypes in response to injury in the liver and in digit regeneration following amputation. These studies provide a pharmacologically relevant target to induce tissue regeneration in a number of diseases, including T1D. PMID:27809303

  15. Leadership in a (permanent) crisis.

    PubMed

    Heifetz, Ronald; Grashow, Alexander; Linsky, Marty

    2009-01-01

    The current economic crisis is not just another rough spell. Today's mix of urgency, high stakes, and uncertainty will continue even after the recession ends. The immediate crisis--which we will get through with policy makers' expert technical adjustments--sets the stage for a sustained, or even permanent, crisis, a relentless series of challenges no one has encountered before. Instead of hunkering down and relying on their familiar expertise to deal with the sustained crisis, people in positions of authority--whether they are CEOs or managers heading up a company initiative--must practice what the authors call adaptive leadership. They must, of course, tackle the underlying causes of the crisis, but they must also simultaneously make the changes that will allow their organizations to thrive in turbulent environments. Adaptive leadership is an improvisational and experimental art, requiring some new practices. Like Julie Gilbert, who overcame internal resistance to reorient Best Buy toward female purchasers, adaptive leaders get things done to meet today's challenges and then modify those things to thrive in tomorrow's world. They also embrace disequilibrium, using turbulence as an opportunity to build crucial new capacities, as Paul Levy did to rescue Beth Israel Deaconess Medical Center from a profound financial crisis. Finally, adaptive leaders, such as Egon Zehnder, the founder of an executive search firm, draw out the leadership skills that reside deep in the organization, recognizing the interdependence of all employees and mobilizing everyone to generate solutions.

  16. ATP-regulated interactions between P1 ParA, ParB and non-specific DNA that are stabilized by the plasmid partition site, parS

    PubMed Central

    Havey, James C.; Vecchiarelli, Anthony G.; Funnell, Barbara E.

    2012-01-01

    Localization of the P1 plasmid requires two proteins, ParA and ParB, which act on the plasmid partition site, parS. ParB is a site-specific DNA-binding protein and ParA is a Walker-type ATPase with non-specific DNA-binding activity. In vivo ParA binds the bacterial nucleoid and forms dynamic patterns that are governed by the ParB–parS partition complex on the plasmid. How these interactions drive plasmid movement and localization is not well understood. Here we have identified a large protein–DNA complex in vitro that requires ParA, ParB and ATP, and have characterized its assembly by sucrose gradient sedimentation and light scattering assays. ATP binding and hydrolysis mediated the assembly and disassembly of this complex, while ADP antagonized complex formation. The complex was not dependent on, but was stabilized by, parS. The properties indicate that ParA and ParB are binding and bridging multiple DNA molecules to create a large meshwork of protein–DNA molecules that involves both specific and non-specific DNA. We propose that this complex represents a dynamic adaptor complex between the plasmid and nucleoid, and further, that this interaction drives the redistribution of partition proteins and the plasmid over the nucleoid during partition. PMID:21965538

  17. Gating of Permanent Molds for ALuminum Casting

    SciTech Connect

    David Schwam; John F. Wallace; Tom Engle; Qingming Chang

    2004-03-30

    This report summarizes a two-year project, DE-FC07-01ID13983 that concerns the gating of aluminum castings in permanent molds. The main goal of the project is to improve the quality of aluminum castings produced in permanent molds. The approach taken was determine how the vertical type gating systems used for permanent mold castings can be designed to fill the mold cavity with a minimum of damage to the quality of the resulting casting. It is evident that somewhat different systems are preferred for different shapes and sizes of aluminum castings. The main problems caused by improper gating are entrained aluminum oxide films and entrapped gas. The project highlights the characteristic features of gating systems used in permanent mold aluminum foundries and recommends gating procedures designed to avoid common defects. The study also provides direct evidence on the filling pattern and heat flow behavior in permanent mold castings.

  18. Permanent magnet multipole with adjustable strength

    DOEpatents

    Halbach, Klaus

    1985-01-01

    Two or more magnetically soft pole pieces are symmetrically positioned along a longitudinal axis to provide a magnetic field within a space defined by the pole pieces. Two or more permanent magnets are mounted to an external magnetically-soft cylindrical sleeve which rotates to bring the permanent magnets into closer coupling with the pole pieces and thereby adjustably control the field strength of the magnetic field produced in the space defined by the pole pieces. The permanent magnets are preferably formed of rare earth cobalt (REC) material which has a high remanent magnetic field and a strong coercive force. The pole pieces and the permanent magnets have corresponding cylindrical surfaces which are positionable with respect to each other to vary the coupling therebetween. Auxiliary permanent magnets are provided between the pole pieces to provide additional magnetic flux to the magnetic field without saturating the pole pieces.

  19. Permanent-magnet multipole with adjustable strength

    DOEpatents

    Halbach, K.

    1982-09-20

    Two or more magnetically soft pole pieces are symmetrically positioned along a longitudinal axis to provide a magnetic field within a space defined by the pole pieces. Two or more permanent magnets are mounted to an external magnetically-soft cylindrical sleeve which rotates to bring the permanent magnets into closer coupling with the pole pieces and thereby adjustably control the field strength of the magnetic field produced in the space defined by the pole pieces. The permanent magnets are preferably formed of rare earth cobalt (REC) material which has a high remanent magnetic field and a strong coercive force. The pole pieces and the permanent magnets have corresponding cylindrical surfaces which are positionable with respect to each other to vary the coupling there between. Auxiliary permanent magnets are provided between the pole pieces to provide additional magnetic flux to the magnetic field without saturating the pole pieces.

  20. Finite element modeling of permanent magnet devices

    NASA Astrophysics Data System (ADS)

    Brauer, J. R.; Larkin, L. A.; Overbye, V. D.

    1984-03-01

    New techniques are presented for finite element modeling of permanent magnets in magnetic devices such as motors and generators. These techniques extend a previous sheet-current permanent magnet model that applies only for straight line B-H loops and rectangular-shaped magnets. Here Maxwell's equations are used to derive the model of a permanent magnet having a general curved B-H loop and any geometric shape. The model enables a nonlinear magnetic finite element program to use Newton-Raphson iteration to solve for saturable magnetic fields in a wide variety of devices containing permanent magnets and steels. The techniques are applied to a brushless dc motor with irregular-shaped permanent magnets. The calculated motor torque agrees well with measured torque.

  1. [Biomaterials in cochlear implants].

    PubMed

    Stöver, T; Lenarz, T

    2009-05-01

    Cochlear implants (CI) represent the "gold standard" for the treatment of congenitally deaf children and postlingually deafened adults. Thus, cochlear implantation is a success story of new bionic prosthesis development. Owing to routine application of cochlear implants in adults but also in very young children (below the age of one), high demands are placed on the implants. This is especially true for biocompatibility aspects of surface materials of implant parts which are in contact with the human body. In addition, there are various mechanical requirements which certain components of the implants must fulfil, such as flexibility of the electrode array and mechanical resistance of the implant housing. Due to the close contact of the implant to the middle ear mucosa and because the electrode array is positioned in the perilymphatic space via cochleostomy, there is a potential risk of bacterial transferral along the electrode array into the cochlea. Various requirements that have to be fulfilled by cochlear implants, such as biocompatibility, electrode micromechanics, and although a very high level of technical standards has been carried out there is still demand for the improvement of implants as well as of the materials used for manufacturing, ultimately leading to increased implant performance. General considerations of material aspects related to cochlear implants as well as potential future perspectives of implant development will be discussed.

  2. Antithrombotic effects of PAR1 and PAR4 antagonists evaluated under flow and static conditions.

    PubMed

    Hosokawa, Kazuya; Ohnishi, Tomoko; Miura, Naoki; Sameshima, Hisayo; Koide, Takehiko; Tanaka, Kenichi A; Maruyama, Ikuro

    2014-01-01

    Thrombin-mediated activation of human platelets involves the G-protein-coupled protease-activated receptors PAR1 and PAR4. Inhibition of PAR1 and/or PAR4 is thought to modulate platelet activation and subsequent procoagulant reactions. However, the antithrombotic effects of PAR1 and PAR4 antagonism have not been fully elucidated, particularly under flow conditions. A microchip-based flow chamber system was used to evaluate the influence of SCH79797 (PAR1 antagonist) and YD-3 (PAR4 antagonist) on thrombus formation mediated by collagen and tissue thromboplastin at shear rates simulating those experienced in small- to medium-sized arteries (600s(-1)) and large arteries and small veins (240s(-1)). At a shear rate of 600s(-1), SCH79797 (10μM) efficiently reduced fibrin-rich platelet thrombi and significantly delayed occlusion of the flow chamber capillary (1.44 fold of control; P<0.001). The inhibitory activity of SCH79797 was diminished at 240s(-1). YD-3 (20μM) had no significant effect at either shear rate. The antithrombotic effects of SCH79797 were significantly augmented when combined with aspirin and AR-C66096 (P2Y12 antagonist), but not with YD-3. In contrast, no significant inhibition of tissue factor-induced clot formation under static conditions was observed in blood treated with SCH79797 and YD-3, although thrombin generation in platelet-rich plasma was weakly delayed by these antagonists. Our results suggest that the antithrombotic activities of PAR1 and/or PAR4 antagonism is influenced by shear conditions as well as by combined platelet inhibition with aspirin and a P2Y12-antagonist. © 2013.

  3. Permanent pacemaker insertion following isolated aortic valve replacement before and after the introduction of TAVI.

    PubMed

    Kogan, Alexander; Sternik, Leonid; Beinart, Roy; Shalabi, Amjad; Glikson, Michael; Spiegelstein, Danny; Levin, Shany; Raanani, Ehud

    2015-04-01

    Permanent pacemaker (PPM) implantation is required in 3-12% of all patients undergoing surgical aortic valve replacement (AVR). Our aim was to evaluate the contemporary incidence and impact of the introduction of transcatheter aortic valve implantation (TAVI) for PPM insertion after isolated AVR. Since 2004, during a 10-year period, a total of 858 patients underwent isolated AVR at our institution. Forty-one patients with PPM before operation were excluded from the study and 817 patients were included in the statistical analysis. Of these, 20 patients (2.45%) developed significant conduction disorders, leading to PPM implantation within 120 days postoperatively. Patients were further divided into two groups. Before (Group I: June 2004 to September 2008) and after (Group II: October 2008 to May 2014) the introduction of the TAVI program. There were 343 patients in Group I and 475 patients in Group II. The incidence of PPM implantation decreased from 3.79% (13 patients) in Group I to 1.47% (seven patients) in Group II (P < 0.001). Risk factors for permanent pacing identified by univariate analysis were: Group I (before introducing TAVI program), pulmonary hypertension, preoperative anemia, age older than 75 years, and previous myocardial infarction. Multivariate analysis identified Group I (before introducing TAVI program; P < 0.005; odds ratio [OR] 15.2, 95% confidence interval [CI] 6.3-19.9) and pulmonary hypertension (P < 0.005; OR 12.5, 95% CI 3.2-18.3) to be significant. Irreversible atrio-ventricular block or symptomatic bradycardia requiring PPM implantation is a relatively rare complication. The incidence of PPM implantation after isolated surgical AVR decreased in a contemporary setting after the introduction of the TAVI program. ©2015 Wiley Periodicals, Inc.

  4. First clinical implant of the VentrAssist left ventricular assist system as destination therapy for end-stage heart failure.

    PubMed

    Esmore, Donald S; Kaye, David; Salamonsen, Robert; Buckland, Mark; Rowland, Michael; Negri, Justin; Rowley, Yvonne; Woodard, John; Begg, John R; Ayre, Peter; Rosenfeldt, Franklin L

    2005-08-01

    The VentrAssist device left ventricular assist system, designed for permanent implantation, is a novel centrifugal pump with a hydrodynamically suspended rotor. The first human implant was into a 72-year-old man with New York Heart Association (NYHA) class IV heart failure due to idiopathic dilated cardiomyopathy. The implant and recovery were uneventful, and the patient survives at 17 months, is NYHA class II, and lives at home. This device shows promise in end-stage heart failure for permanent implantation and bridge to transplantation.

  5. Peri-Implant Diseases

    MedlinePlus

    ... Alcohol Consumption and Gum Health Workshop on Regeneration Periodontal Disease More Prevalent among Ethnic Minorities Dental Implants Periodontal ... factors for developing peri-implant disease include previous periodontal disease diagnosis, poor plaque control, smoking , and diabetes . It ...

  6. Implants for lucky few

    NASA Astrophysics Data System (ADS)

    Brandon, David

    2011-08-01

    In his article "Vision of beauty" (May pp22-27), Richard Taylor points the way to fractal design for retinal implants and makes an enthusiastic case for incorporating such features into the next generation of such implants.

  7. Humanizing the Protease-Activated Receptor (PAR) Expression Profile in Mouse Platelets by Knocking PAR1 into the Par3 Locus Reveals PAR1 Expression Is Not Tolerated in Mouse Platelets

    PubMed Central

    French, Shauna L.; Paramitha, Antonia C.; Moon, Mitchell J.; Dickins, Ross A.; Hamilton, Justin R.

    2016-01-01

    Anti-platelet drugs are the mainstay of pharmacotherapy for heart attack and stroke prevention, yet improvements are continually sought. Thrombin is the most potent activator of platelets and targeting platelet thrombin receptors (protease-activated receptors; PARs) is an emerging anti-thrombotic approach. Humans express two PARs on their platelets–PAR1 and PAR4. The first PAR1 antagonist was recently approved for clinical use and PAR4 antagonists are in early clinical development. However, pre-clinical studies examining platelet PAR function are challenging because the platelets of non-primates do not accurately reflect the PAR expression profile of human platelets. Mice, for example, express Par3 and Par4. To address this limitation, we aimed to develop a genetically modified mouse that would express the same repertoire of platelet PARs as humans. Here, human PAR1 preceded by a lox-stop-lox was knocked into the mouse Par3 locus, and then expressed in a platelet-specific manner (hPAR1-KI mice). Despite correct targeting and the predicted loss of Par3 expression and function in platelets from hPAR1-KI mice, no PAR1 expression or function was detected. Specifically, PAR1 was not detected on the platelet surface nor internally by flow cytometry nor in whole cell lysates by Western blot, while a PAR1-activating peptide failed to induce platelet activation assessed by either aggregation or surface P-selectin expression. Platelets from hPAR1-KI mice did display significantly diminished responsiveness to thrombin stimulation in both assays, consistent with a Par3-/- phenotype. In contrast to the observations in hPAR1-KI mouse platelets, the PAR1 construct used here was successfully expressed in HEK293T cells. Together, these data suggest ectopic PAR1 expression is not tolerated in mouse platelets and indicate a different approach is required to develop a small animal model for the purpose of any future preclinical testing of PAR antagonists as anti-platelet drugs. PMID

  8. Cochlear Implants for Children.

    ERIC Educational Resources Information Center

    Hasenstab, M. Suzanne; Laughton, Joan

    1991-01-01

    The use of cochlear implants in children with profound bilateral hearing loss is discussed, focusing on how a cochlear implant works; steps in a cochlear implant program (evaluation, surgery, programing, and training); and rehabilitation procedures involved in auditory development and speech development. (JDD)

  9. Implantable Heart Aid

    NASA Technical Reports Server (NTRS)

    1984-01-01

    CPI's human-implantable automatic implantable defibrillator (AID) is a heart assist system, derived from NASA's space circuitry technology, that can prevent erratic heart action known as arrhythmias. Implanted AID, consisting of microcomputer power source and two electrodes for sensing heart activity, recognizes onset of ventricular fibrillation (VF) and delivers corrective electrical countershock to restore rhythmic heartbeat.

  10. Permanency and the Foster Care System.

    PubMed

    Lockwood, Katie K; Friedman, Susan; Christian, Cindy W

    2015-10-01

    Each year over 20,000 youth age out of the child welfare system without reaching a permanent placement in a family. Certain children, such as those spending extended time in foster care, with a diagnosed disability, or adolescents, are at the highest risk for aging out. As young adults, this population is at and increased risk of incarceration; food, housing, and income insecurity; unemployment; educational deficits; receipt of public assistance; and mental health disorders. We reviewed the literature on foster care legislation, permanency, outcomes, and interventions. The outcomes of children who age out of the child welfare system are poor. Interventions to increase permanency include training programs for youth and foster parents, age extension for foster care and insurance coverage, an adoption tax credit, and specialized services and programs that support youth preparing for their transition to adulthood. Future ideas include expanding mentoring, educational support, mental health services, and post-permanency services to foster stability in foster care placements and encourage permanency planning. Children in the child welfare system are at a high risk for physical, mental, and emotional health problems that can lead to placement instability and create barriers to achieving permanency. Failure to reach the permanency of a family leads to poor outcomes, which have negative effects on the individual and society. Supporting youth in foster care throughout transitions may mediate the negative outcomes that have historically followed placement in out-of-home care. Copyright © 2015 Mosby, Inc. All rights reserved.

  11. [Implant placement on restricted mesiodistal space with simulation software and guiding system: a case report].

    PubMed

    Shiota, Makoto; Kihara, Hidemichi; Fujii, Masaki; Kasugai, Shohei

    2009-10-01

    A surgical guiding system with simulation software has recently been used for safe implant treatment. We report a clinical case in which we successfully used this system for implant treatment of a congenital tooth missing region with severely restricted mesiodistal space. The patient was a 19-year-old female whose mandibular right deciduous canine was wobbling without a successional permanent tooth and who desired implant treatment. CT images showed that this site was narrow buccal-lingually and only five millimeters in mesiodistal width. The implant position was planned using simulation software (SimPlant : Materialise Dental) based on CT data and a surgical guide template (SurgiGuide : Materialise Dental) was fabricated prior to the implant surgery. During the implant surgery, the deciduous canine was extracted under local anesthesia. The implant bed was prepared with the surgical guide template and an implant was installed. One month after surgery, the position of the implant was examined with a cone-beam CT, which demonstrated that the implant position was exactly the same as planned. At 5 months, a provisional prosthesis was delivered and optimal soft-tissue condition was formed by modifying the provisional prosthesis. Then, the final impression was taken and a ceramo-metal implant-supported crown was delivered. In this case of a congenital tooth missing region with narrow space, implant treatment with simulation software and the surgical guide system provided excellent clinical results.

  12. A comparative study of zirconium and titanium implants in rat: osseointegration and bone material quality.

    PubMed

    Hoerth, Rebecca M; Katunar, María R; Gomez Sanchez, Andrea; Orellano, Juan C; Ceré, Silvia M; Wagermaier, Wolfgang; Ballarre, Josefina

    2014-02-01

    Permanent metal implants are widely used in human medical treatments and orthopedics, for example as hip joint replacements. They are commonly made of titanium alloys and beyond the optimization of this established material, it is also essential to explore alternative implant materials in view of improved osseointegration. The aim of our study was to characterize the implant performance of zirconium in comparison to titanium implants. Zirconium implants have been characterized in a previous study concerning material properties and surface characteristics in vitro, such as oxide layer thickness and surface roughness. In the present study, we compare bone material quality around zirconium and titanium implants in terms of osseointegration and therefore characterized bone material properties in a rat model using a multi-method approach. We used light and electron microscopy, micro Raman spectroscopy, micro X-ray fluorescence and X-ray scattering techniques to investigate the osseointegration in terms of compositional and structural properties of the newly formed bone. Regarding the mineralization level, the mineral composition, and the alignment and order of the mineral particles, our results show that the maturity of the newly formed bone after 8 weeks of implantation is already very high. In conclusion, the bone material quality obtained for zirconium implants is at least as good as for titanium. It seems that the zirconium implants can be a good candidate for using as permanent metal prosthesis for orthopedic treatments.

  13. Permanent Magnetic Bearing for Spacecraft Applications

    NASA Technical Reports Server (NTRS)

    Morales, Winfredo; Fusaro, Robert; Kascak, Albert

    2008-01-01

    A permanent, totally passive magnetic bearing rig was designed, constructed, and tested. The suspension of the rotor was provided by two sets of radial permanent magnetic bearings operating in the repulsive mode. The axial support was provided by jewel bearings on both ends of the rotor. The rig was successfully operated to speeds of 5500 rpm using an air impeller. Radial and axial stiffnesses of the permanent magnetic bearings were experimentally measured and then compared to finite element results. The natural damping of the rotor was measured and a damping coefficient was calculated.

  14. Macroscopic simulation of isotropic permanent magnets

    NASA Astrophysics Data System (ADS)

    Bruckner, Florian; Abert, Claas; Vogler, Christoph; Heinrichs, Frank; Satz, Armin; Ausserlechner, Udo; Binder, Gernot; Koeck, Helmut; Suess, Dieter

    2016-03-01

    Accurate simulations of isotropic permanent magnets require to take the magnetization process into account and consider the anisotropic, nonlinear, and hysteretic material behaviour near the saturation configuration. An efficient method for the solution of the magnetostatic Maxwell equations including the description of isotropic permanent magnets is presented. The algorithm can easily be implemented on top of existing finite element methods and does not require a full characterization of the hysteresis of the magnetic material. Strayfield measurements of an isotropic permanent magnet and simulation results are in good agreement and highlight the importance of a proper description of the isotropic material.

  15. Permanent multipole magnets with adjustable strength

    SciTech Connect

    Halbach, K.

    1983-03-01

    Preceded by a short discussion of the motives for using permanent magnets in accelerators, a new type of permanent magnet for use in accelerators is presented. The basic design and most important properties of a quadrupole will be described that uses both steel and permanent magnet material. The field gradient produced by this magnet can be adjusted without changing any other aspect of the field produced by this quadrupole. The generalization of this concept to produce other multipole fields, or combination of multipole fields, will also be presented.

  16. Prospects for nanoparticle-based permanent magnets

    SciTech Connect

    Balamurugan, B; Sellmyer, DJ; Hadjipanayis, GC; Skomski, R

    2012-09-01

    Magnetic nanoparticles smaller than similar to 15 nm in diameter and with high magnetocrystalline anisotropies K-1 >= 1 MJ m(-3) can be used as building blocks for next-generation permanent magnets. Advances in processing steps are discussed, such as self-assembly, alignment of the easy axes and appropriate nanostructuring that will enable the fabrication of densely packed nanopartide assemblies with improved permanent-magnet properties. This study also proposes an idealized nanocomposite structure for nanoparticle-based future permanent magnets with enhanced energy products. (C) 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  17. ParA and ParB coordinate chromosome segregation with cell elongation and division during Streptomyces sporulation.

    PubMed

    Donczew, Magdalena; Mackiewicz, Paweł; Wróbel, Agnieszka; Flärdh, Klas; Zakrzewska-Czerwińska, Jolanta; Jakimowicz, Dagmara

    2016-04-01

    In unicellular bacteria, the ParA and ParB proteins segregate chromosomes and coordinate this process with cell division and chromosome replication. During sporulation of mycelial Streptomyces, ParA and ParB uniformly distribute multiple chromosomes along the filamentous sporogenic hyphal compartment, which then differentiates into a chain of unigenomic spores. However, chromosome segregation must be coordinated with cell elongation and multiple divisions. Here, we addressed the question of whether ParA and ParB are involved in the synchronization of cell-cycle processes during sporulation in Streptomyces To answer this question, we used time-lapse microscopy, which allows the monitoring of growth and division of single sporogenic hyphae. We showed that sporogenic hyphae stop extending at the time of ParA accumulation and Z-ring formation. We demonstrated that both ParA and ParB affect the rate of hyphal extension. Additionally, we showed that ParA promotes the formation of massive nucleoprotein complexes by ParB. We also showed that FtsZ ring assembly is affected by the ParB protein and/or unsegregated DNA. Our results indicate the existence of a checkpoint between the extension and septation of sporogenic hyphae that involves the ParA and ParB proteins.

  18. ParA and ParB coordinate chromosome segregation with cell elongation and division during Streptomyces sporulation

    PubMed Central

    Donczew, Magdalena; Mackiewicz, Paweł; Wróbel, Agnieszka; Flärdh, Klas; Zakrzewska-Czerwińska, Jolanta

    2016-01-01

    In unicellular bacteria, the ParA and ParB proteins segregate chromosomes and coordinate this process with cell division and chromosome replication. During sporulation of mycelial Streptomyces, ParA and ParB uniformly distribute multiple chromosomes along the filamentous sporogenic hyphal compartment, which then differentiates into a chain of unigenomic spores. However, chromosome segregation must be coordinated with cell elongation and multiple divisions. Here, we addressed the question of whether ParA and ParB are involved in the synchronization of cell-cycle processes during sporulation in Streptomyces. To answer this question, we used time-lapse microscopy, which allows the monitoring of growth and division of single sporogenic hyphae. We showed that sporogenic hyphae stop extending at the time of ParA accumulation and Z-ring formation. We demonstrated that both ParA and ParB affect the rate of hyphal extension. Additionally, we showed that ParA promotes the formation of massive nucleoprotein complexes by ParB. We also showed that FtsZ ring assembly is affected by the ParB protein and/or unsegregated DNA. Our results indicate the existence of a checkpoint between the extension and septation of sporogenic hyphae that involves the ParA and ParB proteins. PMID:27248800

  19. suPAR and Team Nephrology

    PubMed Central

    2014-01-01

    Primary focal segmental glomerulosclerosis (FSGS) accounts for nearly 10 % of patients who require renal replacement therapy. Elevated circulating levels of soluble urokinase receptor (suPAR) have been identified as a biomarker to discriminate primary FSGS from other glomerulopathies. Subsequent reports have questioned the diagnostic utility of this test. In a study in BMC Medicine, Huang et al. demonstrate that urinary soluble urokinase receptor (suPAR) excretion assists in distinguishing primary FSGS from other glomerular diseases, and that high plasma suPAR concentrations are not directly linked to a decline in glomerular filtration rate (GFR). This observation suggests that further investigation of suPAR is warranted in patients with FSGS. It should be interpreted in light of a recent report that B7-1 is expressed in the podocytes of a subset of patients with FSGS, and that blocking this molecule may represent the first successful targeted intervention for this disease. These advances highlight the rapid pace of scientific progress in the field of nephrology. Nephrologists should work together, share resources, and expedite the design of protocols to evaluate these novel biomarkers in a comprehensive and scientifically valid manner. Please see related article http://www.biomedcentral.com/1741-7015/12/81. PMID:24885021

  20. 30 CFR 817.132 - Cessation of operations: Permanent.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... INTERIOR PERMANENT PROGRAM PERFORMANCE STANDARDS PERMANENT PROGRAM PERFORMANCE STANDARDS-UNDERGROUND MINING ACTIVITIES § 817.132 Cessation of operations: Permanent. (a) The person who conducts underground mining... equipment, structures, or other facilities not required for continued underground mining activities...

  1. 30 CFR 817.132 - Cessation of operations: Permanent.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... INTERIOR PERMANENT PROGRAM PERFORMANCE STANDARDS PERMANENT PROGRAM PERFORMANCE STANDARDS-UNDERGROUND MINING ACTIVITIES § 817.132 Cessation of operations: Permanent. (a) The person who conducts underground mining... equipment, structures, or other facilities not required for continued underground mining activities...

  2. Optimal equations for describing the relationship between prostate volume, number of sources, and total activity in permanent prostate brachytherapy.

    PubMed

    Aronowitz, Jesse N; Michalski, Jeff M; Merrick, Gregory S; Sylvester, John E; Crook, Juanita M; Butler, Wayne M; Mawson, Christie; Pratt, David; Naidoo, Devi; Karolczuk, Kathryn

    2010-04-01

    To determine whether there is an optimal type of mathematical equation for predicting seed and activity requirements for permanent prostate brachytherapy. Four institutions with extensive brachytherapy experience each submitted details of more than 40 implants. The data was used to generate power and linear equations to reflect the relationship between preimplant volume and the number of seeds implanted, and preimplant volume and the total implant activity. We compared the R and standard error of the generated equations to determine which type of equation better fit the data. For the limited range of prostate volumes commonly implanted (20-60 mL), power and linear equations predict seed and activity requirements comparably well. Linear and power equations are equally suitable for generating institution-specific nomograms.

  3. Trends in Cochlear Implants

    PubMed Central

    Zeng, Fan-Gang

    2004-01-01

    More than 60,000 people worldwide use cochlear implants as a means to restore functional hearing. Although individual performance variability is still high, an average implant user can talk on the phone in a quiet environment. Cochlear-implant research has also matured as a field, as evidenced by the exponential growth in both the patient population and scientific publication. The present report examines current issues related to audiologic, clinical, engineering, anatomic, and physiologic aspects of cochlear implants, focusing on their psychophysical, speech, music, and cognitive performance. This report also forecasts clinical and research trends related to presurgical evaluation, fitting protocols, signal processing, and postsurgical rehabilitation in cochlear implants. Finally, a future landscape in amplification is presented that requires a unique, yet complementary, contribution from hearing aids, middle ear implants, and cochlear implants to achieve a total solution to the entire spectrum of hearing loss treatment and management. PMID:15247993

  4. [Permanent education in health: a review].

    PubMed

    Miccas, Fernanda Luppino; Batista, Sylvia Helena Souza da Silva

    2014-02-01

    To undertake a meta-synthesis of the literature on the main concepts and practices related to permanent education in health. A bibliographical search was conducted for original articles in the PubMed, Web of Science, LILACS, IBECS and SciELO databases, using the following search terms: "public health professional education", "permanent education", "continuing education", "permanent education health". Of the 590 articles identified, after applying inclusion and exclusion criteria, 48 were selected for further analysis, grouped according to the criteria of key elements, and then underwent meta-synthesis. The 48 original publications were classified according to four thematic units of key elements: 1) concepts, 2) strategies and difficulties, 3) public policies and 4) educational institutions. Three main conceptions of permanent education in health were found: problem-focused and team work, directly related to continuing education and education that takes place throughout life. The main strategies for executing permanent education in health are discussion, maintaining an open space for permanent education , and permanent education clusters. The most limiting factor is mainly related to directly or indirect management. Another highlight is the requirement for implementation and maintenance of public policies, and the availability of financial and human resources. The educational institutions need to combine education and service aiming to form critical-reflexive graduates. The coordination between health and education is based as much on the actions of health services as on management and educational institutions. Thus, it becomes a challenge to implement the teaching-learning processes that are supported by critical-reflexive actions. It is necessary to carry out proposals for permanent education in health involving the participation of health professionals, teachers and educational institutions. To undertake a meta-synthesis of the literature on the main concepts and

  5. Characterizing hydrologic permanence in headwater streams

    EPA Science Inventory

    The presentation will be an overview of research to inform jurisdictional determinations for the Clean Water Act, in particular research that hydrographic comparisons of the extent and hydrologic permanence of headwater streams, indicator development, and an evaluation of a rapid...

  6. Characterizing hydrologic permanence in headwater streams

    EPA Science Inventory

    The presentation will be an overview of research to inform jurisdictional determinations for the Clean Water Act, in particular research that hydrographic comparisons of the extent and hydrologic permanence of headwater streams, indicator development, and an evaluation of a rapid...

  7. Nonuniform radiation damage in permanent magnet quadrupoles.

    PubMed

    Danly, C R; Merrill, F E; Barlow, D; Mariam, F G

    2014-08-01

    We present data that indicate nonuniform magnetization loss due to radiation damage in neodymium-iron-boron Halbach-style permanent magnet quadrupoles. The proton radiography (pRad) facility at Los Alamos uses permanent-magnet quadrupoles for magnifying lenses, and a system recently commissioned at GSI-Darmsdadt uses permanent magnets for its primary lenses. Large fluences of spallation neutrons can be produced in close proximity to these magnets when the proton beam is, intentionally or unintentionally, directed into the tungsten beam collimators; imaging experiments at LANL's pRad have shown image degradation with these magnetic lenses at proton beam doses lower than those expected to cause damage through radiation-induced reduction of the quadrupole strength alone. We have observed preferential degradation in portions of the permanent magnet quadrupole where the field intensity is highest, resulting in increased high-order multipole components.

  8. Nonuniform radiation damage in permanent magnet quadrupoles

    SciTech Connect

    Danly, C. R.; Merrill, F. E.; Barlow, D.; Mariam, F. G.

    2014-08-15

    We present data that indicate nonuniform magnetization loss due to radiation damage in neodymium-iron-boron Halbach-style permanent magnet quadrupoles. The proton radiography (pRad) facility at Los Alamos uses permanent-magnet quadrupoles for magnifying lenses, and a system recently commissioned at GSI-Darmsdadt uses permanent magnets for its primary lenses. Large fluences of spallation neutrons can be produced in close proximity to these magnets when the proton beam is, intentionally or unintentionally, directed into the tungsten beam collimators; imaging experiments at LANL’s pRad have shown image degradation with these magnetic lenses at proton beam doses lower than those expected to cause damage through radiation-induced reduction of the quadrupole strength alone. We have observed preferential degradation in portions of the permanent magnet quadrupole where the field intensity is highest, resulting in increased high-order multipole components.

  9. Permanent disability social insurance programs in Japan.

    PubMed

    Rajnes, David

    2010-01-01

    This article examines Japan's permanent disability social insurance programs. Because there is limited information available about these programs in the literature outside Japan, this analysis helps to further international disability research. Primary public pension systems and their corresponding programs for permanently disabled workers and their families are described, including trends in the number of beneficiaries and benefit expenditures. Importantly, the article analyzes the determination and appeals processes in Japan for claiming permanent social insurance disability pensions. The study also references the Social Security Disability Insurance program operating in the United States and offers comparisons with the system in Japan, which provides insights about operational procedures to researchers and policymakers in both countries. Permanent disability programs in Japan and the United States share similar characteristics, including aspects of their benefit determination and appeals procedures. However, these country program experiences diverge markedly in several areas, making the comparison worthwhile from a policy perspective.

  10. Micromachined permanent magnets and their MEMS applications

    NASA Astrophysics Data System (ADS)

    Cho, Hyoung Jin

    2002-01-01

    In this research, new micromachined permanent magnets have been proposed, developed and characterized for MEMS applications. In realizing micromachined permanent magnets, a new electroplating technique using external magnetic field and a bumper filling technique using a photolithographically defined mold with resin bonded magnetic particles have been developed. The newly developed micromachining techniques allow thick film-type permanent magnet components to be integrated to magnetic MEMS devices with dimensional control and alignment. Permanent magnet arrays with the dimensions ranging from 30 mum to 200 mum have been developed with an energy density up to 2.7 kJ/m3 in precisely defined forms in the micro scale. For the applications of the permanent magnets developed in this work, three novel magnetic MEMS devices such as a bi-directional magnetic actuator, a magnetically driven optical scanner, and a magnetic cell separator have been successfully realized. After design and modeling, each device has been fabricated and fully characterized. The bi-directional actuator with the electroplated permanent magnet array has achieved bi-directional motion clearly and shown good agreement with the analytical and simulated models. The optical scanner has shown linear bi-directional response under static actuation and stable bi-directional scanning performance under dynamic actuation. As a potential BioMEMS application of the developed permanent magnet, the prototype magnetic cell separator using the electroplated permanent magnet strip array has been proposed and demonstrated for magnetic bead patterning. In conclusion, new thick film-type, electroplated CoNiMnP and epoxy resin bonded Sr-ferrite permanent magnets have been developed and characterized, and then, three new magnetic MEMS devices using the permanent magnets such as a bi-directional magnetic actuator, an optical scanner and a magnetic cell separator have been realized in this research. The new micromachined

  11. Clinicopathologic correlate of a fresh eyelid pigment implantation

    SciTech Connect

    Tse, D.T.; Folberg, R.; Moore, K.

    1985-10-01

    An eyelid with freshly applied black eyeliner pigment was examined histologically. X-ray microanalysis of the pigment suspension from the manufacturer's vial indicated that its composition was 98% iron and 2% titanium. Transmission electron microscopic examination disclosed that particles were in the extracellular matrix; intracellular particles were not seen. By light microscopy, implant material was detected in various levels of the dermis and was found in dermal lymphatics as well as within and surrounding a hair follicle. This study suggests that systemic exposure to the implant material is possible and offers explanations for permanent eyelash loss, which the authors have seen following this procedure.

  12. Permanent magnet edge-field quadrupole

    DOEpatents

    Tatchyn, Roman O.

    1997-01-01

    Planar permanent magnet edge-field quadrupoles for use in particle accelerating machines and in insertion devices designed to generate spontaneous or coherent radiation from moving charged particles are disclosed. The invention comprises four magnetized rectangular pieces of permanent magnet material with substantially similar dimensions arranged into two planar arrays situated to generate a field with a substantially dominant quadrupole component in regions close to the device axis.

  13. Permanent magnet edge-field quadrupole

    DOEpatents

    Tatchyn, R.O.

    1997-01-21

    Planar permanent magnet edge-field quadrupoles for use in particle accelerating machines and in insertion devices designed to generate spontaneous or coherent radiation from moving charged particles are disclosed. The invention comprises four magnetized rectangular pieces of permanent magnet material with substantially similar dimensions arranged into two planar arrays situated to generate a field with a substantially dominant quadrupole component in regions close to the device axis. 10 figs.

  14. Permanent education in health: a review

    PubMed Central

    Miccas, Fernanda Luppino; Batista, Sylvia Helena Souza da Silva

    2014-01-01

    OBJECTIVE To undertake a meta-synthesis of the literature on the main concepts and practices related to permanent education in health. METHODS A bibliographical search was conducted for original articles in the PubMed, Web of Science, LILACS, IBECS and SciELO databases, using the following search terms: “public health professional education”, “permanent education”, “continuing education”, “permanent education health”. Of the 590 articles identified, after applying inclusion and exclusion criteria, 48 were selected for further analysis, grouped according to the criteria of key elements, and then underwent meta-synthesis. RESULTS The 48 original publications were classified according to four thematic units of key elements: 1) concepts, 2) strategies and difficulties, 3) public policies and 4) educational institutions. Three main conceptions of permanent education in health were found: problem-focused and team work, directly related to continuing education and education that takes place throughout life. The main strategies for executing permanent education in health are discussion, maintaining an open space for permanent education, and permanent education clusters. The most limiting factor is mainly related to directly or indirect management. Another highlight is the requirement for implementation and maintenance of public policies, and the availability of financial and human resources. The educational institutions need to combine education and service aiming to form critical-reflexive graduates. CONCLUSIONS The coordination between health and education is based as much on the actions of health services as on management and educational institutions. Thus, it becomes a challenge to implement the teaching-learning processes that are supported by critical-reflexive actions. It is necessary to carry out proposals for permanent education in health involving the participation of health professionals, teachers and educational institutions. PMID:24789649

  15. PAR Corneal Topography System (PAR CTS): the clinical application of close-range photogrammetry.

    PubMed

    Belin, M W; Cambier, J L; Nabors, J R; Ratliff, C D

    1995-11-01

    The PAR Corneal Topography System (CTS) is a computer-driven corneal imaging system which uses close-range photogrammetry (rasterphotogrammetry) to measure and produce a topographic map of the corneal surface. The PAR CTS makes direct point-by-point measurements of surface elevation using a stereo-triangulation technique. The CTS uses a grid pattern composed of horizontal and vertical lines spaced about 0.2 mm (200 microns) apart. Each grid intersection comprises a surface feature which can be located in multiple images and used to generate an (x,y,z) coordinate. Unlike placido disc-based videokeratoscopes, the PAR CTS requires neither a smooth reflective surface nor precise spatial alignment for accurate imaging. In addition to surface elevation, the PAR CTS computes axial and tangential curvatures and refractive power. Difference maps are available in all curvatures, refractive power, and in absolute elevation.

  16. Workplace bullying a risk for permanent employees.

    PubMed

    Keuskamp, Dominic; Ziersch, Anna M; Baum, Fran E; Lamontagne, Anthony D

    2012-04-01

    We tested the hypothesis that the risk of experiencing workplace bullying was greater for those employed on casual contracts compared to permanent or ongoing employees. A cross-sectional population-based telephone survey was conducted in South Australia in 2009. Employment arrangements were classified by self-report into four categories: permanent, casual, fixed-term and self-employed. Self-report of workplace bullying was modelled using multiple logistic regression in relation to employment arrangement, controlling for sex, age, working hours, years in job, occupational skill level, marital status and a proxy for socioeconomic status. Workplace bullying was reported by 174 respondents (15.2%). Risk of workplace bullying was higher for being in a professional occupation, having a university education and being separated, divorced or widowed, but did not vary significantly by sex, age or job tenure. In adjusted multivariate logistic regression models, casual workers were significantly less likely than workers on permanent or fixed-term contracts to report bullying. Those separated, divorced or widowed had higher odds of reporting bullying than married, de facto or never-married workers. Contrary to expectation, workplace bullying was more often reported by permanent than casual employees. It may represent an exposure pathway not previously linked with the more idealised permanent employment arrangement. A finer understanding of psycho-social hazards across all employment arrangements is needed, with equal attention to the hazards associated with permanent as well as casual employment. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  17. Permanent Iodine-125 Interstitial Planar Seed Brachytherapy for Close or Positive Margins for Thoracic Malignancies

    SciTech Connect

    Mutyala, Subhakar; Stewart, Alexandra; Khan, Atif J.; Cormack, Robert A.; O'Farrell, Desmond; Sugarbaker, David; Devlin, Phillip M.

    2010-03-15

    Purpose: To assess toxicity and outcome following permanent iodine-125 seed implant as an adjunct to surgical resection in cases of advanced thoracic malignancy. Methods and Materials: An institutional review board-approved retrospective review was performed. Fifty-nine patients were identified as having undergone thoracic brachytherapy seed implantation between September 1999 and December 2006. Data for patient demographics, tumor details, and morbidity and mortality were recorded. Results: Fifty-nine patients received 64 implants. At a median follow-up of 17 months, 1-year and 2-year Kaplan-Meier rates of estimated overall survival were 94.1% and 82.0%, respectively. The 1-year and 2-year local control rates were 80.1% and 67.4%, respectively. The median time to develop local recurrence was 11 months. Grades 3 and 4 toxicity rates were 12% at 1 year. Conclusions: This review shows relatively low toxicity for interstitial planar seed implantation after thoracic surgical resection. The high local control results suggest that an incomplete oncologic surgery plus a brachytherapy implant for treating advanced thoracic malignancy merit further investigation.

  18. Prevalence and factors affecting use of long acting and permanent contraceptive methods in Jinka town, Southern Ethiopia: a cross sectional study

    PubMed Central

    Mekonnen, Getachew; Enquselassie, Fikre; Tesfaye, Gezahegn; Semahegn, Agumasie

    2014-01-01

    Introduction In Ethiopia, knowledge of contraceptive methods is high though there is low contraceptive prevalence rate. This study was aimed to assess prevalence and associated factors of long acting and permanent contraceptive methods in Jinka town, southern Ethiopia. Methods Community based cross sectional survey was conducted to assess the prevalence and factors affecting long acting and permanent methods of contraceptives utilization from March to April 2008. Eight hundred child bearing age women were participated in the quantitative study and 32 purposively selected focus group discussants were participated in the qualitative study. Face to face interview was used for data collection. Data were analyzed by SPSS version 13.0 statistical software. Descriptive statistics and logistic regression were computed to analyze the data. Results The prevalence of long acting and permanent contraceptive method was 7.3%. Three fourth (76.1%) of the women have ever heard about implants and implant 28 (50%) were the most widely used method. Almost two third of women had intention to use long acting and permanent methods. Knowledge of contraceptive and age of women have significant association with the use of long acting and permanent contraceptive methods. Conclusion The overall prevalence of long acting and permanent contraceptive method was low. Knowledge of contraceptive and age of women have significant association with use of long acting and permanent contraceptive. Extensive health information should be provided. PMID:25404960

  19. Prevalence and factors affecting use of long acting and permanent contraceptive methods in Jinka town, Southern Ethiopia: a cross sectional study.

    PubMed

    Mekonnen, Getachew; Enquselassie, Fikre; Tesfaye, Gezahegn; Semahegn, Agumasie

    2014-01-01

    In Ethiopia, knowledge of contraceptive methods is high though there is low contraceptive prevalence rate. This study was aimed to assess prevalence and associated factors of long acting and permanent contraceptive methods in Jinka town, southern Ethiopia. Community based cross sectional survey was conducted to assess the prevalence and factors affecting long acting and permanent methods of contraceptives utilization from March to April 2008. Eight hundred child bearing age women were participated in the quantitative study and 32 purposively selected focus group discussants were participated in the qualitative study. Face to face interview was used for data collection. Data were analyzed by SPSS version 13.0 statistical software. Descriptive statistics and logistic regression were computed to analyze the data. The prevalence of long acting and permanent contraceptive method was 7.3%. Three fourth (76.1%) of the women have ever heard about implants and implant 28 (50%) were the most widely used method. Almost two third of women had intention to use long acting and permanent methods. Knowledge of contraceptive and age of women have significant association with the use of long acting and permanent contraceptive methods. The overall prevalence of long acting and permanent contraceptive method was low. Knowledge of contraceptive and age of women have significant association with use of long acting and permanent contraceptive. Extensive health information should be provided.

  20. Replacement of hopeless retained primary teeth by immediate dental implants: a case report.

    PubMed

    de Oliveira, Rafael R; Macedo, Guilherme O; Muglia, Valdir A; Souza, Sérgio L S; Novaes, Arthur B; Taba, Mário

    2009-01-01

    Hopeless retained primary teeth without permanent successors represent a restorative challenge for clinicians, along with esthetic and functional problems for patients. While various treatment approaches for congenitally missing teeth have been proposed, the replacement of a missing tooth with a dental implant offers specific advantages, such as preservation of the alveolar crest and elimination of the need to restore the adjacent teeth, over other options for tooth replacement. The aim of this article was to illustrate the surgical and prosthetic treatment with implants of a patient with primary teeth without permanent successors.

  1. Ion implantation induced nanotopography on titanium and bone cell adhesion

    NASA Astrophysics Data System (ADS)

    Braceras, Iñigo; Vera, Carolina; Ayerdi-Izquierdo, Ana; Muñoz, Roberto; Lorenzo, Jaione; Alvarez, Noelia; de Maeztu, Miguel Ángel

    2014-08-01

    Permanent endo-osseous implants require a fast, reliable and consistent osseointegration, i.e. intimate bonding between bone and implant, so biomechanical loads can be safely transferred. Among the parameters that affect this process, it is widely admitted that implant surface topography, surface energy and composition play an important role. Most surface treatments to improve osseointegration focus on micro-scale features, as few can effectively control the effects of the treatment at nanoscale. On the other hand, ion implantation allows controlling such nanofeatures. This study has investigated the nanotopography of titanium, as induced by different ion implantation surface treatments, its similarity with human bone tissue structure and its effect on human bone cell adhesion, as a first step in the process of osseointegration. The effect of ion implantation treatment parameters such as energy (40-80 keV), fluence (1-2 e17 ion/cm2) and ion species (Kr, Ar, Ne and Xe) on the nanotopography of medical grade titanium has been measured and assessed by AFM and contact angle. Then, in vitro tests have been performed to assess the effect of these nanotopographies on osteoblast adhesion. The results have shown that the nanostructure of bone and the studied ion implanted surfaces, without surface chemistry modification, are in the same range and that such modifications, in certain conditions, do have a statistically significant effect on bone tissue forming cell adhesion.

  2. EDITORIAL: Permanent revolution - or evolution?

    NASA Astrophysics Data System (ADS)

    Dobson, Ken

    1998-03-01

    Honorary Editor It was that temporary Bolshevik Leon Trotsky who developed the principle of `permanent revolution', a principle that perhaps characterizes the recent history of education in (south) Britain more than does, say, principles traditionally associated with the Conservative or Labour parties. As this editorial is being written, changes are being made to primary school education, and the long-awaited details of the post-Dearing reorganizing of post-16 education are yet to hit the overful bookshelves and filing cabinets of school heads and examination board officials. But something unique has happened recently which might have surprised even Trotsky. The Secretary of State for Education has set up targets for primary school pupils' attainment and threatened (or promised) to resign if they are not met within the lifetime of our newly elected parliament. Of course, if Mr Blunkett is still in a position to resign at that stage he will have been the longest serving Secretary of State since time immemorial. But we should not carp: this is truly a revolutionary idea. Not the promise to resign - although this idea is not so fashionable now as it once was. The revolutionary idea is that a major change to an educational process is actually being made that carries with it a predicted and testable outcome. By contrast, when school physics was refreshed a generation ago by the introduction of Nuffield courses at both pre- and post-16 stages, no `targets' were set. I and many other physics teachers certainly preferred teaching these to teaching their predecessor syllabuses, and might even dare to assert that the pupils liked them too. But we still don't really know whether or not they learned more - or even better - physics. Very little happened as far as the outside world was concerned: the usual fraction of students gave up physics at the usual ages, and those who were examined didn't really get a better reward for their more up-to-date and more enjoyably learned

  3. View from west to east of PAR site resident engineer's ...

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

    View from west to east of PAR site resident engineer's office building (REOB) - Stanley R. Mickelsen Safeguard Complex, Resident Engineers Office Building, Southeast of intersection of PAR Access Road & Fourth Avenue, Nekoma, Cavalier County, ND

  4. Élaboration de films de molécules organiques par ablation par laser UV

    NASA Astrophysics Data System (ADS)

    Hernandez-Perez, M. A.; Garapon, C.; Champeaux, C.; Coleman, A. W.

    2006-12-01

    Les potentialités des méthodes de dépôt par ablation laser (PLD) pour la préparation de films minces de matériaux organiques sont illustrées par un bref rappel bibliographique et par des résultats expérimentaux concernant des molécules d'intérêt biologique (acides aminés, calix-arènes, protéines). Les films sont préparés par PLD avec un laser KrF sans dégradation de la structure chimique des molécules dans une gamme de fluences de quelques dizaines à quelques centaines de mJ/cm2. Les propriétés structurales et optiques des films sont étudiées en fonction de la fluence du laser et mettent en évidence des arrangements moléculaires particuliers induits par cette méthode de dépôt. Le guidage optique a été obtenu pour des films de toutes ces molécules.

  5. A Combined Global and Local Approach to Elucidate Spatial Organization of the Mycobacterial ParB-parS Partition Assembly

    SciTech Connect

    B Chaudhuri; S Gupta; V Urban; M Chance; R DMello; L Smith; K Lyons; J Gee

    2011-12-31

    Combining diverse sets of data at global (size, shape) and local (residue) scales is an emerging trend for elucidating the organization and function of the cellular assemblies. We used such a strategy, combining data from X-ray and neutron scattering with H/D-contrast variation and X-ray footprinting with mass spectrometry, to elucidate the spatial organization of the ParB-parS assembly from Mycobacterium tuberculosis. The ParB-parS participates in plasmid and chromosome segregation and condensation in predivisional bacterial cells. ParB polymerizes around the parS centromere(s) to form a higher-order assembly that serves to recruit cyto-skeletal ParA ATPases and SMC proteins for chromosome segregation. A hybrid model of the ParB-parS was built by combining and correlating computational models with experiment-derived information about size, shape, position of the symmetry axis within the shape, internal topology, DNA-protein interface, exposed surface patches, and prior knowledge. This first view of the ParB-parS leads us to propose how ParB spread on the chromosome to form a larger assembly.

  6. Kallikrein 6 Signals through PAR1 and PAR2 to Promote Neuron Injury and Exacerbate Glutamate Neurotoxicity

    PubMed Central

    Yoon, Hyesook; Radulovic, Maja; Wu, Jianmin; Blaber, Sachiko I.; Blaber, Michael; Fehlings, Michael G.; Scarisbrick, Isobel A.

    2014-01-01

    CNS trauma generates a proteolytic imbalance contributing to secondary injury, including axonopathy and neuron degeneration. Kallikrein 6 (Klk6) is a serine protease implicated in neurodegeneration and here we investigate the role of protease activated receptors 1 (PAR1) and PAR2 in mediating these effects. First we demonstrate Klk6 and the prototypical activator of PAR1, thrombin, as well as PAR1 and PAR2, are each elevated in murine experimental traumatic spinal cord injury (SCI) at acute or subacute time points. Recombinant Klk6 triggered ERK1/2 signaling in cerebellar granule neurons and in the NSC34 spinal cord motoneuron cell line, in a PI3K and MEK-dependent fashion. Importantly, lipopeptide inhibitors of PAR1 or PAR2, and PAR1 genetic deletion, each reduced Klk6-ERK1/2 activation. In addition, Klk6 and thrombin promoted degeneration of cerebellar neurons and exacerbated glutamate neurotoxicity. Moreover, genetic deletion of PAR1 blocked thrombin-mediated cerebellar neurotoxicity and reduced the neurotoxic effects of Klk6. Klk6 also increased glutamate-mediated Bim signaling, PARP cleavage and lactate dehydrogenase (LDH) release in NSC34 motoneurons and these effects were blocked by PAR1 and PAR2 lipopeptide inhibitors. Taken together these data point to a novel Klk6-signaling axis in CNS neurons that is mediated by PAR1 and PAR2 and is positioned to contribute to neurodegeneration. PMID:23647384

  7. A Combined Global and Local Approach to Elucidate Spatial Organization of the Mycobacterial ParB-parS Partition

    SciTech Connect

    Chaudhuri, Barnali; Gupta, Sayan; Urban, Volker S; Chance, Mark; D'Mello, Rhijuta; Smith, Lauren; Lyons, Kelly; Gee, Jessica

    2010-01-01

    Combining diverse sets of data at global (size, shape) and local (residue) scales is an emerging trend for elucidating the organization and function of the cellular assemblies. We used such a strategy, combining data from X-ray and neutron scattering with H/D-contrast variation and X-ray footprinting with mass spectrometry, to elucidate the spatial organization of the ParB-parS assembly from Mycobacterium tuberculosis. The ParB-parS participates in plasmid and chromosome segregation and condensation in predivisional bacterial cells. ParB polymerizes around the parS centromere(s) to form a higher-order assembly that serves to recruit cyto-skeletal ParA ATPases and SMC proteins for chromosome segregation. A hybrid model of the ParB-parS was built by combining and correlating computational models with experiment-derived information about size, shape, position of the symmetry axis within the shape, internal topology, DNA-protein interface, exposed surface patches, and prior knowledge. This first view of the ParB-parS leads us to propose how ParB spread on the chromosome to form a larger assembly.

  8. Nickel-induced systemic contact dermatitis and intratubal implants: the baboon syndrome revisited.

    PubMed

    Bibas, Nathalie; Lassere, Jacques; Paul, Carle; Aquilina, Christian; Giordano-Labadie, Françoise

    2013-01-01

    Permanent sterilization using intratubal implants is becoming increasingly popular worldwide. We report the first case of a 40-year-old woman presenting a systemic contact dermatitis due to nickel-containing intratubal implants: the Essure system. The diagnosis was confirmed with positive patch test result for nickel and total clearance of dermatitis after removing the implants that contain a metallic spiral of nitinol (alloy of 55% nickel and 45% titanium). Systemic contact dermatitis to the intratubal implants could be explained by the corrosion of nitinol after implantation resulting in the release of nickel. In the literature, no similar case has been reported despite the introduction of intratubal implants since 2002. Dermatologists and gynecologists need to be aware of this type of complication. In practice, a thorough assessment for possible nickel contact dermatitis in a woman undergoing sterilization with Essure is recommended. Preoperative patch testing must be carried out if there is any doubt.

  9. Host response biomarker in sepsis: suPAR detection.

    PubMed

    Giamarellos-Bourboulis, Evangelos J; Georgitsi, Marianna

    2015-01-01

    Recent studies of our group have shown that suPAR may complement APACHE II score for risk assessment in sepsis. suPAR may be measured in serum of patients by an enzyme immunosorbent assay developed by Virogates (suPARnostic™). Production of suPAR from circulating neutrophils and monocytes may be assessed after isolation of neutrophils and monocytes and ex vivo culture. This is followed by measurement of suPAR in culture supernatants.

  10. Fine trabecularized carbon: ideal material and texture for percutaneous device system of permanent left ventricular assist device.

    PubMed

    Tagusari, O; Yamazaki, K; Litwak, P; Kojima, A; Klein, E C; Antaki, J F; Watach, M; Gordon, L M; Kono, K; Mori, T; Koyanagi, H; Griffith, B P; Kormos, R L

    1998-06-01

    The development of a percutaneous artificial internal organ system requires a reliable biocompatible connection between the external environment and the inside of the human body. Such is necessary for the success of a permanent left ventricular assist device. However, the search for a satisfactory interface at the epidermal level has proven to be difficult. Carbon has been proposed for this application, but its texture does not typically promote ingrowth from surrounding tissue. We have therefore employed a new processing method to produce a fine trabecularized carbon implant. The method for preparing the implant involves infiltrating low temperature pyrolytic carbon into the surface of a carbon core which is wrapped with carbon fabric. This results in a tightly woven porous structure of carbon (carbon fiber diameter: 35-50 microm, maximal pore size >200 microm) with gradually increasing porosity from 15-75%. We implanted test samples percutaneously in a calf for in vivo histological evaluation. Thirty days after implantation epidermal downgrowth was minimal. Microscopic analysis revealed that a thin fibrous capsule surrounded the implant, and mature connective tissue with accompanying blood vessels filled the pores of the fine trabecularized carbon layer. From these results we suggest that fine trabecularized carbon is ideally suited for a percutaneous device system in a permanent left ventricular assist device.

  11. Diffusion and Electrical Activation After a Rapid Thermal Annealing of an As and B-Co-Implanted Polysilicon Layer

    NASA Astrophysics Data System (ADS)

    Gontrand, C.; Sellitto, P.; Tabikh, S.; Latreche, S.; Kaminski, A.

    1997-01-01

    This work provides an experimental insight into the physical mechanisms involved in the co-diffusion of arsenic and boron in polysilicon/monocrystalline Si bilayers, during the formation of shallow N^+ emitters for the BiCMOS technology. The RTA-induced redistribution of As and B successively implanted in a 380 nm LPCVD polysilicon layer is studied by SIMS measurements. Hall effect, as well as sheet resistance measurements, show that the electrical activation of dopants in the co-implanted structures is satisfactory from a RTA temperature of 1100 °C. Nous présentons ici un travail expérimental mettant en évidence les mécanismes physiques intervenant dans la co-diffusion de l'arsenic et du bore dans une bicouche polysilicium sur silicium polycrystallin, durant la formation des émetteurs étroits N^+ destinés à la technologie BiCMOS. La redistribution de As et B induite par un RTA, successivement implantés dans une couche de polysilicium de 380 nm, est appréhendée par des mesures SIMS. Des mesures par effet Hall et par résistances par carrés mettent en évidence que l'activité électrique des dopants dans les structures implantées est satisfaisante à partir d'une température de 1100 °C.

  12. Implant-connected versus tooth-connected implant-supported partial dentures: 2-year clinical and radiographic comparative evaluation.

    PubMed

    Mostafa, Tamer Mohamed; El-Sheikh, Mohamed M; Abd El-Fattah, Fadel

    2015-01-01

    The purpose of this study was to clinically and radiographically compare implant-connected and tooth-connected implant-supported fixed-detachable mandibular partial dentures. Twenty partially edentulous patients (age range: 25 to 50 years) with mandibular Kennedy Class II configurations were equally divided into two groups receiving a three-unit, fixed-detachable, screw-retained partial denture. Group 1 comprised patients with unilateral missing mandibular molars and premolars. Two implants were placed at the mandibular first premolar and first molar areas. Group 2 comprised patients with missing mandibular molars and second premolars. An implant was placed at the mandibular first molar area, the first premolar was prepared, and a coping was cemented to the tooth with permanent cement. Each case was evaluated clinically and radiographically at baseline (partial denture insertion) and after 6, 12, and 24 months. Data were collected and statistically analyzed using repeated-measures one-way and two-way analysis of variance tests. There was no statistically significant difference between the two groups (P > .05). The implant-tooth-supported prosthesis provided an equally predictable treatment option compared to the totally implant-supported prosthesis in terms of implant survival and loss of marginal bone.

  13. Preliminary assessment of a hysteroscopic fallopian tube heat and biomaterial technology for permanent female sterilization

    NASA Astrophysics Data System (ADS)

    Divakar, Prajan; Trembly, B. Stuart; Moodie, Karen L.; Hoopes, P. Jack; Wegst, Ulrike G. K.

    2017-02-01

    Recent failures in hysteroscopic female sterilization procedures have brought into question the implantation of nonresorbable metal devices into the fallopian tubes due to long-term risks such as migration, fragmentation, and tubal perforation. The goal of this study is to assess whether a porous, biodegradable implant can be deposited into the fallopian tube lumen with or without a local mild heat treatment to generate a safe and permanent fallopian tube occlusion/sterilization event. The technologies investigated included freeze-cast collagen-based scaffolds and magnetic nanoparticle (MNP) based scaffolds. In vitro assessment of iron oxide MNP-based scaffolds was performed to determine the absorption rate density (ARD); subsequent computational modeling quantified the thermal in vivo steady state temperature as a function of tubal radius for treatment planning. For collagen-based scaffolds, in vivo testing was performed to study the biocompatibility in a mouse flank model, followed by implantation into an in vivo anestrus feline uterine horn (animal model for the fallopian tube). Biological responses were studied histopathologically. Uterine horn patency was assessed via radiographic imaging. Preliminary studies suggest the MNP-impregnated scaffold and a safe, noninvasive AMF excitation field have potential to generate a sufficient focal fallopian tube thermal dose to create a fibrotic healing event and ultimately, permanent tubal occlusion.

  14. Scattering effects of irradiation on surroundings calculated for a small dental implant.

    PubMed

    Friedrich, Reinhard E; Todorovic, Manuel; Heiland, Max; Scheuer, Hanna A; Krüll, Andreas

    2012-05-01

    A fundamental improvement of restorative dentistry is the compensation of missing teeth by insertion of artificial dental roots allowing retention of dental prosthesis. The function of dental implants conserves a permanent perforation of the mucosa and upholds a non-physiological contact of bone with foreign material and oral micro-organisms. Occasionally head and neck cancer patients are scheduled to receive radiotherapy but are wearing dental implants. An earlier study had shown that the distribution of x-rays is noteworthily changed when dental implants are present in the irradiation field. New implants of smaller size are currently being designed that allow sufficient retention for dental prosthesis. The aim of this consecutive study was to calculate alterations in the irradiated bone caused by a foreign body, representing an implant of reduced size and physical qualities equivalent to titanium, using a stochastic (Monte Carlo) simulation. A clinical linear accelerator was simulated using BEAM/EGS4. The calculations showed that the presence of a dimension-reduced implant results in remarkable differences of the dose distribution all around the implant. Titanium dental implants of reduced size located in the field of irradiation were capable of causing significant radiation scattering. Similar to standard implants, the risk for dose enhancement was notably important for the bone in direct contact with the implant. All therapists involved in the therapy of cancer patients undergoing head and neck radiotherapy should consider the impact of dental implants on the radiation beam as a catalyst of osteoradionecrosis.

  15. Friction coefficient and effective interference at the implant-bone interface.

    PubMed

    Damm, Niklas B; Morlock, Michael M; Bishop, Nicholas E

    2015-09-18

    Although the contact pressure increases during implantation of a wedge-shaped implant, friction coefficients tend to be measured under constant contact pressure, as endorsed in standard procedures. Abrasion and plastic deformation of the bone during implantation are rarely reported, although they define the effective interference, by reducing the nominal interference between implant and bone cavity. In this study radial forces were analysed during simulated implantation and explantation of angled porous and polished implant surfaces against trabecular bone specimens, to determine the corresponding friction coefficients. Permanent deformation was also analysed to determine the effective interference after implantation. For the most porous surface tested, the friction coefficient initially increased with increasing normal contact stress during implantation and then decreased at higher contact stresses. For a less porous surface, the friction coefficient increased continually with normal contact stress during implantation but did not reach the peak magnitude measured for the rougher surface. Friction coefficients for the polished surface were independent of normal contact stress and much lower than for the porous surfaces. Friction coefficients were slightly lower for pull-out than for push-in for the porous surfaces but not for the polished surface. The effective interference was as little as 30% of the nominal interference for the porous surfaces. The determined variation in friction coefficient with radial contact force, as well as the loss of interference during implantation will enable a more accurate representation of implant press-fitting for simulations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Drosophila 14-3-3/PAR-5 is an essential mediator of PAR-1 function in axis formation.

    PubMed

    Benton, Richard; Palacios, Isabel M; St Johnston, Daniel

    2002-11-01

    PAR-1 kinases are required to determine the anterior-posterior (A-P) axis in C. elegans and Drosophila, but little is known about their molecular function. We identified 14-3-3 proteins as Drosophila PAR-1 interactors and show that PAR-1 binds a domain of 14-3-3 distinct from the phosphoserine binding pocket. PAR-1 kinases phosphorylate proteins to generate 14-3-3 binding sites and may therefore directly deliver 14-3-3 to these targets. 14-3-3 mutants display identical phenotypes to par-1 mutants in oocyte determination and the polarization of the A-P axis. Together, these results indicate that PAR-1's function is mediated by the binding of 14-3-3 to its substrates. The C. elegans 14-3-3 protein, PAR-5, is also required for A-P polarization, suggesting that this is a conserved mechanism by which PAR-1 establishes cellular asymmetries.

  17. Dose escalation in permanent brachytherapy for prostate cancer: dosimetric and biological considerations

    NASA Astrophysics Data System (ADS)

    Li, X. Allen; Wang, Jian Z.; Stewart, Robert D.; Di Biase, Steven J.

    2003-09-01

    No prospective dose escalation study for prostate brachytherapy (PB) with permanent implants has been reported. In this work, we have performed a dosimetric and biological analysis to explore the implications of dose escalation in PB using 125I and 103Pd implants. The concept of equivalent uniform dose (EUD), proposed originally for external-beam radiotherapy (EBRT), is applied to low dose rate brachytherapy. For a given 125I or 103Pd PB, the EUD for tumour that corresponds to a dose distribution delivered by EBRT is calculated based on the linear quadratic model. The EUD calculation is based on the dose volume histogram (DVH) obtained retrospectively from representative actual patient data. Tumour control probabilities (TCPs) are also determined in order to compare the relative effectiveness of different dose levels. The EUD for normal tissue is computed using the Lyman model. A commercial inverse treatment planning algorithm is used to investigate the feasibility of escalating the dose to prostate with acceptable dose increases in the rectum and urethra. The dosimetric calculation is performed for five representative patients with different prostate sizes. A series of PB dose levels are considered for each patient using 125I and 103Pd seeds. It is found that the PB prescribed doses (minimum peripheral dose) that give an equivalent EBRT dose of 64.8, 70.2, 75.6 and 81 Gy with a fraction size of 1.8 Gy are 129, 139, 150 and 161 Gy for 125I and 103, 112, 122 and 132 Gy for 103Pd implants, respectively. Estimates of the EUD and TCP for a series of possible prescribed dose levels (e.g., 145, 160, 170 and 180 Gy for 125I and 125, 135, 145 and 155 for 103Pd implants) are tabulated. The EUD calculation was found to depend strongly on DVHs and radiobiological parameters. The dosimetric calculations suggest that the dose to prostate can be escalated without a substantial increase in both rectal and urethral dose. For example, increasing the PB prescribed dose from 145 to

  18. Recuit thermique rapide de semi-conducteur par énergie micro-onde

    NASA Astrophysics Data System (ADS)

    Covas, M.; Gay, H. C.

    1993-05-01

    This paper proposes a new technique for rapid thermal annealing of semi-conductors. This technique is based on microwave energy, and offers the same advantages as the rapid thermal annealing by incoherent light, in terms of rapidity, and contamination. However, our technique reduces considerably the required energy for the annealing process. This technique has been compared to the rapid thermal by incoherent light: lab experiments, carried out on boron implanted silicon samples, showed that a power gain ratio of about 10 can be achieved. Nous proposons une méthode de recuit thermique rapide du silicium par énergie micro-onde. Cette technique offre les mêmes avantages que les traitements thermiques rapides par lumière incohérente, c'est-à-dire des durées de chauffage très brèves, limitant ainsi la diffusion des dopants, et un traitement plaquette par plaquette : les risques de contamination de tout un lot sont ainsi éliminés. De plus notre méthode requiert une faible énergie : pour parvenir à des recuits de qualité similaire à celle obtenue dans des fours de recuit rapide à lampes il faut un flux de puissance 10 fois plus faible.

  19. [Cochlear implant in adults].

    PubMed

    Bouccara, D; Mosnier, I; Bernardeschi, D; Ferrary, E; Sterkers, O

    2012-03-01

    Cochlear implant in adults is a procedure, dedicated to rehabilitate severe to profound hearing loss. Because of technological progresses and their applications for signal strategies, new devices can improve hearing, even in noise conditions. Binaural stimulation, cochlear implant and hearing aid or bilateral cochlear implants are the best opportunities to access to better level of comprehension in all conditions and space localisation. By now minimally invasive surgery is possible to preserve residual hearing and use a double stimulation modality for the same ear: electrical for high frequencies and acoustic for low frequencies. In several conditions, cochlear implant is not possible due to cochlear nerve tumour or major malformations of the inner ear. In these cases, a brainstem implantation can be considered. Clinical data demonstrate that improvement in daily communication, for both cochlear and brainstem implants, is correlated with cerebral activation of auditory cortex.

  20. ViPAR: a software platform for the Virtual Pooling and Analysis of Research Data

    PubMed Central

    Carter, Kim W; Carter, KW; Francis, RW; Bresnahan, M; Gissler, M; Grønborg, TK; Gross, R; Gunnes, N; Hammond, G; Hornig, M; Hultman, CM; Huttunen, J; Langridge, A; Leonard, H; Newman, S; Parner, ET; Petersson, G; Reichenberg, A; Sandin, S; Schendel, DE; Schalkwyk, L; Sourander, A; Steadman, C; Stoltenberg, C; Suominen, A; Surén, P; Susser, E; Sylvester Vethanayagam, A; Yusof, Z

    2016-01-01

    Background: Research studies exploring the determinants of disease require sufficient statistical power to detect meaningful effects. Sample size is often increased through centralized pooling of disparately located datasets, though ethical, privacy and data ownership issues can often hamper this process. Methods that facilitate the sharing of research data that are sympathetic with these issues and which allow flexible and detailed statistical analyses are therefore in critical need. We have created a software platform for the Virtual Pooling and Analysis of Research data (ViPAR), which employs free and open source methods to provide researchers with a web-based platform to analyse datasets housed in disparate locations. Methods: Database federation permits controlled access to remotely located datasets from a central location. The Secure Shell protocol allows data to be securely exchanged between devices over an insecure network. ViPAR combines these free technologies into a solution that facilitates ‘virtual pooling’ where data can be temporarily pooled into computer memory and made available for analysis without the need for permanent central storage. Results: Within the ViPAR infrastructure, remote sites manage their own harmonized research dataset in a database hosted at their site, while a central server hosts the data federation component and a secure analysis portal. When an analysis is initiated, requested data are retrieved from each remote site and virtually pooled at the central site. The data are then analysed by statistical software and, on completion, results of the analysis are returned to the user and the virtually pooled data are removed from memory. Conclusions: ViPAR is a secure, flexible and powerful analysis platform built on open source technology that is currently in use by large international consortia, and is made publicly available at [http://bioinformatics.childhealthresearch.org.au/software/vipar/]. PMID:26452388

  1. ViPAR: a software platform for the Virtual Pooling and Analysis of Research Data.

    PubMed

    Carter, Kim W; Francis, Richard W; Carter, K W; Francis, R W; Bresnahan, M; Gissler, M; Grønborg, T K; Gross, R; Gunnes, N; Hammond, G; Hornig, M; Hultman, C M; Huttunen, J; Langridge, A; Leonard, H; Newman, S; Parner, E T; Petersson, G; Reichenberg, A; Sandin, S; Schendel, D E; Schalkwyk, L; Sourander, A; Steadman, C; Stoltenberg, C; Suominen, A; Surén, P; Susser, E; Sylvester Vethanayagam, A; Yusof, Z

    2015-10-08

    Research studies exploring the determinants of disease require sufficient statistical power to detect meaningful effects. Sample size is often increased through centralized pooling of disparately located datasets, though ethical, privacy and data ownership issues can often hamper this process. Methods that facilitate the sharing of research data that are sympathetic with these issues and which allow flexible and detailed statistical analyses are therefore in critical need. We have created a software platform for the Virtual Pooling and Analysis of Research data (ViPAR), which employs free and open source methods to provide researchers with a web-based platform to analyse datasets housed in disparate locations. Database federation permits controlled access to remotely located datasets from a central location. The Secure Shell protocol allows data to be securely exchanged between devices over an insecure network. ViPAR combines these free technologies into a solution that facilitates 'virtual pooling' where data can be temporarily pooled into computer memory and made available for analysis without the need for permanent central storage. Within the ViPAR infrastructure, remote sites manage their own harmonized research dataset in a database hosted at their site, while a central server hosts the data federation component and a secure analysis portal. When an analysis is initiated, requested data are retrieved from each remote site and virtually pooled at the central site. The data are then analysed by statistical software and, on completion, results of the analysis are returned to the user and the virtually pooled data are removed from memory. ViPAR is a secure, flexible and powerful analysis platform built on open source technology that is currently in use by large international consortia, and is made publicly available at [http://bioinformatics.childhealthresearch.org.au/software/vipar/]. © The Author 2015. Published by Oxford University Press on behalf of the

  2. [Ambroise Paré in French literature].

    PubMed

    Dumaitre, P

    1995-01-01

    The 16th century by its passionate side has been the favourite one of authors of historical novels in which among the heroes of "cloak and dagger stories" appears sometime Ambroise Paré. Alexandre Dumas (the father) has shown him at the court of Charles IX in La Reine Margot (1845) where he does not however play a great role. On the contrary, Balzac in Le Martyr calviniste (1842) has given him a capital part close to the dying François II, whom he intended to trepanize but had to give up this idea as a consequence of the opposition of the queen-mother Catherine de Médicis. In the present century, Robert Merle in Paris ma bonne ville (Fortune de France, 3, 1980) shows Paré at the time of the Saint Barthélemy.

  3. [Ambroise Paré and Latin].

    PubMed

    Drouin, Emmanuel

    2010-06-01

    We report a study of a medical book written by Antoine Mizaud (Memorabilium utilium, in ac iucundorum aphorismos Arcanorum omnis generis locupletes, perpulchre digestae), which was written in Latin, but has been extensively annotated in French.The book is from the personal collection of one of the physicians of Napoleon III. There is an oral tradition within his family that one of the works in the book had been annotated by Ambroise Paré. We know very little, apart from a few receipts and his signature, about the writing of the master of French surgery. Did he understand the language of Galen? There are many annotated passages in the works of Pare which are in the book. We examine whether these annotations were actually made by Ambroise Paré or whether they were done for him.

  4. Les Brulures Chimiques Par Le Laurier Rose

    PubMed Central

    Bakkali, H.; Ababou, M.; Nassim Sabah, T.; Moussaoui, A.; Ennouhi, A.; Fouadi, F.Z.; Siah, S.; Ihrai, H.

    2010-01-01

    Summary Le laurier rose ou Nerium oleander est un arbuste qui pousse naturellement dans les régions méditerranéennes. Au Maroc on le trouve dans les lieux humides. Il est réputé par ses risques de toxicité systémique en cas d'empoisonnement à cause de la présence de deux alcaloïdes, surtout l'oléandrine. La littérature illustre des cas d'utilisation locale des feuilles de cette plante contre la gale, les hémorroïdes et les furoncles. Nous rapportons deux cas de brûlures chimiques par le laurier rose de gravité différente. Cela doit aboutir à une information élargie de la population, ainsi qu'une réglementation stricte de sa commercialisation. PMID:21991211

  5. [Improved design of permanent maglev impeller assist heart].

    PubMed

    Qian, Kunxi; Zeng, Pei; Ru, Weimin; Yuan, Haiyu

    2002-12-01

    Magnetic bearing has no mechanical contact between the rotor and stator. And a rotary pump with magnetic bearing has therefore no mechanical wear and thrombosis due to bearing. The available magnetic bearings, however, are devised with electric magnets, need complicated control and remarkable energy consumption. Resultantly, it is difficult to apply an electric magnetic bearing to rotary pump without disturbing its simplicity, implantability and reliability. The authors have developed a levitated impeller pump merely with permanent magnets. The rotor is supported by permanent magnetic forces radially. On one side of the rotor, the impeller is fixed; and on the other side of the rotor, the driven magnets are mounted. Opposite to this driven magnets, a driving motor coil with iron corn magnets is fastened to the motor axis. Thereafter, the motor drives the rotor via a rotating magnetic field. By laboratory tests with saline, if the rotor stands still or rotates under 4,000 rpm, the rotor has one-point contact axially with the driving motor coil. The contacting point is located in the center of the rotor. As the rotating speed increases gradually to more than 4,000 rpm, the rotor will detache from the stator axially. Then the rotor will be fully levitated. Since the axial levitation is produced by hydraulic force and the driven magnets have a gyro-effect, the rotor rotates very steadly during levitation. As a left ventricular assist device, the pump works in a rotating speed range of 5,000-8,000 rpm, the levitation of the impeller hence is ensured by practical use of the pump.

  6. Implant treatment planning considerations.

    PubMed

    Kao, Richard T

    2008-04-01

    As dental implants become a more accepted treatment modality, there is a need for all parties involved with implant dentistry to be familiar with various treatment planning issues. Though the success can be highly rewarding, failure to forecast treatment planning issues can result in an increase of surgical needs, surgical cost, and even case failure. In this issue, the focus is on implant treatment planning considerations.

  7. Combined DSEK and Transconjunctival Pars Plana Vitrectomy

    PubMed Central

    Sane, Mona; Shaikh, Naazli

    2016-01-01

    We report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for rapid anatomical recovery and return of function and visual acuity in a single sitting. PMID:27413563

  8. Par Pond refill water quality sampling

    SciTech Connect

    Koch, J.W. II; Martin, F.D.; Westbury, H.M.

    1996-08-01

    This study was designed to document anoxia and its cause in the event that the anoxia caused a fish kill. However, no fish kill was observed during this study, and dissolved oxygen and nutrient concentrations generally remained within the range expected for southeastern reservoirs. Par Pond water quality monitoring will continue during the second summer after refill as the aquatic macrophytes become reestablished and nutrients in the sediments are released to the water column.

  9. Update on Permanent Contraception Options for Women

    PubMed Central

    Patil, Eva; Jensen, Jeffrey T.

    2015-01-01

    Purpose of review Permanent methods are the most commonly used contraceptive options worldwide. Even with the increase in popularity and accessibility of long-acting reversible methods, there remains high demand for permanent options, especially among women in developing countries. Recent findings Traditional methods of permanent contraception (PC), such as post-partum tubal ligation and interval surgical tubal occlusion or electrocautery by mini-laparotomy or laparoscopy are safe and highly effective. Bilateral total salpingectomy for ovarian cancer risk reduction is currently being investigated. Hysteroscopic tubal occlusion reduces or eliminates the need for anesthesia, but requires surgical training and specialized equipment. Alternative PC methods are being explored including immediately effective hysteroscopic methods, and non-surgical permanent contraception (NSPC) methods that have the potential to improve access and reduce cost. Summary PC methods are an important part of the contraceptive methods mix designed to meet the needs of women who have completed desired family size or wish never to become pregnant. Current surgical approaches to permanent contraception are safe and highly effective. The development of a highly effective nonsurgical approach could simplify the provision of PC. PMID:26406934

  10. Cylindrical Hall thrusters with permanent magnets

    NASA Astrophysics Data System (ADS)

    Raitses, Yevgeny; Merino, Enrique; Fisch, Nathaniel J.

    2010-11-01

    The use of permanent magnets instead of electromagnet coils for low power Hall thrusters can offer a significant reduction in both the total electric power consumption and the thruster mass. Two permanent magnet versions of the miniaturized cylindrical Hall thruster (CHT) of different overall dimensions were operated in the power range of 50-300 W. The discharge and plasma plume measurements revealed that the CHT thrusters with permanent magnets and electromagnet coils operate rather differently. In particular, the angular ion current density distribution from the permanent magnet thrusters has an unusual halo shape, with a majority of high energy ions flowing at large angles with respect to the thruster centerline. Differences in the magnetic field topology outside the thruster channel and in the vicinity of the channel exit are likely responsible for the differences in the plume characteristics measured for the CHTs with electromagnets and permanent magnets. It is shown that the presence of the reversing-direction or cusp-type magnetic field configuration inside the thruster channel without a strong axial magnetic field outside the thruster channel does not lead to the halo plasma plume from the CHT.

  11. Cylindrical Hall Thrusters with Permanent Magnets

    SciTech Connect

    Raitses, Yevgeny; Merino, Enrique; Fisch, Nathaniel J.

    2010-10-18

    The use of permanent magnets instead of electromagnet coils for low power Hall thrusters can offer a significant reduction of both the total electric power consumption and the thruster mass. Two permanent magnet versions of the miniaturized cylindrical Hall thruster (CHT) of different overall dimensions were operated in the power range of 50W-300 W. The discharge and plasma plume measurements revealed that the CHT thrusters with permanent magnets and electromagnet coils operate rather differently. In particular, the angular ion current density distribution from the permanent magnet thrusters has an unusual halo shape, with a majority of high energy ions flowing at large angles with respect to the thruster centerline. Differences in the magnetic field topology outside the thruster channel and in the vicinity of the channel exit are likely responsible for the differences in the plume characteristics measured for the CHTs with electromagnets and permanent magnets. It is shown that the presence of the reversing-direction or cusp-type magnetic field configuration inside the thruster channel without a strong axial magnetic field outside the thruster channel does not lead to the halo plasma plume from the CHT. __________________________________________________

  12. Permanent magnet materials and their application

    SciTech Connect

    Campbell, P.

    1994-12-31

    Permanent magnets are of great industrial importance in industrial drives, consumer products, computers, and automobiles. Since 1970, new classes of magnet materials have been developed. This book reviews the older and newer materials and is presented as a comprehensive design text for permanent magnets and their applications. After an initial chapter on the fundamentals of magnetism, the author discusses magnetic physics considerations specific to permanent magnets and describes the fabrications and characteristics of commercial materials: alnico, samarium-cobalt, ferrite, and neodymium-iron-boron. Thermal stability, magnet design procedures, magnetic field analysis methods, and measurement methods are discussed in subsequent chapters, followed by a concluding chapter reviewing commercial and industrial products that use permanent magnets. The chapter on thermal properties of magnet materials is of particular interest, bringing together information not readily found elsewhere. The review of applications is also deserving of attention, specifically the sections on motors and actuators. Although particle accelerator applications are discussed, the use of permanent magnet sextuples in modern ECR ion sources is not mentioned.

  13. Osseointegrated implant prosthodontics.

    PubMed

    Rogoff, G S

    1992-06-01

    This review covers recent literature on prosthodontic aspects of osseointegrated implants. Long-term prognosis, diagnosis and treatment planning, and clinical impression techniques and fabrication technology are discussed.

  14. [Silastic implant and synovitis].

    PubMed

    Sennwald, G

    1989-07-22

    The silastic implant based on siloxane polymere induces granulomatous synovitis in certain predisposed individuals, a reaction which may continue even after removal of the implant. This is also true of a prosthesis of the trapezium in two of our patients, though to a lesser degree. This is probably the reason why the problem has not yet been widely recognized. The hypothesis is put forward that an enzymatic predisposition may allow chemical degradation of the fragmented silastic implant into a toxic component responsible for the pathologic condition. The slow progression of the lesions is a challenge for the future and puts in question the further use of silastic implants.

  15. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States. ...

  16. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States. ...

  17. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States. ...

  18. Permanence and global attractivity for Lotka-Volterra difference systems.

    PubMed

    Lu, Z; Wang, W

    1999-09-01

    The permanence and global attractivity for two-species difference systems of Lotka-Volterra type are considered. It is proved that a cooperative system cannot be permanent. For a permanent competitive system, the explicit expression of the permanent set E is obtained and sufficient conditions are given to guarantee the global attractivity of the positive equilibrium of the system.

  19. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States....

  20. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States....

  1. 13 CFR 120.900 - Sources of permanent financing.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Sources of permanent financing... Development Company Loan Program (504) Permanent Financing § 120.900 Sources of permanent financing. Permanent financing for each Project must come from three sources: the Borrower's contribution, Third-Party Loans, and...

  2. 38 CFR 62.11 - Participants-occupying permanent housing.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... permanent housing. 62.11 Section 62.11 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... permanent housing. (a) Occupying permanent housing. A very low-income veteran family will be considered to be occupying permanent housing if the very low-income veteran family: (1) Is residing in...

  3. Risk Factors Associated With Complication Rates of Becker-Type Expander Implants in Relation to Implant Survival: Review of 314 Implants in 237 Patients.

    PubMed

    Taboada-Suarez, Antonio; Brea-García, Beatriz; Magán-Muñoz, Fernando; Couto-González, Iván; González-Álvarez, Eduardo

    2015-12-01

    Although autologous tissue reconstruction is the best option for breast reconstruction, using implants is still a reliable and simple method, offering acceptable aesthetic results. Becker-type implants are permanent implants that offer a 1-stage reconstructive option. A retrospective study was carried out in our center reviewing the clinical reports of 237 patients, in whom a total of 314 Becker-type prostheses were implanted. Overall survival was calculated using a Kaplan-Meier estimate. Cox proportional hazard models were used to calculate adjusted hazard ratios. At the end of the study, 214 expanders (68.15%) presented no complications, 40 (12.47%) developed significant capsular contracture, in 27 (8.60%) infection occurred, 24 (7.64%) suffered minor complications, and 9 (2.87%) ruptured. The mean survival time of the expanders was 120.41 months (95% CI: 109.62, 131.19). Radiotherapy, chemotherapy, high Molecular Immunology Borstel, age, mastectomy performed previously to the implant, ductal carcinoma, advanced tumoral stage, experience of the surgeon, and Becker 35-type implants were significantly related to a high number of complications in relation to the survival of the implants. Cox regression analysis revealed that the main risk factors for the survival of expander implants included radiotherapy and surgeon experience. The complication hazard ratio or relative risk caused by these 2 factors was 1.976 and 1.680, respectively. One-stage reconstruction using Becker-type expanders is an appropriate, simple, and reliable option in delayed breast reconstruction in patients who have not received radiotherapy and as long as the procedure is carried out by surgeons skilled in the technique.

  4. Critical Role for PAR1 in Kallikrein 6-Mediated Oligodendrogliopathy

    PubMed Central

    Burda, Joshua E.; Radulovic, Maja; Yoon, Hyesook; Scarisbrick, Isobel A.

    2014-01-01

    Kallikrein 6 (Klk6) is a secreted serine protease preferentially expressed by oligodendroglia in CNS white matter. Elevated levels of Klk6 occur in actively demyelinating multiple sclerosis (MS) lesions and in cases of spinal cord injury (SCI), stroke and glioblastoma. Taken with recent evidence establishing Klk6 as a CNS-endogenous activator of protease-activated receptors (PARs), we hypothesized that Klk6 activates a subset of PARs to regulate oligodendrocyte physiology and potentially pathophysiology. Here, primary oligodendrocyte cultures derived from wild type or PAR1-deficient mice and the murine oligodendrocyte cell line, Oli-neu, were used to demonstrate that Klk6 mediates loss of oligodendrocyte processes and impedes morphological differentiation of oligodendrocyte progenitor cells (OPCs) in a PAR1-dependent fashion. Comparable gliopathy was also elicited by the canonical PAR1 agonist, thrombin, as well as PAR1-activating peptides (PAR1-APs). Klk6 also exacerbated ATP-mediated oligodendrogliopathy in vitro, pointing to a potential role in augmenting excitotoxicity. In addition, Klk6 suppressed the expression of proteolipid protein (PLP) RNA in cultured oligodendrocytes by a mechanism involving PAR1-mediated Erk1/2 signaling. Microinjection of PAR1 agonists, including Klk6 or PAR1-APs, into the dorsal column white matter of PAR+/+ but not PAR−/− mice promoted vacuolating myelopathy and a loss of immunoreactivity for myelin basic protein (MBP) and CC-1+ oligodendrocytes. These results demonstrate a functional role for Klk6-PAR1 signaling in oligodendroglial pathophysiology and suggest that PAR1 or PAR1-agonists may represent new targets to moderate demyelination and to promote myelin regeneration in cases of CNS white matter injury or disease. PMID:23832758

  5. Permanent isolation surface barrier: Functional performance

    SciTech Connect

    Wing, N.R.

    1993-10-01

    This document presents the functional performance parameters for permanent isolation surface barriers. Permanent isolation surface barriers have been proposed for use at the Hanford Site (and elsewhere) to isolate and dispose of certain types of waste in place. Much of the waste that would be disposed of using in-place isolation techniques is located in subsurface structures, such as solid waste burial grounds, tanks, vaults, and cribs. Unless protected in some way, the wastes could be transported to the accessible environment via transport pathways, such as water infiltration, biointrusion, wind and water erosion, human interference, and/or gaseous release.

  6. Permanent Pacemaker-Induced Superior Vena Cava Syndrome: Successful Treatment by Endovascular Stent

    SciTech Connect

    Lanciego, Carlos Rodriguez, Mario; Rodriguez, Adela; Carbonell, Miguel A.; Garcia, Lorenzo Garcia

    2003-11-15

    The use of metallic stents in the management of benign and malignant superior vena cava syndrome (SVCS) is well documented. Symptomatic stenosis or occlusion of the SVC is a rare complication of a transvenous permanent pacemaker implant. Suggested treatments have included anticoagulation therapy, thrombolysis, balloon angioplasty and surgery. More recently, endovascular stenting has evolved as an attractive alternative but the data available in the literature are limited. We describe a case in which venous stenting with a Wallstent endoprosthesis was used successfully. The patient remains symptom free and with normal pacemaker function 36 months later.

  7. [Permanent-wear of gas-permeable rigid lenses: a new solution for the aphakic patient].

    PubMed

    Elie, G

    1985-01-01

    The authors reviews his experience during a period of six years with permanent wear gas-permeable hard contact lenses. Problems with dislocation of the lens during sleep was solved by using a diameter of 11 mm. Corneal respiration was maintained due to the oxygen permeability of the new material. A new fitting technique was developed advising daily wear for 8 days post-operatively, extended wear at the 15th day, and the final lens given after 45 days. The results obtained suggests that the technique is a very real alternative to intraocular lens implantation.

  8. Use of Retrievable Compared to Permanent Inferior Vena Cava Filters: A Single-Institution Experience

    SciTech Connect

    Ha, Thuong G. Van Chien, Andy S.; Funaki, Brian S.; Lorenz, Jonathan; Piano, Giancarlo; Shen, Maxine; Leef, Jeffrey

    2008-03-15

    The purpose of this study was to review the use, safety, and efficacy of retrievable inferior vena cava (IVC) filters in their first 5 years of availability at our institution. Comparison was made with permanent filters placed in the same period. A retrospective review of IVC filter implantations was performed from September, 1999, to September, 2004, in our department. These included both retrievable and permanent filters. The Recovery nitinol and Guenther tulip filters were used as retrievable filters. The frequency of retrievable filter used was calculated. Clinical data and technical data related to filter placement were reviewed. Outcomes, including pulmonary embolism, complications associated with placement, retrieval, or indwelling, were calculated. During the study period, 604 IVC filters were placed. Of these, 97 retrievable filters (16%) were placed in 96 patients. There were 53 Recovery filter and 44 Tulip filter insertions. Subjects were 59 women and 37 men; the mean age was 52 years, with a range of from 18 to 97 years. The placement of retrievable filters increased from 2% in year 1 to 32% in year 5 of the study period. The total implantation time for the permanent group was 145,450 days, with an average of 288 days (range, 33-1811 days). For the retrievable group, the total implantation time was 21,671 days, with an average of 226 days (range, 2-1217 days). Of 29 patients who returned for filter retrieval, the filter was successfully removed in 28. There were 14 of 14 successful Tulip filter retrievals and 14 of 15 successful Recovery filter retrievals. In one patient, after an indwelling period of 39 days, a Recovery nitinol filter could not be removed secondary to a large clot burden within the filter. For the filters that were removed, the mean dwell time was 50 days for the Tulip type and 20 days for the Recovery type. Over the follow-up period there was an overall PE incidence of 1.4% for the permanent group and 1% for the retrieval group. In

  9. Permanent or temporary IVC filtration with a novel double-ring anchoring technology optional nitinol filter.

    PubMed

    Rundback, John H; Zybulewski, Adam; Manno, Joseph

    2010-01-01

    Permanent or temporary implantation of inferior vena cava filters for protection against pulmonary embolism is well established. There have been numerous devices developed for this purpose, each of which has proprietary design considerations that affect performance and potentially impose limitations with regard to positioning, efficacy and risk profile. This article describes a recently developed, unique inferior vena cava filter design that employs a separated filtration component and a novel double-ring anchoring system that allows intraprocedural capture and repositioning for optimized placement. In addition, early experience suggests easy removal when desired, a high rate of filtration success and excellent caval patency.

  10. Use of retrievable compared to permanent inferior vena cava filters: a single-institution experience.

    PubMed

    Van Ha, Thuong G; Chien, Andy S; Funaki, Brian S; Lorenz, Jonathan; Piano, Giancarlo; Shen, Maxine; Leef, Jeffrey

    2008-01-01

    The purpose of this study was to review the use, safety, and efficacy of retrievable inferior vena cava (IVC) filters in their first 5 years of availability at our institution. Comparison was made with permanent filters placed in the same period. A retrospective review of IVC filter implantations was performed from September, 1999, to September, 2004, in our department. These included both retrievable and permanent filters. The Recovery nitinol and Günther tulip filters were used as retrievable filters. The frequency of retrievable filter used was calculated. Clinical data and technical data related to filter placement were reviewed. Outcomes, including pulmonary embolism, complications associated with placement, retrieval, or indwelling, were calculated. During the study period, 604 IVC filters were placed. Of these, 97 retrievable filters (16%) were placed in 96 patients. There were 53 Recovery filter and 44 Tulip filter insertions. Subjects were 59 women and 37 men; the mean age was 52 years, with a range of from 18 to 97 years. The placement of retrievable filters increased from 2% in year 1 to 32% in year 5 of the study period. The total implantation time for the permanent group was 145,450 days, with an average of 288 days (range, 33-1811 days). For the retrievable group, the total implantation time was 21,671 days, with an average of 226 days (range, 2-1217 days). Of 29 patients who returned for filter retrieval, the filter was successfully removed in 28. There were 14 of 14 successful Tulip filter retrievals and 14 of 15 successful Recovery filter retrievals. In one patient, after an indwelling period of 39 days, a Recovery nitinol filter could not be removed secondary to a large clot burden within the filter. For the filters that were removed, the mean dwell time was 50 days for the Tulip type and 20 days for the Recovery type. Over the follow-up period there was an overall PE incidence of 1.4% for the permanent group and 1% for the retrieval group. In

  11. Transponders as permanent identification markers for domestic ferrets, black-footed ferrets, and other wildlife

    USGS Publications Warehouse

    Fagerstone, Kathleen A.; Johns, Brad E.

    1987-01-01

    A 0.05-g transponder implanted subcutaneously was tested to see if it provided a reliable identification method. In laboratory tests 20 domestic ferrets (Mustela putorius furo) received transponders and were monitored for a minimum of 6 months. None showed signs of inflammation, and necropsies conducted at the end of the study showed no scar tissue or transponder migration. Seven of 23 transponders failed during the test because of leakage through the plastic case, and a glass case is now being manufactured that does not have the leakage problem. During mark-recapture studies in September and October 1985, transponders were implanted in 20 black-footed ferrets (M. nigripes), 11 of which were subsequently recaptured and 9 of which were brought into captivity; none showed signs of inflammation. Transponders provide a reliable new method for identifying hard-to-mark wildlife with a unique, permanent number than can be read with the animal in-hand or by remote equipment.

  12. Tricuspid valve repair for torrential tricuspid regurgitation after permanent pacemaker lead extraction.

    PubMed

    Mehrotra, Deepak; Kejriwal, Nand K

    2011-01-01

    Tricuspid regurgitation secondary to percutaneous lead extraction is uncommon, and it rarely requires surgical intervention. Most tricuspid regurgitation occurs during the implantation of tined leads, which can be entrapped in the tricuspid valve apparatus and may require immediate withdrawal. Severe tricuspid regurgitation as a sequela of extracting chronically implanted leads has rarely been reported. Herein, we report a case of torrential tricuspid regurgitation in a 67-year-old woman after the extraction of a permanent pacemaker lead. The regurgitation was confirmed on transesophageal echocardiography during lead extraction, and the tricuspid valve was successfully repaired with suture bicuspidization of the valve and the support of ring annuloplasty. A short review of the relevant literature follows the case report.

  13. Suicide attempt by complete self-removal of a 12-year-old permanent pacemaker system: case report.

    PubMed

    Norgaard, Mette Lykke; Melchior, Thomas; Wagner, Thomas; Haugan, Ketil

    2014-01-01

    Psychological adaption after pacemaker implantation can be challenging in patients with psychiatric disease. Suicide by self-removal of a permanent pacemaker system is a rare phenomenon described in a few cases in patients with psychiatric disorders. We describe a case of attempted suicide by complete self-removal of a 12-year-old permanent pacemaker system in a 70-year-old male patient with a bipolar disorder and a history of previous suicide attempts. Suicide attempt by self-removal of a permanent pacemaker system is very rare. In patients with a history of psychiatric disease and previous suicide attempts, careful information about the function of a pacemaker should be given. © 2014 Wiley Periodicals, Inc.

  14. Developpement d'algorithmes de reconstruction statistique appliques en tomographie rayons-X assistee par ordinateur

    NASA Astrophysics Data System (ADS)

    Thibaudeau, Christian

    de geometrie d'acquisition. Le present memoire se consacre a l'etude de ces algorithmes statistiques en imagerie TDM et a leur implantation logicielle. Le prototype d'imageur TEP/TDM base sur la technologie LabPET(TM) de l'Universite de Sherbrooke possede tous les pre-requis pour beneficier de ces nombreux avantages. Mot-cles : tomodensitometrie (TDM), reconstruction statistique, reconstruction iterative, scanner, rayons-z, tomographie d'emission par positrons (TEP), TEP/TDM

  15. Association between implantation depth assessed by computed tomography and new-onset conduction disturbances after transcatheter aortic valve implantation.

    PubMed

    Almeida, João Gonçalves; Ferreira, Sara Moura; Fonseca, Paulo; Dias, Tiago; Guerreiro, Cláudio; Barbosa, Ana Raquel; Teixeira, Pedro; Carvalho, Mónica; Ferreira, Wilson; Ferreira, Nuno Dias; Oliveira, Marco; Gonçalves, Helena; Braga, Pedro; Ribeiro, José; Primo, João; Ribeiro, Vasco Gama

    Transcatheter aortic valve replacement (TAVR) is often associated with intraventricular conduction disturbances. We aimed to determine the association between implantation depth assessed by multidetector computed tomography (MDCT) and new-onset conduction abnormalities after TAVR. Retrospective single-center study including patients consecutively submitted to TAVR, between August/2007 and October/2016, who underwent routine MDCT 3 months after the procedure. The endpoint of conduction disturbances included permanent pacemaker implantation and/or new-onset left bundle-branch block. Implantation depth was determined as the distance between the ventricular end of the prothesis and the native ring, at the level of the non-coronary cusp. 138 patients were included (female gender 52.2%, mean age 78.7 ± 6.9 years). The EuroSCORE II was 4.0 ± 3.9% and 57.2% were treated with self-expanding prosthesis. The endpoint of conduction abnormalities was found in 45.7% (n = 63). The implantation depth was greater in the group with conduction disturbances (7.7 vs 6.4 mm, p = 0.006). Chronic obstructive pulmonary disease, oversizing and implantation depth were independent predictors of conduction abnormalities. Implantation depth had an AUC of 0.64 (p = 0.004) for the prediction of conduction abnormalities and a cut-off value of 7.1 mm predicted the composed endpoint with a sensitivity and specificity of 65% and 70%, respectively. Implantation depth assessed by MDCT is associated with new-onset conduction disturbances after TAVR. In patients with conduction abnormalities, which do not qualify for the immediate implantation of pacemaker, the assessment of implantation depth by MDCT may be an additional marker of risk to aid decision-making. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  16. Bilateral irreversible severe vision loss from cosmetic iris implants.

    PubMed

    George, Mathew K; Tsai, James C; Loewen, Nils A

    2011-05-01

    To report a case of bilateral neovascular glaucoma with central retinal vein occlusions secondary to cosmetic iris implantation. Interventional case report. setting: Tertiary care center; ophthalmology clinic. patient: A 25-year-old woman presented with persistent bilateral blurry vision after simultaneous bilateral cosmetic iris implantation. Examination showed best-corrected visual acuity of hand motion in the right and 20/400 in the left eye with intraocular pressures (IOP) of 48 mm Hg in the right and 40 mm Hg in the left eye on maximal medical therapy. She had bilateral neovascularization of the iris and angle with synechial angle closure, surgical aniridia, central retinal vein occlusion, and end-stage glaucomatous optic neuropathy. She was diagnosed with neovascular glaucoma in both eyes, associated with cosmetic iris implants. intervention procedures: Humphrey 24-2 visual field testing, optic nerve coherence tomography, and fundus imaging were performed. After bilateral intravitreal bevacizumab and panretinal photocoagulation, Ahmed glaucoma drainage devices were implanted in both eyes. main outcome measures: IOP, anterior chamber inflammation, neovascularization. Despite aggressive treatment, severe permanent bilateral vision loss ensued. We strongly advise against the use of anterior chamber iris implants for cosmetic indications. Close monitoring of implanted individuals is necessary. Explantation should be considered at the earliest sign of adverse reaction. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. A Threat to Autonomy? The Intrusion of Predictive Brain Implants.

    PubMed

    Gilbert, Frederic

    2015-10-02

    The world's first-in-human clinical trial using invasive intelligent brain devices-devices that predict specific neuronal events directly to the implanted person-has been completed with significant success. Predicting brain activity before specific outcomes occur brings a raft of unprecedented applications, especially when implants offer advice on how to respond to the neuronal events forecasted. Although these novel predictive and advisory implantable devices offer great potential to positively affect patients following surgery by enhancing quality of life (e.g., provide control over symptoms), substantial ethical concerns remain. The invasive nature of these novel devices is not unique; however, the inclusion of predictive and advisory functionalities within the implants, involving permanent monitoring of brain activity in real time, raises new ethical issues to explore, especially in relation to concerns for patient autonomy. What might be the effects of ongoing monitoring of predictive and advisory brain technologies on a patient's postoperative sense of autonomy? The role played by predictive and advisory implantable brain devices on patient's feelings of autonomy following surgery is completely unknown. The first section of this article addresses this shortcoming by reporting on a pilot study that we conducted with one of the patients implanted with one of these novel brain devices. The second section examines how overreliance on predictive and advisory brain technologies may threaten patients' autonomy. The third section looks into ethical problems concerning how devices delivering automated therapeutic responses might, hypothetically speaking, be used to monitor and control individual's autonomy through inhibition of undesirable behaviors.

  18. A Threat to Autonomy? The Intrusion of Predictive Brain Implants

    PubMed Central

    Gilbert, Frederic

    2015-01-01

    The world's first-in-human clinical trial using invasive intelligent brain devices—devices that predict specific neuronal events directly to the implanted person—has been completed with significant success. Predicting brain activity before specific outcomes occur brings a raft of unprecedented applications, especially when implants offer advice on how to respond to the neuronal events forecasted. Although these novel predictive and advisory implantable devices offer great potential to positively affect patients following surgery by enhancing quality of life (e.g., provide control over symptoms), substantial ethical concerns remain. The invasive nature of these novel devices is not unique; however, the inclusion of predictive and advisory functionalities within the implants, involving permanent monitoring of brain activity in real time, raises new ethical issues to explore, especially in relation to concerns for patient autonomy. What might be the effects of ongoing monitoring of predictive and advisory brain technologies on a patient's postoperative sense of autonomy? The role played by predictive and advisory implantable brain devices on patient's feelings of autonomy following surgery is completely unknown. The first section of this article addresses this shortcoming by reporting on a pilot study that we conducted with one of the patients implanted with one of these novel brain devices. The second section examines how overreliance on predictive and advisory brain technologies may threaten patients' autonomy. The third section looks into ethical problems concerning how devices delivering automated therapeutic responses might, hypothetically speaking, be used to monitor and control individual's autonomy through inhibition of undesirable behaviors. PMID:26740906

  19. Implantable ultrasound devices

    NASA Astrophysics Data System (ADS)

    Vilkomerson, David; Chilipka, Thomas; Bogan, John; Blebea, John; Choudry, Rashad; Wang, John; Salvatore, Michael; Rotella, Vittorio; Soundararajan, Krishnan

    2008-03-01

    Using medical implants to wirelessly report physiological data is a technique that is rapidly growing. Ultrasound is well-suited for implants -- it requires little power and this form of radiated energy has no ill effects on the body. We report here on techniques we have developed in our experience gained in implanting over a dozen Doppler ultrasound flow-measuring implants in dogs. The goal of our implantable device is to measure flow in an arterial graft. To accomplish this, we place a Doppler transducer in the wall of a graft and an implant unit under the skin that energizes the 20 MHz Doppler transducer system, either when started by external command or by internal timetable. The implant records the digitized Doppler real and imaginary channels and transmits the data to a nearby portable computer for storage and evaluation. After outlining the overall operation of the system, we will concentrate on three areas of implant design where special techniques are required: ensuring safety, including biocompatibility to prevent the body from reacting to its invasion; powering the device, including minimizing energy used so that a small battery can provide long-life; and transmitting the data obtained.

  20. Batteryless implanted echosonometer

    NASA Technical Reports Server (NTRS)

    Kojima, G. K.

    1977-01-01

    Miniature ultrasonic echosonometer implanted within laboratory animals obtains energy from RF power oscillator that is electronically transduced via induction loop to power receiving loop located just under animal's skin. Method of powering device offers significant advantages over those in which battery is part of implanted package.

  1. Implantable, Ingestible Electronic Thermometer

    NASA Technical Reports Server (NTRS)

    Kleinberg, Leonard

    1987-01-01

    Small quartz-crystal-controlled oscillator swallowed or surgically implanted provides continuous monitoring of patient's internal temperature. Receiver placed near patient measures oscillator frequency, and temperature inferred from previously determined variation of frequency with temperature. Frequency of crystal-controlled oscillator varies with temperature. Circuit made very small and implanted or ingested to measure internal body temperature.

  2. A no bleed implant.

    PubMed

    Ersek, R A; Navarro, J A; Nemeth, D Z; Sas, G

    1993-01-01

    Breast implants have evolved from the original saline-filled, smooth-surfaced silicone rubber bag to silicone gel-filled smooth-walled sacs to a combination of a silicone gel-filled bag within a saline-filled sac, and, most recently, a reversed, double-lumen implant with a saline bag inside of a gel-filled bag. Texture-surfaced implants were first used in 1970 when the standard silicone gel-filled implant was covered with a polyurethane foam. Because of concerns about the degradation products of this foam, they were removed from the market in 1991. In 1975 double-lumen silicone textured implants were developed, followed by silicone gel-filled textured implants. In 1990 a new radiolucent, biocompatible gel was produced that reduced the problem of radioopacity of silicone implants. Because of the gel's sufficiently low coefficient of friction, leakage caused by fold flaw fracture may also be decreased. We present a case where this new biocompatible gel implant was repositioned after four months. The resulting scar capsule in this soft breast was thin [< 0.002 cm (0.008 in.)] and evenly textured as a mirror image of the textured silicone surface. Scanning electron microscopy and x-ray defraction spectrophotometry revealed no silicone bleed.

  3. Smoking and dental implants

    PubMed Central

    Kasat, V.; Ladda, R.

    2012-01-01

    Smoking is a prevalent behaviour in the population. The aim of this review is to bring to light the effects of smoking on dental implants. These facts will assist dental professionals when implants are planned in tobacco users. A search of “PubMed” was made with the key words “dental implant,” “nicotine,” “smoking,” “tobacco,” and “osseointegration.” Also, publications on tobacco control by the Government of India were considered. For review, only those articles published from 1988 onward in English language were selected. Smoking has its influence on general as well as oral health of an individual. Tobacco negatively affects the outcome of almost all therapeutic procedures performed in the oral cavity. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and the risk of peri-implantitis are adversely affected by smoking. To increase implant survival in smokers, various protocols have been recommended. Although osseointegrated dental implants have become the state of the art for tooth replacement, they are not without limitations or complications. In this litigious era, it is extremely important that the practitioner clearly understands and is able and willing to convey the spectrum of possible complications and their frequency to the patients. PMID:24478965

  4. Batteryless implanted echosonometer

    NASA Technical Reports Server (NTRS)

    Kojima, G. K.

    1977-01-01

    Miniature ultrasonic echosonometer implanted within laboratory animals obtains energy from RF power oscillator that is electronically transduced via induction loop to power receiving loop located just under animal's skin. Method of powering device offers significant advantages over those in which battery is part of implanted package.

  5. Implantable CMOS Biomedical Devices

    PubMed Central

    Ohta, Jun; Tokuda, Takashi; Sasagawa, Kiyotaka; Noda, Toshihiko

    2009-01-01

    The results of recent research on our implantable CMOS biomedical devices are reviewed. Topics include retinal prosthesis devices and deep-brain implantation devices for small animals. Fundamental device structures and characteristics as well as in vivo experiments are presented. PMID:22291554

  6. Teeth and implants.

    PubMed

    Palmer, R

    1999-08-28

    An osseointegrated implant restoration may closely resemble a natural tooth. However, the absence of a periodontal ligament and connective tissue attachment via cementum, results in fundamental differences in the adaptation of the implant to occlusal forces, and the structure of the gingival cuff.

  7. Inhibition of diacylglycerol lipase (DAGL) in the lateral hypothalamus of rats prevents the increase in REMS and food ingestion induced by PAR1 stimulation.

    PubMed

    Pérez-Morales, Marcel; López-Colomé, Ana María; Méndez-Díaz, Mónica; Ruiz-Contreras, Alejandra E; Prospéro-García, Oscar

    2014-08-22

    Stimulation of the protease-activated receptor 1 (PAR1) in vitro, was shown to induce synaptic retrograde signaling through the endocannabinoid 2-arachidonoylglycerol (2-AG) synthesis and activation of the cannabinoid receptor type 1 (CB1R). The activation of PAR1 by the agonist S1820 in the lateral hypothalamus (LH) increases rapid eye movement sleep (REMS) and food intake in rats, and both effects are prevented by the CB1R inverse agonist AM251. In the present study, we implanted rats with electrodes and with cannulae aimed bilaterally to the LH. We administered tetrahydrolipstatin (THL), an inhibitor of the diacylglycerol lipase (DAGL), the enzyme responsible for 2-AG synthesis, to evaluate the sleep-wake cycle and food ingestion. THL in the LH readily prevented the increase in REMS and food intake induced by PAR1 stimulation, further supporting 2-AG as an upstream activator of PAR1. Our results demonstrate that the effect of PAR1 on REMS and food intake is blocked by the inhibition of DAGL, further suggesting that PAR1 stimulation in the lateral hypothalamus of rats induces an increase in sleep and food intake through 2-AG.

  8. Antibacterial titanium surfaces for medical implants.

    PubMed

    Ferraris, S; Spriano, S

    2016-04-01

    Bacterial contamination is a critical problem in different fields (ranging from everyday life to space missions, and from medicine to biosensing). Specifically, in the case of medical implants, foreign materials are preferential sites for bacterial adhesion and microbial contamination, which can lead to the development of prosthetic infections. These problems can in turn lead to the necessity of a prolonged antibiotic therapy (which can last for years) and eventually to the removal of the device, with a consequent significant increase in the hospitalization times and costs, together with a stressful, painful and critical situation for the patient. Commercially pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone, and the prevention of infections on their surface is therefore a crucial challenge for orthopaedic and dental surgeons. The problem of the bacterial contamination of medical implants is briefly described in the first part of the present review. Then the most important inorganic antibacterial agents (Ag, Cu and Zn) are described, and this is followed by a review of the reported attempts of their introduction onto the surface of Ti-based substrates. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Percutaneous and skeletal biocarbon implants

    NASA Technical Reports Server (NTRS)

    Mooney, V.

    1977-01-01

    Review of carbon implants developed by NASA discussed four different types of implants and subsequent improvements. Improvements could be of specific interest to rehabilitation centers and similar organizations.

  10. Percutaneous and skeletal biocarbon implants

    NASA Technical Reports Server (NTRS)

    Mooney, V.

    1977-01-01

    Review of carbon implants developed by NASA discussed four different types of implants and subsequent improvements. Improvements could be of specific interest to rehabilitation centers and similar organizations.

  11. [Use of percutaneous anesthesia in cardiac pacemaker implantation].

    PubMed

    Trigano, J A; Paganelli, F; Taramasco, V; Levy, S; Lorec, A M; Blin, O; Bruguerolle, B

    Assess the efficacy of an anesthesic cream for pacemaker implantations. Percutaneous anesthesia was studied in a series of permanent pacemaker transvenous implantations. The anesthesic cream composed of a mixture of lidocaine and prilocaine was applied precisely over operative areas after marking the skin. Percutaneous anesthesia should be applied 2 hours before entering the operating room. This percutaneous local anesthesia was perfectly effective for simple replacement procedures. At first implantations, it was used alone in 4 out of 10 cases while intradermal injections were needed to anesthetize the deep layers in the other patients. Serum concentrations indicate very low levels which are tolerated very well. Alone or combined with lidocaine infiltration, the use of an anesthesic cream is safe and effective in transvenous pacemaker surgery.

  12. Graphene for Biomedical Implants

    NASA Astrophysics Data System (ADS)

    Moore, Thomas; Podila, Ramakrishna; Alexis, Frank; Rao, Apparao; Clemson Bioengineering Team; Clemson Physics Team

    2013-03-01

    In this study, we used graphene, a one-atom thick sheet of carbon atoms, to modify the surfaces of existing implant materials to enhance both bio- and hemo-compatibility. This novel effort meets all functional criteria for a biomedical implant coating as it is chemically inert, atomically smooth and highly durable, with the potential for greatly enhancing the effectiveness of such implants. Specifically, graphene coatings on nitinol, a widely used implant and stent material, showed that graphene coated nitinol (Gr-NiTi) supports excellent smooth muscle and endothelial cell growth leading to better cell proliferation. We further determined that the serum albumin adsorption on Gr-NiTi is greater than that of fibrinogen, an important and well understood criterion for promoting a lower thrombosis rate. These hemo-and biocompatible properties and associated charge transfer mechanisms, along with high strength, chemical inertness and durability give graphene an edge over most antithrombogenic coatings for biomedical implants and devices.

  13. Ejaculatory Function After Permanent {sup 125}I Prostate Brachytherapy for Localized Prostate Cancer

    SciTech Connect

    Huyghe, Eric Delannes, Martine; Wagner, Fabien M.; Delaunay, Boris; Nohra, Joe; Thoulouzan, Matthieu; Shut-Yee, J. Yeung; Plante, Pierre; Soulie, Michel; Thonneau, Patrick; Bachaud, Jean Marc

    2009-05-01

    Purpose: Ejaculatory function is an underreported aspect of male sexuality in men treated for prostate cancer. We conducted the first detailed analysis of ejaculatory function in patients treated with permanent {sup 125}I prostate brachytherapy for localized prostate cancer. Patients and Methods: Of 270 sexually active men with localized prostate cancer treated with permanent {sup 125}I prostate brachytherapy, 241 (89%), with a mean age of 65 years (range, 43-80), responded to a mailed questionnaire derived from the Male Sexual Health Questionnaire regarding ejaculatory function. Five aspects of ejaculatory function were examined: frequency, volume, dry ejaculation, pleasure, and pain. Results: Of the 241 sexually active men, 81.3% had conserved ejaculatory function after prostate brachytherapy; however, the number of patients with rare/absent ejaculatory function was double the pretreatment number (p < .0001). The latter finding was correlated with age (p < .001) and the preimplant International Index of Erectile Function score (p < .001). However, 84.9% of patients with maintained ejaculatory function after implantation reported a reduced volume of ejaculate compared with 26.9% before (p < .001), with dry ejaculation accounting for 18.7% of these cases. After treatment, 30.3% of the patients experienced painful ejaculation compared with 12.9% before (p = .0001), and this was associated with a greater number of implanted needles (p = .021) and the existence of painful ejaculation before implantation (p < .0001). After implantation, 10% of patients who continued to be sexually active experienced no orgasm compared with only 1% before treatment. in addition, more patients experienced late/difficult or weak orgasms (p = .001). Conclusion: Most men treated with brachytherapy have conserved ejaculatory function after prostate brachytherapy. However, most of these men experience a reduction in volume and a deterioration in orgasm.

  14. New approach for immediate prosthetic rehabilitation of the edentulous mandible with three implants: a retrospective study.

    PubMed

    Hatano, Naoki; Yamaguchi, Masahiko; Yaita, Tomoyuki; Ishibashi, Takao; Sennerby, Lars

    2011-11-01

    Immediate/early prosthetic rehabilitation of the edentulous mandible with four or more implants for support of a fixed bridge is a well-documented procedure. Only a few studies have reported on the outcome of using three implants for this purpose. To retrospectively analyze the clinical outcome when using three implants for support of an immediately loaded fixed bridge in the totally edentulous mandible. In total, 132 patients (67 females and 65 males, mean age 62.6 years, range 35-85 years) treated with 396 implants (Brånemark System) over an 11-year period in one clinic were retrospectively analyzed with regard to implant survival. Implants with both machined and oxidized surface had been used. Eighty percent of the implants were 13 mm in length or longer. The permanent bridge with acrylic teeth was delivered to the patient the same day. The patients were re-called annually for clinical examinations. All patients had been followed for at least 1 year, with the longest follow-up of 10 years and a mean follow-up of 5 years. Thirteen implant failures in 10 patients were experienced, all occurring during the first 12 months of loading. The overall survival rate was 96.7% for implants and 92.4% for original bridges. More machined than oxidized implants failed, 7% vs. 1.2%. Fourteen additional implants were placed at the time of removal of the failed implants when also the fixed bridge was adjusted on the same day. Thus, all patients received and maintained a fixed bridge, except for a few hours in the 10 failure cases when the bridges were adjusted. This retrospective survival analysis shows that three implants can be used to support a fixed bridge for immediate loading in the edentulous mandible. The study indicated that oxidized implants were more successful than machined ones. © 2011 John Wiley & Sons A/S.

  15. The novel PAR2 ligand C391 blocks multiple PAR2 signalling pathways in vitro and in vivo

    PubMed Central

    Boitano, Scott; Hoffman, Justin; Flynn, Andrea N; Asiedu, Marina N; Tillu, Dipti V; Zhang, Zhenyu; Sherwood, Cara L; Rivas, Candy M; DeFea, Kathryn A; Vagner, Josef; Price, Theodore J

    2015-01-01

    Background and Purpose Proteinase-activated receptor-2 (PAR2) is a GPCR linked to diverse pathologies, including acute and chronic pain. PAR2 is one of the four PARs that are activated by proteolytic cleavage of the extracellular amino terminus, resulting in an exposed, tethered peptide agonist. Several peptide and peptidomimetic agonists, with high potency and efficacy, have been developed to probe the functions of PAR2, in vitro and in vivo. However, few similarly potent and effective antagonists have been described. Experimental Approach We modified the peptidomimetic PAR2 agonist, 2-furoyl-LIGRLO-NH2, to create a novel PAR2 peptidomimetic ligand, C391. C391 was evaluated for PAR2 agonist/antagonist activity to PAR2 across Gq signalling pathways using the naturally expressing PAR2 cell line 16HBE14o-. For antagonist studies, a highly potent and specific peptidomimetic agonist (2-aminothiazo-4-yl-LIGRL-NH2) and proteinase agonist (trypsin) were used to activate PAR2. C391 was also evaluated in vivo for reduction of thermal hyperalgesia, mediated by mast cell degranulation, in mice. Key Results C391 is a potent and specific peptidomimetic antagonist, blocking multiple signalling pathways (Gq-dependent Ca2+, MAPK) induced following peptidomimetic or proteinase activation of human PAR2. In a PAR2-dependent behavioural assay in mice, C391 dose-dependently (75 μg maximum effect) blocked the thermal hyperalgesia, mediated by mast cell degranulation. Conclusions and Implications C391 is the first low MW antagonist to block both PAR2 Ca2+ and MAPK signalling pathways activated by peptidomimetics and/or proteinase activation. C391 represents a new molecular structure for PAR2 antagonism and can serve as a basis for further development for this important therapeutic target. PMID:26140338

  16. The low-field permanent magnet electrostatic plasma lens

    NASA Astrophysics Data System (ADS)

    Goncharov, A.; Gorshkov, V.; Maslov, V.; Zadorozhny, V.; Brown, I.

    2004-05-01

    We describe the status of ongoing research and development of the electrostatic plasma lens as used for the manipulation of high current broad beams of heavy ions of moderate energy. In some collaborative work at Lawrence Berkeley National Laboratory the lens was used to good effect for carrying out high dose ion implantation processing. In the process of this work a very narrow range of low magnetic field was found for which the ion-optical characteristics of the lens improved markedly. Subsequent theoretical analysis and computer modeling has led to an understanding of this phenomenon. These serendipitous results open up some attractive possibilities for the development of a new compact and low cost plasma lens based on permanent magnets rather than on current-driven field coils surrounding the lens volume. The development of this kind of lens, including both very low noise and minimal spherical aberration effects, may lead to a tool suitable for use in the injection beam lines of high current heavy ion linear accelerators. Here we briefly review the lens fundamentals, some characteristics of focusing heavy ion beams at low magnetic fields, and summarize recent theoretical and experimental developments, with emphasis on the relevance and suitability of the lens for accelerator injection application.

  17. Sexism and Permanent Exclusion from School

    ERIC Educational Resources Information Center

    Carlile, Anna

    2009-01-01

    Focussing on narratives collected during a two year participant observation research project in the children's services department of an urban local authority, this article addresses the intersection between incidents of permanent exclusion from school and assumptions made on the basis of a young person's gender. The article considers gendered…

  18. War Crimes Tribunals: A Permanent Criminal Court?

    ERIC Educational Resources Information Center

    Dorsey, James E.; Rudelius-Palmer, Kristi

    1997-01-01

    Reports on the establishment and jurisdiction of war crimes tribunals in recent years. The tribunals, established and supported by the United Nations, investigate atrocities and other crimes committed during wartime. Discusses the tribunals in Rwanda and Yugoslavia, and the political opposition to the establishment of a permanent court. (MJP)

  19. Permanent Further Education: Chapter II, Section 2.

    ERIC Educational Resources Information Center

    Ministry of Education and Science, Bonn (West Germany).

    Permanent further education means "that organized learning is extended to cover later stages in life, and that the attitude towards education changes considerably." Further education comprises further vocational training, retraining at other educational establishments, and adult education. It supplements the traditional courses of…

  20. PROCEDURE FOR ESTIMATING PERMANENT TOTAL ENCLOSURE COSTS

    EPA Science Inventory

    The paper discusses a procedure for estimating permanent total enclosure (PTE) costs. (NOTE: Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use PTEs, enclosures that mee...

  1. A comparison of periodic versus permanent surveys

    Treesearch

    Michael Kohl; Charles T. Scott

    2000-01-01

    Extensive forest surveys can be periodic or permanent, regional or national, can include midcycle updates or not, or use partial replacement of plots or not. Fifty-two combinations of these and other factors were evaluated, not solely on a statistical basis, but also on their perceived ability to meet various design and customer objectives. These criteria include...

  2. Permanent field plot methodology and equipment

    Treesearch

    Thomas G. Cole

    1993-01-01

    Long-term research into the composition, phenology, yield, and growth rates of agroforests can be accomplished with the use of permanent field plots. The periodic remeasurement of these plots provides researchers a quantitative measure of what changes occur over time in indigenous agroforestry systems.

  3. PROCEDURE FOR ESTIMATING PERMANENT TOTAL ENCLOSURE COSTS

    EPA Science Inventory

    The paper discusses a procedure for estimating permanent total enclosure (PTE) costs. (NOTE: Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use PTEs, enclosures that mee...

  4. Sexism and Permanent Exclusion from School

    ERIC Educational Resources Information Center

    Carlile, Anna

    2009-01-01

    Focussing on narratives collected during a two year participant observation research project in the children's services department of an urban local authority, this article addresses the intersection between incidents of permanent exclusion from school and assumptions made on the basis of a young person's gender. The article considers gendered…

  5. War Crimes Tribunals: A Permanent Criminal Court?

    ERIC Educational Resources Information Center

    Dorsey, James E.; Rudelius-Palmer, Kristi

    1997-01-01

    Reports on the establishment and jurisdiction of war crimes tribunals in recent years. The tribunals, established and supported by the United Nations, investigate atrocities and other crimes committed during wartime. Discusses the tribunals in Rwanda and Yugoslavia, and the political opposition to the establishment of a permanent court. (MJP)

  6. 27 CFR 18.38 - Permanent discontinuance.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Permanent discontinuance. 18.38 Section 18.38 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Qualification...

  7. 27 CFR 18.38 - Permanent discontinuance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Permanent discontinuance. 18.38 Section 18.38 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Qualification...

  8. Developments in electrical machines using permanent magnets

    NASA Astrophysics Data System (ADS)

    Chalmers, B. J.

    1996-05-01

    The availability of high-field permanent-magnet materials has created opportunities for the development of electrical machines with advantageous properties including high efficiency, compact size, low weight and brushless operation. The paper reports the design and performance of a number of motors and generators which have recently been developed and demonstrated.

  9. [Pets as permanent excretors of zoonoses pathogens].

    PubMed

    Mayr, B

    1993-02-01

    When scrutinizing zoonoses with regard to risks for human beings, the spectrum of pathogens with dogs, cats and birds leading to persistent infections and consequently to the fact that the animals become carriers and permanent excretors is relatively small. Most of the zoonoses cause clinical symptoms and will be taken care of correspondingly. With regard to dogs there is a multitude of persistent infections that are transferred from the pet to the human being and vice versa. In reality, however, the importance of the dog as permanent excretor of zoonosis pathogens endangering human health is minimal, except for some parasitoses. As far as cats are concerned, the situation is totally different. Cats are carriers and permanent excretors of pasteurella, the pathogens of the so-called cat-scratch disease, trichophyton and microsporum species, toxoplasmosis and orthopox viruses. The new zoonosis feline pox serves as an example of the necessity of a permanent observation of persistently infected pets. Healthy, but persistently infected birds form a source of infection not to be underestimated. Through the beat of their wings they constantly stir up dried infectious excrements and dust and thus favour the airborn infection of human beings. Chlamydia psittaci, the Newcastle disease virus and Mycobacterium avium are of major importance in this context. The risk of transferring zoonosis pathogens from persistently infected pets to human beings can be minimized through prophylactic diagnosis, strict measures of hygiene, observation of the schedule of vaccinations for the respective species and regular use of anthelmintica.

  10. Pupil Dilation and Object Permanence in Infants

    ERIC Educational Resources Information Center

    Sirois, Sylvain; Jackson, Iain R.

    2012-01-01

    This paper examines the relative merits of looking time and pupil diameter measures in the study of early cognitive abilities of infants. Ten-month-old infants took part in a modified version of the classic drawbridge experiment used to study object permanence (Baillargeon, Spelke, & Wasserman, 1985). The study involved a factorial design where…

  11. Considerations on the Development of Permanent Education.

    ERIC Educational Resources Information Center

    Ogunsbiye, Ayo

    This document presents possible ways in which Permanent Education in France could develop, based on experiments and research carried out at the Centre Universitaire de Cooperation Economique et Sociale (CUCES) and at the Institut National pour la Formation des Adults (INFA). Part one includes the following: the good to be had from continuing…

  12. The history of permanent-magnet materials

    NASA Astrophysics Data System (ADS)

    Livingston, J. D.

    1990-02-01

    From lodestones and carbon steels to today's rare-earth magnets, a steady improvement in magnetic properties has expanded the technological importance of permanent-magnet materials. These materials have progressed through several major developmental stages, with a bit of serendipity contributing to the discovery process.

  13. Dovetail spoke internal permanent magnet machine

    DOEpatents

    Alexander, James Pellegrino; EL-Refaie, Ayman Mohamed Fawzi; Lokhandwalla, Murtuza; Shah, Manoj Ramprasad; VanDam, Jeremy Daniel

    2011-08-23

    An internal permanent magnet (IPM) machine is provided. The IPM machine includes a stator assembly and a stator core. The stator core also includes multiple stator teeth. The stator assembly is further configured with stator windings to generate a stator magnetic field when excited with alternating currents and extends along a longitudinal axis with an inner surface defining a cavity. The IPM machine also includes a rotor assembly and a rotor core. The rotor core is disposed inside the cavity and configured to rotate about the longitudinal axis. The rotor assembly further includes a shaft. The shaft further includes multiple protrusions alternately arranged relative to multiple bottom structures provided on the shaft. The rotor assembly also includes multiple stacks of laminations disposed on the protrusions and dovetailed circumferentially around the shaft. The rotor assembly further includes multiple pair of permanent magnets for generating a magnetic field, which magnetic field interacts with the stator magnetic field to produce a torque. The multiple pair of permanent magnets are disposed between the stacks. The rotor assembly also includes multiple middle wedges mounted between each pair of the multiple permanent magnets.

  14. Review of PAR parameterizations in ocean ecosystem models

    NASA Astrophysics Data System (ADS)

    Byun, Do-Seong; Wang, Xiao Hua; Hart, Deirdre E.; Zavatarelli, Marco

    2014-12-01

    Commonly-used empirical equations for calculating downward 'photosynthetically available radiation' or PAR were reviewed in order to identify a more theoretically-sound parameterization for application to ocean biogeochemical models. Three different forms of broadband PAR parameterization are currently employed in biogeochemical models, each of them originating from the downward irradiance formulations normally applied to ocean circulation models, which produce poor attenuation estimates for PAR. Two of the PAR formulations, a single-exponential function and a double-exponential function, are parameterized by multiplying surface irradiance by a coefficient determining the portion of underwater PAR. The third formulation uses the second term of the double-exponential function. After elucidating the theoretical problems of modeling PAR using these parameterizations, we suggest an improved, R-modified double-exponential PAR formulation, including Paulson and Simpson's (1977) parameter values. We also newly estimate PAR penetration via least-squares fitting of values digitized from Jerlov's (1976) observations in different oceanic water types, and compare this PAR-observation derived parameterization with our new, theoretical, R-modified parameterization. Finally, we discuss a universal limitation inherent in current theoretical approaches to PAR parameterization.

  15. Modelisation par elements finis du muscle strie

    NASA Astrophysics Data System (ADS)

    Leonard, Mathieu

    Ce present projet de recherche a permis. de creer un modele par elements finis du muscle strie humain dans le but d'etudier les mecanismes engendrant les lesions musculaires traumatiques. Ce modele constitue une plate-forme numerique capable de discerner l'influence des proprietes mecaniques des fascias et de la cellule musculaire sur le comportement dynamique du muscle lors d'une contraction excentrique, notamment le module de Young et le module de cisaillement de la couche de tissu conjonctif, l'orientation des fibres de collagene de cette membrane et le coefficient de poisson du muscle. La caracterisation experimentale in vitro de ces parametres pour des vitesses de deformation elevees a partir de muscles stries humains actifs est essentielle pour l'etude de lesions musculaires traumatiques. Le modele numerique developpe est capable de modeliser la contraction musculaire comme une transition de phase de la cellule musculaire par un changement de raideur et de volume a l'aide des lois de comportement de materiau predefinies dans le logiciel LS-DYNA (v971, Livermore Software Technology Corporation, Livermore, CA, USA). Le present projet de recherche introduit donc un phenomene physiologique qui pourrait expliquer des blessures musculaires courantes (crampes, courbatures, claquages, etc.), mais aussi des maladies ou desordres touchant le tissu conjonctif comme les collagenoses et la dystrophie musculaire. La predominance de blessures musculaires lors de contractions excentriques est egalement exposee. Le modele developpe dans ce projet de recherche met ainsi a l'avant-scene le concept de transition de phase ouvrant la porte au developpement de nouvelles technologies pour l'activation musculaire chez les personnes atteintes de paraplegie ou de muscles artificiels compacts pour l'elaboration de protheses ou d'exosquelettes. Mots-cles Muscle strie, lesion musculaire, fascia, contraction excentrique, modele par elements finis, transition de phase

  16. Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology.

    PubMed

    Nag, Subir; Demanes, D Jeffrey; Hagan, Michael; Rivard, Mark J; Thomadsen, Bruce R; Welsh, James S; Williamson, Jeffrey F

    2011-10-01

    The Nuclear Regulatory Commission deems it to be a medical event (ME) if the total dose delivered differs from the prescribed dose by 20% or more. A dose-based definition of ME is not appropriate for permanent prostate brachytherapy as it generates too many spurious MEs and thereby creates unnecessary apprehension in patients, and ties up regulatory bodies and the licensees in unnecessary and burdensome investigations. A more suitable definition of ME is required for permanent prostate brachytherapy. The American Society for Radiation Oncology (ASTRO) formed a working group of experienced clinicians to review the literature, assess the validity of current regulations, and make specific recommendations about the definition of an ME in permanent prostate brachytherapy. The working group found that the current definition of ME in §35.3045 as "the total dose delivered differs from the prescribed dose by 20 percent or more" was not suitable for permanent prostate brachytherapy since the prostate volume (and hence the resultant calculated prostate dose) is dependent on the timing of the imaging, the imaging modality used, the observer variability in prostate contouring, the planning margins used, inadequacies of brachytherapy treatment planning systems to calculate tissue doses, and seed migration within and outside the prostate. If a dose-based definition for permanent implants is applied strictly, many properly executed implants would be improperly classified as an ME leading to a detrimental effect on brachytherapy. The working group found that a source strength-based criterion, of >20% of source strength prescribed in the post-procedure written directive being implanted outside the planning target volume is more appropriate for defining ME in permanent prostate brachytherapy. ASTRO recommends that the definition of ME for permanent prostate brachytherapy should not be dose based but should be based upon the source strength (air-kerma strength) administered.

  17. Permanent isolation surface barrier development plan

    SciTech Connect

    Wing, N.R.

    1994-01-01

    The exhumation and treatment of wastes may not always be the preferred alternative in the remediation of a waste site. In-place disposal alternatives, under certain circumstances, may be the most desirable alternatives to use in the protection of human health and the environment. The implementation of an in-place disposal alternative will likely require some type of protective covering that will provide long-term isolation of the wastes from the accessible environment. Even if the wastes are exhumed and treated, a long-term barrier may still be needed to adequately dispose of the treated wastes or any remaining waste residuals. Currently, no {open_quotes}proven{close_quotes} long-term barrier is available. The Hanford Site Permanent Isolation Surface Barrier Development Program (BDP) was organized to develop the technology needed to provide a long-term surface barrier capability for the Hanford Site. The permanent isolation barrier technology also could be used at other sites. Permanent isolation barriers use engineered layers of natural materials to create an integrated structure with redundant protective features. Drawings of conceptual permanent isolation surface barriers are shown. The natural construction materials (e.g., fine soil, sand, gravel, riprap, asphalt) have been selected to optimize barrier performance and longevity. The objective of current designs is to use natural materials to develop a maintenance-free permanent isolation surface barrier that isolates wastes for a minimum of 1,000 years by limiting water drainage to near-zero amounts; reducing the likelihood of plant, animal, and human intrusion; controlling the exhalation of noxious gases; and minimizing erosion-related problems.

  18. Peri-implant mucositis and peri-implantitis: bacterial infection.

    PubMed

    Khammissa, R A G; Feller, L; Meyerov, R; Lemmer, J

    2012-03-01

    Osseointegrated dental implants have a ong-term success rate of over 90%, but may be threatened by peri-implant mucostis and peri-implantitis, bacteria biofilm-induced inflammatory conditions. While peri-implant mucositis is a reversible inflammatory condition confined to the peri-implant soft-tissue unit, peri-implantitis is characterised by progressive inflammatory destruction of the crest of the alveolar bone supporting the implant, by increased peri-implant probing depths, and by bleeding and/or suppuration on probing. Effective treatment of peri-implant mucositis will prevent the development of peri-implantitis. Plaque accumulation on the implant/abutment surface juxtaposed to the junctional epithelium and to the connective tissue zone of the peri-implant soft-tissue unit induces the development of peri-implant mucositis which can subsequently progress to peri-implantitis. The aim of this paper is to review some aspects of bacterial infection of the tissue supporting dental implants, and to explore how to maintain the healthy peri-implant soft-tissue unit.

  19. [Extra-oral implants: principal areas of implantation].

    PubMed

    Badie-Modiri, B; Kaplanski, P

    2001-08-01

    The success of extra-oral implants raises a certain number of technical and medical problems. Among these, the anatomy of the implant zone and bone quality are determining factors for osteointegration of the implants. We describe the principal zones of implantation detailing the risks involved in each area.

  20. Dental Implant Systems

    PubMed Central

    Oshida, Yoshiki; Tuna, Elif B.; Aktören, Oya; Gençay, Koray

    2010-01-01

    Among various dental materials and their successful applications, a dental implant is a good example of the integrated system of science and technology involved in multiple disciplines including surface chemistry and physics, biomechanics, from macro-scale to nano-scale manufacturing technologies and surface engineering. As many other dental materials and devices, there are crucial requirements taken upon on dental implants systems, since surface of dental implants is directly in contact with vital hard/soft tissue and is subjected to chemical as well as mechanical bio-environments. Such requirements should, at least, include biological compatibility, mechanical compatibility, and morphological compatibility to surrounding vital tissues. In this review, based on carefully selected about 500 published articles, these requirements plus MRI compatibility are firstly reviewed, followed by surface texturing methods in details. Normally dental implants are placed to lost tooth/teeth location(s) in adult patients whose skeleton and bony growth have already completed. However, there are some controversial issues for placing dental implants in growing patients. This point has been, in most of dental articles, overlooked. This review, therefore, throws a deliberate sight on this point. Concluding this review, we are proposing a novel implant system that integrates materials science and up-dated surface technology to improve dental implant systems exhibiting bio- and mechano-functionalities. PMID:20480036

  1. Single implant tooth replacement.

    PubMed

    Briley, T F

    1998-01-01

    It has been shown that direct bone anchorage of dental implants will provide long-term predictability for single tooth implants and multi-unit implants. The function of implant-supported restoration is now routinely achieved. The real challenge facing the restorative dentist and laboratory technician is to achieve optimal aesthetics. The learning objective of this article is to review the prosthodontic procedures essential to maximizing natural aesthetics in implant supported restorations. It will provide a review of master impression techniques, prepable titanium abutments and designing the cement on restoration. Particular emphasis is directed to the soft tissue model from which a series of sequenced techniques can be followed to achieve optimal aesthetics. Analysis of the implant alignment with regard to the neighboring teeth will result in having to make a choice of which prepable abutment will maximize the aesthetic result. The following case outlines how to replace a single missing tooth using an externally hexed implant system and a prefabricated titanium abutment on a 26-year-old male patient.

  2. Boron implanted strontium titanate

    NASA Astrophysics Data System (ADS)

    Cooper, C. J. M.

    Single crystals of strontium titanate implanted with boron were found to have highly conductive surface layers. The effects of varying dose from 10 to the 16th power to 10 to the 17th power ions/sq cm, implantation voltage from 50 to 175 keV and annealing conditions on the room temperature surface resistance and Hall mobility are presented. Variation of the implantation voltage did not have a major effect on the sheet resistances obtained by boron implantation of strontium titanate, while dose and annealing conditions have major effects. Doses of 5 x 10 to the 16th power ions/sq cm required annealing on the order of one hour at 500 K for maximum reduction of the room temperature resistance in the implanted layer. Samples implanted with a dose of 1 x 10 to the 17th power ions/sq cm required slightly higher temperatures (approximately 575 K) to obtain a minimum resistance at room temperature. Long term (several weeks) room temperature annealing was found to occur in high dose samples. After one to two months at room temperature followed by an anneal to 575 K, the surface resistances were found to be lower than those produced by the annealing of a freshly implanted sample to 575 K.

  3. A Conserved Mode of Protein Recognition and Binding in a ParD−ParE Toxin−Antitoxin Complex

    SciTech Connect

    Dalton, Kevin M.; Crosson, Sean

    2010-05-06

    Toxin-antitoxin (TA) systems form a ubiquitous class of prokaryotic proteins with functional roles in plasmid inheritance, environmental stress response, and cell development. ParDE family TA systems are broadly conserved on plasmids and bacterial chromosomes and have been well characterized as genetic elements that promote stable plasmid inheritance. We present a crystal structure of a chromosomally encoded ParD-ParE complex from Caulobacter crescentus at 2.6 {angstrom} resolution. This TA system forms an {alpha}{sub 2}{beta}{sub 2} heterotetramer in the crystal and in solution. The toxin-antitoxin binding interface reveals extensive polar and hydrophobic contacts of ParD antitoxin helices with a conserved recognition and binding groove on the ParE toxin. A cross-species comparison of this complex structure with related toxin structures identified an antitoxin recognition and binding subdomain that is conserved between distantly related members of the RelE/ParE toxin superfamily despite a low level of overall primary sequence identity. We further demonstrate that ParD antitoxin is dimeric, stably folded, and largely helical when not bound to ParE toxin. Thus, the paradigmatic model in which antitoxin undergoes a disorder-to-order transition upon toxin binding does not apply to this chromosomal ParD-ParE TA system.

  4. Nanotechnology for dental implants.

    PubMed

    Tomsia, Antoni P; Lee, Janice S; Wegst, Ulrike G K; Saiz, Eduardo

    2013-01-01

    With the advent of nanotechnology, an opportunity exists for the engineering of new dental implant materials. Metallic dental implants have been successfully used for decades, but they have shortcomings related to osseointegration and mechanical properties that do not match those of bone. Absent the development of an entirely new class of materials, faster osseointegration of currently available dental implants can be accomplished by various surface modifications. To date, there is no consensus regarding the preferred method(s) of implant surface modification, and further development will be required before the ideal implant surface can be created, let alone become available for clinical use. Current approaches can generally be categorized into three areas: ceramic coatings, surface functionalization, and patterning on the micro- to nanoscale. The distinctions among these are imprecise, as some or all of these approaches can be combined to improve in vivo implant performance. These surface improvements have resulted in durable implants with a high percentage of success and long-term function. Nanotechnology has provided another set of opportunities for the manipulation of implant surfaces in its capacity to mimic the surface topography formed by extracellular matrix components of natural tissue. The possibilities introduced by nanotechnology now permit the tailoring of implant chemistry and structure with an unprecedented degree of control. For the first time, tools are available that can be used to manipulate the physicochemical environment and monitor key cellular events at the molecular level. These new tools and capabilities will result in faster bone formation, reduced healing time, and rapid recovery to function.

  5. Optimization of dental implantation

    NASA Astrophysics Data System (ADS)

    Dol, Aleksandr V.; Ivanov, Dmitriy V.

    2017-02-01

    Modern dentistry can not exist without dental implantation. This work is devoted to study of the "bone-implant" system and to optimization of dental prostheses installation. Modern non-invasive methods such as MRI an 3D-scanning as well as numerical calculations and 3D-prototyping allow to optimize all of stages of dental prosthetics. An integrated approach to the planning of implant surgery can significantly reduce the risk of complications in the first few days after treatment, and throughout the period of operation of the prosthesis.

  6. Oxygen implanter for simox

    NASA Astrophysics Data System (ADS)

    Guerra, M.; Benveniste, V.; Ryding, G.; Douglas-Hamilton, D. H.; Reed, M.; Gagne, G.; Armstrong, A.; Mack, M.

    1985-01-01

    Interest in silicon or) insulator (SOI) technology has led to the development of several alternatives to silicon on sapphire. One of the most promising techniques makes use of an ion implanter to form a buried oxide layer directly in the silicon substrate. To have useful single crystalline silicon on top of the oxide layer, it is necessary to do the implant at high wafer temperatures and rely on solid phase epitaxy to maintain surface structure. A high current, 160 keV, Nova ion implanter has been adapted to provide the ability to perform oxygen implants at elevated temperatures. The operator is free to choose any temperature in the range between 400°C and 600°C. The system then preheats the wafers to the selected temperature before the implant begins. A novel technique for providing both heating and cooling capability to the end station is employed. An infrared signal from the wafers is monitored by a room temperature lead salt detector. This signal is then used by a servo-loop to control the heating of the end station and to maintain the wafer temperature to within ± 20°C during the implant. High doses of the type necessary to form a silicon dioxide buried layer require long lived, high current oxygen sources. An oxygen source has been specially developed, which provides as much as 10 mA of ion current. At a 6 mA output, source lifetimes in excess of 40 hours have been achieved. The implanter uses a specifically designed high temperature disk, which holds ten wafers, each of four inch diameter. A variety of implant angles lying between 0° and 15° is available. The beam is scanned mechanically and an electron flood gun can be used to prevent wafer charging. Special thermal barriers have been employed to protect the apparatus from extreme temperatures and to make the heating sequence more efficient and more rapid. Every effort has been made to avoid contamination of the implant. The implant disk, for example, is overcoated with silicon monoxide. Silicon

  7. Biomedical implantable microelectronics.

    PubMed

    Meindl, J D

    1980-10-17

    Innovative applications of microelectronics in new biomedical implantable instruments offer a singular opportunity for advances in medical research and practice because of two salient factors: (i) beyond all other types of biomedical instruments, implants exploit fully the inherent technical advantages--complex functional capability, high reliability, lower power drain, small size and weight-of microelectronics, and (ii) implants bring microelectronics into intimate association with biological systems. The combination of these two factors enables otherwise impossible new experiments to be conducted and new paostheses developed that will improve the quality of human life.

  8. Transcatheter aortic valve implantation.

    PubMed

    Oliemy, Ahmed; Al-Attar, Nawwar

    2014-01-01

    Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease.

  9. A new model for estimating boreal forest fPAR

    NASA Astrophysics Data System (ADS)

    Majasalmi, Titta; Rautiainen, Miina; Stenberg, Pauline

    2014-05-01

    Life on Earth is continuously sustained by the extraterrestrial flux of photosynthetically active radiation (PAR, 400-700 nm) from the sun. This flux is converted to biomass by chloroplasts in green vegetation. Thus, the fraction of absorbed PAR (fPAR) is a key parameter used in carbon balance studies, and is listed as one of the Essential Climate Variables (ECV). Temporal courses of fPAR for boreal forests are difficult to measure, because of the complex 3D structures. Thus, they are most often estimated based on models which quantify the dependency of absorbed radiation on canopy structure. In this study, we adapted a physically-based canopy radiation model into a fPAR model, and compared modeled and measured fPAR in structurally different boreal forest stands. The model is based on the spectral invariants theory, and uses leaf area index (LAI), canopy gap fractions and spectra of foliage and understory as input data. The model differs from previously developed more detailed fPAR models in that the complex 3D structure of coniferous forests is described using an aggregated canopy parameter - photon recollision probability p. The strength of the model is that all model inputs are measurable or available through other simple models. First, the model was validated with measurements of instantaneous fPAR obtained with the TRAC instrument in nine Scots pine, Norway spruce and Silver birch stands in a boreal forest in southern Finland. Good agreement was found between modeled and measured fPAR. Next, we applied the model to predict temporal courses of fPAR using data on incoming radiation from a nearby flux tower and sky irradiance models. Application of the model to simulate diurnal and seasonal values of fPAR indicated that the ratio of direct-to-total incident radiation and leaf area index are the key factors behind the magnitude and variation of stand-level fPAR values.

  10. MRI induced torque and demagnetization in retention magnets for a bone conduction implant.

    PubMed

    Jansson, Karl-Johan Fredén; Håkansson, Bo; Reinfeldt, Sabine; Taghavi, Hamidreza; Eeg-Olofsson, Måns

    2014-06-01

    Performing magnetic resonance imaging (MRI) examinations in patients who use implantable medical devices involve safety risks both for the patient and the implant. Hearing implants often use two permanent magnets, one implanted and one external, for the retention of the external transmitter coil to the implanted receiver coil to achieve an optimal signal transmission. The implanted magnet is subjected to both demagnetization and torque, magnetically induced by the MRI scanner. In this paper, demagnetization and a comparison between measured and simulated induced torque is studied for the retention magnet used in a bone conduction implant (BCI) system. The torque was measured and simulated in a uniform static magnetic field of 1.5 T. The magnetic field was generated by a dipole electromagnet and permanent magnets with two different types of coercive fields were tested. Demagnetization and maximum torque for the high coercive field magnets was 7.7% ± 2.5% and 0.20 ± 0.01 Nm, respectively and 71.4% ± 19.1% and 0.18 ± 0.01 Nm for the low coercive field magnets, respectively. The simulated maximum torque was 0.34 Nm, deviating from the measured torque in terms of amplitude, mainly related to an insufficient magnet model. The BCI implant with high coercive field magnets is believed to be magnetic resonance (MR) conditional up to 1.5 T if a compression band is used around the skull to fix the implant. This is not approved and requires further investigations, and if removal of the implant is needed, the surgical operation is expected to be simple.

  11. Prospective clinical study of a new implantable peripheral nerve stimulation device to treat chronic pain.

    PubMed

    Deer, Timothy R; Levy, Robert M; Rosenfeld, Evan L

    2010-06-01

    To evaluate clinical use of the StimRouter, an investigational implanted peripheral nerve stimulator for treating chronic neuropathic pain, using the median nerve as a model for that general application. Eight patients with carpal tunnel syndrome and chronic pain despite both carpal tunnel release and treatment with oral pain medications were enrolled in a single-center, open-label trial after institutional review board approval. Primary endpoints were successful implantation near the target peripheral nerve and safety. All 8 patients were implanted temporarily at the median nerve in at least one arm and 2 patients were implanted bilaterally, with 10 implants total. Each implant was considered a separate "patient." For 5 days, all patients received 6 hours of daily transdermal electrical stimulation targeting the median nerve. Pain was measured at baseline, during implant, and after explant. Two patients experienced clinically meaningful (>or=30%) pain reduction throughout the entire 5-day treatment period. Apparent carryover effect in pain reduction also was observed after daily stimulation. After explant, pain returned to baseline, increasing 36.8% to 45.6% relative to average reduced pain with daily stimulation. No significant or unexpected adverse events occurred. Mean patient study satisfaction was 96%, and 100% of patients indicated a preference for permanent implant. Temporary implant of the StimRouter device resulted in both pain reduction and reduced use of oral opioid pain medication during the 5-day stimulation period. The results suggest that permanent implant of the StimRouter System may be safe and effective for treating chronic peripheral neuropathic pain.

  12. Primary migration of a mini-implant under a functional orthodontic loading.

    PubMed

    Pittman, Joseph W; Navalgund, Anand; Byun, Steve H; Huang, Hechang; Kim, Albert H; Kim, Do-Gyoon

    2014-04-01

    The objective of this study was to examine whether cortical bone thickness and bone mineral density (BMD) can explain the primary migration of a mini-implant under a functional orthodontic tangential loading at the early stage following implantation. Mini-implants were installed in human mandibular sections. A constant tangential load (2 N) was applied to the mini-implant under hydration. Creep, which is a time-dependent viscoelastic displacement in the bone surrounding the mini-implant, was assessed as the change in displacement during 2 h of loading. The total migration was measured as a maximum displacement that combined an initial elastic displacement and creep. After removal of the mini-implant, all specimens were scanned together by cone beam computed tomography. Cortical bone thickness and BMD were measured for the bone voxels surrounding the implant site. BMD had significant correlations with the displacement parameters (p < 0.019), but the cortical bone thickness did not (p > 0.272). Permanent bone deformation adjacent to the implant was observed to be resulting from substantial creep development under the orthodontic functional loading level. BMD controls the primary migration of the mini-implant system in mandibular bone. Viscoelastic creep can develop at a small constant functional loading level, leading to migration of the mini-implant. The current results indicated that mini-implant migration can develop under the small level of functional orthodontic load used in clinic. If the active bone remodeling around the mini-implant accelerates the migration, the risk of causing damage in vital organs next to the mini-implant increases.

  13. 2. HI PAR (ACQUISITION RADAR) TOWER AND ENLISTED MEN (EM) ...

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

    2. HI PAR (ACQUISITION RADAR) TOWER AND ENLISTED MEN (EM) BARRACKS WITH RADAR ATTACHED. - Nike Hercules Missile Battery Summit Site, Battery Control Administration & Barracks Building, Anchorage, Anchorage, AK

  14. DEALING WITH DENTAL IMPLANT FAILURES

    PubMed Central

    Levin, Liran

    2008-01-01

    An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options. When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them. PMID:19089213